Practitioner Seed #8: Strive for Specificity!

Train like you play!

The end result being: “Return to X” (Insert sport,  job, ADL or recreational activity). The time taken to achieve the outcome varies based on the injury biology, individual and contextual factors. When it is safe to do so we MUST aim to restore activity components that reflect the end game.

Walking progresses into jogging, then running

Passing progresses into shooting baskets, then 1v1 defending

Stationary foot passing progresses toward field passing then goal strikes

Training specific to the demands of the sport is multi-dimensional:

• Training specific physical qualities  – A rugby winger requires speed & agility training compared to a front rower who might spend more time in the gym training brute strength.
• Joint angle specificity – A rugby player with shoulder instability, will require training of strength, stability and power in outer ranges of shoulder extension, that which is required to tackle effectively.
• Muscular components – MMA fighters require the lot!  Strength, endurance, speed & power.
• Energy system specificity– An AFL midfielder requires a high level of aerobic capacity/ lactic tolerance, while a  small pressure forward requires short anaerobic bursts of speed.
• Skills & movement patterns–  Sports that require kicking must do enough kicking! Not only to enhance skill acquisition but also to condition tissues involved in the kicking action, such as the rectus femoris.

An example of training specificity comes from the literature on strength training. Schoenfield et al (2021) have highlighted that strength gains occurred more readily in movements that were trained previously.

As an example, athletes produced a better bench press 1RM if they had been training heavy bench press.

But what happens physiologically to produce the strength improvements?

Although muscle volume and architecture are important elements of strength, maximal force production is thought to be driven by recruitment of high threshold motor units, thus, promoting a neurological adaptation.

So……….. in this sense, we are causing a specific adaptation to an imposed demand.

Tissues remodel based on the loading demands placed upon them.

Wolfs law states that when stress is applied to bone, it results in an anabolic response, producing stronger bone (Brody, 2012). However, the stimulation of osteocyte metabolism requires a heavy magnitude stimulus.

Tensile stress applied to the extra- cellular matrix of connective tissues, improves the ability for the tissue to transfer tensile forces. A classic example of this is load applied to tendinopathic tissues. While there are some schools of thought that tendon tissue is very difficult to turnover after puberty, recent evidence has proven otherwise.

Steffen et al (2022) conducted a laboratory study where they engineered and simulated human patella tendon in rats. They then applied a tensile loading protocol comparing isometrics (4x30s holds) v Dynamic loading of the same duration (360×0.33s bouts). They found that collagen turnover toward a healthy type 1 occurred at the region of the patella tendinopathy after 2 weeks of loading isometrically.

Many sports require rapid reactivity and split second decisions.

There is considerable debate over nature v nature in what makes athletes elite in this domain. Training these qualities in a fatigued state is pivotal to ultimate performance. However when the injury biology takes precedence, the athlete is unable to reach the intensity required to reflect a competitive environment.

Take the example of an acute hamstring strain.

The athlete is unable to reach speeds high enough to complete effective decelerations. Decelerating from high speed running in a field based sport, is an integral piece to the injury prevention jigsaw. So in the early stages of the rehab journey, this athlete might partake in some heavy load movements on a fly wheel to provide the high magnitude eccentric stimulus, without the element of speed and the risk of re-injury. As soon as the healing injury is ready, the athlete is back out on the field completing high speed run throughs and decels!

Another important control-chaos progression is that of a body contact/ competitive nature.

When we have a high speed contact injury such as a shoulder instability, we need a stepping stone from no contact, to full scale match play.

Here is an example of contact progressions:

1. Bag work bumps
2. Bag work light tackles
3. 1:1 Light bumps and single step tackles
4. 1v2 then 1v3  keepings off
5. 8v8 small sided game
6. 3v3 small sided games
7. Gradual exposure to match play

In this instance we have manipulated the environment and the number of competitors. You might notice that 8v8 starts before 3v3? In a field sport and a shoulder instability where number and intensity of tackles is the variable in question, the athlete is going to get a lot more hits at a higher intensity in a 3v3 then the open expanses of 8v8.

So let’s transfer this into practice –  What variables can we manipulate to improve specificity?

Gym based: Load, Sets, Reps, Rest, Tempo (TUT), Speed, Joint ROM, Contraction type , Frequency

Energy systems: Volume, speed, acc/decels, duration, frequency 

Skill based: Agility, reactive skills, kicking, shooting, throwing, joint ROM

So next time you are rehabilitating an athlete back to sport, remember to include the concept of specificity as soon as possible. You will be giving your athlete every chance of not only returning to play, but returning to performance!

Reference

Schoenfeld BJ, Grgic J, Van Every DW, Plotkin DL. Loading Recommendations for Muscle Strength, Hypertrophy, and Local Endurance: A Re-Examination of the Repetition Continuum. Sports (Basel). 2021 Feb 22;9(2):32.

Brody LT. Effective therapeutic exercise prescription: the right exercise at the right dose. J Hand Ther. 2012 Apr-Jun;25(2):220-31.

Steffen D, Mienaltowski MJ, Baar K. Scleraxis and Collagen I Expression Increase Following Pilot Isometric Loading Experiments in a Rodent Model of Patellar Tendinopathy. Matrix Biol. 2022 Mar 28