The benefits of strength training are far greater than most people realize. Strength training improves physical and athletic performance by increasing bone, muscle, tendon, and ligament strength; improves joint function; and reduces potential for injury.

"Strength training is huge for anyone who is active and wants to remain active throughout their life," says Patrick Naylor, MS, PT, physical therapy manager at Boulder Center for Sports Medicine (BCSM) in Colorado. "Our motto is, ‘If You're Active, You're An Athlete.' "

"Boulder is a mecca for pro runners and cyclists," says Sue Torrence, MS, PT, ATC. "We see everything from professional athletes to weekend warriors to those who do not call themselves ‘athletes' but who are hurt and want the level of care we provide."

BCSM has two locations—one is in Boulder, another is in Louisville, Colo—and Naylor estimates that about 740 patients pass through the doors each week. The Boulder facility is split into two inter-related sports medicine departments: a combined physicians' clinic/Sports Physical Therapy department, which offers multidisciplinary care; and the Human Performance Laboratory (Sports Science), which offers biomechanical testing (for running and cycling gait analysis) and physiology testing (such as VO₂ max and lactate threshold testing) to help pinpoint and prevent injury, as well as to provide information that can improve performance.

"Some patients just come in for physical therapy; others just come in for our sports science offerings, though about a third go to both areas," Naylor says. "The team approach to treatment that we offer is what makes us really unique. In addition to having ATCs, massage therapists, PTs, physician assistants, as well as an entire sports science department that focuses on exercise physiology and nutrition, we also have physicians from the top local orthopedic clinics rotate through our clinic one day a week. That way our PTs and patients get face-to-face contact with the physicians and vice versa. Our clients don't have to go elsewhere to take care of any aspect of their care."

BEST EQUIPMENT, MAXIMUM RESULTS

Whether BCSM's staff is planning care for postinjury clients or for those seeking to improve their athletic performance, they have access to a wide variety of equipment to help them achieve their goals.

"Good free weights are a must for strength training, and we have a wide range of free weights including body bars ranging from 3 pounds up to 45-pound Olympic barbells," Naylor says. "Free weights are important because you have to control the weight, which calls on the stabilizing muscles and require greater balance. Of course, the correct form is important as well, and we teach our clients how to use weights properly so they don't get injured."

"A variety of weight machines is important. In addition, the Total Gym® [by efi Sports Medicine, San Diego] has been an excellent tool for us because it offers less than full weight-bearing strengthening, which promotes muscle function and lessens stress on the joints," Torrence says. "We also have both spinner and standard upright bikes, which are useful for helping patients do warm-ups and work on range of motion."

Both Naylor and Torrence stress the importance of focusing on balance as well as strength, and they often incorporate the BOSU Balance Trainer, Airdisk, Slide Board, foam rollers, and foam balance beams into training.

"Different balance tools are helpful to grade people's progression," Torrence says. "Foam balance beams can be progressed to the Airdisk and BOSU in various ways. The Slide Board can help progress from squats to lunges by sliding a foot back into a retro lunge. This helps to progress strength without the impact traditional lunges have."

TREATMENT PROGRAMS

BCSM sees a lot of people recovering from knee injuries, particularly ACL injuries. With clients recovering from either operative or nonoperative ACL injury, Naylor says he likes to start them out on a stationary bike as soon as possible because it's great for getting their range of motion back.

"The motion also helps pump the edema out of the lower leg and the knee with very little stress to the joint," he says.

Since it's important to work on balance at the same time, Naylor also begins with some one-leg balancing on the floor and then on foam beams.

"We may incorporate some very easy partial squats, first on the floor and then on the foam beams, eventually progressing to Airdisks," he says. "Early on, we often connect a few 4-foot foam beams and have the client walk along the beams using ski poles to challenge their sense of balance, without overstressing the knee joint."

From there, clients progress to shallow mini-squats or working on low steps (2-inch to 8-inch), then later to balancing strength moves on the BOSU ball.

Other techniques to help build strength and balance include having the client stand on a mini-trampoline or the BOSU ball with both legs and do weight shifts back and forth, then progress to one leg, then to mini-squats. As they get stronger, Naylor may have them use dumbbells and do the same thing, or start doing lunges with one foot on an Airdisk. "Then for pure strength, we have them do the leg press machine."

"Once I see that they are progressing, I may have them use the Slide Board," Naylor says. "Of all the types of stationary aerobic equipment we have, the Slide Board is the least expensive yet it requires the most balance and coordination. It's really the only aerobic equipment that displaces your center of gravity, and it requires the patient to deal with lateral and rotational forces that aren't present on treadmills, bikes, or elliptical machines."

In the later stages of recovery, Naylor will sometimes use a harness that attaches to a bungee cord around the chest or hips. The therapist then provides resistance while the client tries to walk or run backward, forward, or sideways.

"That's great for functional training. We can also do some work with the balance boards and the Swiss balls, especially doing bridge work for hamstrings and glutes," he adds.

When doing rehab for skiers, Naylor incorporates the Dynamic Edge, a piece of ski simulation equipment.

"We have various types of equipment that we can use to imitate motion relative to all kinds of sports," Torrence says. "For those who play hockey or skate, we use the Slide Board to help them work on their lateral transition. For people who do Tae Kwon Do, there are various ways of using the foam beams, step boxes, and balls to get into certain positions that allow them to work on angular changes, and I often use weighted pulleys and bands with overhead athletes to help get them into ranges where they need to be and work on strength in those ranges."

THE FUTURE OF SPORTS MEDICINE

BCSM is often used as a test site for new technology, and that gives its clients access to cutting-edge treatment usually available only to elite athletes. For instance, Peak Performance 3D technology can be used to analyze cycling gait in real time. Six infrared cameras are used to analyze motion, and reflective markers are placed on specific anatomic landmarks.

The Biodex System 2, by Biodex Medical Systems, Shirley, NY, measures the amount of strength produced at different velocities and can be used to determine the patient's ability to perform at different speeds of motion.

"Another great product that we just started using has benefits for strength training and beyond," Naylor says. "It's a software product for video called Dartfish, and it can break down movements image by image (as seen in the last Winter Olympics during ski racing replays). The software also allows you to go back on video and measure exact joint angles or mark one spot on the body—for example the greater trochanter of the hip—and follow that spot through a full movement sequence to see if the client is moving symmetrically."

While BCSM does not yet have any equipment using vibration-plate technology, Naylor is looking into it. Whole-body vibration training exposes the entire body to mechanical vibrations as the individual stands on a vibrating platform. Mechanical stimulations, characterized by direction, amplitude, velocity, and frequency, are transmitted through the entire body. Some recent studies have shown that vibration combined with conventional resistance training may help people attain greater gains in neuromuscular performance than from conventional resistance training alone.¹

"Research is showing that performing strength training in the presence of vibration stimulates greater strength gains by eliciting a better neuromuscular response, so that's definitely something we'll be looking into for the future," Naylor says. "I'm also interested in checking out kettlebells, which were developed in Russia centuries ago but have been spreading to the athletic world with good results. There are a lot of new strength training products in the market, and we're constantly looking to see which ones will give our patients the most benefit in terms of more effective rehabilitation and enhanced athletic performance."

Liz Finch is a contributing writer for  Physical Therapy Products. For more information, contact .

REFERENCE

1. Luo J, McNamara B, Moran K. The use of vibration training to enhance muscle strength and power. Sports Med. 2005;35:23–41.