The Master Secret to Excelling in Sports

Free Presentation with Dr. Steven Macagnone

Saturday April 9, 7:00pm-8:00pm

Location:  Ur Vitamin Store Conference Room
Address:  250 Larkfield Rd, East Northport, NY

Learn a powerful secret to excelling in sports and how to apply it.
This technique has been around for ages, but often overlooked in our modern society laden with equipment and training innovations. Olympians and Professional athletes have devoted hours to it, and it is becoming more popular in competitive Youth sports.

Athletes and their families welcome to attend.

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Biomechanics in Sport

• Biomechanics is a tool to understand human movement that can be applied to enhance athletic performance and prevent injury.
• Performance of a skill can be broken down into multiple layers of components, ranging from muscle strength to joint trajectories.
• Tools to measure human movement include video, accelerometry, medical imaging, and 3-D motion capture.
• Optimal movement is affected by body size and shape. Elite athletes move optimally and this knowledge can be used to coach and train others.

Robotics, physics, mathematical analysis, imaging, and computer simulations are the some of the latest tools in the quest to improve athletic performance. Together they are used in the study of biomechanics-the physiological analysis of the interaction of forces and effects of forces on and within the human body. Biomechanics researchers are able to examine each aspect of a movement to enhance performance and to understand the mechanisms of injury.

Measuring Movement

Measuring movement can take place in a lab or on the playing field. Dr. Besier often uses simple video analysis to assess temporal-spatial relationships, steps, stride length, and other components of movement. From there, he uses more complex equipment to study the player’s kinematics (three-dimensional motion), kinetics (the forces of motion), and muscle activation.

One of the challenges of biomechanics is that elite athletes can perform at their highest level but have different techniques. Two tennis players can serve in completely different ways. But is any one way better? Is there an optimal way? Or one with less chance of causing an injury? We have to take into consideration that we all have different constraints, such as body sizes, range of motion, and strength. Applying robotic techniques can help determine whether an athlete is moving optimally by estimating muscle movement to calculate effort. 

Preventing Injuries

Most musculoskeletal injuries have a mechanical etiology. The stress applied exceeds the strength of the tissue. The extent of the damage is related to the magnitude, rate, and frequency of loading, and recovery and rehabilitation must incorporate the body’s ability to adapt to these mechanical loads (including the body’s adaptations to over- and under-use). Tibial fatigue fractures, for example, are caused by stresses in the bone, which are influenced by loading factors, such as distance or frequency, along with bone mineral density and bone shape. In addition, the biological response of tissue to different loads can induce tissue to change.

An anterior cruciate ligament (ACL) injury, for example, occurs when the load exceeds the strength of the ligament, taking into consideration factors such as posture, muscle forces, and ligament strength. To prevent such an injury, an athlete needs to reduce external loads (by improving perception skills to anticipate movement), improve muscular support of the external loads (through appropriate training programs), and/or grow stronger ligaments. (Ligaments will adapt to their mechanical environment and potentially get stronger with loading.)

If you understand the mechanisms behind injury, then you can prevent it. 

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Biomechanics of the Lacrosse Shot

The lacrosse shot it an essential skill for each offensive player. The purpose of this movement is to accelerate the ball as fast as possible while maintaining accuracy to place the ball into the goal. The lacrosse shot may be broken down into the following phases: approach, crank-back, stick acceleration, stick deceleration, follow through, and recovery (See Table 1). Each of the mentioned phases has a beginning of the phase and an ending of the phase. The lacrosse shot may be performed overhand, underhand, or side arm, thus all shots may not fit into or encompass all of the phases listed. Events in which players are shooting with a long stick as opposed to the typical short stick an offensive player carries will also alter the typical movement pattern. 

Approach. --- The approach phase of the lacrosse shot initiates with the player taking several steps towards the goal with the intent to shot (See Figure 6A). These steps are typically of high velocity and include stepping styles such as stepping forward, sideways, backwards, cross-over, or hopping. The approach phase concludes when the player decreases lower extremity velocity and the “drive leg” is planted into the ground. The drive leg is the lower extremity that performs forceful hip extension, knee extension, and ankle plantarflexion during the lacrosse shot to exert force upward through a rigid level and push the player forward. The “lead leg” to be referenced later, is the other lower extremity which is the leg planted in front of the player during the lacrosse shot. When performing a right handed lacrosse shot the drive leg is the right leg and the lead leg is the left leg; vice versa for a left handed lacrosse shot. 

Crank back. --- The crank back phase, also called the wind-up or cocking phase, consists of preparatory movements for the angular motion seen in the stick acceleration phase. The crank back phase begins with the drive leg planting into the ground (See Figure 6B). The crank back phase ends when the top arm, arm in between the bottom arm and the head of the stick, attains maximum elbow flexion. During a right handed shot the right arm is the top arm, while a left handed shot establishes the left arm as being the top arm. The crank phase is subdivided into phase A and phase B. 

Phase A deal with placement of the lower extremities, known as a drive step, in preparation for stick acceleration. This phase of the crank back begins when the drive leg contacts and is planted into the ground. Phase A ends when the foot of the lead leg contacts the ground. 

Phase B deals with placement of the upper extremities into a wind up position in preparation for stick acceleration. The phase begins when the foot of the lead leg contacts the ground. The phase ends when maximum flexion is demonstrated at the elbow of the top arm. Placement of the stick is of upmost importance during this phase. Proper placement is necessary for increased shot velocity and accuracy. Peak elbow flexion velocity has also been hypothesized to elicit a stretch-shortening reflex and increase elbow extension velocity during the stick acceleration phase. 

Stick Acceleration. --- Stick acceleration phase is an extremely short and dynamic phase. The phase begins when the elbow of the top arm reaches maximum flexion (See Figure 6C). From this point of maximal flexion, rapid extension of the elbow and forward propulsion of the stick occur. The trunk swiftly transitions from a backward rotation and extension position to a forward rotation and flexion position based on the stick handling side. The rapid change of position propels the head of the stick in the direction of the goal and releases the ball from the pocket of the crosse. The stick acceleration phase concludes with the release of the ball. 

Stick deceleration. --- The stick deceleration phase of the lacrosse shot begins once the ball is released from the pocket of the crosse (See Figure 6D). This phase will vary based on the shot technique performed, player skill level, stick type, and the general acceleration arc of the head of the stick. During this phase shoulder musculature for stability and elbow flexor eccentric strength for deceleration of the extending elbow are tested. The phase ends when the elbow of the top arm reaches maximum extension. 

Follow-through. --- The follow-through motion represents an essential phase of movement to dissipate forces produced from the previous phases of the lacrosse shot and to prevent injuries. The phase begins when the top arm reaches maximal elbow extension (See Figure 6E). As the body continues to attempt to decelerate the upper extremity, the trunk begins to rotate. This phase is comparable to the follow-through phase seen in a baseball swing. The phase is ends with the completion of trunk rotation. 

Recovery. --- Recovery phase is considered a transitional phase. The phase begins with the termination of trunk rotation. Movements during this phase vary based on the next task the player needs to perform. There is no specific movement which concludes this phase. Players will often perform a lacrosse pass or checking maneuver while running down field rather than immediately beginning another lacrosse shot. 

Figure 6. Lacrosse Shot Sequence. A, Approach Phase. B, Crank Back Phase. C, Stick Acceleration Phase. D, Stick Deceleration Phase. E, Follow-Through Phase

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Sitting, Slouching, and Sport: The Thoracic Spine

Prolonged slumped postures – the curse of modern day society – force the thoracic spine into structural hyper-kyphosis. Sportspeople are by no means immune. The vast majority are recreationally active and therefore as likely as their sedentary counterparts to be slumped and desk-bound for large parts of the working day. Even full-time elite athletes spend significant periods relaxing in the normal fashion: hunched over a computer game or the internet, or slouching in front of the TV. 

Poor upper-back posture can set up an injury chain reaction

The thoracic spine and ribcage have extremely complex anatomy and articulations, and are commonly neglected in the injury management of spinal and peripheral sports injuries. Yet thoracic mobility and ideal posture are vital to injury prevention and recovery.

The thoracic spine has 12 vertebrae and is the most stable region of the spine, thanks to the limitations imposed by the structural elements of the ribcage and the vast array of ligamentous and muscular connections (1). The function of this relative immobility – and hence stability – is to protect our vital organs, such as the heart and lungs, but this has implications for the contribution of thoracic spine stiffness to sporting injuries.

The first to seventh ribs are classified as ‘true’ ribs, as they articulate directly with the sternum. The eighth to 10th are ‘false’ ribs, as they don’t articulate with the sternum but with costal cartilage, and the 11th an 12th are floating ribs as they have no sternal attachments at all (1). Use this classification only as a guide: there can be major anatomical variations between individuals.

Ribs 2 to 10 each articulate with the vertebrae above and below; and although variable, ribs one, 11 and 12 generally articulate with only one vertebra. Every rib articulates with its thoracic vertebra(e) via two joints, the lateral ‘costotransverse’ joint (which attaches to the transverse process) and the more medial ‘costovertebral’ joint (which attaches to the vertebral body).

The ligamentous connections between the ribs and the spine and sternum are extremely stable and provide for only limited motion. Because of this, movement in the thoracic spine, while possible in all directions, occurs only in small magnitudes.

Flexion/extension is more limited in the upper thoracic region; rotation/lateral flexion is more limited in the lower thoracic spine. Extension is limited by the ribs, anterior longitudinal ligament, contact of the spinous processes and articular facets and disc structure. Rotation is mainly limited by the ribcage (ribs plus cartilage plus articulations). The significance of these structural limitations increases with age.

There is a dearth of literature on links between the thoracic spine and sporting injuries but Harrison et al (2) showed that thoracic spine kyphosis (convex curve), which increases with posterior translation of the thoracic spine, may be linked with low back pain. Scapulo-thoracic crepitus and bursitis (pain and grinding underneath the shoulder blade) has also been linked with an increased thoracic spine kyphosis (3). Although there is no specific empirical evidence, anecdotally thoracic spine stiffness and kyphosis can be a common predisposing factor to upper-limb overhead injuries, as well as thoracic and low back pain.

Skeletal changes with age

A normal newborn has to have an extremely compliant chest wall, so that it can deform in order to exit the birth canal. It is mainly cartilaginous: ossification does not occur for several months after birth, and skeletal development does not cease until the 25th year with the growth of the rib tubercle.

With aging, the costal cartilages ossify and allow less movement, and as the ligamentous and joint capsules stiffen, the thoracic spine loses mobility. The thoracic vertebrae commonly become anteriorly wedge-shaped, as the result of postural issues and/or osteoporotic vertebral collapse. This contributes to an increasingly kyphotic spine. Bone mass starts to deteriorate after the third decade, and although certain kinds of weight- bearing activity have been shown to reduce the rate of bone loss, roughly 70% of over-75s have osteoporosis of the ribs and spine.

Case study

Impinged shoulder, stiff spine

Brian was a keen amateur triathlete with a sedentary day job. He had a five-year history of shoulder impingement, which had never become serious enough to be functionally limiting, but which he said gave him an achy shoulder that he was always aware of. He routinely protected his arm when doing sprint training in the pool.

Brian’s posture was very poor, with an obvious slouch in both standing and sitting. His thoracic spine was stiff through T3 to T10, with limited extension, and while his gleno-humeral range of movement was normal, his scapula was classically protracted, anteriorly tilted and downwardly rotated. Impingement tests were positive on his right (dominant) shoulder.

We tried taping, which had a minimal effect in reducing his pain symptoms. We mobilised the thoracic spine and the patient stretched over a Swiss ball for five minutes and then on a foam roller. This immediately produced a large improvement in thoracic extension and reduction in shoulder symptoms above the head.

We set Brian a daily exercise programme, using Swiss balls, foam roller and Bakballs. After six months his shoulder symptoms had all disappeared: thanks to his improved thoracic mobility his scapular positioning was now also corrected.

Effects of structural changes

The thoracic spine and chest wall have been shown unequivocally to become less compliant and mobile with age. The healthy thoracic spine has a natural kyphosis. This normal anatomical position is under threat as poor, prolonged slumped postures – the curse of modern day society – force the thoracic spine into further kyphosis, or structural hyper-kyphosis. Sportspeople are by no means immune. The vast majority are recreationally active and therefore as likely as their sedentary counterparts to be slumped and desk-bound for large parts of the working day. Even full-time elite athletes spend significant periods relaxing in the normal fashion: hunched over a computer game or the internet, or slouching in front of the TV. Pro cyclists and triathletes are particularly at risk as a direct result of their sporting posture.

A hyper-kyphotic thoracic spine rarely develops in isolation. As the curvature increases, there are accompanying anatomical consequences. In sitting, the cervical spine and head move forward. This causes excessive upper cervical extension and lower cervical anterior shearing, often creating neck pain and headaches (4). If treatment is only directed to the cervical spine and not at the thoracic stiffness causing the problem, symptoms may temporarily reduce but the pain will never go away.

Prolonged slumped sitting and thoracic hyper-kyphosis cause posterior pelvic tilting, which contributes to lumbar flexion or loss of lordosis. The prolonged positioning of the spine in thoracic kyphosis and lumbar flexion can contribute to permanent elongation of ligamentous and muscular tissue.

As time progresses, this hyper-kyphotic posture becomes chronic and the neural and connective tissue adaptations become difficult to remedy. Pain often accompanies chronic postural hyper-kyphosis because of micro-trauma inflicted on the posterior muscular, ligamentous and/or neural structures from prolonged stretching.

The spinal discs, especially in the thoracic and lumbar spines, may also be structurally affected: compressed anteriorly and stretched posteriorly, causing posterior annular degeneration and potentially disc bulges/prolapses, which can be devastating for the sportsperson. When standing, the hyper-kyphosis will remain and it is easy to observe the consequential pelvic, lumbar and cervical alterations. These, too, can predispose the individual to upper and lower limb conditions as they make adjustments to their biomechanics.

Upper limb biomechanics

If the thoracic spine is held in hyper-kyphosis, the scapulae (shoulder blades) must also move in a relatively anterior-tilted, downward rotated and protracted position – a position linked with gleno-humeral impingement (5). The hypothesis is that as the scapula and hence the acromium move forward and downwards, the head of the humerus has less room to move under the acromium, which leads to micro-trauma of the supraspinatus and other sub-acromial structures, causing pain.

In sitting, the therapist can demonstrate the effect to their client by getting them to compare their range of shoulder elevation and pain first in an ideal upright posture and then in a slumped hyper-kyphotic posture. It is more than likely that they will have considerably less movement and greater shoulder pain in the slumped position.

In terms of the sporting population of swimmers, tennis players and golfers, any thoracic mobility restrictions they have will predispose them to shoulder pathology. This has implications for the assessment of all shoulder patients: it should be mandatory to assess the client’s thoracic extension and rotation to ascertain if thoracic stiffness is contributing to their condition.

Thoracic hyper-kyphosis is likely, also, to be linked to spinal and upper-limb conditions such as thoracic outlet syndrome (neurovascular compression), T4 syndrome (nonneurological numbness in the hands and arms) and Scheuermann’s disease (hereditary juvenile kyphosis), because of the consequent structural changes in the thoracic spine and positional changes of the scapula.

Lower limb

If there is a loss of lumbar lordosis because of the hyper-kyphotic thoracic spine and posterior pelvic tilt, the lower limb will be prevented from moving in an ideal pattern, which may predispose the individual to a variety of lower limb conditions. Hypothetically the motor patterning of the muscles that cross the pelvis and hip, such as hamstring, rectus femoris and adductors, may be altered, risking muscle tearing.

Respiration

As the costal cartilages ossify and the kyphotic spine alters structurally and stiffens, reduced rib and spinal mobility will affect the normal movement of respiration, which is a rib ‘bucket handle’ effect. In older patients the result may be to cause or lead to worsening respiratory conditions. In athletes, it may lead to reduced tidal volume and VO2max, impacting on sporting performance.

Again, the therapist can readily demonstrate to their client the effect of poor posture. In sitting, compare their ability to take a deep breath in an ideal upright posture and then in a slumped hyper-kyphotic position. They should be able to breathe more deeply and freely with ideal posture.

Techniques to improve thoracic mobility

If the thoracic spine has lost extension, the therapist needs to take active measures to reverse permanent structural changes. If this altered posture is the result of a disease state such as Scheuermann’s disease or osteoporosis, it is going to be impossible to restore normal spinal alignment, so the emphasis should be on postural advice and exercises to maintain the client’s mobility levels.

Where there is no underlying condition, the therapist should aim not just to restore mobility but also to ensure the client maintains ideal posture in the future. The most important aspect of re-education will be when the patient is sitting. Strategies for this are:

Visual cues – posting a red dot above the computer screen acts as a reminder to the client that whenever the dot catches their eye they should sit up straight

Verbal cues – get the client to set their watch or programme their computer to produce an alarm/hourly reminder to sit up straight

Physical cues – tape the thoracic spine into extension using two strips, starting from each collar bone and crossing in the mid- thoracic region.

Simple home exercises to maintain and increase thoracic extension

Gentle extension exercises (see figs 1 and 2) can initially be performed once a day, in static lying, using:

rolled-up towel/rolling pin or

foam rollers or

easy-to-use and portable products such as Bakballs (see www.bakballs.com).

The support should be placed at each vertebral level in turn for 20 to 30 secs. As the client’s toleration improves, the exercises should be performed two to three times a day. An alternative would be to arch back over a chair or Swiss ball.

Conclusion

It is easy to overlook thoracic spinal stiffness when a client presents with shoulder problems (especially in athletes), but assessment of the thoracic spine should be an integral part of the sports therapist’s initial examination.

Aim always to restore mobility and provide the necessary exercises and long- term postural re-education to ensure that the client retains ideal posture in the future.

References

Norkin C, Levangie P (1992) Joint Structure and Function FA Davis Company, Philadelphia

Harrison D et al (2002) ‘How do anterior/posterior translations of the thoracic cage affect the sagittal lumbar spine, pelvic tilt, and thoracic kyphosis?’ Eur Spine J Jun;11(3): 287-93

Kuhn J et al (1998) ‘Symptomatic scapulothoracic crepitus and bursitis’ J Am Acad Orthop Surg Sep-Oct;6(5): 267-73

Hiskins B (2004) Thoracic Workshop Australian Institute of Sport

Lewis J et al (2005) ‘Subacromial impingement syndrome: the effect of changing posture on shoulder range of movement’ J Orthop Sports Phys Ther Feb;35(2):72-87

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What is Functional Biomechanics?

The Philosophy Behind Functional Biomechanics

To understand the concept of functional biomechanics it is important to know that all human movement is based upon the functioning of the neuromusculoskeletal system (NMS). Simply put any and all movement depends on the many nerves, muscles, and bones operating efficiently, in the way they were designed, to allow us to do everything from walking and running to daily household activities and sports. The different parts that make up the neuromuscular system rely upon one another to do their job as designed in order to be able to carry out their specific tasks. The science of how these systems interact and affect one another in a fluid relationship of kinetic chain reactions is the study of Functional Biomechanics.  

What does Functional Biomechanics Have to Do With Chiropractic Care?

Understanding how something properly operates in the most optimal conditions allows for an easier determination of the cause of areas of breakdown. 

For example, a football coach notices that his go to play doesn’t seem to be working out the way it normally does. He knows in detail where all of his players should be and the actions each of them should take. All of the players on the team are still there and playing, but the outcome is sloppy and the play isn’t a smooth as it once was. When the coach breaks down each player as a part of the play (or system) rather than on the whole, he is able to identify that the breakdown is with the initial pass. His quarterback that was once throwing 35 yards lately has only been able to throw half that distance. This has caused his receiver to adjust his location, which in turn has caused a whole set of changes amongst the other players resulting in the breakdown of the play on the whole.

It is the same concept with functional biomechanics. When all of the players in our NMS are operating smoothly we are pain free and able to carry out tasks as usual, but when just one player isn’t operating normally, the process can be affected. Both repetitive motion injuries from everyday life and traumatic injuries can easily alter the smooth functioning of our systems. Our bodies are made to adapt and it is this ability to adapt that can change the normal processes our bodies were designed to carry out. However, when part of our NMS undergoes a stressor it may adapt in a way that alters it’s ideal fundamental action negatively, which can often lead to dysfunction rather than function, in its attempt to compensate. 

For instance a joint, muscle or tissue that has undergone injury may in its simplest effect cause pain and an inability to complete normal tasks because of restricted motion. In even more advanced scenarios, an injury or instability to one area may lead to dysfunction in another area. For example, a common cause for low back pain is simply a chronic habit of “sucking in” your stomach. You may think that having a six pack or tight core muscles is a sign of a stable spine, but the simple act of sucking in your belly deactivates the diaphragm. When the diaphragm isn’t active it creates a lack of sufficient pressure that is needed to stabilize the lower back and, inevitably, this lack of stability causes pain. Chronic instability of the lower back can lead to irritation of the joints, disc bulges, disc herniations, and nerve pain into the hips and or legs (sciatic pain).

An inability to properly function pain-free or an inability to move with the highest range of motion is just the starting point of the information we will assess and evaluate before we develop a treatment plan for your injury. Being able to provide cutting edge chiropractic care relies on an in-depth knowledge of the science of functional biomechanics. It is only with this knowledge that we can identify the cascade effect a seemingly isolated injury can have on the rest of your body. We are skilled at identifying the underlying cause of breakdown within the normal process of functional movement that is causing you pain and at developing treatment plans that will help you avoid further injury. These core fundamentals are what allow us to not only treat your pain, but also to revive performance, alignment, movement, and function. Redefining human performance by restoring the functional aspect of each body’s biomechanics is our primary goal.

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Players Ask Doctor to Treat Brazilian Soccer Team

The Brazilian soccer team has won a new advantage off the field this week. This is because of a chiropractor invited by the team doctor to treat the players in Brazil. Chiropractic is a health care approach focusing on spinal function and alignment. It can be a treatment for pain, but it should also be used to improve function and prevent injury, which is what is being done for most teams at the World Cup. 

Dr. Elisa, the team chiropractor for Brazil, uses an interesting analogy to explain the importance of chiropractic care. “I often compare spinal care with dental care. You eat and brush daily, and need to get regular care for your teeth. With the spinal column is the same. You use it all the time, but some people only remember to go for care when they have pain. Indeed, it is important to have regular preventive treatment “she explains. However, the world of soccer (football) is not new to her. She has treated former soccer player and Brazilian Captain Carlos Alberto Torres, the three-time champion, since he had disabling back pain in 2010.Torres, credits chiropractic with resolving chronic disabling back pain that had kept him relying on crutches to walk. Traditional medical treatments had not helped, and finally someone referred him to a chiropractor. The chiropractic care he received enabled him to have a quick and full recovery so he could walk again without crutches and free of pain. 

Although little known in Brazil, chiropractic is widely used by soccer (football) players. Dante, who has benefited from chiropractic treatment for more than six years since he played in Belgium, was one of the players who requested the services of a chiropractor. 

“It is an excellent help. You feel that your body is more balanced, with everything in place. This makes a difference when it comes to high performance,” said the soccer player. 

Football does take a toll on the musculoskeletal system of soccer players. Quite often players get injured due to the quick movements they do. Running, twisting, turning, changing direction, heading the ball and diving can all result in injuries. The neck, back, knees and ankles are prone to injure due to the stress exerted in the twisting action of the body when the feet are planted and the quick change of direction of the upper body. Quite often ligaments of the knees and/ ankles are likely to injure. As 

Dr. Erik Plasker, the team chiropractor for one of the top US youth soccer teams noted, “while the other teams are scrambling to change their lineups due to injuries, our team bounces back fast and brings an energetic advantage to championship games. The players and coach agree that chiropractic care helps them compete at the highest level and avoid injuries.”

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Biomechanics of the Lacrosse Pass

Lacrosse Swing/Pass A fundamental movement of the sport is the lacrosse swing or pass. Teams must have the ability to quickly and effectively transition the ball from defense to offense. Offense relies heavily on this movement to pass the ball and create shot opportunities. Although there are several variations of the swing, an overhand swing is used most often during play. The swing consists of two phases: the draw phase and the release phase (See Figure 7). During the draw phase the stick is overhead and the shoulder is down and behind the head. The upper arm is in a flexed and externally rotated position. During this phase the stick acts as a long lever that allows the player to apply leverage and increase the velocity of the ball to act as a catapult during the release phase. During the release phase the head of the stick is moved in a forward and downward direction. The upper arm moves into a position of extension and internal rotation. The other lacrosse swings include underhand, backhand, and side-arm swings. Each swing consists of the two mentioned phases while movement of the upper arm depends on the swing utilized. The lacrosse pass should be directed at the shoulder of the intended player opposite of the defender, which allows the offensive player to provide a shield. Passes performed while running should be directed in front of the receiving player to allow maintenance of running speed. The pass should be strong and quick to allow a high velocity pass and avoid interception by a defender due to a soft, slow, floating pass.

During lacrosse movements, the trunk acts as a solid base from which all movements originate. In terms of the lower extremities, movements mimic those observed in soccer and basketball. High velocity cuts, pivots, and twists as well as sudden body blocks compose the sport’s footwork. The lower extremities may be affected by the upper extremities during passing and shooting. This is due to the increased lever arm as mentioned previously, as well as the fact that these actions are performed with both hands holding the lacrosse stick. By placing both hands on the stick, an increased valgus load is placed on the knee when landing and cutting.

Different biomechanical abilities are needed for each of four field positions associated with the sport of lacrosse (See Table 2). For an offensive position or attacker, the player needs to possess speed, agility, and elite stick skills in order to outmaneuver an opponent and score. For a defensive position, agility is still necessary, however, the ability to produce large power outputs is also mandatory in order to body check opponents and guard the goal. For a midfielder, speed and stamina are required as a means of playing both offensive and defensive positions. For a goaltender, agility is still needed but hand-eye coordination as well as proprioceptive footwork is essential for providing full goal coverage.

The previously mentioned biomechanics performed during the sport cause athletes to possess a physiological fitness profile similar to that of basketball, soccer, and track players. However, lacrosse players differ in that they possess only average flexibility and a body fat percentage 5.9% higher than that of collegiate soccer players. These findings suggest there is room for improvement in lacrosse players’ physiological fitness profiles which may in turn produce biomechanical improvements in movement. 

Figure 7. Lacrosse Swing/Pass. A, Overhead pass starting position. B, Overhead pass final position. C, Side pass starting position. D, Side pass final position.

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