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dsabella 2015
Women on the Run
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Olympic-styleweightlifting
www.physiodetective.com
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The Pregnant Athlete
Runners guide 2010, GrindTV.com
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Life LongAthlete
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WHY FEMALE ATHLETES?
Across a lifespan Rise in participation
www.usatriathlon.org www.runningUSA.org
Impact stress has on a Women’s Body Injuries Reproductive system Neural dynamics
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TRENDS Women are more prone to ACL injuries (Voskanian, 2013)
Female athletes 3.5x at risk of non contact ACL injury Jumping/ cutting activities 4-6x greater than male
counterparts Women sustain higher number of overuse knee
injuries when compared to males (Gent R N van, 2007)
The predominant running site for running injuries: The knee (Powers, 2010)
Women use less hip/core muscles vs. knee extensors (Stearns & Powers 2012)
Quad Dominance (Powers 2010)
Women have overall weaker hip extensors vs. male counter parts
Women have less proprioception and trunk control
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ANATOMICAL
Pelvis Body Composition Hormonal Moving/ Landing
Patterns (Stearns, 2013)
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FACTORS THAT INFLUENCE HER PERFORMANCE
Anatomical Age Societal Behavioral
Training Programs Cross Training Rest/ Recovery Nourishment Nutrition
Nutrient Dense foods Vitamins
Running Economy Genetics “State of Readiness”
-Cook, Gary 2014
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NOURISHMENT
Mobility Joints
Motion is lotion Soft tissue
Pliability Dynamic
movements Nutrients
Soft tissue Recovery Bone health Vit. D, Iron,Calcium
Disordered Sleeping Quality vs. quantity
Disordered Eating Vs. Eating disorder
Hydration Recovery of your Central
Nervous System.
Nourish your system to enhance your ability to perform.
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“EFFECTS OF FEMALE REPRODUCTIVE HORMONES ON SPORTS PERFORMANCE”
BY C.M. LABRUM, 2013
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FACTORS THAT INFLUENCE HER PERFORMANCE
Energy Drain Fatigued Athlete Overuse Syndrome Disordered Eating/ Eating Disorder Sleep/ Recovery Female Athlete Triad Athletic Anemia Menstrual Cycle Fluctuations/ Hypo-estrogenic athlete Pregnancy Age
A Systems Approach (not just the MS for performance)
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UNSPOKEN INJURIES
The Subtle Signs Fatigue Levels “More is better…” Reoccurring injury Increase use of
Ibuprofen* Disordered Sleeping Disordered Eating Coping Strategies
The “NOT so” subtle signs Quality of hair/nails Fatigue Levels/Caffeine Stress reactions/ Stress
Fx. Quality of Sleep Female Triad
Osteoporosis/ Osteopenia/Fx.
Chronic Nagging Injuries
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FEMALE ATHLETE
What’s up, Down there?
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PELVIC FLOOR
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UNSPOKEN INJURIES…
Pelvic Floor Disorder (PFD)
“Activities most likely to provoke incontinence include jumping, high impact landings and
running” (Nygaard, 1994)
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TRENDS
Prevalence of Pelvic Flood Disorders in Pregnancy related Aging Obesity
“Nulliparous, highly fit, young, without classic risk factors”
(Carls, et al. 2007)
“Do you pee during workouts” (https://www.youtube.com/watch?v=UKzq1upNIgU)(www.HermanandWallace.com)
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“NULLIPAROUS, HIGHLY FIT, YOUNG, WOMEN WITHOUT CLASSIC RISK FACTORS”
(CARLS ET AL. 2007)
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A DISRUPTION TO THE SYSTEM
The Obvious Disorders Stress Urinary Incontinence (SUI) Urge Urinary Incontinence (UUI) Mixed Incontinence
Pelvic Prolapse Pelvic Pain Pain with sex
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A HEALTHY BLADDER
Bathroom trips approx. 7-9 x per day Bladder Diary
Stream approx. 10 seconds long Waking up 1x> at night to urinate *Post pregnancy night feeds Habitual patterns
Prior to hills At a certain mile Increase power for performance
Prevention urination Fluid Restrictions
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SUI RISK FACTORS Training (95.2%)>Competition (51.2%) Training Volume
5-8 hrs. per week Endurance athletes* (90 min.<) Ultra athlete (4 hr.<)
Training Intensity At/near max efforts Power athlete
Lower BMI/Body weight Inadequate nutritional support for mm, lig. And collagen
growth Inadequate race nutrition
Bladder Health (& Diet)Klenstinski, J: APTA-Combined Sections Meeting Feb. 2014
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URINARY INCONTINENCE IN SPORT WOMEN: FROM RISK FACTORS TO TREATMENT; A REVIEW
( DA ROZA, THUANE, 2013)
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REPORTING
In General: <50% tell caregiver of HCP about UI Athletes: 50-90% do NOT tell their coach friend, or
parent Shame/embarrassed/quality of life/social isolation “More than 25% of those completing surveys indicated
experienced incontinence, more than 90% never told anyone and also had NO knowledge of preventative measures”
-(Carls, 2007) Tension of Opposites: supposed to be a “healthy
athlete” but feel “unhealthy”.
Klenstinski, J: APTA-Combined Sections Meeting Feb. 2014,
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THE KEGEL
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HOW DOES IT WORK?
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HOW DOES IT WORK?
“High and tight pelvic floor”
Pain with insertion, pain with sex, leaky system
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HOW DOES IT WORK?
“Neck Pain”
Power “Leak”
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THE ANTICIPATORY CORE: THE CENTRAL STABILIZER
Support organs Supports Spine Bladder control Sphincter control Sexual Function Central Stability Maintain IAP
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OPTIMAL FUNCTION: THE ABC’S
Alignment Rib Cage (Bell) Pelvis (Bowl)
Breathe How to do it correctly Integrate
Central Stability NO! to
“Flatten your low back” “Squeeze Shoulder
Blades” Sit ups Static exercises
Neutral Rib Cage
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ALIGNMENT
The Bell Adolescents:
Pelvis Rib Cage
APT PPTFNP Bell up Bell down
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WHERE ARE WE…HEADED?
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THE SPORT OF MOTHERHOOD
Pregnancy is the most common start of PF muscle weakness *
Incontinence is quite common during pregnancy
Post pregnancy Post post-post
pregnancy
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BREATHING
Diaphragmatic Breathing Pattern
Turns on: Your road to
recovery “rest & digest” Initiates a chain of
stability Prevents a “high &
tight” pelvic floor Allows for the piston
to effectively do its job
Prevents a prolapse
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CENTRAL STABILITY
Coordination of gears CORE Integration* Teammates• Glutes• Obliques• Thoracic Spine• **Pel-trunk-ula
*www.juliewiebept.com**www.grayinstitute.com
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AN ORTHOPEDIC MASK
Chronic Nagging Injuries High Hamstring Pain Piriformis Syndrome Hip Bursitis Neck/ Shoulder Pain Low Back Pain Hip Pain Knee Pain Foot Pain
Power muscles vs. stabilizers.
Increase use of accessory muscles.
Increased tone
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TREATMENT: NOT JUST A KEGEL!
First line of defense Injured tissue
Treat the source of the symptom, not the symptom Isolationist model vs. functional anatomy
A systems approach Integrative Anatomy Chain Reaction
Functions of daily living Performance for life:
Picking up groceries, babies, suit cases Running up/ down stairs Balance
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TREAT THE SOURCE NOT THE SYMPTOM.
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FUNCTIONAL TRAININGIndividual/ Task Dependent
Three Dimensional
Mobility/ Stability System
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FUNCTIONAL TRAINING
Task Specific Multi planar (3D)
Sagittal (F/B)Frontal (S/S)Transverse (Rot.)
Chain Reaction
Mo stability
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FUNCTIONAL THERAPY
Hip Strengthening vs. Quad strengthening Planes of motion
Sagital= Front/back Frontal=side to side Transverse= rotation
“If you don’t use it, you lose it” “Turning on a muscle” or “loading a muscle All 3 planes of motion Task dependent
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VIDEOS
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FUNCTIONAL TRAINING
THE CORE
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FUNCTIONAL TRAINING
THE CORE
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ARE YOU READY FOR IMPACT?
These factors that influence our performance are treatable, and preventable!
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CREATE AN ENVIRONMENT FOR SUCCESS
A Collaborative Approach Functional vs. Isolationist concepts Pain is a symptom/ not the dysfunction Recognizing chronic pain is a crack in your
foundation Education on hips vs. quad dominance Influencing your alignment for life *Discouraging a faulty system at an early age
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A COLLABORATIVE APPROACH
Physical Therapist Women’s Physical
Therapist Medical Doctor Gynecologist Urologist Endocrinologist
Nutritionist Dermatologist Orthopedic MD. Coach Life Coach Friend, parent, etc.
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CREATE AN ENVIRONMENT FOR SUCCESS
Alignment Breath holding! Do you “feel” the
exercise in the right place? Quality of motion Quantity of motion
Assessing soreness Assessing fatigue
levels Assessing your “FIT”
towards your goals
Is your program: Multi Dimensional
Sagittal (F/B) Frontal (Side/Side) Transverse (Rotation)
Coordination, plyos, core, flexibility/mobility
Relaxation/ restoration Techniques
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Nutrition Calcium, Iron, Vit. D Quality & Quantity In/out of season
Hydration Muscles, ligaments &
tendons Replenish lost reserves Pale yellow
Soft Tissue Mobilizations Massages
Rest, Recover & Rejuvenate
Stress Modifications Mindfulness Meditation Relaxation techniques
Coping Skills Emotional response Perceptions
Bladder health Prevention urination Habitual urination Fluid restrictions Sweat vs. urine
Sleeping Quantity Quality
NOURISHED FEMALE ATHLETES
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“THE PRESCRIPTION”
A UNIQUE APPROACH TO EMPOWER, ENHANCE AND ENRICH
MOVEMENT, HEALING & PERFORMANCE
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RESOURCES
Physical Therapy www.apta.org http://www.womenshealthapta.org/American Congress of Obstetricians & Gynecologists www.acog.org www.femaleathletetriad.org Bladder Health Consensus
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3206217/
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A CLOSER LOOK AT
WOMEN ON THE RUNDanielle Sabella
DPT, ATC, CSCS, FAFS
www.coreconcepts-pt.com
Run2Live
Thank you!
