TrueSport: August 2020

As a coach, you may have heard the term ‘neuromuscular training’ and dismissed it as being too complicated, too academic, or simply too time-consuming to add to your already-packed practice and gameday schedule. But at its core, neuromuscular training simply means getting back to basics with your athletes and working to improve their fundamental movement patterns in order to see more success as things get complicated on the field.

Here, Dr. Michele LaBotz, TrueSport Expert and sports medicine physician, explains exactly what neuromuscular training really means for sport and how you can apply it to your coaching practice.

What is neuromuscular training?

"A lot of times when we think about conditioning, we think about traditional strength and endurance, but integrated neuromuscular training is really about teaching quality of movement rather than amount of movement or strength of movement,” LaBotz explains. "A really common example is when you're watching a girls' basketball game and you see young girls jump. When they land, their knees tend to collapse inward and that’s not a healthy pattern of movement, nor is it an efficient one.” Neuromuscular training focuses on correcting that jumping pattern, not just for performance, but to help prevent acute and chronic injuries as well.

“Neuromuscular training is really teaching nerves how to make the muscles work in a way that is consistent with best performance and lower injury risk,” she adds. You may have heard this referred to as fundamental or foundational movement patterns, or physical literacy — it emphasizes patterns of movement, not just repetition. The goal is to both improve the strength and connections of muscles, as well as increase your players’ awareness of their technique and how their bodies move.

Why should you add neuromuscular training to your coaching?

Not only will you see athletes improve on the field if they focus on the fundamentals of jumping, running, throwing, and balancing, but they’ll also be less prone to injuries like the dreaded ACL tear, and more likely to pursue healthy levels of physical activity throughout life. “This isn’t just about creating great athletes,” LaBotz says. “It’s about creating healthy humans who can succeed in a variety of activities and sports as they grow."

Who should practice this?

Athletes at all levels and all ages can benefit from integrated neuromuscular training to learn and relearn smarter movement patterns. “Ultimately, the earlier you can develop the good habits, the better,” says LaBotz. “There are different stages of development that lead to windows of ‘trainability' for different types of athletic skill. It used to be that we just focused on the amount of movement that kids got each day, but now we're also talking about the quality of that movement. The goal is to work toward optimal motor development, giving athletes the skills and physical literacy to understand how their bodies move and to be able to execute those movements in a variety of settings.”

How does it work?

The American Academy of Pediatrics (AAP) recently released guidelines for how to add neuromuscular training to practice, and the good news for coaches is that it doesn’t need to take up much of your time — you may even be doing some of it already. Drills that emphasize agility, balance and speed are great ways to add in that training without needing an outside resource. “You have to span the gap between play and direct, supervised training that incorporates movement correction,” LaBotz notes.

1. Try to find ways to challenge normal movements. If you typically do air squats with your team, LaBotz suggests trying to add a balance element by having them do squats standing on a Bosu ball or other type of balance trainer. “You're really looking for that nexus between a more traditional kind of strength training combined with agility and coordination training. That is the crux of integrative neuromuscular training."
2. If you’re noticing sloppy movement patterns emerging in your team, it might be appropriate to bring in an outside expert, such as a physical therapist or a certified athletic trainer or strength and conditioning specialist, to really hone certain movements. “Teaching does need to be done with correct technique,” she notes.

In the example of the young girls dealing with knees collapsing in at every jump, LaBotz would start by assessing overall strength, then add movement. “First, you have to make sure that they have adequate strength: The thing that keeps knees from going in on the landing is strong hip muscles. So, if hip muscles are weak, then they don't have the capacity to land correctly. But even with adequate strength, a lot of girls still land with knees in because that’s been their movement pattern in the past. That’s where the neuromuscular training comes in. You can have them jump in front of a mirror, film the movement, or demonstrate to them what they're doing. And then, you give can them cues like ‘When you land, keep your knees over your second toes.’” Addressing this movement pattern has been shown to reduce ACL injuries, and the AAP has resources to help coaches develop appropriate drills for their athletes.

1. Using a mirror or video are often effective ways to highlight problems. "Nothing beats visual feedback in terms of athletes being able to see themselves and adjust,” LaBotz says. “That’s true not only for jumping, but even for running. We do a lot of video gait analysis in our physical therapy department because if you don't see it, it's hard to visualize what’s happening and how to change it.”

Takeaway

Remember that this process will take time and patience on your and your athlete's part. "Those motor pathways are like super-highways for the nerves and the muscles to communicate and your body already has default patterns in place. So, there needs to be more mindfulness about the movement,” LaBotz concludes. “Athletes and coaches have to pay closer attention. And athletes must be willing to tackle not only the physical effort but the mental effort to break an old habit. That is the hardest part and the greatest challenge."

When your athlete is recovering from a sports injury that’s keeping them from taking part in practice and play, proper nutrition becomes more critical than ever. Eating well during this time can speed up healing and a return to play, while overindulging in junk food can actually set recovery back. Here, TrueSport Expert Kristen Ziesmer, a registered dietitian and board-certified specialist in sports dietetics, explains how to use nutrition to help recover from a sports injury.

Eating healthy is eating for injury

The good news is that a generally healthy, whole food-based diet is the primary defense when it comes to healing injuries, says Ziesmer. “Cut down on processed foods and focus on whole foods,” she explains. "Don’t restrict carbohydrates, but opt for whole grain versions versus white flour. Fill up on fruits and vegetables. Make your protein intake slightly higher, but only increase it by around 10 percent. And focus on good sources of fat, including nuts and seeds, avocado, olive oil and fatty fish like salmon or tuna that contain high amounts of Omega3 fatty acids.”

This doesn’t mean your injured athlete can never have potato chips, she adds, but ultra-processed foods should be reduced. “Watch out for how many processed foods your athlete is having. Avoid processed meat like bacon or sausage, and most pre-packaged foods,” she explains. “Those processed and ultra-processed foods can raise the level of inflammation in the body and make it harder for the body to heal."

Lower sugar intake

It may be tempting to overindulge your injured athlete with ice cream and treats, but Ziesmer cautions against it. “Limit the amount of sugar that your athlete is having because that also raises the level of inflammation in the body,” she explains. "Plus, it's just excess carbohydrates that the body doesn't need when your athlete is unable to train at the same level as before, so that could turn into excess weight.”

Be careful here: While research has shown that obesity can lead to a heightened risk of injury when playing sports and it’s important to help your athlete maintain a healthy weight at this time, it's also critical to avoid creating issues around body image that may come from not being able to play their sport.

Skip supplements

Your goal should be to establish a ‘food-first mentality,’ so giving your young athlete a handful of supplements isn’t the best solution to healing an injury—nor is it the most effective. Rather than relying on supplements, look for foods that are rich in antioxidants, vitamin D, C, E and A, says Ziesmer. “Taking vitamin C and A or antioxidants in supplement form can actually inhibit muscle recovery because it's too high of a dosage. So, forget about the supplements and eat healthier foods,” she says. "Dark leafy greens and citrus fruits are great. For vitamin D, just make sure your athlete gets outside for 30 minutes each day, ideally in the middle of the day. And if your athlete has a bone or joint injury, some calcium is going to help, so add a little bit more milk or yogurt to their diet."

For more information on supplements and the risks, check out the TrueSport Supplement Guide.

Hydrate properly

It's easy to forget about hydration when you're not in training mode, but fluids are still critical. “Water is involved in every process that goes on in your body,” Ziesmer explains. “So, it's definitely important to make sure that your athlete is getting more water because that's going to help to carry more nutrients throughout the body, which is critical for healing.” Focus on water, not sports drinks, since your athlete won’t need to replenish glycogen or electrolytes as much during their time on the bench.

But don’t just think about water: Bone broth is a great way to hydrate while providing vital nutrients to injured athletes. “Gelatin helps any type of injury of tendons or ligaments,” says Ziesmer. “Bone broth is a great way to add that to a diet.” If your athlete isn’t excited about the idea of bone broth, hide it by adding vegetables and noodles to make it a more traditional soup for lunch or dinner.

Look on the bright side

While your athlete is recovering from an injury, this might be the optimal time to help him or her get interested in nutrition and cooking. “Your athlete likely has more free time during recovery,” says Ziesmer. "This can be a great time to help them learn some basic kitchen skills and hone a few healthy recipes.”

Try to help your athlete see this as an opportunity to focus on all the healthy habits that will keep them at the top of their game after recovery. Outside of the kitchen, this could also include things like getting enough sleep, doing recommended physical therapy exercises and practicing mental skills like visualization.

Takeaway

It might be hard to imagine that nutrition and recovery are connected, but these nutrition tips can make a big impact on your injured athlete’s return to play.

You’ve likely never considered adding ‘stronger feet’ to your list of what makes an athlete great. “We talk a lot about how important it is for a young athlete to be strong,” says Dr. Michele LaBotz, TrueSport Expert and sports medicine physician. “But we almost always ignore feet.”

Unless the sport you’re involved with is foot-focused (like ballet), you’ve likely never considered the importance of the many bones and muscles that make up the foot, but evidence suggests that bringing foot strength to the forefront will help prevent injuries and improve overall athleticism. But how can a coach implement foot-specific protocols? Here, LaBotz explains why and how to bring some focus to feet.

WHY

First, it’s important to understand that for the last few decades, shoe sales have led the discussion and research around feet, and that discussion was all about comfort and support. “When it comes to the foot, it tends to be all about finding the right shoes, getting the right orthotics and supporting and cushioning the foot,” says LaBotz. “But lately, there’s been a push to actually build up the intrinsic muscles of the foot rather than simply cushion them.”

“Having an arch is a good thing because it absorbs shock, and so do the other muscles in your foot,” she explains. “So if we can build up the arch and those muscles together, you have a foot that's a going to be more functional. In addition to simple foot health, the intrinsic foot work may be performance enhancing.”

This applies to athletes in every sport, though obviously those in sports that involve a lot of running or are performed barefoot, such as gymnastics or dance, are the most obvious sports where strong feet will help athletes. But most sports like soccer, football, and basketball involve plenty of footwork and athletes in them aren’t immune to foot health issues and injuries over time.

The foot is more complex than you might think, and it’s often overlooked until it’s too late and an injury has already occurred. “Everybody knows about the plantar fascia and that’s what often is blamed for foot pain when running,” LaBotz explains. “But there are four layers of muscles that are all within the foot that are really in charge. If you've ever seen an X-ray of the foot, the foot is basically a big bag of bones, and those muscles are in charge of holding those bones together, keeping them stable and absorbing impact.” But no one thinks too much about foot strengthening because the muscles are so small that it’s hard to quantify progress the same way a leg press can boost quad size. “You get no bragging rights for strong feet,” she laughs.

HOW

While extrinsic exercises would target muscles around the foot, including ankles, calves and the tendons that run up and down your legs, intrinsic foot work involves exercises that reach the four layers of muscles in the foot. LaBotz has a few fun activities that are easy to try with your athletes and/or have them incorporate into strength and mobility sessions. Her favorite is simple: Pick up marbles (or other small objects) with your toes. This simple action helps your arches do the work that normally is done by the arch in a pair of sneakers on the field.

Going barefoot when possible is useful as well. This may not be possible or sanitary outside, but young athletes now are often wearing shoes even inside the house. “Kids rarely just run around anymore, and even when they are moving, they’re now in structured shoes,” LaBotz says. Just spending some time at home walking around, whether it’s in the backyard or up a few flights of stairs, will help build those muscles.

Lastly, if you want to try something new with your athlete while working on foot strength, LaBotz highly recommends stand-up paddle boarding. The action of keeping your feet firmly planted and gripping the board will work nearly every small muscle in the foot. "It’s a surprisingly good foot workout,” she says. “One of the first things a new paddleboarder always talks about is how much their feet hurt. And that's because you're really engaging those intrinsic foot muscles.”

Takeaway

While it might be tempting to just focus on muscles and strength workouts that lead to obvious gains, intrinsic foot strengthening can keep athletes on the field and healthy, which is the only way those other muscles can be put to use. With some fun and easy foot strengthening activities, your athletes can remain injury-free and maybe even perform better.