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Pre-Participation Physicals: It May Just Save Your Child's Life

February 3, 2018

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The Warm Up: An Often Overlooked and Underutilized Aspect of Improved Performance and Injury Reduction

 

As promised in my previous article, Injury Versus Normal Soreness: How to Differentiate Between the Two, this week we discuss the importance of a quality, well-planned, and well-executed warm-up. More often than I would like to admit, I see professional, collegiate, and youth athletes perform their movement preparation (aka warm-up) with little concern for proper technique. However, sometimes it is the design of the warm-up that is missing major components resulting in limited mobility, poor muscle coordination, or a lack of integrated foundational movements. As a result, performance is compromised or even worse, the door is left open to possible injury. Let’s discuss the goals of movement preparation, its major components (including examples), and highlight the benefits of a properly designed and executed warm-up. 

 

To begin, it’s imperative to acknowledge and review the most common risk factors for injury.  These are: (1) Previous injury (2) Asymmetries and (3) Balance/motor control dysfunctions (Pilsky, Rauh, Kaminski & Underwood, 2006). Of course, without proper screening of athletes it’s impossible to know which, if any, are present. Therefore, a movement “check,” such as the Functional Movement Screen (FMS), is crucial in the evaluation of movement to detect underlying asymmetries or motor control limitations. Based on the results of the screen, a warm-up specific to the deficiencies of the athlete can now be designed, which is just one important piece to the puzzle regarding decreasing injury potential. 

 

In order to design a comprehensive warm-up, we must discuss its components. Here’s a quick overview of each element before we go into further explanation.

 

1. Increase core temperature and vascularity

2. Increase range of motion

3. Activate proprioceptive musculature

4. Muscle coordination/co-activation

5. Integrate foundational movement patterns

6. Sport and activity-specific movements

 

Increase core temperature and vascularity 

The goal of this first step is to improve blood flow and oxygen to the very muscles that will be the focus of stretching and moving. This may include an easy jog/stationary bike with arm circles/swings, jumping jacks, etc. By increasing blood flow and temperature to major muscles groups as well as soft tissue, improving range of motion becomes more comfortable and attainable.

 

Increase range of motion 

This leads to our next step of improving range of motion. Static and fascial stretching, joint mobilizations, foam rollers, massage sticks, and acupressure balls are all common techniques/devices to decrease tone within specific muscles and improve the pliability of other soft tissue structures (e.g. joint capsule, ligaments, fascia, etc.). For some, a gentle comfort stretch focusing on major joints of the body is enough. For others, more focused stretching and joint mobilizations into specific regions may be necessary. One technique, however, that often gets overlooked is breathing. Focused diaphragmatic breathing can stimulate the parasympathetic nervous system, which shifts the body into a relaxed “rest and digest” state thus assisting in the lengthening of soft tissue. Additionally, breathing can mobilize the rib cage and shift the diaphragm into a more optimal position thus laying the foundation for ideal integration of the trunk, pelvis, and extremities. In other words, do not forget this integral piece of the puzzle. 

 

I want to take a moment to emphasize the importance of addressing range of motion limitations. Again, your movement screen will help you identify areas where an athlete is limited. Remember, asymmetries contribute more often than we would like to athletic injuries. Therefore, ensure the warm-up is targeting those specific joints which are limited, not only to help decrease the risk of injury, but also improve performance. On that note, limited mobility influences the proprioceptive input from a joint to the brain. This means less feedback to the brain with regard to what is happening at that joint, which has a direct effect on balance, stability, strength, power, etc. Furthermore, the smaller the degree of motion, the less range the athlete has to generate force and thus power. As a result, the athlete is unable to jump as high, run as fast, or throw as hard and overall performance suffers. 

 

Activate proprioceptive musculature

Now is the time to integrate newly acquired range of motion by activating the musculature controlling the movement and therefore, the proprioceptive feedback to the brain. Think of this step as upgrading the software (nervous system) now that you have improved hardware (range of motion of the joint). Examples of a few exercises might be the Rock Back Quadruped Rotation or Side-lying Windmill. These exercises incorporate the musculature controlling the shoulder and thoracic spine and bring awareness to trunk and pelvis position by incorporating breathing. For the hip and ankle, Half Kneeling Adductor Dips, open and engage the adductors while incorporating ankle mobility and proprioception. A single leg bridge in this video incorporates the hip extensors while requiring stabilization of the knee in the frontal plane and controlling the pelvis in the sagittal and transverse plane. All of these videos are courtesy of Eric Cressey of Cressey Sports Performance. Functional Range Release is a powerful technique to improve flexibility and motor control. Here is a great sequence of stretching to improve internal and external rotation of the hip followed by activation to “upload” that new range. In all, the goal of this step is to sharpen the connection from the brain to the peripheral joints and muscles and vice versa for optimal feedback. 

 

Muscle coordination/co-activation

This next component builds on the last step. Movements during this phase require synergistic activity of the agonists and antagonists reflexively controlling the joint for proper centration. In other words, is the appropriate musculature firing at the right time, in the right sequence, to control joint position through the entire range of motion ensuring smooth, unequivocal movement? Physical therapist, Shirley Sahrmann, author of Diagnosis and Treatment of Movement Impairments, describes this phenomenon as the path of instantaneous rotation. This is precisely where improper practice leads to poor muscle coordination jeopardizing performance and leading to possible injury. The old adage, “practice makes perfect,” was slightly misleading. It should read, “perfect practice makes perfect,” because engaging in poor movement technique only ingrains improper movement patterning in the brain. As a result, timing and coordination of both the muscles that stabilize the joint during movement as well as the muscles that create the movement, are trained in a way that leads to aberrant joint mechanics and inefficiency. Exercises in this section may include maintaining a plank while performing single arm shoulder taps to incorporate shoulder and trunk stability with shoulder movement or a bird dog, which incorporates opposite arm and leg movement while stabilizing the spine. These movements require the athlete to concentrate on moving certain joints while minimizing the movement of others. 

 

Integrate Foundational Movement Patterns

As we progress toward the end of the warm up, it is time to incorporate multi-joint movements in a coordinated effort to produce efficient groundwork. It’s about getting the athlete’s body into the right position at the right time with maximal leverage and minimal compensation. This portion of the warm-up is often referred to as a dynamic warm-up, which integrates foundational movement patterns. Typical exercises include those that move across the field/court. They may include crawling, inch worms, knee hugs, squatting variations, lunges moving forward/backward/sideways/cross body, skipping, hopping, kareokas, etc. These activities are a trial run for mobility and motor control prior to a more vigorous form of the exercise and activity. 

 

Sport and activity-specific movements

Lastly, sport and activity-specific movements are introduced. This phase is dependent on the activity. For example, if the athlete is preparing for a lifting session, he/she may rehearse hip hinging patterns or drills for Olympic lifts that prime the body to perform those movements. If the athlete is preparing for a soccer game, he/she will engage in kicking, cutting maneuvers, headers, etc. that incorporate movements they will use during the match. 

 

As one can see the warm-up should build from one section to the next utilizing the effects of the previous section to construct the succeeding segment. The athlete is slowly developing simple activities into more complex ones with the goal of attaining maximal range of motion with coordinated muscle firing patterns to produce the most efficient and effective movement for optimal performance. Unfortunately, there is no set time as to how long a warm-up should take, however, it should never be so long or intense that it induces fatigue. For some who have a long history of injury, it could take 30 minutes due to multiple areas of mobilization and motor control exercises. For others without a history of injury, it could be 15 minutes. Also, the younger the athlete, the shorter and less structured the warm-up will be. In fact, the warm-up described above might be reserved for age 15 and up, however, a condensed version could be incorporated for younger age groups so that they begin to understand its importance and flow. Regardless, a warm-up should require evaluation, planning, and perfect execution in order to obtain the benefits of improved mobility, stability, motor output, balance, mental focus, and performance. Without it, the athlete leaves performance variables on the table and potentially opens the door to injury. It’s up to the coaches to give athletes the very best tools in order to set them up for success and the warm-up is a great place to start.  

 

 

Bibliography

 

Plisky, P., Rauh, M., Kaminski, T., Underwood, F. “Star Excursion Balance Test as a Predictor of Lower Extremity Injury in High School Basketball Players.” Journal of Orthopaedic and Sports Physical Therapy. 36.12 (2006): 911-19. Print.

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