Preparing Clients for Change of Direction

physical therapy change of direction. lateral

Preparing for Lateral Locomotive Patterns and Change of Direction

This post will be detailing how to move from linear to lateral locomotor tasks in a rehab program. Initiating linear jogging following an injury or as part of a post-operative rehab protocol has fairly definitive benchmarks for when this is appropriate. They are as follows. Enough time has passed to allow physiological healing and the previous injury is ready for impact. The individual meets whatever pre-determined physical capabilities to manage impact and running.

Benchmarks for Linear Running

The physical benchmarks I like to have athletes meet before initiating linear jogging include the following:

  • Enough ROM
  • Sufficient body weight competency in loading in a variety of planes (YBT >85% works here)
  • Ability to perform >10 reps of a single leg sit to stand
  • Ability to perform >15 reps of single leg elevated hamstring bridge
  • Ability to perform >25 reps of a single leg calf raise
  • Ability to perform at least 30s of a side plank
  • Ability to store energy with the lower leg demonstrated by performing 30 seconds of double and single leg pogos at a 150 bpm cadence
  • Ability to absorb force in the sagittal plane with tasks like snap downs, low intensity hop and sticks (essentially a mini-bound), or low intensity linear single leg depth drops (off a 6″ step)
  • Gradual progression and accumulation of ground contacts with pre-running tasks like ladder drills, a-running, a-skips, and others

While it is fairly well outlined when to initiate linear jogging post-injury/surgery, it is sometimes less clear for clinicians when to introduce other planes of motion with locomotives like lateral shuffling, cross over/under, and carioca. Not to mention when it may be a good idea to add in change of direction.

Benchmarks for Lateral Movements

From a general overview, I like to have a few interactions allowing the athlete to get fairly comfortable and demonstrating competency with linear jogging before initiating lateral work. Although, this is not a hard and fast rule.

But in terms of actually introducing lateral movements like shuffling, I tend to see them as not inherently dangerous or risky. Especially when you’ve cleared a few of the following questions. These are not all that dissimilar to determining preparedness for linear locomotive tasks. Answer the following questions correctly and you’ll feel confident about initiating lateral locomotives, deceleration, and change of direction:

  • Can the athlete perform static position foundational patterns without [area of injury] irritability? Benchmark: Lateral squat/lunge, slider lunge patterns
  • Can the athlete perform energy storage tasks (extensive, very low intensity plyometrics) in the frontal plane? Benchmark: Lateral pogo hopping (double leg), lateral line hop pogos (double then single leg)
  • Can the athlete accept load quickly in that plane? Benchmark: Tolerance and competency with snap downs and hop and sticks in the frontal plane, competency and tolerance with lower level single leg depth drops (6″ step)
  • Has the athlete met the previously mentioned basics? Benchmarks: see above on linear jogging

What does the progression look like?

Once you’ve answered the above questions and met the benchmarks it’s a simple game of introduce action, build volume, and layer in intensity in a logical manner. It may look something like this for lateral shuffling. The amount of sessions and length of time building up is dependent on how long the athlete spent recovering or the severity of the injury. These session numbers are fairly arbitrary and are simply meant to demonstrate the point.

  • Session 1-2: introduce and progress volume of lateral shuffling at sub-maximal intensities.
  • Session 3-4: progress intensity of shuffling (without need for deceleration), introduce and increase volume of shuffling to a deceleration at a cone at sub-maximal intensities.
  • Session 5-6: Progress intensity of shuffling decelerations, introduce shuffle shuttles moving continuously at progressive volumes and intensities
  • Session 7-8: Integrate shuffling into closed loop drills like a box drill and combine with other locomotor movements (e.g. running and backpedaling)

This process can be repeated (and layered in with a slight lag behind shuffling) with fairly similar benchmarks with locomotives that have more of a transverse plane demand like cross over running or carioca.

Questions or comments? Drop them below, on social media, or email me at!

 From Dr. Greg Ellis, a R2P Academy speaker, and creator of the Sports Rehab Advisor. Article Originally Posted Here


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