Acute and chronic injuries attributed to participation in sports, recreation, and exercise (SRE) are major contributors to the public health burden in America today. According to The Centers for Disease Control and Prevention’s (CDC) National Center for Injury Prevention, more than 10,000 people are treated in emergency departments (ED) for injuries sustained in SRE activities every day (2006). In fact, “at least one of every five ED visits for an injury results from participation in sports or recreation.” The CDC (2006) also estimates that 715,000 sports and recreation injuries occur annually in school settings alone.
The susceptibility of children and female athletes is a special concern. The prevention of chronic injuries attributed to repetitive microtrauma in children is critical as “biomechanical and clinical evidence suggests that growth cartilage, especially that of the articular surface, is less resistant to repetitive microinjury” when compared to adults (Micheli & Klein, 1991). An estimated 2,200 anterior cruciate ligament (ACL) ruptures occur annually in female collegiate athletes in both the recreational and competitive ranks resulting in treatment and rehabilitation costs of about $17,000 per ACL injury (Owen, et. al, 2006). This of course does not consider the loss of long term participation, loss of a scholarship, and future disability from arthritic changes in a reconstructed knee (Owen, et. al, 2006).
The impact of unintended SRE-induced injuries on the prevalence of physical inactivity is paramount as it exacerbates the epidemic of obesity in America. According to data from the National Health and Nutrition Examination Survey, 2009–2010, more than one-third of adults (35.7%) and approximately 12.5 million (17%) of children and adolescents aged 2 to19 years of age are obese in the United States (CDC, 2012). The main goal in performing pre-participation or performance screenings is to decrease the prevalence of these injuries, enhance performance, and ultimately improve the quality of life (Cook, et.al). Filipa, et. al (2006) advocate the implementation of a neuromuscular training program (NMTP) that focuses on core stability exercises to prevent lower extremity injury, especially in female athletes who have deficits in trunk proprioception and neuromuscular control.
Anatomical malignment and muscle-tendon imbalances increase the risk for injury by contributing to joint problems and deficiencies in muscular strength, flexibility, and range of motion. Poor core stability and decreased muscular synergy of the trunk and hip stabilizers have been theorized to inhibit optimal performance in power activities and to increase the susceptibility for injuries secondary to lack of control of the center of mass, especially in female athletes (Filipa, et. al, 2010). Age is also an important risk factor for chronic orthopedic injuries such as rotator cuff tears. “Approximately 40% of asymptomatic patients over 50 years of age have full-thickness rotator cuff tears and the prevalence of partial-and full-thickness tears in symptomatic patients over 60 years old is greater than 60%” (Moosikasuwan, et. al, 2005). Repetitive micro-trauma, subacromial impingement, tendon degeneration, and hypovascularity, are theorized to be responsible for most tears and account for this age-dependent prevalence (Moosikasuwan, 2005).
When it comes to the goal of keeping athletes and active populations free of unintended orthopedic injuries, the old adage: “a pound of prevention is worth an ounce of cure” holds true. The traditional sports medicine model, pre-participation, and rehabilitation examinations rely on isolated, objective testing for joints and muscles along with skill performance assessments do not provide an adequate amount of baseline information (Cook, et.al, 2006). These systematic methods are inferior as they neglect to assess common fundamental movement patterns that are essential to everyday movement and participation in exercise among active populations. The use of a pre-participation screening to include the assessment of fundamental movements and muscular function; however, is essential for designing safe, effective fitness programs that prevent injury and improve the efficiency of muscular movement to enhance overall wellness and performance.
Over the past 20 years, the profession of sports rehabilitation has experienced a paradigm shift, trending away from traditional, isolated assessment and strengthening and moving towards integrated, functional approaches, incorporating the principles of proprioceptive neuromuscular fascilitation (PNF), muscle synergy, and motor learning (Cook, Burton & Hoogenboom, 2006). Advances in functional movement assessment developed by the leading physical therapist, Gray Cook, quantify an individual’s risk for injury and preparedness for activity through their Functional Movement Screen (FMS). The FMS utilizes a ranking and grading system to detect functional limitations and asymmetries (FMS, 2012). The FMS generates the Functional Movement Screen Score which serves as a baseline for targeting problems and tracking progress (FMS, 2012). The system also facilitates the implementation of corrective exercise and functional training programs that improve movement patterns, physical conditioning, and optimal performance. Cook has introduced his FMS regimens to the U.S. Navy SEALS and the NFL (Tierney, 2011). In addition, an estimated 8 out of 10 NFL teams, including the Atlanta Falcons, apply FMS to pinpoint muscular asymmetries and to develop appropriate functional training programs (Tierney, 2011). In an American culture that embraces participation in sports, recreation, and exercise (SRE), functional movement assessments like the FMS are critical to detect deficits in mobility and balance that increase the susceptibility for injury and hinder performance.
With origins in rehabilitative exercise, the concept of functional training and its equipment has evolved as a means for correcting muscle and joint imbalances and impaired movement patterns. Functional training targets the neuromuscular system using a progressive and individualized program of primarily weight bearing, multijoint and multiplanar exercises to improve dynamic and static balance, coordination, and proprioception (Beckham & Harper, 2010). Functional training involves the integration of the nervous system by engaging the muscles that produce joint movement and stabilize the spine, hip, and scapulae (Beckham & Harper, 2010). This strengthens the kinetic chain and the transfer of energy and force from one joint to another in support of efficient movement (Beckham & Harper, 2010). While traditional resistance training methods that rely on machines or free weights are more capable of providing large amounts of constant or variable resistance, they often limit range of motion and require less stabilization and balance when compared to functional training (Beckham & Harper, 2010). A functional assessment completed prior to designing any functional training programs detects movement deficiencies, determines appropriate exercises, and provides a baseline for measuring progress.
The emergence of several exciting functional training equipment innovations such as the TRX Suspension Trainer and Dynamic Variable Resistance Training have facilitated the diffusion of functional training by physical therapists, chiropractors, allied health professionals, fitness experts, and the public, resulting in a revolution of the fitness industry. The TRX Suspension Trainer builds total body stability and strength by leveraging the user’s weight through hundreds of functional exercises. The first proto-type was developed by Randy Hetrick, a former US Navy SEAL and special operations squadron commander who needed a way to keep his command and himself fit while deployed in South East Asia. Without access to fitness facilities, Hetrick stitched together some parachute webbing to make straps and attached them to an anchor point. Using his first prototype for the TRX Suspension Trainer, Hetrick developed the first TRX routines using his own body weight for resistance. Fifty variations and 10 years later, the portable straps have grossed over $20 million in sales since they first hit the market in 2005 and have led to the emergence of further innovations in functional training equipment (Hu, 2009).
While the concept of functional training is not new, innovations such as the TRX are revolutionizing the fitness industry for its versatility and applicability to a wide variety of active populations including older adults. The research of Whitehurst and colleagues (2005) reported significant improvements in agility, balance, and flexibility after functional training in addition to self-reported ratings of physical functioning and fewer doctors’ visits. Fitness and rehabilitative exercise programs utilizing functional training and equipment can be implemented for anyone, regardless of age or fitness ability because the level of difficulty is determined by body positioning, speed, range of motion, duration of the exercise, and number of repetitions. This style of training is compatible with any demographic from individuals rehabilitating from injuries to elite athletes preparing for competition.
As an FMS certified fitness professional, I advocate the habitual use of functional movement screening and advanced functional training regimens as part of an integrative approach to achieving health and wellness. The reinforcement of proper functional movement patterns and advanced training helps individuals achieve the maximum benefits of regular functional exercise including improved fitness, weight management, and injury prevention. Functional screening and training are sustainable modalities that will continue to be an integral part of fitness programming now and for years to come.
Beckham, S.G. & Harper, M. (2010). Functional training: Fad or here to stay? AmericanCollege of Sports Medicine Health and Fitness Journal, 14(6), 24-30. Retrieved from http://blog.tri4fitness.net/files/3/1/9/7/6/276764-267913/FUNCTIONAL_TRAINING__Fad_or_Here_to_Stay__8.pdf
The Centers for Disease Control and Prevention: National Center for Injury Prevention and Control. (2002). CDC Injury Research Agenda. Atlanta, Georgia. Retrieved from http://www.cdc.gov/ncipc/pubres/research_agenda/Research%20Agenda.pdf
Cook, G., Burton, L., & Hoogenboom, B. (2006). Pre-participation screening: The use offundamental movements as an assessment of function – Part . North American Journal of Sports Physical Therapy, 1(2), 62-72. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2953313/
Filipa, A., Byrnes, R., Paterno, M.V., Meyer, G.D., & Hewett, T.E. (2010). Neuromuscular Training improves performance on the Star Excursion Balance Test in young female athletes. Journal of Orthopaedic & Sports Physical Therapy, 40(9), 51-558.
Functional Movement Systems (FMS). (2012). Retrieved from http://www.functionalmovement.com/fms.
Hu, J. (2009, August 28). Ex-Navy Seal building a fitness empire. The San Francisco Chronicle. Retrieved from http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2009/08/27/DDGF19BH48.DTL
Moosikasuwan, J.B., Miller, T.T., & Burke, B.J. (2005). Rotator cuff tears: Clinical, radiographic, and US findings. RadioGraphics, 25, 1591-1607. doi: 10.1148/rg.256045203 Retrieved from http://radiographics.rsna.org/content/25/6/1591.full
Micheli, L.J. & Klein, J.D. (1991). Sports injuries in children and adolescents. British Journal of Sports Medicine, 25(1), 6-9. doi: 10.1136/bjsm.25.1.6. Retrieved from http://bjsm.bmj.com/content/25/1/6
Ogden, C.L., Carroll, M.D., Kit, B.K., & Flegal, K.M. (2012). Prevalence of obesity inthe United States, 2009-2010. The Centers for Disease Control and Prevention’s National Center for Health Statistics (NCHS). Hyattsville, MD. Retrieved from http://www.cdc.gov/nchs/data/databriefs/db82.pdf
Owen, J.L., Campbell, S., Falkner, S.J., Bialkowski, C., & Ward, A.T. (2006). Is there evidence that proprioception or balance training can prevent anterior cruciate ligament (ACL) injuries in athletes without previous ACL injury? Journal of the American Physical Therapy Association, 86,1436-1440. doi: 10.2522/ptj.20050329. Retrieved from http://ptjournal.apta.org/content/86/10/1436.full.pdf+html.
Tierney, M. (2011, December 25). Falcoms have had a winning strategy for fitness. TheNew York Times. Retrieved from http://www.nytimes.com/2011/12/26/sports/football/falcons-have-winning-fitness-strategy.html?_r=1
Whitehurst M.A., Johnson B.L., Parker C.M., Brown L.E., Ford, A.M.(2005). The benefits of a functional exercise circuit for older adults. [Abstract]. Journal of Strength and Conditioning Research, 19(3), 647-651.