Movers to Athletes to Specialists

As their 13-year-old daughters played in their first soccer game of the spring season, the mothers discussed their dedication to their children, and their children’s dedication to the game. One mother spoke about her older daughter, a high-school sophomore, who missed the fall soccer season because of knee surgery. This caught my attention, and I scanned the field: Four of the 22 players – 12 and 13 years old – on the field wore bulky knee braces indicative of some form of injury. 

Another mother mentioned the ankle injuries of an older sibling, and a father mentioned the concussions. Each parent appeared to try and top the others with stories of their children’s injuries and surgeries from their participation in soccer, as though being injured and returning to continue one’s career was a badge of honor. The players who were revered were not the ones who capably moved around the field, avoiding tackles, and skillfully playing the ball, but the ones who limped around the field, showing their toughness as they returned to soccer from an injury, probably far too quickly.

Rene Wormhoudt, the strength and conditioning coach for the Netherlands Football Federation, said at the Seattle Sounders Sports Science Conference that children become good movers, good movers become good athletes, and good athletes become specialists, or skilled soccer players. These u14 girls appeared to have skipped the first two steps and moved directly toward the goal of becoming a skilled soccer player.

Mike Reinold's 4 Keys to Long-Term Athletic Development

Mike Reinold’s 4 Keys to Long-Term Athletic Development

The skill level was impressive for an early season game between 12 and 13 year olds. The players used tactics and skills that I never learned or tried in my 10 years of youth soccer. Players played the ball back to the goalie to avoid pressure rather than panicking with the ball in their defensive third. Goalies controlled the ball and juked on-rushing attackers rather than kicking the ball as quickly and as far as possible. Players used one-twos all over the field, and played the ball with their right and left feet. They kept their shape, talked to each other on the field, and showed a good understanding of the game.

Despite their game understanding and technical skills, the majority were terrible soccer players. Their skills were no match for the few athletic players on the field. The vast majority of players moved so poorly that the mere act of playing soccer was likely a risk to their health. The injuries discussed by the parents were no surprise after watching 20 minutes of their younger daughters.

Despite their sport-specific skills, they lacked good motor control. When they jumped to head or chest the ball, their arms flailed wildly. When they ran shoulder to shoulder with an opponent, one of the players inevitably went tumbling, unable to absorb any contact. When players landed from jumps, without jumping very high, their knees caved in (knee valgus), a common precursor to ACL ruptures. They struggled to decelerate or change directions to avoid collisions, and many fouls were symptoms of poor movement skills and body control.

Rather than becoming good movers initially and progressing to sport-specific skills, these players appeared to strive for soccer success. These teams dutifully performed the FIFA11+ warmup (below), designed to reduce injuries by teaching and training basic movements, but there was no concentration or corrections on the warmup. The coach set up the next drill as the players performed their warmup, and the players quickly moved through the exercises in order to get to the important drills, the ones with the ball. The warmups with the ball were primarily linear; they dribbled in a straight line and passed to another player, or they dribbled at the goal and took a shot. Very few of the movements in warmups engaged the players or challenged their movement skills.

Despite their soccer success, these girls were not good athletes. Based on the conversations of the parents, most played year-round soccer rather than compete in another sport. The year-round play may have helped with the early mastery of their sport-specific skills, but none of the girls had a long future in the sport unless they greatly enhanced their athleticism and movement skills.

In all likelihood, more of those 22 players will miss a season in their four years of high school due to an injury suffered while playing soccer than will extend their soccer career beyond high school. Adolescent females who specialized in one sport were 1.5 times as likely as those who participated in multiple sports to suffer from patellofemoral pain (PFP; Hall et al., 2014), and girls’ soccer has the highest rate of ACL injuries, with 11.7 injuries for every 100,000 athlete exposures (an athlete exposure is one athlete participating in one practice or competition; Comstock et al., 2013). Furthermore, youth soccer players who practiced four or more days per week prior to age 12, as did some of these girls based on the sideline conversations, were more likely to suffer cam deformities to their hip than those who waited until after age 12 to practice four or more days per week (Tak et al., 2015).

Rather than focus on more soccer and continuing to expand their soccer skills, these players would be served better by playing another sport, especially track and field. University of North Carolina head coach Anson Dorrance has said that he prefers to recruit sprinters because of the added speed on the field. These players are working backwards, as they originally skipped the correct progression of mover to athlete to player. Now, they must try to work backward from player to athlete to mover, and running track and field, and especially the sprints, would be one approach to learn better movement skills. Additionally, the players should concentrate in their movement warmup and expand upon this brief warmup with additional plyometics and strength exercises. Before trying to add another layer of skill, or another step-over dribbling move, they should master running, jumping, landing, and stopping.

When I was a child, playing and training was less sophisticated than it is for the current generation. However, in our sophistication, we have ignored the basic progressions. When I was a child, we played in the streets and at recess before we joined teams. We played tag, hopscotch, and other childhood games. From an adult training perspective, these games appear frivolous; however, this progression enabled us to learn basic movement skills first. When we joined teams, we had a better base of fundamental movement skills that we developed through these playful games. When children skip this natural learning and jump straight into sophisticated, sport-specific training schemes, they miss these learning opportunities. They may master technical skills or game awareness, but without the basic movement skills and athleticism, their performance eventually will stagnate because other children – often the multi-sport athletes or the late developers – move better and are more athletic. Sport-specific skill is important; however, the proper progression of mover to athlete to skill enables the greatest expression of the sport-specific skill in adolescence and beyond.

Orginally published in Los Angeles Sports & Fitness Magazine October 2015 By Brian McCormick, PhD

Rethinking Movement: Why You Should See A Physical Therapist Every Year

Screenshot 2015-05-30 22.32.38Why is it that superbly fit athletes can find themselves in as much back, knee, or neck pain as their flabby fans, who sit at desks all day long then watch sports from overstuffed sofas?

“When you do an activity over and over again, your body adapts to that activity,” warns Dr. Shirley Sahrmann, professor emerita of physical therapy at Washington University School of Medicine. “If you play tennis, your arm gets bigger on that side; if you do karate you get adaptations in your hip and leg. Even if you just sit, you lean, you slump, your neck goes forward.” Either your body fails to build up musculature to support itself, or it overbuilds certain muscles and throws off the symmetry your skeleton craves.

That’s why Sahrmann wants to see an annual physical therapy exam become as routine as a dental checkup. “We go to the dentist twice a year and spend thousands to straighten our teeth, and all we do with them is eat and talk. Meanwhile the rest of our body’s just hanging out there.”

People think of PT as something generic their doctor orders after an injury, she says. But by analyzing the way you walk, bend, sit, and carry yourself, physical therapists can prevent injuries and head off future surgeries and chronic pain.

“Kids don’t sit correctly, they slump, so they wind up sitting on the middle of their back,” she says. “We have these little bones on our bottom where we are supposed to sit and keep our spine erect. When you slump, the muscles get stretched out, and they’re not going to function optimally.”

A temporary phase? Maybe. But “bones adapt to the alignment that you keep them in,” Sahrmann points out, “and your spine becomes shaped like that.”

Watching teenagers walk makes her crazy: “They are not using what we consider a normal gait. They walk without bending at the hip and knee and pushing off. They shuffle. And they sway back—their shoulders are behind their hips—so their gluteal muscles don’t work as much as they should. All of these little cultural changes in sitting posture, what’s considered cool—even the clothing.” For a while there, she says, “the new waistline was the gluteal fold! And how do you walk when your legs are strapped together with a belt? Their knees get caught in the crotch of their pants—it’s hysterical. But it’s also not good.”

In years past, there was little appreciation of how lifestyle affected your health. “My family thought they just got diabetes or hypertension; it had nothing to do with the cans of Crisco my grandmother cooked with.” The way we move and align ourselves is just as important as what we eat, she says. “There is complexity to movement, and you can do it right or wrong.”

I bring up ergonomics—surely that’s helped? “It’s not just whether the setup is right,” she points out. “It’s what you bring to that setup and what you do when you’re not there.” We’re designed to keep changing position, not sit frozen in the perfect chair. Even working out requires real knowledge, if you want to lift weights or do aerobic training without compromising the performance of all your other joints.

Sahrmann’s one of the nation’s pioneers in pushing the concept of a movement system, emphasizing the subtle, necessary interconnections of muscles and bones and nerves but also heart, lungs, and the endocrine system. Her career has spanned more than half a century, and its twists and turns led her to see the body whole. She began work at the end of the polio era and spent nine years taking care of patients who’d suffered head injuries or strokes. In order to understand the disordered motor control of patients with central nervous system lesions, she left clinical practice to earn a Ph.D. in neurobiology. Then serendipity sent her a different kind of patient: athletes who had musculoskeletal pain. Screenshot 2015-05-30 22.33.00

“I started teaching them to move differently, and they got better for reasons I didn’t understand,” she says. “I’ve spent a good many years with my colleagues at Wash.U. working to analyze these relationships between movement and musculoskeletal pain.”

She’s written two books and talked herself hoarse, urging people to see the body’s movement as systemic. Now that approach is finally catching hold, not just here but nationally and internationally. But she’ll know she’s really succeeded when PT evaluations are annual, and there are formal diagnoses based on movement patterns that consistently cause pain: flexion syndrome, when the back bows out; extension syndrome when it bows in and hunches you over; tibiofemoral rotation that can lead to knee problems.

“We all move differently,” she says. “I’ve seen patients whose feet are so callused I don’t know how they put their shoes on, and I’ve seen marathon runners with no calluses at all.

“You need to have an exam by a body expert at least once a year,” she finishes crisply. “Even if insurance doesn’t cover it, the cost is no more than you’d pay a personal trainer. I think we could substantially reduce the number of injuries and slow the process of osteoarthritis as people age.” She’s not saying arthritis can be eliminated altogether—but it can be delayed and its effects minimized. “There’s evidence that if a joint is lax, or you have injury, or your muscles are weak, you can get these arthritic changes.” Move right, and you lower the chance of injury—whether you’re an Olympian or a couch potato.

By Jeannette Cooperman May 11, 2015 / St. Louis Magazine