Conditioning in the Pro Locker Room Chiropractic's Integral Role

by Dr. Tim Maggs and Coach Al Miller © 1999

(This is the second in a series of articles co-authored by Dr. Tim Maggs and Coach Al Miller,
Head Strength and Conditioning Coach for the Atlanta Falcons.)

For years, Chiropractic has been trying to create and take possession of a niche within the sports world. Although years of research and success stories overwhelmingly prove the benefits of Chiropractic treatment for athletes, individual Chiropractors haven't always faired as well when attempting to become part of organized sports teams. Organizational politics and professional biases will always contribute to preventing the "new kid on the block" from entering the sanctity of a pro or college locker room.

In order for Chiropractic to enter this arena and carve out the much desired turf amongst the other professionals working for a team, there must be a professionalism and consistency in the protocol brought to a program. There must be a bigger purpose other than to relieve pain. The massage therapist can relieve pain. The physical therapist can relieve pain. The medical doctor can relieve pain. Stealing their precious turf in the locker room is virtually impossible. But, to become the biomechanics specialist with an iron clad protocol that is easily understood by all will lead Chiropractors to a corner in the locker room which is uninhabited. That is, until players, coaches and medical personnel begin to understand and appreciate the value and benefits of detecting and correcting biomechanical faults.

Ally of Strength and Conditioning Department

Strength and Conditioning Departments are highly concerned with all physical, biomechanical and structural information on an athlete, however, are unable to perform, interpret and provide the same testing and treatment that Chiropractors are skilled at providing. This relationship thus becomes the most important relationship for all Chiropractors interested in working with teams. As discussed in last months article, the Strength Coach and the Chiropractor should work hand in hand in reviewing each others evaluation of an athlete and the rehabilitative program should be cooperatively understood for the long term benefits of the athlete.

Chiropractic Rehab Program

True Chiropractic rehabilitative care can only begin with the absence of symptoms. If symptoms brought the athlete in for care, then symptoms need to be resolved prior to any rehab program.

Objective findings can come from multiple sources. One of the more valued objective structural tests available to the Chiropractor is that of the standing x-ray. There are many marking systems which show if an athlete is structurally aligned and balanced. Structural defects, or imbalances, include pelvic rotations, subluxations (locked joints), increased or decreased curves and narrowing or swelling of the disc spaces.

Some of the more popular markings used to show structural status are the gravity line, as seen on the lateral L-S view, dropped from the center of the body of L3, straight down. This gravity line should bisect the anterior third of the sacral base. If the line is anterior or posterior to this point, weight is being handled by parts of the spine not designed to handle the weight, and eventual problems are predictable. A second marking is that of the sacral base angle, which is normally 36°-42°. An angle greater or lesser will suggest a pelvic angle inconsistent with normal positioning of the pelvis, thus producing a work load which will not be tolerated well. These findings become compounded with the introduction of any athletic activity and are key references when setting up a rehab program.

The length of care and treatment in setting up a rehab program will be influenced by many factors. Typically, the age and health of the athlete are the two most important criteria, but the degree of structural defect usually dictates the amount of time needed for maximum improvement. Frequency of treatments and specifics of treatment provided will vary from doctor to doctor, technique to technique and patient to patient. A successful time frame for most rehab programs dealing with spinal rehabilitation will take anywhere from 3-6 months. The ultimate goal is to have objective improvements on a final re-examination, which will include re-x-rays, as well as any other contributing tests which were initially performed.

During this 3-6 month period, proper treatments and therapies are provided. Improved habits are taught. The integration of rehabilitative exercise and conditioning will provide the maximum potential benefits to all patients. Working with a strength coach, or physical personal trainer, will enhance Chiropractic rehabiltative care. This program can also include nutrional support and positive psychological training. But, the critical component here is time, and if a Chiropractor cannot communicate to and manage the patient for a long enough period of time, the likelihood of success is reduced greatly.

Strength and Conditioning Program

Also discussed in last month's article was The Pyramid System (Fig. 1), which is a conditioning program designed by Coach Al Vermeil, Head Strength and Conditioning Coach of the Chicago Bulls. This system is the backbone of the conditioning program for the Chicago Bulls and Atlanta Falcons.

The Pyramid System

The Pyramid System is a calculated individualized approach which brings each athlete along at a rate they are capable of handling. The desired goal for everyone involved is to push an athlete through a conditioning program as hastily as possible, but never at a pace that will produce injuries.

Work Capacity-1st Phase

Keep in mind that the best players in almost all sports are your fastest and most explosive athletes. The lower the conditioning level of an athlete, the more time they need to spend in the work capacity phase.

In this phase, there are many different types of exercises done. Medicine balls are used for abs and total body work. These can also be used with tempo runs. For example, an athlete can do 100 yards of underhand/overhand throw with 6 kilos, 10 kilos and 15 kilos. Once they reach 100 yards, they'll run 200 yards of tempo work, come back, throw it 100 yards and walk to the ball. Other exercises used could also be teeter boards for the lower body and physio balls for the upper body. All of these exercises are very important in preparing the body for overhead lifting.

The Work Capacity phase of the Pyramid System, for the most part, is done without the use of added weights to an athlete's program. There are six sub-categories, and each one provides immeasurable benefits in the final quest to get and keep an athlete conditioned. No athlete should go to the second phase of conditioning (Strength) until they are fully capable of performing all six sub-categories of Work Capacity.

1. Anaerobic Capacity-In basketball, the furthest distance you can run is 90 feet. In football, the furthest you'd ever run at one time is 110 yards. Anaerobic capacity is the athlete's ability to explode for periods of 5-6 seconds at a time with rapid recovery. This type of conditioning requires serious training, as the body's oxygen utilization system must dramatically improve as well as the recovery ability of the athlete. The athlete will ultimately need to perform the same task 10-15 times with a rest of about 40 seconds, which is the same as the time clock in football.
2. Body Composition-Today, there are extremely sophisticated means of detecting body fat that can come within a half-point of accuracy, plus or minus. Depending on the sport and position the athlete plays, the ideal body composition is critical for success of that athlete. The program is designed to help the athlete reach close to ideal body weight and composition before moving on to the second phase of the Pyramid.
3.  Joint Mobility-as Chiropractors have known for years, full and unrestricted joint mobility is critical for maximum performance and ultimate prevention of injuries. Joint mobility is influenced by the tendons of a muscle, the tension of supportive muscles, surrounding ligaments and biomechanical defects of an athlete. This area is especially important for Strength Coach and Chiropractor to work together on. For example, an increased sacral base angle will alter an athlete's ability to either flex or extend at the hips and waist. Without the knowledge and correction of this structural defect, an athlete may be pushed beyond what he's capable of handling.
4. Strength Endurance-This category works hand in hand with Anaerobic Capacity. This is an athlete's ability to apply a given force time and again, play after play for 50-70 plays per game. The strength aspect is recognized by an athlete's ability to show absolute strength, or the ability to exert force without the equation of time being a factor.
5. Core Strength-This is one of the most important categories in the Pyramid. Core strength refers to abdominal strength. This ranges all the way up to the thoracic cavity and down to the pubic crest. Core strength is critical for full body stabilization. If a body can't stabilize, an athlete will have a difficult time exerting force into the ground while moving fast. This will translate into an inability to take on blockers or playing against other players. This also requires strong low back muscles, such as the gluteals, lumbar erector spinae group and other pelvic muscles. This area of development is critical as it is one of the strongest parts of the body and the strength here will permeate out to the rest of the body.  Much abdominal work is done either on the floor or on physio balls. There is also an ab bench that is used, both with and without weights. The lumbar area is initially worked by performing hyperextensions without weights, or with pauses. This must be mastered before an athlete can ever add weights on their backs or over their heads.
6. Aerobic Capacity-this categoy is usually acquired if the anaerobic capacity is done correctly. For athletes such as football players, too much distance work should never be done, as that will retard both strength and speed.

Strength-2nd Phase

Once an athlete shows they can actively demonstrate running tempo runs, have improved core strength, good joint mobility, improved body composition, aerobic and anaerobic skills and are going through the warm-up series efficiently, they are now ready and able to go onto the next phase, the strength phase. This phase also continues to help body composition. Joint mobility is critical now as the athlete has to be able to perform movements with added weight. As discussed earlier, if an athlete has restricted movement without additional weights, problems will occur once weight training is added to the program. There are 3 sub-categories in the strength phase.

1. Maximum/Relative-Maximum is just what it says, the maximum amount of weight an athlete can press or squat. Relative is the amount of weight an athlete can lift relative to body weight. The ratio governs the amount of weight best tolerated by the athlete's height and weight. This ratio, along with the position a player plays, will determine the amount of weight used in strength training. It's important to make sure a player can power clean or snatch a certain percentage of their body weight and it helps to set up maximums without having to test the athlete. A 185 pound receiver certainly shouldn't lift the same as a 300 pound lineman or a 250 pound linebacker.
2. Eccentric Strength-Occurs often, especially when an athlete has to decelerate and perform quickly. This is done when an athlete has to stop quickly, change directions and load new muscles. Many athletes can fluidly move, but when asked to stop and load new muscles, many of their unseen problems become magnified, such as joint problems (i.e. hips, knees, feet, ankles). Using certain rhythms in weight training is important. Ideally, an athlete should come down slowly with weights and go up with explosion.
3. Static Strength-Again, this can only occur after work capacity has been achieved. This is the strength needed to assume and maintain a position for some period of time. Examples would be a batter in a stance, a lineman holding a 3 point position, etc.

Strength Speed/Speed Strength-3rd Phase

This is the phase an athlete will enter after completing the first two phases of the pyramid. Strength speed is basically your Olympic lifts, while speed strength is your plyometric movements, your bounding, your uphill work and similar exercises. Appropriate exercises are recommended to athletes based on their need for increased speed or increased strength. The important issue here is that a proper progression must be utilized to give the central nervous system adequate time to become educated.

1. Starting Strength-this is the amount of force you can generate from a stopped position, overcoming the inertia of the bar.
2. Explosive Strength-this addresses the rate of force development. With specific exercises, the speed of an athlete's explosiveness improves, which is a reflection of the speed and time needed for a muscle to attain maximum strength during a specific movement.
3. Reactive or Elastic Strength-movement where there is a rapid decelerization followed by a small amortization period followed by a very strong concentric contraction. An example of this is the depth jump.

Speed-4th Phase

Simply put, speed is the moving of the body through a range of motions, both arms and legs, in the fastest times. As stated earlier, the best athletes in all sports are typically those with the best speed.

Speed without strength will prevent an athlete from ever reaching full potential. The Olympic lift is mandatory for an athlete to gain complete strength. Other important factors consist of joint mobility, body composition and core strength, just to name a few. Ultimate speed is the culmination of all the ingredients which make up the pyramid. There are 3 sub-categories in the speed phase.

1. Acceleration-This is the most important ingredient in sports. This covers 0-about 45 yards.
2. Absolute Speed-This is the speed that takes over after the 45 yard mark.
3. Specific Speed-This refers to each particular sports pattern which has to be accomplished within a particular position. Every position needs different requirements. There may be similar movements, but no two positions have identical movements. Offensive guards pull and take angles, where defensive linemen don't. Wide receivers run a lot longer distances than an offensive lineman. A defensive back always starts out running backwards. A quarterback is going to run while looking over a shoulder. Linebackers can run either forward, lateral or backward. Running backs are like catching ricochet rabbit. And the tight ends are a combination of all the above. There is no one way to increase speed for all players, but there are common factors to impove speed for all positions.

Conclusion

Regardless of which protocol you refer to, whether it be a thorough consultation, examination, report of findings and corrective biomechanical program by a Chiropractor, or a thorough assessment and management of an athlete through the pyramid and throughout the season by a Strength Coach, the end result is only as good as the detail of the work done.

The benefit to the athlete improves greatly if both Chiropractor and Strength Coach go the extra mile to employ thorough management of the athlete. This benefit further improves if full and continued communication takes place.

Those Chiropractors interested in sports and working in the locker rooms throughout the country have to become more involved with the details of the athletes biomechanics and the objective improvements which can be made. They need to develop close working relationships with other members of organized sports teams, especially the strength coaches throughout the country.

And with every opportunity, continued biomechanical education needs to be provided to the athletes of all sports. Only with hard work and a committed effort by all will Chiropractic one day become that biomechanics authority in the pro locker room.

Conditioning Pyramid