Pre-Hab Protocol

Our Pre-Hab Protocol will utilize principles inspired by ATG Knees Over Toes Zero & Dense methods but culled down from a multiple day approach to condensed single of a la carte pre-hab training. I believe the biggest obstacle in allocating training hours for injury proofing focus is often the time spent training in sport or domain of activity and the cross training that prepare us for said activity. Time is often a pressured factor and when applied, life often prioritizes with first cuts likely sourced from recovery oriented work. With this in mind, and understanding the importance of regularly training pre-hab, the below workout provides a Lite compendium for challenging the bodies mobility, balance, neuromuscular communication, and muscle groups often neglected and associated with stability.

What is Pre-Hab?

Pre-hab is a theory of strengthening patterned weak spots often found is athletes and weekend casuals prior to the manifestation of compensations (muscular imbalances and altered joint arthrokinematics) and eventual injury. Generally, most sports involve the practice of repeated movements often unnatural in frequency which requires a rebalancing and reversing of overuse through a structured and progressive format. Hope is not a strategy for protecting against injuries and impediments to progress. Go out on the attack leaning forward with an aggressive campaign for injury-proofing, while also increasing the body’s preparation for increased performance structurally and neurologically.

Below are 17 pre-hab exercises that can be mixed and matched depending on current weak or tight areas. Periodize depending on your needs for rehab and performance.

Warm Up:

• Reverse Out Knee Pain: Walk backwards with focus on knee over toe form. 3 min.

Workout:

1. Tibialis Raise & Dense: Lean against wall with glutes touching and walk legs a few steps forward keeping the knees straight. Secure a position where one can comfortably flatten feet, pivot on heels, and raise toes. Reverse out and repeat. Progressing feet further out for increased difficulty. For increased progression, also consider wrapping one leg and converting to single leg unilateral exercise. 25 reps. Adding load with available machine, floss wrap with dumbbell or can hang kettle bell off foot. 2 sets of 8.
2. L-Sit: start in seated L position; 90 degree between legs stretched in front and upright upper body. Place palms on the side of each leg slightly forward with upper back rounding. Alternate lifting one leg at a time holding for 2 seconds each. This can be progressed to lifting both legs off ground and holding simultaneously. Progressed further to lifting glutes and entire lower body off ground only being supported by hands. Last progression may require going back to 90 degree L sit. 60 seconds total.
3. KOT (Knees Over Toes) Calf Raise: Stand arms length from wall for support if necessary. Similar to FHL (Flexor Hallucis Longus) Calf Raise with focus on knees sliding over toes. Drop the body low and as far as knees can lower forward testing mobility of the ankle (analogous to a squat with hands down by sides counterbalancing). Heels will raise and arms hanging by sides lowering towards the ground. Lower body resembles a 45 degree Z from foot to glute. Reverse out from end range extending knee and starting back from standing position. For increased progression, consider wrapping one leg and converting to single leg exercise. 25 reps.
4. Patrick Step: Start in KOT Calf Raise position (see KOT Calf Raise above) and progress with forward leg extending straight forward and slightly angled downward. As the opposite rear leg squats down (ROM is knees over toes here), extend the straightened leg’s heel forward and touch the ground. Arms will help with balance by the sides. Reverse out and repeat. Can also perform on elevated box for increased range of motion. 25 reps each side.
5. ATG Split Squat: Start in a a split lung position; degrees of forward, backward, and lateral leg separation and position will depend on body type, flexibility, & mobility. Split lunge: begin with upper body in upright position, take a large step forward with single leg and rear leg extending back with both feet flat. Front leg will lean into a KOT position with aim of it’s calf touching hamstring (heel may lift). Rear leg will seek knee to lower just above floor; weight distributed heavily on ball and toes (FHL conditioned). Upper body will straighten in upright position. If done correctly, one should feel an incredible stretch in the hip flexor and challenge in lead leg’s quadricep. 3 sets of 8 each leg. 30 sec rest between each leg’s sets.
6. Dense Nordics: In this exercise, back of achilles will be arrested / held down by various tools (Nordic bench, straight bar in rack, partner hold etc.) with body in kneeling position. Keep the upper body (above the knees to head) straight (think backwards L-position), lower down and forward controlled until prone belly down. Initially you may be unable to continue loaded eccentric to flat completion, catching upper body with both hands (don’t smash your forehead). From here engage the glutes, core and hamstring, pushing off with the hands and reversing out the position to starting through full range concentric (powerful and contracted effort). Progression to MSL (Marty St. Louis / hockey player) with hands resting in diamond positioning in the low back; glutes & core stimulating the initiation for return to starting position via a strong concentric. Regress uses monster band (attached securely behind body, holding strap or in under the arms lasso position anteriorly to reduce gravity load and increase time under tension). 3 sets of 6.
7. Dense Reverse Nordics: Initially start in a kneeling position with shins and tops of feet (dorsal) against the ground; keeping the upper body straight (knees to head): L-position. Hinging upper body backwards, lower with intent of upper back being flat upon the ground in loaded eccentric phase. Reversing out, contract the quads, glutes, and core, concentrically returning upper body to all in one straight line. Can progress by holding a dumbbell or kettle bell. Regress by using a monster band (secured firmly in front of body holding with both hands to assist in both eccentric lower and concentric return to start). 3 sets of 6.
8. Dense Full Range Pull Over: Starting with mid back resting against a bench, feet flat and hamstrings parallel with ground. Diamond grip with a dumbbell or kettle resting on low to mid stomach, press up and extend arching overhead with straightened arms behind head to end range. Reverse out to starting position3 sets 8 reps; using up to 25% M & 20% F.
9. Dense External Shoulder Rotation: . Sit on a bench with one foot flat on the bench and the other on the floor rotated out 90 degrees. Place ipsilateral elbow on knee (slightly internal with same side elbow on bench elevated foot) with dumbbell in hand. Rotate internally until end range / comfortable stretch (eccentric) and reverse out (concentric) back to start. 3 sets of 8; using up to 10% M & 8% F.
10. Full Range Dumbbell Bench Row Super Set: Start in standard supine position on bench. With dumbbells or kettles in each hand fully elevated above body with elbows locked out. Lower to end range with orientation being mid chest range for best stretch (closed fists facing body). Super Set: move into pronation position on bench with ipsilateral knee and hand on bench. Contralateral arm holds dumbbell with same foot on floor; back is flat and parallel with surface. Lower controlled in eccentric and return to start squeezing at top touching dumbbell to mid chest. 8 reps each (3 per exercise); using up to 25% M & F.
11. Couch Sit: Start in kneeling split squat position with rear leg’s knee on ground, tibialis flat against the couch in 90 degree relative to ground, and hamstring touching calf. From leg is in KOT position and upper body to a 90 degree with said lunged leg. Hips can be thrust forward accompanied with strong stretch sensation in hip flexor and quadriceps. 60 seconds per side.
12. Dense Jefferson Slant Curl: Starting on an elevated surface (slant board recommended but not necessary) with a kettle bell in both hands in front of body hanging slack. Beginning with rounding the upper back, shoulders elevated lengthening under tension in an arc to end range (goal of touching nose to knee). Slow opening tempo providing a progressive stretch as lowering, reverse in concentric phase to straight back. Keep core braced as to provide protection to the spine. 3 sets 5 reps; using up to 25% M & 20% F.
13. ATG Style Seated Good Morning: Straddling a bench, orient feet flat with heels aligned front of knee (for optimum stretch). Keep back upright and flat. Holding a dumbbell or kettle bell, lower eccentrically between the legs initiating a lengthening in the adductors and lower back to end range. Concentric will return back to upright. With the bar, attempt to touch belly to bench. Dumbbells or barbell: 3 sets of 8 reps; 25% for M & 20% for females.
14. Lateral Quadratus Lomborum Extension: Using 45 degree back extension tool angled side ways. Eccentrically fold to end range with feet staggered. Concentrically reverse back to starting. Without back extension tool, stand in staggered stance and hold dumbbell or kettle bell internally to lead split leg. Opposite hand will hold at the back of the head. Max stretch is achieved on the loaded eccentric and strength challenge achieved on the concentric return to start. 3 sets 8 reps per side.
15. Elephant Walk: Begin in a quadruped position similar to downward dog with palms on floor and pressure on balls of feet upon ground. Flex the quadriceps a press heel down (stretch being felt in hamstring) one at a time alternating. 30 reps per leg.
16. Lateral Incline Pidgeon Pose: Using a standard yoga pigeon pose with the addition of elevation and or incline; elevation determines difficulty. Pose involves the leading leg to be perpendicular to body with hip internally rotated. Rear leg will drop into a lung and presses forward applying modulated body weight load to front leg. Can progress exercise by holding a dumbbell in contralateral side (referenced to stretched leg). 2 sets 30 seconds per side.
17. Lateral Standing Groin: Level 1 – back flat on the ground (x-axis), heels against the wall upright (Y-axis), allowing gravity to pull the legs to the ground initiating a stretch to the groin (adductors). Level 2 – Assuming a split position standing, space the legs apart to end range. Hold the elbows and hinge at waist down and hold. Level 3 – Building off last level, return upper body to extension. Can alternate folding down progressing forward to touching head to ground all increasing load on stretched adductors while working the low back. Level 4a – This variant will begin from side position using a bench to rest top flexed leg (perpendicular to body) on top of bench with below leg below bench. Upper body will anchor on single forearm with top arm resting at the hip. Sag the lower leg eccentric load with body caving closer to exercise surface. Return to top position in concentric phase. Level 4b – Building off 4a, replace the stabilizing forearm arm and extend out with hand as stabilizing anchor. Lower leg hanging below bench will straighten as the hip and glute touch the floor in eccentric load initiating the stretch in top adductor. Returning to starting side plank for concentric phase. 2 sets of 30 seconds per side.