FILEX 2014 - Dr Mark McKean - Training paralympic athletes Handouts

FILEX 2014 6/04/2014

Dr Mark McKean University of the Sunshine Coast 1

Strength training athletes

with disabilities

Dr Mark McKean PhD AEP CSCS RSCC*E

Sponsored by

Journal of Fitness Research

Current Issue April 2014 Vol. 3, No. 1

FREE Access

Free registration and subscription

Fitness research related scientific articles

Double blind peer reviewed

Current research manuscripts

My experience - Paralympic Swimming

First Paralympic swimmer 1991

First Paralympic medallist 1996 Atlanta games

USC High Performance program 2011

USC High Performance 2011 - present

Worked as S&C Coach with USC High Performance team since its inception

Most successful Paralympic swim team ever second only to China with 26 medals at London Games

Multiple world records, Paralympic and World champions

Most challenging yet enjoyable experience in my 25+ year coaching career

Classifications related to Para Athletes

The sport class names in Swimming consist of a prefix “S,” “SM,” or “SB” and a number. The prefixes stand for the strokes and the number indicates the sport classes.

The prefixes stand for:

S: Freestyle, Butterfly and Backstroke events

SM: Individual Medley

SB: Breaststroke

Sport Classes S1 - S10: Physical impairment

There are ten different sport classes for athletes with physical impairment, numbered 1-10. A lower number indicates a more severe activity limitation than a higher number

You will notice that athletes with different impairments compete against each other. The impact of their impairment on swim performance, however, is similar.

S7 SB6 SM7 - This profile is designated for athletes with one leg and one arm amputation on opposite sides, double leg amputations or a paralysis of one arm and one leg on the same side. Moreover, swimmers with full control over arms and trunk and some leg function can compete in this class.

S8 SB7 SM8 - Swimmers who have lost either both hands or one arm are eligible to compete in this class. Also, athletes with severe restrictions in the joints of the lower limbs could compete in this class.

FILEX 2014 6/04/2014


S9 SB8 SM9 - Athletes in this class swim with joint restrictions in one leg,double below-the knee amputations or an amputation of one leg.

S10 SB9 SM10 - Eligible impairments would be the loss of a hand or both feet and a significantly limited function of one hip joint.

Sport Classes 11-13: Visual Impairment - Swimmers with visual impairment compete in the sport classes 11-13, with 11 meaning a complete or nearly complete loss of sight and 13 describing the minimum eligible visual impairment. Athletes in sport class 11 compete with blackened goggles.

Sport Classes 14: Intellectual impairment - Swimmers with intellectual impairment who also meet the sport-specific criteria compete in class 14.

My approach

Para athletes follow same standardised principles of training

I’ve learnt to improvise to find the best solution for the swimmer

Athletes know their function better than I do so speak to them about what they think they can and can’t do, but don’t take the ‘can’t do’ as true until you confirm it

I challenge every athlete to get stronger and more dynamic regardless of what class they are in and what they think their limitations are

I talk to the head coach almost daily about each swimmer, swim volume, individual goals and what she is after from them

Each athlete must still to ‘earn the right to progress’

Most athletes have developed skills/ways to live and do what is required daily so observe these behaviours and it will help guide you in selecting training options and exercises

When in doubt about what to do with an athlete always go back to what youknow for sure.

E.g. Poor start due to lack of leg drive – need stronger coordination of triple extension

E.g. Can’t get arm into ideal position above the head for backstroke – improve flexibility of shoulder girdle

E.g. can’t balance with loaded bar – change exercise

As you’ll see most athletes have a combination of impairments

Solving training puzzles Different abilities

Different Fingers, Hands, Arms

Impacts on ability to grip bars, DB, etc.

Impacts on elbow extension-flexion movements as hands can’t be used to adjust position and muscles that cross elbow and wrist have altered mechanics.

Typically influences overall shoulder girdle posture and function

Diminished surface area for pulling changes speed of limb through the water

Training prosthetic developed for gripping bar

mmckean

Rectangle

FILEX 2014 6/04/2014


Pros-Cons

Great for pushing related movements such as bench press and even DB press

Not always ideal for pulling due to

slippage of prosthetic on limb as limb narrow to point of amputation and prosthetic grip has nothing but friction to maintain connection

grip capacity not engaging muscles that cross elbow joint therefor major muscles involved are those that act on the shoulder girdle

Potential to cause shoulder strength ratios that are unusual

Learning how to manage bench throws

Engaging trunk in pulling motions

Grip hooks – note sweat bands

Pros-Cons

Enable athlete to perform most pulling type movements however there are some issues

Load is taken by tight wrapping around distal wrist structure which loads wrists structure without fully functional muscles of hand to provide strength and normal connective tissue development at wrist for stability

Reliant on strength of the manufactured grip and its integrity

Of no value in pushing movements

Note limitations in movement

mmckean

Rectangle

mmckean

Rectangle

FILEX 2014 6/04/2014


Note straight arm pull shape

Figure 8 wraps provide stability and control

Pros-Cons

Enable athlete to perform most pulling type movements however there are some issues with slippage

Load is taken by distal wrist structure which loads wrists structure without fully functional muscles of hand to provide strength and normal connective tissue development at wrist for stability

Reliant on tightness of straps and how well you can maintain tension

Can assist in pushing movements

Will occasionally slip mid exercise

Note different speed of pull between sides

Things I’ve Learnt

DIFFERENT FINGERS, HANDS, ARMS

FILEX 2014 6/04/2014



Work with the athlete, coach, Doctor, Prosthetic manufacturers to develop ways for your athlete to hold on bars, cables, grips, DB, etc.

Appreciate the impact using new tools and creating new stressors will have on the limb its attached to, the joints above that will strengthen differently, and the overall movement pattern trained.

Take care not to include too many body weight type exercises where limb/prosthetic/hooks, straps have to support body weight.

Build up this volume slowly and over long periods of time so the wrist/forearm/elbow adjust to such massive loads where there is no grip strength to support the connective tissue development


Shoulder girdle will typically end up with different strength qualities/ratios, so be aware of how this will impact on sport and daily life alike.

Aim to still include shoulder muscle balance exercises where possible such as bent over trap raises, external shoulder rotation, multi angle deltoid development

Be sure to teach more single arm movements and engage the latsin pulling rotational exercises

But also just as importantly include bilateral exercises so each side learns how to coordinate movement in sequence.


Follow normal principles of training and progress based on ability and capacity for more weight, more reps, more complex movements.

Be creative with exercise selection and modifications to suit the demand

Ask the athlete how they think they might use the tools they have or tools they might consider to perform or solve these types of puzzles.

Different Toes, Feet, Legs

Impacts on ability to stand, balance, adjust position, triple extend,

Impacts on adjustment and control when carrying loaded bar/weights on upper body in free stance situations

Inhibits ability to dynamically triple extend through reduced ankle involvement and knee muscle mechanics

Typically influences overall knee and hip posture and function

Diminished surface area for kicking which changes speed of limb through the water and alters hip stability for alternate control of opposite arm/shoulder

Foot Prosthetic – watch balance function

Pros-Cons

Provide stable platform for walking and control

Increased safety to feet in gym environment

Provide little or no proprioceptive feedback to the athlete and hence adjustments to balance can appear to be larger than normal

Little or no absorption through the arch of the foot via the windlass mechanism so all load absorbed through muscles above the knee that resist knee flexion on landing which can result in stiffness and loss of ROM

FILEX 2014 6/04/2014


Balance from hips and trunk not feet

Still able to jump and explode

Note asymmetric kicking pattern Limb Prosthetic –deciding when to use it

Trying to engage both hips where possible

Still not strong enough to push off wall

mmckean

Rectangle

mmckean

Rectangle

mmckean

Rectangle

mmckean

Rectangle

mmckean

Rectangle

FILEX 2014 6/04/2014


Pros-Cons

Provide ability to move around and play games sport fitness etc.

Enable athlete to perform most lower body type movements however there are some issues

Load is taken by one leg in most standing/sitting exercises

Prosthetic leg can be locked or unlocked providing control or flexibility

Time consuming in taking on and off so consider order of exercises to assist in time efficacy

Reliant on type of prosthetic ie does it provide rebound effect in toe off, does knee auto swing in gait, how much of the limb is encased in sleeve,


DIFFERENT TOES, FEET, LEGS


Develop ways for your athlete to move and stand on different surfaces and in different postures with bilateral even stance and unilateral uneven stance.

Appreciate the way lower limb prosthetics alter gait, balance, stability, and especially dynamic movement.

Expect to see differences between sides and don’t expect to correct them all.

Be sure to spend time developing the hip and limb of the prosthetic side so as to minimise changes in pelvic girdle/lumbar posture.


Normal leg can be used for all single leg exercises but be sure to try and use the prosthetic leg where possible (even if its unloaded or unevenly loaded) to engage the hip where possible for control or stability.

Be sure to have athlete rest in seated position when doing leg work rather than walk around and chat

Great way to add load to upper body is using prosthetic leg and similarly when first training upper body lifts like chin ups take the leg off.


Learn how each prosthetic limb works what they’re made off (carbon graphite or titanium), how the foot contributes to gait (built in flex or not, full foot or

blade), how the knee swings (lockable or not), how much load can be distributed through the prosthetic leg

(stand on it singularly or not) This will help you select exercises more suited to capability of

prosthetic

Limited hearing

Need to consider means of communication If they lip read need to be sure you always get their

attention and talk directly to them.

Find out if one side is best for hearing and try and always stand on that side when chatting to them

FILEX 2014 6/04/2014


Other considerations

Limited hearing can also influence balance and stability if vestibular apparatus is damaged. Therefore eyes closed activity may need to be limited and need to provide activities that promote muscular proprioceptive feedback for balance

Safety issues – athlete may not hear what is happening in immediate environment or hear warning calls.

Watch the finish procedure – normally not correct but allowed here


LIMITED HEARING


Make sure you develop an agreed way to communicate. E.g. touch their shoulder when you want to talk so they know to look at you or move so their best hearing side is closer to you.

Be sure to get athlete to say back to you what they think you said to be sure the instructions were read correctly. Its very easy to be misunderstood and to not trust that what you say is taken in the right context.

Wait till the end of each set to provide advice or cues to save repeating yourself and ensuring the right message is received.


Be close by to spot/support all challenging exercises as your call from afar will not be heard or seen

Try and pair athletes together if in squads to help each other Teach them to feel the weights rather than hear them. E.g. bar

hitting catch rail, balance of load on bar, range of movement on a machine.

FILEX 2014 6/04/2014


Limited sight

Obvious safety issues to consider

Awareness and knowing where equipment is that they don’t see

Understand the effect the limited sight has on the athlete

What can they ‘see’, If use peripheral vision need to understand where to look when performing different exercises and how they will ‘see’ you

Can they move around training environment safely unaided

Developing balance and awareness

Lunge movement puzzles to challenge balance and control

More secure feeling of bar position


LIMITED SIGHT


Find out exactly what their sight capacity is. E.g. some can use peripheral vision to see so wont look directly at you but can still see you

Need to print in big font or use large pictures on program charts If unable to read or see images will need one on one support at all

times. Learn to use touch as an indication that you want them to do

something or listen.

mmckean

Rectangle

FILEX 2014 6/04/2014



Demonstrations of movements will not be best way to teach a movement so select exercises where you can have them do it and cue or teach aspects of it as they are doing it.

Different levels of vision will requires different degrees of support. But most will still want to progress and lift more weight where possible

Cerebral Palsy

Things to consider

Regions of the body impacted and how these areas influence movement

Often creates unilateral strength/flexibility imbalances and different loads between right-left need to be considered

Different levels of coordination between right-left

Stretching may have little or no effect

Expect the movements to look different on each side and gross body movements may not be perfect but find ways to help make it the best they can

Provide exercises to account for dominant side differences

Note asymmetry and stability differences

mmckean

Rectangle

mmckean

Rectangle

FILEX 2014 6/04/2014



CEREBRAL PALSY


Fully understand what the athlete can and can’t do and what areas or movement of their body are affected. Can be very different levels of impairment and ability to train in gym.

Work with Doctor and coaches to get this right so you fully appreciate their impairment.

Consider the level of impairment and the impact improved function may have on the athletes classification


Difficult to increase muscle bulk in some areas impacted by CP yet strength can always improve

Similar in response to training as neuromuscular impaired athletes

Longer recovery periods to help manage fatigue leading into competitions and heavy training cycles

Typically a shorter time to lose benefits of training

Neuromuscular issues

Has similar issues associated with limited hearing and CP

Balance, stability, unequal movements, all come into play

Weakness from neuromuscular issues will not always be evenly spread or equally balanced on right or left side

Muscular proprioceptive feedback can be affected and influence balance, control and muscle tension awareness.

Challenge balance and control

Dynamic movements much harder to learn control

FILEX 2014 6/04/2014



NEUROMUSCULAR IMPAIRMENTS


Can be very easily overloaded and fatigued Different recovery rate according to HRV study completed Take care not to challenge neuromuscular system too much in any

single session. E.g. complex lifts or all free standing exercises can often overload neuromuscular system and cause fatigue

Consider what else is trained on the same day as strength and plan around it. E.g. if speed sets in pool, don’t do max strength or power type sessions in gym if possible on same day


Use right-left side drills where possible and trick the brain into focusing on movement not the side performing the action.

A volume based approach to strength training can cause drop in ability to recover and adapt. A high intensity – low volume approach has worked best.

Aim for 2-3 quality exercises per workout and expect them to be performed well. Then allow for secondary exercises to have a more relaxed approach with lower demands on technique, complexity and loads.


Allow for longer periods to develop good technique and control and expect occasional mistakes with both

Build rate of force contraction (power) training in early as this may be hardest to develop, so don’t leave it too late.

Allow longer lead ins or tapers prior to competitions to allow more full recovery and return to a state where they are ready to compete.

But try and get them back into gym as soon after comp as possible to reduce loss of strength that was so hard to gain

Short stature

Typically strong in power to weight

Joint ROM is important training goal

Balance issues due to most weight distributed in top half of the body so alignment of load to centre of balance is important.

E.g. hang deadlift/BB jump modifications

E.g. size of Olympic plates to leg length modifications

Grip and hand size may require assistance in exercises where holding BB or handles is concerned.

Consider ways to account for balance requirements

FILEX 2014 6/04/2014



SHORT STATURE


Carefully select exercises to account for differences in stature against bar size (length and girth), plate size (Olympic plates bigger diameter), equipment size (limb length), bench height, step height etc.

Account for different balance mechanism with weight distribution for exercises where load is away from body free standing.

Easier to develop a program around free weights than machines


Most are very strong through short ranges of movement but struggle to achieve full range. Common complaint with all coaches is to help the athlete get length into stroke pattern.

Expect heavy weights to be lifted by most if experienced in the gym

Have smaller increments in steps/boxes due to reduce ability to hip flex and step up without pelvic tilt and rotation


Its easy to overload the shoulders because they are normally very strong and take brunt of most exercise loads.

Reduced ROM about most joints means it harder to develop power and increased rate of force contraction

Intellectual impairment

Same principles as any other person new to the gym

Complexity of program instructions

Cues used for exercise technique

How to make total weight including the bar

Expectations on effort and loads used

Teach systems and routines

Program design

Include expected loads each exercise, each set, each session

Use pictures instead of exercise names

Provide positive feedback and support

Pain tolerance or comfort can vary from exercise so find postures and movements the athlete ‘likes’ more

mmckean

Rectangle

FILEX 2014 6/04/2014


Choose exercises that can be progressed in lots of ways that can promote a learnt and ingrained pattern


INTELLECTUAL IMPAIRMENT


Set up longer blocks of training perhaps 6 week cycles rather 3-4 to allow more time to learn, feel comfortable and develop a system.

Change program styles less often and keep key exercises in for 2-3 cycles to allow time to develop good technique and ‘remember’ what to do for each

Only include 2-3 ‘hard’ or ‘complex’ movements (multi planar or single leg movements)

Set mini goals weekly and be there as the trainer for those key exercises when goals are being chased to help out and support


Have a conversation with the athlete at the start and end of each session to confirm they know what they have to do and also chat about how they went regards target weights etc.

Remind them constantly about rest periods and tempo, probably the two hardest things for any athlete to learn.

Summary

Same principles just a new solution required to another training puzzle.

Get the athletes buy into the program and use their unique skills and experiences to help guide what you prescribe for them.

Like any athlete/client they will try and get away with whatever they can if you let them.

Most are extremely dedicated to their sport and love a challenge, just find the right way to provide it.

You will learn more about training and presciption and extend your own knowledge more than you thought possible.

Dr Mark McKeanResearch Fellow – USC

Tel: +61 7 54565528

Email: [email protected]

THANKYOU

mmckean

Rectangle

Documents

FILEX 2014 - Dr Mark McKean - Training paralympic athletes Handouts