The article below was written for an assignment at Setanta College. It talks about a possible corrective exercise program for a powerlifter. Every athlete will have different problems, but hopefully this article gives you some insight on what to look for in a powerlifter.

Profiling the Subject

• Name, Last Name: Rachele
• Age: 34
• Sex: Female
• Weight: 48 kgs
• Height: 151 cm
• Sport: RAW Powerlifting
• Previous injuries: no previous injuries, only a hamstring muscle spasm in the left leg.
• Goals: injury prevention, maximizing performance in the squat, bench and deadlift

Rachele is a raw & equipped powerlifter who has been training with weights for the last 4-5 years with no injuries and multiple competition in which she got multiple first places and Italian and European (WEC) records in the -47kg class.

She is currently training for her next meet, which will be deadlift only in early 2020.

Currently doing an accumulation phase, she is looking to improve her form and prevent injuries while training 4 to 5 days a week.

Screening of the Subject

Multiple screening tests were done on the athlete.

Starting from a postural assessment, we then proceeded to many different tests utilizing a few of the functional movement screening tests and Janda’s movement test as well, including some clearing tests which I thought were essential for the subject.

The test I used on Rachele were:

• Postural assessment
• Overhead squat
• Modified Thomas test
• Active straight leg test
• Shoulder mobility test
• Shoulder clearing test
• Push up test
• Soleus wall test
• Hip extension & abduction tests

Postural Assessment Test

Assessing dynamic movement dysfunctions is essential, but starting with a static posture assessment is also vital. An aligned posture tells us that the athlete has a balanced relationship between the muscles, standard rom and efficiency at the joints, and good force absorption.

Overhead Squat Assessment

The overhead squat test is the most sport-specific test we can do for a powerlifter.

The squat pattern is used during the first lift at a powerlifting meet for the 1RM squat. Having a perfect form with over twice your body weight on your shoulders is essential in order to prevent possible injuries. Not only: using the correct and balanced squat pattern with no dysfunction assures no energy leaks which is essential during a 1RM test. Having even a slight leakage of energy caused by an inefficient movement pattern can cause a decrease of a few kilograms in the actual lift. Since many times the gold medal is won or lost for such small differences, making sure the athlete has a perfect and stable squat pattern with no energy leak is vital.

Modified Thomas Test

This test was used since the athlete has gotten a red light from one side at the last two competitions. At the powerlifting meet, the side judges look for depth, and tight hip flexors may be an issue. We, therefore, need to understand if the problem is a technique issue or a hip flexors tightness issue. Another main reason for this test was the constant tightness perceived in the quads by the athlete.

Active Straight Leg Test

A primitive movement pattern that is essential for a quad-dominant squatter such as the subject, who uses a very close and upright stance, shifting most of the weight moved on quads and less on glutes, not utilizing the hamstrings as much as other low bar squatters. All this quad emphasis can cause an imbalance in the HQ (hamstring-to-quads) ratio, putting the athlete at considerable risk of injury. Making sure the hamstrings has enough range of motion and is not in a vulnerable position is therefore essential. Also, the hamstrings are highly engaged in the hip-hinge pattern used for the deadlift, the third and final exercise at a powerlifting meet. The athlete also had previous muscle spasm issues on her right hamstrings. A short hamstring spends too much time in a vulnerable position and may cause lumbar flexion, which we want to avoid during the deadlift at all costs. Lower extremity injuries are associated with muscle tightness. (Knapik et al. 1991)

Shoulder Mobility Test & Shoulder Clearing Test

A primitive movement pattern that is essential for basically any sport, and particularly for the powerlifter, who stresses multiple times per week the shoulder girdle with a very high amount of horizontal movements such as the bench press and it’s variations, often neglecting upper back work and not balancing out the pressing with enough pulling. The risk for shoulder impingement is very high, so we need to test the mobility and see if any pain is present during the shoulder clearing test. In fact, athletes with muscle imbalances in the shoulder are at a higher risk of injury (Wang and Cochrane, 2001).

Push Up Test

An excellent test for stability, motor control and coordination between upper and lower body, since the core plays a major role as a stabilizer in both the squat and the deadlift.

Soleus Wall Test

Another important test for a powerlifter, since tight calves can limit depth during the squat pattern. As mentioned above, with a trained eye we need to look and find out if the squat depth problem at the last meets might be caused by a lack of flexibility at the ankle joint or at the hip joint, or both. Also, a lack of dorsiflexion is often associated with lower extremity injuries, a possible cause for low back pain, and plantar fasciitis. (Kibler et al. 1991).

Hip Extension & Abduction Tests

The hip extensors are highly used in powerlifting, and making sure that both extensors and abductors of the hip have no dysfunctions is therefore essential. The hip abduction test is also used to see if the athlete can correctly activate the glutes, which help in stabilizing both the hip and the knees in the squat and deadlift.

Analysis of screen

Postural Assessment Analysis

The athlete shows an aligned posture. No signs of upper or lower crossed syndrome are present. The head is aligned with the shoulders, knees, malleolus. The tone of the muscles is very balanced.

Overhead Squat Assessment Analysis

The athlete cannot perform a complete full squat with either the hands overhead or arms crossed. Using squat shoes, she still cannot reach depth. With arms crossed, the depth did not increase to a meaningful degree, but it did with heels elevated. This shows restrictions at the ankle, which is why we used the soleus wall test. Possibly the lack of depth might be caused by hip flexors tightness as well, which is why we further proceeded with the modified Thomas test. Not being able to reach full depth even with heels elevated, the athlete scores a 1 (FMS Scoring System). Also, the athlete shows a typical compensation: a slight knee valgus during the eccentric portion. This might be caused by inhibition or weakness of the glute muscles, further tested or tight adductors.

Modified Thomas Test Analysis

This test shows tightness at both hip flexors and both quadriceps. Notably, the right quads look very tight and shortened, shown by the open-angle (more than 90°) at the knee joint. This, along with the positive soleus wall test and the tightness of the soleus and gastrocnemius muscles, are the primary reasons for the lack of depth shown during the overhead squat assessment.

Active Straight Leg Test Analysis

A score of 3 is given to the athlete, showing no sign of hamstring tightness and overall excellent flexibility and control of the hamstring muscles, with no evident asymmetries.

Shoulder Mobility Test Analysis

A score of 3 is given for the left shoulder, while a lower score of 2 is given for the right shoulder, showing asymmetry between the two. No pain is present during the clearing test: the issue can be limited mobility since stability and motor control does not seem to be an issue for the athlete as seen in the other tests such as the push up test, which showed perfect control of the scapula. Lack of mobility is probably at the shoulders since in the postural assessment and other tests, the athlete showed no sign of pec major or minor tightness.

Shoulder Clearing Test Analysis

Negative. The athlete can perform the test with perfect control and no pain.

Push Up Test Analysis

Athlete tested negative: she can perform a perfect push-up test with fine motor control, correct timing and firing pattern showing no compensations.

Soleus Wall Test Analysis

Athlete tested positive. She cannot touch the wall with the knee while placing the foot at 10 cm away from it. Both ankles seem to expose the same tightness, with no asymmetry. Tight calf muscles are probably the main issue.

Hip Extension & Abduction Tests

Athlete tested negative. The subject demonstrates perfect form and motor control with no asymmetries between the two limbs. Inhibition at the glutes does not seem to be an issue.

Prescription of Corrective Exercise

We follow the MAMSM approach of:

• Mobilization
• Activation
• Modification
• Stabilization
• Movement

The main issues found on the athlete were:

• Tightness in the right shoulder, both calf muscles, quads and hip flexors
• Slight knee valgus during the overhead squat

Here is the program I have prescribed to the athlete:

For the shoulders:

• Thoracic spine foam rolling & rotation 30s
• Posterior shoulder capsule with ball, 30s
• Quadruped thoracic spine rotation, 1×30
• Open the book, 1×30
• Cable squeezes 3×10
• Inverted rows 3×10
• External rotation with bands 3×10

For the ankles:

• Foam roll on calves 30s, stretching (x3)
• Plantar fascia release with a ball
• Peroneals release with foam roll
• Ankle dorsiflexion with a dowel, 3×10
• 1-10 ankle movements, 3×10
• Heal drops and raises, 3×10

For the hip flexors:

• Hip flexor release with ball, 30s
• 3D Hip flexor stretch, 2x30s

For the quads:

• Foam roll on the quads, 30s
• Standing stretching of the quads, 60s per leg (particular emphasis on right leg)

For the knee valgus issue:

• Inner thigh stretching, 60s
• Lateral band walk, 3×10
• RNT Lunge with bands 3×10

The athlete can repeat the program 2-3 times a week.

This corrective program is used to help the athlete fixing her issues, which are mainly mobility issues, rather than activation or motor pattern issues. Using the MAMSM (mobilize, activate, modify, stabilize, movement) approach, the program concentrates mainly on mobility.

First, we clear the shoulders as it is a primary movement pattern that showed asymmetry between left and right side. With the thoracic spine foam rolling and posterior capsule with a ball, we want to release some of the tightness at the shoulder joint, reduce tension and increase rom. We proceed with static stretching to reduce muscle stiffness since the combination of foam rolling with stretching gives us better results. We then move the joint through a full range of motion with the open book exercise to increase movement capacity. While removing completely overhead pressing and reducing the total volume on the bench press for a few weeks, we proceed further down the corrective continuum with strengthening the shoulder joint with cable squeezes, inverted row (for the upper back) and external rotation against light bands.

For the ankles, we firstly foam roll the calves and then stretch them in order to reduce tension and increase range of motion since the ankles are one of our major concerns since their tightness reduce the capacity of the athlete to reach full depth during the squat pattern. We also foam roll the peroneals and plantar fascia in order to reduce stiffness and improve rom. After releasing much of the tension, we proceed with exercises that activate the muscles of concern: 1-10 ankle movements, ankle dorsiflexion with a dowel and heal drops and raises will not only activate but also strengthen the soleus and gastrocnemius.

I will not remove the squat pattern since the athlete needs it for her sport, and pain is not present at all. Also, the lack of depth and tightness at the ankle and hip flexors are only present during the overhead squat assessment. The athlete can perform a full squat with a wider stance and some degree of external rotation of the feet, minimizing the need for additional work. I have not used any core or glute stability exercises since the athlete shows fine motor control and firing patterns at both the core and the glutes. For example, the athlete tested negative at both the hip abduction and extension tests and also for the push up test: her core is strong and active as shown in the test and the athlete can perform many push-ups with perfect execution even if using a male hands position. I find that additional core and glute stabilization exercise, aside from activations exercises already used in her routine such as planks, side planks and bridges before squats and deadlifts, would be redundant.

For the hip flexors and the quads, simply foam rolling and stretching will significantly reduce the tension at the target muscles, further allowing for better depth during the squat. Additional emphasis is placed on the right quad, which showed more tightness compared to the left one.

Many exercises cited above will also improve the knee valgus, but we will add inner thigh stretching since the adductors might be tight and one of the main reasons for the buckling inwards of the knees. We then proceed with activation exercises such as the lateral mini-band walk and reactive neuromuscular training such as the lunge with bands, which will exaggerate the fault and teach the athlete how to activate and control the movement better.

Outcomes for the Corrective Exercises program of the Powerlifter

The athlete, after only two weeks of implementing the corrective exercise program proposed above, already shows greater depth in the squat pattern thanks to the reduced tension in the hip flexors and greater mobility at the ankle joint. Also, the restricted shoulder is already moving with fewer restrictions caused by overactive muscles. The knee valgus is still present but does not show up as much during her normal squat pattern, which has a wider stance and more externally rotated feet than the overhead squat assessment. We further need to improve this fault by utilizing reactive neuromuscular training, also implementing exercises such as the goblet squat, which more closely resembles her squat pattern. Periodic re-screening will be needed to make sure the athlete is constantly improving and also to make sure that no other dysfunction arises, possibly caused by mesocycles of high volume training during the initial stages of preparation for her next competition in June 2020 which might compromise joint health, particularly at the shoulder joint, where the very high volume of work with the bench press is needed for the athlete, exposing the shoulders at higher risk. Since the athlete had excellent posture and only limited problems with no great asymmetries, she kept her training fairly similar, and we did not feel the need to remove or modify, as the MAMSM approach would suggest.

References

1. Kibler, W.B., Goldberg, C. and Chandler, T.J., 1991. Functional biomechanical deficits in running athletes with plantar fasciitis. The American Journal of Sports Medicine, 19(1), pp.66-71.
2. Knapik, J.J., Bauman, C.L., Jones, B.H., Harris, J.M. and Vaughan, L., 1991. Preseason strength and flexibility imbalances associated with athletic injuries in female collegiate athletes. The American journal of sports medicine, 19(1), pp.76-81.
3. Wang, H.K. and Cochrane, T., 2001. Mobility impairment, muscle imbalance, muscle weakness, scapular asymmetry and shoulder injury in elite volleyball athletes. Journal of sports medicine and physical fitness, 41(3), pp.403-410.