SPORTS SPECIFIC TRAINING perturbations initiated by the therapist and rehabilitation aids.

In relation to inguinal canal disruption, co-activation of the external and internal oblique, together with the transervus abdominus can increase the stiffness of the inguinal canal and this mechanism is proposed to reduce the risk of inguinal canal disruption. However co-activation is not the only response that can be elicited from stability training; therapists should observe for correct muscular recruitment and timing, although there is still much debate about optimal patterning (17).

Functional stability training should reflect the demands of the particular sport without an emphasis on particular muscles, as no single muscle group is more important to stability than another (18). McGill et al (19) state that 'stability results from highly co- ordinated muscle activation patterns, involving many muscles and that the recruitment patterns must continually change, depend- ing on the task'.

generated on mat exercises and that spinal loading was reduced on the Swiss ball. The authors concluded that Swiss ball exercis- es didn't create a greater challenge in terms of global system strength. By reducing spinal load, the emphasis of Swiss ball training is more on regaining stability.

Figure 4: Use of Swiss ball in facilitating local system activation

Figure 2: Side holds

Isometric holds to facilitate tonic co-activation of the external obliques, internal obliques, abductors, adductors and gluteals while the spine is in a neutral position. Although the sport spe- cific nature is not immediately obvious, this exercise reproduces holding off an opponent in soccer when protecting the ball

Figure 5: Increasing the movement control challenge with a medicine ball

The spine should be in neutral, although in both Figures 4 and 5 the model demonstrates over active spinal extensors, producing spinal extension. There is co-activation of gluteals, hamstrings, external oblique, internal oblique. The unstable base of the Swiss ball introduces perturbations that facilitate local system activa- tion.

Figure 3: Side holds with resisted abduction

Side holds with resisted abduction offers a more difficult progres- sion of the isometric side hold with isotonic lower limb resis- tance. This exercise can be further progressed with resistance pro- vided by the therapist to stimulate perturbations, or with resis- tance bands providing resistance against upper limb extension. EMG studies have indicated that multifidus displays different pat- terns of activity during rapid arm movements (20). Stevens et al (13) recently indicated that recruitment patterns can be changed by training that emphasises neuromuscular control.

Swiss ball exercises are used extensively in the stability training. Drake et al (21) examined the effect of Swiss ball exercises on spinal extensor muscle strength. They found that more force was

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FORMULATING A STABILITY PROGRAMME The progression of this type of training involves the formulation of increasingly functional positions, whilst maintaining a neutral spinal position. These exercises should reflect the sport and the specific requirements of the player and are limited only by the imagination of the therapist. Swiss balls, medicine balls, wobble boards, agility discs, resistance bands and cords can all be utilised within a programme that challenges stability with the spine in neu- tral. Weight bearing exercises are particularly important for sports and positions with hip extension and hip abduction are especially relevant for the prevention of inguinal canal disruption.

THE AUTHOR David Wales is a clinical specialist physiotherapist who has worked full time for Arsenal Football Club for the past six years. After graduating in physiotherapy from the University of Manchester, he was awarded a Masters degree in Sports Medicine and Rehabilitation from the University of the West of England. David is also Medical Director of www.PhysioRoom.com - the UK’s leading sports injury website.

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