Which is more important? Flexibility or Strength?
In the field of sports medicine, there are generally two camps of thought: doctors who think a lack of flexibility is the cause of most injuries and doctors who think a lack of strength is the cause of most injuries. Those two groups of doctors influence athletic trainers, personal trainers, coaches and parents to either teach their athletes to be constantly stretching or constantly strengthening. Since these two camps have been entrenched in sports medicine several years, we are now able to see if an emphasis on stretching or strengthening helps prevent athletic injuries. Interestingly enough, athletes in both groups have just about the same number of injuries.
So does that mean that stretching and strengthening are both a waste of time? Although it’s easy to make that argument, new research is now showing that both flexibility and functional strength play a large role not only in injury prevention, but in athlete performance as well. The problem is that many of the measurements that we commonly use on athletes to guage their flexibility and strength are looking at the wrong parameters.
Take for instance the sit-and-reach test. This tool has been used to measure athlete flexibility in sports ranging from baseball to track to basketball. The test itself is flawed. Although we think that we are measuring pure hamstring flexibility (hip flexion), we are really measuring hamstring flexibility coupled with low back flexion. Just look at this picture. See how the low back is rounded? That biases the results and doesn’t tell you anything about your athlete’s true hamstring flexibility.
On the strengthening side, many times we monitor how much our athletes can chest press or squat in the weight training room. What do those movements have to do with your athlete’s pitching technique or running efficiency? Little to nothing. Those strengthening exercises train athletes for gross strength (big, powerful movements), not agility or core strength (small, fine movements that protect from injury and also increase performance).
In response to this new research, there is a new movement in sports medicine called functional strengthening. The keystone of this philosophy is that we need to measure athlete risk by taking them through functional tests that include both flexibility and agility/core strength parameters to determine areas that are tight, tender, weak or deconditioned. Examples of these tests include the squat test (pictured here), and wall angel tests.
If the athlete can pass these tests, their risk of injury is very low and can often continue with a basic strength/conditioning program. If the athlete cannot pass these tests and are pain-free, they can start an individualized training program to loosen restricted areas and increase strength in their weak spots. Often they are released from the individual program within 4-6 weeks and can then continue with a basic strength/conditioning program. If the athlete cannot pass these test and has signs of injury/pain, they need to start rehabilitation ASAP (even if the pain isn’t stopping them from competing) to reverse these tight/weak muscle patterns and prevent a career-ending injury.
We take every patient (athletic or not) through these functional tests so that we can not only help eliminate their pain, but prevent it from returning by treating it from its source. As part of our sports clinic outreach, we also conduct workshops for coaches and athletic trainers on the basic functional tests and how to triage injuries so that they can help their athletes improve performance and return to play. If you have further questions on functional strength testing or would like us to come conduct a workshop for your group, please email drerin@ducatchiropractic.com.