Is the ability to change the direction of the movement of the entire body rapidly and accurately in space?

What is agility?

Technically agility is difficult to define. Some have traditionally defined it as the physical action of changing direction, stopping and starting – without any recognition for the integral role how the brain and the ever-changing dynamic nature of soccer can affect agility performance. While there are several definitions for agility, we like the way Verstegen and colleagues (2001) define agility as a physical skill in which players can slow down, change direction, or accelerate in response to a task-relevant cue such as an opponent or in anticipation of a pass from a teammate.

AGILITY TESTING

Agility is defined as “a skill-related component of physical fitness that relates to the ability to rapidly change the position of the entire body in space with speed and accuracy.”51 Thus clinical tests of agility can be appropriate function- and sports-specific tests for sports involving cutting, such as basketball, volleyball, football, lacrosse, and soccer. The reader should note that many of the tests for CORE power, such as the T-test, shuttle run, and single-leg hops, are also good tests of agility (Table 12-17).

Agility

Agility training forms an integral role during performance rehabilitation. The focus of this intervention is to develop the connection between the physical and psychological systems necessary to carry out complex multidirectional tasks in response to a stimulus with the aim of improving the mind–body connection when processing signals and cues from the environment (Sheppard and Young, 2006). Challenging an athlete’s mental processing speed during sport-specific tasks reinforces reaction learning and allows them to initiate movement faster and/or with the most appropriate timing to achieve the best outcome (Pojskic et al., 2018). To influence the perceptual and decision-making components of agility, reactive drills, small sided games or 1v1s can help to reduce the total response time, by influencing the time needed to react to a stimulus (processing of the sensory input) and duration of time needed to perform the movement (motor-control response) (Serpell et al., 2011; Young et al., 2015; Young and Rogers, 2014). For a more in-depth discussion on how to train agility, see Chapter 33.

13.6 Agility Tests

Agility is the capacity to change course, controlling the direction and position of one’s body while maintaining momentum. It is important in all ball games and combat sports. There are numerous methods to test agility and many of them were developed for specific sports. Using the most accepted test for a given sport offers the possibility to compare test results with other players. Indeed, tests are not just used to measure individual progress but, if the given tests are used widely, the results can be compared in larger sport-specific populations. Below are short descriptions of some agility tests that are used internationally.

The Balsom Agility Test is designed for soccer players, and mimics the changes in running direction during a soccer game. The course of this test is shown in Fig. 13.2. Players start at point A, and sprint to the cones at point B. They turn at point B, sprint back through point A, turn to the left, and sprint through point C to point D. They turn at point D and then sprint back through C, turn to the right, and sprint through point B to the finishing gate shown at point E (Fig. 13.2). This test is widely used, which provides the possibility of comparing the results of players at different levels.

The Arrowhead Agility Test got its name from the shape of placed markers that the players have to cover, i.e., three marker cones placed in an arrowhead shape, and one set of cones or line marker to indicate the start and finish lines. The players run as fast as possible from the start line to the middle cone (A), turn to run around the cone (C) or (D), around the far cone (B), and back through the start/finish line. The best time out of four trials is registered. This test is also often used in soccer and team-handball, and is helpful to evaluate the objective agility of the players (Flotum et al., 2016).

The Lateral Change Direction Test aims to test the agility required for basketball and handball players. Three cones (A, B, C) are placed in a line, 5 m apart. The player stands behind the middle cone (B) and on a sign from an assistant moves either right (C) or left (A). The player touches the first designated cone, then returns past the middle cone to the far cone and touches it, and then returns to and touches the middle cone to complete the test. The shortest time out of four trials is registered.

The Star Agility Test has been shown to be appropriate for children aged 8–10 (Golle et al., 2015). They are asked to run using different running techniques (e.g., forward, backward, side steps) from the center of a 9 × 9-m star-shaped field to the edge and back with four markers. The time of this trial is measured. This agility test is often used in long-term development in various sports, including ball games.

The Illinois Agility Test measures the ability to turn in different directions and at different angles in a course which is marked by cones (10 m long and 5 m wide) (Fig. 13.3). Each subject starts face down, in a prone position, with the head at the start line and hands by the shoulders; they wait for the signal of an assistant to start to run over the course, without knocking down any cones.

The t-test measures the ability to change direction at high speed. Four cones are arranged in a T-shape, with cone B placed 9.14 m from cone A, and two additional cones (C and D) placed 4.57 m on either side of cone B. Players starts to run, on a sound signal, forward from A to B, shuffle 4.57 m to the left to cone C, shuffle 9.14 m to the right to cone D, and shuffle 4.57 m back left to cone B before finally running backwards to reach cone A. The time is recorded.

Emotional Agility and Mindfulness

Practicing mindfulness enables you to improve your emotional agility during the discussion phase.

You have a stream of inner thoughts and emotions that shape your mindset and help you interpret what is happening. This inner stream can be empowering (mindful, productive, energizing) or it can be disparaging (triggering doubts, fears, criticism). Instead of avoiding or suppressing your thoughts and emotions, acknowledge them.

Emotional agility is the ability to manage or change the direction of your emotional state. It requires an internal sense of equilibrium, emotional strength, and integration. Developing emotional agility takes time, practice, and experimentation. The practice can be broken down into the following steps:

Acknowledge your pre-existing emotions, thoughts, or mindset.

Assess these thoughts and emotions without being attached to them.

Evaluate the values (or standards) that are attached to these emotions.

Identify your ideal emotional state.

Determine what actions or commitments are consistent with your values and ideal state.

One of the most heavily negotiated issues in the workplace (and at home) is the topic of “work–family balance.” Fortunately many institutions and businesses accommodate flexible work arrangements as a matter of policy. Nevertheless, these conversations can still be difficult. They require emotional agility and mindfulness on both sides. In many cases, the conflict is not in ideals or policies, but rather in how to balance your values with the choices and expectations of others. Focusing on common interests and motivations will be more productive than trying to find a common opinion about how to achieve “balance.” The value of the process is not necessarily found in the outcomes, but lies in the discovery of what really matters to you.

Having a strong, loving family, an exciting job and being happy requires emotional agility and mindfulness…

I recognized early in my career that I needed work that provided a sense of adventure. I like solving difficult problems and enjoy accepting challenges that others think are impossible and I’m also fond of learning new things, talking and sharing ideas.

As I searched for an assignment that met my criteria, I was promoted to lead and manage one of our company’s most profitable and innovative operations in North America. The business was growing and we needed to expand our entire supply chain’s capacity. This was a crucible1 assignment, which meant the stakes were high. This defining role for my career required that I balance conflicting values and priorities.

The job required me to commute two and half hours each day from our home. As we negotiated this challenging situation, my husband and I both talked with several trusted mentors who coached us to be mindful of what was important for our family versus relying solely on the company’s transfer and relocation policies.

Due to the demands of the job, long work hours, and the long commute, we decided that I needed a safe, secure place to stay near the plant during the week. My husband also had a challenging technical job that required long hours and occasional traveling. Based on his work situation and our two young sons’ education, we determined that it would be best that he stay at our home location with them. These were not easy decisions, and they may not have been appropriate for every family.

In making the decision, I recognized my desire to feel that I am making a difference in the world and living a balanced life. I work hard and I am devoted to my family. I am a great leader and I need personal quiet time to read, study, reflect, or recharge my energy. This reflection caused me to realize that regardless of my location or circumstances, I defined myself as a full-time manager, wife, mother, sister, daughter, and friend.

Discussing and articulating these insights with my manager led to breakthroughs in our negotiations. Maintaining my whole identity was not only one of my core values, but it also became a success factor for my assignment.

Based on the complexity of our situation, most times I would commute to work from our home base. However, there were also times when the family would have to commute back and forth. I was able to negotiate that the company would provide a two-bedroom home to accommodate our family in the work location (versus categorizing me as a ‘single employee transferee’) and also pay expenses for me to drive back and forth (if needed) twice per week (versus expensing only one trip every 2 weeks). I also negotiated standard times that I would be unavailable for face-to-face meetings in the office.

It may seem like we made many changes to accommodate only one employee. In reality, there was a growing need to accommodate dual-career families and the company needed to be more flexible about how to place the right talent in the right locations. We examined our traditional culture, challenged old assumptions, and became more innovative about how we managed the work. For example, we rescheduled (or eliminated) several meetings that were conveniently scheduled for managers, but burdensome to other employees.

Paradoxically, this assignment actually deepened our family relationships and our working relationships. Instead of shrinking, our network of support expanded across the two cities. As a result, we successfully fulfilled this assignment and built long-lasting friendships with people in both locations.

People tend to identify each other in one specific context or another. Through these negotiations, I learned that gaining support for my identity in other areas was, in fact, my main point of concern with each of the stakeholders (my husband, children, managers, peers, subordinates, and friends).

Frequently check your emotional state during the various stages of the negotiation process. Being alert and aware of your thoughts and emotions allows you to isolate them, experience them, and determine whether or not something important is at stake and how it might apply to the situation at hand. This practice is known as “mindfulness.”

Mindfulness allows you to examine your emotions and experiences in a thoughtful, productive fashion without buying into them. Practicing mindfulness enables you to improve your emotional agility, communicate more effectively, and find common ground based on values and ideals. (Chapter 4 offers more strategies for developing mindfulness, mental agility, and other aspects of mental toughness.)

It’s impossible to block out difficult thoughts and emotions. Effective leaders are mindful of their inner experiences but not caught in them. They know how to free up their internal resources and commit to actions that align with their values. Developing emotional agility is no quick fix […] over time, leaders who become increasingly adept at it are the ones most likely to thrive.

Extract from “Emotional Agility”, by Susan David and Christian Congleton, Harvard Business Review, 2014

Balance and Agility

Balance and agility are the most commonly overlooked components of fitness, yet poor balance and its associated risk of falling are potentially the greatest health concerns for many older adults. Balance and agility require a rapid central nervous system (CNS) response to signals from the inner ears (vestibular signals), eyes (visual signals), postural muscles in the legs and back (proprioceptive signals), and touch (tactile signals). Although some deterioration in the quality of these signals occurs with age, it is primarily a slower rate of integration and response by the CNS that appears to cause the loss of function (disuse atrophy). Function loss is cyclical; low function results in reduced confidence, which leads to avoidance of balance challenges, and further reduction in function follows in a destructive cycle. Even highly skilled athletes lose function rapidly if they become injured or fail to practice.

Balance and agility can be restored by safe challenges to the system with appropriate exercises. Tai chi, dance, and simple balance exercises such as standing on one foot while brushing the teeth or hair provide effective signals to stimulate CNS adaptation.30 In severe cases, ai chi, a form of tai chi performed in a swimming pool, provides a no-falling-risk stimulus to the balance control system. Sports such as tennis and bicycling are greater challenges and are associated with both higher risk and greater potential to achieve improvement. High-level activities, including skiing, skating, and martial arts, are appropriate for a select group of patients.

Therapeutic Review

The ACSM4,5,26 provides guidelines that illustrate the standard of care and prove invaluable for clinicians and physiologists who make exercise recommendations. This organization also offers a resource manual to support these guidelines, which includes background summaries in applied anatomy, exercise physiology, exercise testing and programming, emergency procedures, terminology, and more.31-32

A comprehensive exercise program has a synergistic effect. Improved strength in the postural muscles is reflected in better balance because those muscles can more effectively respond to signals from the balance centers. Better cardiorespiratory conditioning allows a more challenging strength training program, and improved body composition allows greater range of motion for more effective stretching. Equally important, enhanced function allows greater participation, usually resulting in better compliance. Exercise prescription need not be complicated; virtually any activity has positive effects. The key is to gently challenge each of the physiological systems in such a way to allow patients to experience enhanced function and then encourage them to modestly increase the stimulus.

Key Web Resources

Speed and Agility

Agility is the ability to rapidly change body direction, accelerate, or decelerate. It is influenced by balance, strength, coordination, and skill level. Agility can be improved by first developing an adequate base of strength and conditioning that is appropriate for the difficulty level of the athlete. After this is achieved, drills designed to enhance reactive and explosive motor skills can be progressively incorporated (Fig. 33-4).

Guidelines for speed and agility training are as follows:

Allow adequate warm-up

The athlete should have an appropriate strength/conditioning base for the selected drills

Speed and agility should be performed early in the training session or preferably on separate days to maximize training effect, avoid fatigue, and prevent overuse

Allow adequate rest between sets and repetitions. Heart rate and respiration should return to almost normal levels after the drill. A 1 : 4-6 work-to-rest ratio is recommended.22

Number of sessions per week may vary depending on the sport, the individual's current level, history of injury, intensity of the drill, and/or period of the mesocycle. Two times per week can be used as a general rule.

Volume: two to five sets of each exercise

Quality not quantity

Box 33-6 lists various speed and agility drills. This list provides examples only; the reader may wish to refer to specific resources on speed, agility, and plyometric training for a more comprehensive list and description of drills.20,22,25,26

Two-component Design

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The two-component Agility design is the only implant with US Food and Drug Administration approval currently.

The Agility Ankle is a second-generation design that resurfaces the superior, medial, and lateral surfaces of the tibial plafond as well as the talus. A polyethylene insert is fitted to the larger tibial implant, which then articulates with the talar component (fixed bearing).

Lack of congruency between the larger tibial and smaller talar components allows for some sliding and rotational motion.

Because its solid tibial component incorporates the medial and lateral malleolar surfaces, fusion of the syndesmosis is required. Either through the same anterior incision, or a separate lateral approach, the syndesmosis is debrided and stabilized with screws.

Failure of syndesmosis fusion leads to a higher rate of reoperation, with valgus tilting of the talus in severe cases. Motion at the unfused syndesmosis leads to “ballooning” osteolysis in the distal fibula.

There is some evidence that use of a plate with the two syndesmotic screws may increase the rate of syndesmosis fusion.

Advantages of the two-component design include complete resurfacing of the ankle and greater surface area to support the tibial component. This larger surface area distributes forces well across, and subsidence of the tibial component is not a common complication.

Transformation of the ankle from a three-to a two-bone joint is controversial but does allow this total resurfacing, and after fusion avoids a painful distal tibiofibular joint. However, the larger component does require more extensive bone resection, and consequently a potentially more difficult salvage. Additionally, the syndesmosis fusion often requires a second incision, increasing the risk of soft tissue problems, and failure of syndesmotic fusion is problematic.

The two large series of two-component TARs were published recently.

In one study of 126 patients with mean follow-up of 9 years, the revision rate was 15%. Greater than 90% of patients reported satisfaction and pain relief. Average arc of range of motion was 18°. Complications included syndesmotic non-union in 8%, subsidence in 14%, and periimplant lucency in 76%. Importantly, a significant number of patients developed adjacent joint arthritis in the subtalar and talonavicular joints (Knecht et al. 2004).

The patients in this series were selected by the inventor of the Agility Ankle, and so were probably all ideal candidates.

Spirt et al. (2004) reported a series of 306 consecutive ankle arthroplasties with an average 33-month follow-up. Overall, they observed less favorable results. Five-year survivorship was 80% using the end point of failed TAR, and 54% with reoperation as the end point. Younger patients (< 55 years) did significantly worse than older patients. Failure of syndesmosis fusion, loosening, and subsidence were cited as common complications. A few patients required below-knee amputation (BKA) as a salvage procedure.

This series had less strict inclusion criteria, including many younger patients, and most patients were not at all ideal candidates.

Although data regarding outcomes of the Agility TAR are mixed, several points of agreement exist.

The majority of patients are satisfied in the short term, but long-term results are as yet unknown.

Younger patients tend to have worse implant survival and increased complications.

Range of motion is not fully restored after TAR, with an average of about 30°.

Syndesmosis fusion is important to successful Agility TAR.

Adjacent joint arthritis may occur after TAR, but it is unclear whether the rate of arthritis is lower than after ankle arthrodesis.

Develop Awareness

The first step in developing mental agility is learning to recognize the internal signs and symptoms associated with states of heightened arousal. We’ve all experienced them: the muscular tension in our throats, chests, and shoulders; the knot in our stomachs; the shallow breathing (or holding of our breath); the narrowing of our focus and attention; even, perhaps, a welling up of tears or a desire to lash out in anger. All these are a normal part of the human “fight or flight” reaction and can be triggered by myriad circumstances (e.g., anticipation of an upcoming performance review, feeling overwhelmed by the mounting pressures of multiple work responsibilities, conflict with a colleague, extended or excessive concentration on a crucial task caused by perfectionism, missing an important deadline because of procrastination).

All too often, our own thoughts can compound the problem. If we do not view the triggering situations clearly or if our thinking is distorted (see “Mental Balance” section), we may well react even more strongly. Being able to distinguish the situations that engender strong emotional reactions and becoming aware of our thoughts before, during, and after these “crises” are crucial to defusing our reactions and learning to act responsively under pressure.

What is important is to recognize them quickly and deal with them immediately. The goal is to prevent our normal heightened arousal from escalating to the point where we feel helplessly caught up in a flood of feeling that controls our actions—that is, where we are “in the grip” of emotional reactivity. It is important to respond in ways that will enable us to maintain our professionalism, rather than to react in ways that may undermine the respect of our colleagues or make us feel bad about ourselves in the long run. Understand that these reactions are normal and may take some time to be able to recognize. But you will learn. Awareness and acceptance of this are also part of the process.