In order to resolve and prevent these and other similar conditions, it is helpful to have an understanding of the healing process and the role of eccentric strengthening in promoting the healing of connective tissues. An eccentric activation of muscle is one that occurs while a muscle is being lengthened. The lowering of the weight phase of a biceps curl is a simple example of an eccentric activation, whereas the lifting of the weight to the shoulder is the concentric phase of the exercise. The muscle and tendon is still actively controlling the load and under tension as it lengthens during the eccentric contraction phase. Due to the nature of muscle and tendon, it is possible for these structures to tolerate greater loads (tensile forces) during eccentric activation than they can produce during concentric activation. This information can be applied to help resolve nagging injuries such as plantar fascitis or Achilles tendonitis.

The common difficulty with these “-itis” injuries is that the tissues form scar tissue to heal microscopic structural tears when we are at rest, but with activity and tensile loading of the tissues, the structural tears recur. This is why you often feel the pain first thing in the morning, but after you have been walking for a little while you feel better. As you rest, the tissues heal in a shortened and weakened position, then when you walk, you tear apart the healing that occurred during the nights rest. In order to heal fully, you have to balance stretching and strengthening through a full range of motion with controlling for not overloading the structure and perpetuating the injury. It is easy to tell when overload occurs; you will feel the return of your pain. Of course, simply doing nothing may keep you out of pain, but it will not rebuild the strength and flexibility needed in the tissues to return to full activity.

The Three mechanical components for healing are inflammation control, restoration of tissue flexibility and restoration of tensile loading strength. Ice and anti-inflammatory medications are standbys for the first component. For flexibility, gentle prolonged progressive stretching in a pain free range is required. For weight bearing structures such as the feet, this can be accomplished by holding a weight bearing stretch for 3 minute plus intervals. Restoration of tensile load strength without damaging overload can be accomplished by focusing on eccentric exercises. It is important that the exercise be performed through the full range of motion available. In the case of the plantar fascia and Achilles tendon, this means doing strength work such as calf raises (plantar flexion) from a position of fully up on the ball of the foot and lowering till the heel is lower than the ball of the foot and the limit of flexibility is reached. Obviously to accomplish this the weight must be on the ball of the foot with the heel hanging off the edge of whatever you are standing on. Initially start with lifting up using both legs and holding on for balance, then shifting more weight to the painful side and lowering with an emphasis on that leg. One should do repetitions to fatigue, but never load the leg with so much weight that you provoke your pain. In this case, stretching before the strength work and icing afterwards to control for inflammation are critical.

These same concepts can be applied to other tendon or connective tissue injuries in the body. If these steps do not help to fully resolve problems, then seek out a therapist, podiatrist or other professional that can perform a detailed biomechanical assessment of your whole body and evaluate if other options such as orthotics may help. If you work on the feet diligently and the feet don’t get better, it is probably not the fault of the feet. Everything is connected and the whole system must function smoothly for it to remain pain free.

Brian Beatty, PT, CSCS rides when he can and complains of not riding enough when he can’t. He also talks incessantly to anyone who will listen about biomechanics, physics and experiential learning. When not riding he can be found from too early in the morning till too late at night hanging around Balanced Physical Therapy and Balanced Movement Studio in Carrboro and Durham.

Dr. Michele Ferrari, Lance Armstrong’s trainer, as quoted in conversation with Daniel Coyle in Lance Armstrong’s War. p.124.

A week’s vacation in Nags Head is a great place to relax, breathe deeply, and catch up on some reading. I took along a couple of books, the new book on Lance (noted above) and a textbook by Stuart McGill, PhD, one of the top biomechanics researchers on spinal disorders. The latter is not everybody’s pick for beach reading, but I admit to being a geek. While breathing in ocean air after my morning rides, I was struck by a recurring theme.

Dr. McGill’s book contained some interesting new research and ideas relating breathing to spine stability. One of the interesting findings in people with back pain is the inability to maintain spine stability when they performed stabilization drills while breathing heavily.

This research raised interesting questions for me. If the ability to breath without compromising stability is important for health, how can we tie that into better mechanics of breathing for performance? If, as Dr. Ferrari seems to suggest, there is improvement to be gained in oxygen exchange, then it would seemed appropriate to study the basic mechanics of breathing and stability first. The logical goal would be to gain a foundation of skills and awareness that could be used for exercises and gaining insight into breathing techniques that could improve the oxygen exchange process. The oxygen exchange topic will be explored in a future article, some basic breathing concepts are introduced here.

To inhale with force, the diaphragm and muscles between the ribs must contract. To exhale forcefully, the abdominal muscles and other muscles between the ribs contract. The diaphragm is shown in the accompanying pictures. It has a unique dome shape, and attaches to the lower ribs and lumbar spine. Study of the diaphragm’s attachments suggests that if the diaphragm is held rigid, it could provide stability between the spine and upper torso. However, this would obviously have a detrimental impact on breathing performance.

There seems to be a large amount of discussion in exercise about what is the core and what stabilizes the spine, but not as much about the muscles used for breathing. The fact that Dr. McGill & other’s research shows that an impact on stability is often seen with heavy breathing suggests that we may be inappropriately restricting the breathing muscles when performing core strength exercise in an attempt to create the desired stability. The same abdominal muscles that we are commonly instructed to hold tight during core exercises are actually required to expand and contract to achieve maximum breathing efficiency. If we are holding the breath and not moving the diaphragm during core exercise, the implications for poor control during aerobic events is even worse.

Another interesting fact from McGill’s book is that spinal stability can be increased with the internal pressure of maximal inhalation. During maximal inhalation, the diaphragm is contracting downward and the abdominal muscles bulge outward (not ‘suck it in’ to the spine). Maximal spinal stability is achieved when the abdominal obliques engage to initiate exhalation from this expanded position of full inhalation. Dr. McGill suggests that functional spinal stability for athletic performance or heavy work conditions cannot be achieved until one has mastered the ability to separate heavy respiration from the muscle patterns used for core stabilization. This month’s Core Corner contains a basic exercise idea that incorporates this concept. This idea also questions the efficacy of a body building routine that suggest always inhaling or exhaling with a certain portion of a lift. Training the body to be reliant on one specific pattern may not have functional carryover into athletic activities requiring elevated heart rate and respiration. A deep breath with proper control can enhance your strength; so don’t be afraid to let the diaphragm work and the torso and belly expand.

The important information for predicting spine problems is the ratio of endurance strength measured in how many seconds one can hold the test posture. The three test positions used for the research are shown in the accompanying photos.

The Flexor Test involves holding a straight spine at a 60-degree incline in a sit-up type position. The normal lumbar curve (lordosis, as if one where standing) is held throughout the test. If the spine curves, or the torso drops 10 degrees (about 3 inches), the test is over. Knees and hips are flexed 90 degrees and arms folded across the chest.

In the Extensor Test, the torso is held out over the end of a bench or table while the pelvis and legs on the bench. The feet can be either hooked under a strap or held by a partner. Arms are again across the chest with hands on opposite shoulders. The test position is held until the body drops below the horizontal.

The Lateral Musculature Test uses the side-bridge position, supported on the elbow and forearm. Both legs are fully extended with the top foot in front of the bottom foot. The top arm folded with the hand supporting the lower shoulder. The entire body is lifting to form a straight line and the position is held until the pelvis drops and the line is lost.

The following ratios are suggested as ideal:
Right side bridge / left side bridge endurance > 0.05
Flexor / Extensor endurance > 1.0
Side bridge (either side) / extensor endurance > 0.75

These test positions can also be used as strength building exercises for a healthy spine. The side bridge / lateral test is an excellent exercise for most people. However, the Flexor and Extensor test positions may not be appropriate for people already experiencing spinal pain. If you choose to use these positions as exercises, know that unlike an endurance test situation where you hold a posture for as long as you can, when using a static posture as a strengthening exercise, you should only hold the posture for 8-10 seconds. Holding a static load longer than this can create oxygen deficient in the muscle-tendon unit as the contraction restricts blood flow. To avoid this problem and maximize gain, perform multiple repetitions of the positions held for 8-10 seconds, relaxing the position and taking a recovery breath between each repetition. Repeat for as many repetitions as you can do with good form. Make sure that you can maintain a normal breathing rhythm while holding each position. Without oxygen there is no endurance. But that is a topic for next month.

So, what does this have to do with exercise as they get older? As we have written in previous articles, the muscles of the core, abdominals and gluteals, set up the position of the pelvis and affect the efficiency and overall strength of the hip and lower extremity muscles. This efficiency leads to less strain, and better force production/reduction. The end result is a more efficient athlete with fewer injuries. Usually, this leads to a life long athlete and exercise participant.

So, how do we encourage our children and instill a joy of exercise without training them like we are coaching a future Olympian? Simple, we follow a very old and well-established principle of learning, variability of practice. Expose children from a very young age to a variety of activities in a variety of places. Just create a safe environment were they can trip, fall, roll around and get up again without being harmed. Yes, that includes when they are infants. Let your child run, jump, hop, skip, bounce, and roll. Let them learning to pedal, balance, and walk on a beam. These are all activities that can start by the time they are 2 years old. When your child is about 5 years old and can follow directions, get them involved in organized activity that is not too competitive. Let them experiment with many activities and watch them gain self-confidence. Just remember to make it fun. Go on family hikes or walks and mix in skipping and running. Children love to laugh. If you can make them laugh and do exercise, you are well on your way to creating a love for the activity.

What about swimming and running? Once a child can follow instruction, involvement in organized exercise is fine. The goal is to build a love for activity and lifelong skills. Let your child choose the activity, this will help them gain self-esteem. From a Physical Therapist’s perspective, varied experience leads to better retention of skills. This leads to more efficient muscle use, better balance, easier skill acquisition, and less injuries. Overall that means more fun, better self-esteem and a lifelong love of being active.

As a final perspective, let me say that the most effective way to get children interested and engaged in activity is to let them model yours and other adult’s positive behaviors. This is really what children want to do. Now, lets get out and train our future Olympians.

During activity performance, multi-tasking with the Iillio-tibial Band (ITB) in the hip and leg can lead to a variety of problems and performance deficits. The most common complaint with the IT band is excessive tightness. There is a variety of IT stretches that many of us do regularly; yet still complain about tight IT bands. This excessive tension often can’t be helped, since functionally we are asking the ITB to multi-task during running or cycling activity. This functional multi-tasking is inefficient and stressful to the physical structures.

The IT Band is a thick fibrous tract of tissue that originates from Tensor Fascia Latae (TFL) muscle on the most superior and lateral aspect of the hip. The IT band covers the outer portion of the thigh from the above the hip to below the knee. The role of the TFL and ITB is to provide a broad stable attachment site for the Gluteus Maximus muscle. The glut. max. is the primary power muscle for extending the hip, i.e. driving the leg backwards to propel the body forward in space. The TFL & ITB are also positioned so they can provide lateral support to hold the pelvis erect during single leg stance. However, this should not be the primary role of the ITB & TFL. The deep, central buttocks muscles, the Gluteus Medius & Minimus are responsible for holding the pelvis upright so that the pelvis doesn’t drop to one side or shift out to the side excessively when you are extending the hip with the Glut Max. If the gluts are not working properly, then the ITB must multi-task, becomes excessively strained and becomes problematic.

A simple exercise to help overcome these problems is shown. In keeping with the theme of this article, the intention for this exercise is to focus on the posterior hip musculature.

Start position: Stand on one leg and lift the opposite knee allowing the arms to swing as if running.
Finish position: Squat down on the stance leg by sitting back with the pelvis. Extend the hip to straighten the leg that was in the air behind you while reversing the positions of the arms.
Maintain an erect torso as you do the squat. If you desire more load, do the exercise holding dumbbells.

The work should be felt primarily in the glutes in the back of the hip. If you feel strain in outside of hip and down side of thigh, then you are using ITB/TFL too much for stability. To correct this, shift the pelvis left or right while focusing on maintaining the top of the pelvis level until you feel the deeper gluts in the back of the hip. If the work is mainly in front of thigh/quadriceps instead of the gluts, then the knee joint is contributing too much. To correct, bring knee further back relative to the foot and drop the pelvis further backward as you squat till you feel the work in the center of the buttocks.

There are three important ideas in core stability that are often overlooked or misunderstood that are critical to integrating core work into performance improvement and injury management.

The Core is a functional concept rather than an anatomical address.
The core can be defined as the stable base from which motion occurs. Therefore, the core consists of skeletal segments, their muscular attachments and the joint structures between the segments that create this stable base. There is no one particular set of muscles (i.e. abdominals) that form the core.

Core stability is task dependent.
For every task, there are components that provide the stable base and components that create the motion. For every desired activity; running, cycling, swimming, climbing, tennis, etc. there are different body parts that create the stability of the core.

Stability and rigidity are different.
All too often stability is confused for rigidity. As an interesting exercise, review the definitions of rigid and stable in the dictionary.
Stability is defined as: “maintaining equilibrium or self-restoring”.
Rigid is defined as: “marked by a lack of flexibility; rigorous and exacting”.
A ‘contract and hold’ strategy for core stability often just robs efficiency of movement when applied to activities.

To maintain improve core stability relative to a desired activity, it is necessary to know what structures hold the stable base and what structures drive the dynamic motion for that activity. One way to think about this is to ask what holds the body in place against gravity for the desired movements of the task.

For example, in cycling, your contact is the base of the pelvis on the saddle extending through the torso and shoulders all the way to where the hands contact the bar. In running, the hip muscles hold the pelvis and torso erect as the feet contact the ground. In swimming, a balance between the muscles on the front and back of the spine maintains the body forward, long and buoyant.

The whole purpose of core stability training is to gain efficiency by having a stable base for the dynamic parts of the movement. To apply this theory to exercise selection, find exercises that challenge you to hold the appropriate core parts stable while moving the major muscles used by the activity.

Using these definitions:
The cycling core extends from the hands to the pelvis while the hips, knees and ankles are moving.
The running core is harder to define. The hip flexors and extensors (gluts) drive the running motion, but they must also combine with the muscles on the inside and outside of the hips to hold the pelvis stable. While this is happening at the hips, the abdominal and spinal muscles combine to hold the torso erect over the pelvis and allow the shoulders and arms to rotate opposite the legs. All of this must happen as you stand on one leg.
In swimming, the core involves the abdominals and the muscles running the length of the spine from the tailbone to the base of the head, including the neck.

Exercises that challenge you to hold any of these body parts in balance may be considered core exercises depending upon the activity you want to train for. Think about what you are training to do and your workout routine, and then see how you answer the question of where is your core. For example: a push up would be considered a core exercise relative to cycling but not running. A single leg squat would be a core exercise relative to running, but not cycling. This approach can make a big difference in productivity and results.

First, lets consider what it is that makes a swimmer look like they are gliding on top of the water. The term is efficiency. An efficient stroke requires a stable core with a “long spine” position. The long spine position is accomplished by utilizing the gluteal muscles, abdominals, spinal extensors, and cervical (neck) retractors. All of these muscle groups work to maintain the spine in a neutral, long, position with very little to no wasted movement in the frontal or sagittal planes.

In understanding the actions of these muscle groups on the spine, it is helpful to work from the center outward. At the front center of your body, lies the abdominal muscle group, consisting of the: rectus abdominus, internal and external obliques, and the transverse abdominus muscles. They function to maintain the pelvis, ribs, and lumbar vertebrae in a neutral position. A neutral, erect spine allows the larger muscle groups connecting to the spine to be at their optimal length to work efficiently. This neutral position of the spine is the place that makes one feel like the swimmer’s body is lengthened. The spinal extensors work together and in conjunction with the abdominals to resist motion in the sagittal (forward and backward bending) plane to keep the spine straight. An inefficient swimmer will use other muscles in a dysfunctional pattern, to keep the head and legs in a position to move forward in the water. In this scenario, the gluteals and cervical/thoracic spine extensors are over stressed and will have difficulty holding the spine in a “long spine’ position. If the gluteals have to work to help maintain a neutral pelvic position, it will interfere with the gluteals primary function of extending the hip and lower extremity into and out of extension. This in turn keeps the swimmer from using the full strength of the hip extensors to create a powerful kick in the water.

Now that we know what the potential problems are and the theory behind wanting to change dysfunctional patterns for swimmer, what do we do to prevent it? A simple starting point is to add these four basic exercises to your in-season program. As you perform the exercises, let your primary goal be to pay attention to what muscles you are using to accomplish a “long spine”. Then you can begin to explore how those same muscles are being used when you are in the water.

1) The Human Arrow. Here the swimmer will place their forearms on the ground with their hands clasped and elbows spread to create an ‘arrowhead’ position. Then place your toes on the floor with your knees and hips in a neutral/extended position. Hold the torso and pelvis off the floor using the abdominal, lumbar and pelvic muscles. You should be able to maintain this muscle contraction while still breathing. The head and neck are stretched so that spine is attempting to get as long as possible and the top of the head moves away from the pelvis and in line with the rest of the spine. Maintain this position for isometric sets of 1 minute in length, and repeat 3-4 times.

2) Opposite Arm and Leg Reach in the arrow position. Assume the arrow position as described above. Shift your weight to one leg and extend the other leg moving from the hip. It is important to understand that the extended position is not just a lift to the ceiling. The position in the lower extremity is accomplished by tightening the gluts, quads, and calf. To progress to a more challenging exercise, add extension of the arm opposite the lifted leg. In the upper extremity, the triceps are contracted to maintain a straight arm, while the shoulder blade and arm are simultaneously lifted and reaching to elongate the upper extremity.

3) Back Extension on the ball. The swimmer lies on an exercise ball with their hips over the top of the ball. The abdominals are contracted and the lower extremities are extended at the knees and ankles. The swimmer tightens the gluts and lifts the upper body off the ball into a long spine position as they rise.

4) Alternating Hip and Lower Extremity extension. The swimmer lays on the ball in the same position. This time the swimmer places both hands on the ground and will extend the lower extremities in an alternating fashion, while maintain as little motion as possible on the ball. Again, the raising of the lower extremities should be hip, knee, and ankle extension, not just a rise to the ceiling.

These four exercises are the start of an exercise program to improve strength, power, and efficiency in the swimmers stroke. Stay tuned for further information and exercises as we explore the function of the upper extremity and rotation about the ‘long spine’ in future articles.

Balance of activity is critical for sustainability. As you plan what events you will do this year, also plan for cross training. Relative to endurance sports, desired cross training activities can be summarized as anything that moves your body in a different direction or goal than going forward. Cycling is not cross training for running, but volleyball, soccer, weight lifting and tennis all would be. Another concept for cross training is seeking activities where moving fast and outward is not important, but rather the focus is on slow and internal attention. Yoga and tai-chi are excellent practices to provide this type of balance. Look for activities like this that you enjoy and don’t hesitate to spend time doing them; they only help your training, not take away from it.

None of the above efforts needs to be undertaken alone either. Though we often think of endurance events as individual sports, it still takes a support team to get us to the start line. The family team, friends & training partner team and health support team. To be sustainable, your event goals and trainings need to include the family. Anyone who disagrees with this needs more assistance than I can provide and know that the endurance community supports you getting it.

A great group to train with can make all the difference in the fun and sustainability factor. Community support can be found at all of the great local stores that cater to our equipment needs as well as the many fine health clubs. Running stores, bike shops and outdoor stores not only provide great equipment analysis and advice but support group activities. There are many training programs organized by events, coaches & stores. Local clubs exist for about every interest in every town. The mental support of a group and diversity of resources help keep everyone well balanced and having fun.

From a physical well being standpoint it is always helpful to have further biomechanical analysis. This can be as simple as asking a friend or training partner to carefully watch what you are doing. Bike shops will help with fit issues and there are talented people providing detailed fit and analysis to the cycling community use them. If you want further refinement, many excellent coaches can review form and training schedules with you. If there are specific areas in the body that seem to always fatigue, this could be a sign to enlist a personal trainer or physical therapist. We are also lucky to have some excellent performance labs available for detailed physiological assessment to fine-tune your fitness.

Physical stresses, strains and some small injuries are inevitable. The key to sustainability here is prevention and early detection when possible. If injury does occur, have your medical team to help get you back together. A good group includes massage therapist and bodyworks, personal trainers, physical therapist, chiropractor, primary care doctor, sports medicine doctor and even sports psychologist. If you have been doing endurance events for a long time, you probably already have many of these folks ‘in your camp’. If you don’t know the above professionals yet, ask your training partners and look for people interested in your activities. There is no better resource than within the pages of this great magazine.

There are two equally big considerations for planning in-season strength work: What to do and when to do it. How often is simple, research indicates that a minimal frequency of two times per week is needed to maintain strength levels. Increased frequency can be beneficial, however trying to maintain off-season strength workout intensity with competition and activity training can lead to unrealistic time demands, no recovery time, over-use injury and sub-optimal performance.

The ‘What to do’ question is probably the most important. Since you will devote most of your time to your chosen activities, the muscle groups that are most active to perform those activities are getting plenty of strength building work. The important muscles to focus on during strength workouts are the muscles that support your activity. Using this perspective, all workouts become ‘core’ workouts. ‘Core’ being defined as a functional concept, not an anatomical location.

For running, workouts need to target the muscle groups that: hold you upright during single leg stance (hip abductors, adductors & rotators); maintain a stable torso / pelvis relationship as you run (abdominal obliques, transverse abdominus & quadratus laborum); and hold the torso and shoulders erect over the pelvis (spinal extensors).

For cycling, workouts should focus on the groups that: stabilize the shoulder girdle over the handlebars (serratus anterior, trapezuis); maintain a stable pelvis and torso (abdominals, quadratus & spinal extensors); and shift pelvis for handling (hip abductors, adductors& rotators).

In swimming, maintaining strength in the supporting muscles can be crucial for healthy shoulders. Important groups to include are: the muscles that stabilize the scapula to the torso (lower trapezius, rhomboids & serratus anterior); the muscles that position and stabilize the arm (rotator cuff); and the muscles that keep you erect in the water (spinal & hip extensors, and obliques).

As a general rule, one should have at least as many individual workout routines as event activities in which you are participating. In the triathlete example below, separate workouts for run, swim and cycle are utilized.

The ‘When to do’ is influenced by the ‘what you do’ decisions. If your workout is structured around the supporting muscles for an activity, then the workout timing should fit into the activity training schedule in such a way that you are never overly fatigued in the supporting muscles during a day when you have hard activity training to do. A sample triathlete training schedule with supplemental strength workouts inserted is shown below.

3-week workout template
Intermediate level Triathlete in Pre-Competitive Phase (8 weeks before 1st major event)
S: swim; B: bike; R: run; W: strength workout

Mon Tue Wed Thu Fri Sat Sun Week comments
S: easy
W: swim
B: easy
R: hard S: aerobic
W: run
B: hard
R: easy S: hard
B: aerobic
*R: aerobic
*brick

R: aerobic
W: bike
S: easy

B: easy
R: hard S: aerobic
W: swim
B: hard
R: easy S: hard

R: aerobic
W: bike
B: aerobic
*R: aerobic
*brick
OFF

B: easy
R: hard S: easy
W: run
B: hard
R: easy S: aerobic
B: easy
R: easy
W: swim
R: aerobic Recovery week

Notes:
Three week cycle: third week as recovery week (lower volume and intensity)
Intensities: Easy (recovery) / Aerobic (steady to moderately hard) /
Hard (intervals approaching race intensity)

Our thanks go to Jay Crooker of IronCoach.com for supplying the sample training schedule information into which we inserted the strength training examples.

(Photos: prone rotator cuff and scapula stabilizer exercises)

It is difficult to perform and enjoy endurance exercise when any part of the lower extremity is not functioning at its best. The following quick and easy test can help determine if you are at risk for a lower extremity injury.

This simple single leg standing reach test is derived from a functional exercise known as the Star Excursion Balance Test. This test requires level ground and a tape measure. The test yields more definitive results if performed after exercise when the legs are post exertion ‘tired’ but not fully fatigued. It is performed by:

1. Standing on one leg while reaching with the opposite foot as far as you can along the taped line.
2. For a valid test repetition, the standing foot should not wobble or move. The foot that is reaching must touch the ground lightly, but cannot have any weight shifted to it or be used to support the body in any way when it touches the ground.
3. Three different directions of reaching should be measured. A: Medial (opposite leg reaches out to the opposite side, i.e. for left standing foot, reach the right leg as far directly right as possible); B: Anteromedial, at a 45 degree angle opposite and forward from the stance side; C: Posteromedial, at a 45 degree angle opposite and back from the stance side.
4. Measure the distance of 3 valid reaches in each direction allowing a 10 second rest between attempts, for each leg.
5. Average the distances for each direction and compare the results left to right.

If the difference in average reach left to right leg is greater than 5-to10% in any direction, then there is an increased risk for problems on that side. Most relevant to runners, this test has been shown to be predictive of chronic ankle problems. Turning one’s ankle while running is a familiar event for most of us. Often we get lucky and can walk or run after the incident and show no lasting effect. Unluckily, this is not always the case and a significant ankle sprain injury will result. Research suggests that 40% of the people who suffer a sprain will develop some level of long-term ankle difficulty.

Recurrent ankle sprains / pain is the most common problem, and is known clinically as Chronic Ankle Instability (CAI). The greatest impacts of ankle sprains are a loose ankle joint and a loss of sensorimotor control. Sensorimotor control is a fancy way of saying that the body can no longer accurately know how to react to the position of the foot relative to the forces traveling through it. It is a multi-dimensional problem of neurologically knowing where the foot is in space, forming the appropriate response to maneuver the body, and having the skill and strength to maintain optimal joint position.

The great news is that the above test also functions as an excellent exercise for training the lower extremity for strength and sensorimotor control. Research has shown that improved performance using this and similar sensorimotor control exercises result in less lower extremity injuries and improved performance in sport activities and daily life. This month’s ‘Core Corner’ illustrates a protocol for using the Star Excursion Balance Test as a training exercise.