Eye on the Ball

May 18, 2016

Looking for a way to increase player safety and improve performance, the University of Cincinnati baseball and football teams set their sights on building a comprehensive vision training program.

This article first appeared in the May/June 2016 issue of Training & Conditioning.

By Robert Mangine, Dr. Joseph Clark, and Kimberly Hasselfeld

Robert Mangine, MEd, ATC, PT, is Associate Athletic Director for Sports Medicine at the University of Cincinnati and National Director of Sports and Physical Therapy Education for NovaCare Rehabilitation. He can be reached at: manginre@ucmail.uc.edu.

Joseph Clark, PhD, ATC, is a Professor of Neurology at the University of Cincinnati and consults with the sports medicine department. He can be reached at: joseph.clark@uc.edu.

Kimberly Hasselfeld, MS, is the Clinical Research Manager for the Department of Orthopedics and Sports Medicine in the University of Cincinnati College of Medicine.

For the University of Cincinnati’s football and baseball teams, there’s more to preseason workouts than meets the eye. Over the past several years, we’ve been incorporating vision training alongside conventional strength training to prevent injuries and enhance athletic performance.

Why the need for vision training? The answer is twofold.

First of all, athletes have gotten bigger, faster, and stronger over the past 30 years. Consequently, the speed and intensity of football and baseball have increased. Athletes collide at higher speeds on the gridiron, and baseball hitters face more pitchers who throw 90-plus than ever before.

At the same time, contemporary athletes have come of age in the era of cell phones, tablets, and other handheld screens. While these devices are undeniably convenient, several studies have shown they can limit an individual’s visual field over time in terms of depth, width, and convergence (tracking the speed at which an object comes at him or her).

Obviously, a compromised field of vision can negatively affect an athlete’s ability to respond to stimuli. For football players, not seeing an opponent lining them up for a hit leaves them no time to prepare, which some studies say contributes to the sport’s high rate of concussions. In baseball, an inability to track a 95 mph fastball can lead to a plummeting batting average.

Our vision training program sought to address these concerns. By implementing a variety of modalities to improve peripheral and central vision, strengthen the accommodative (focusing) systems of the eye, and lower reaction time, we’ve been able to produce several years of positive results.

FIRST LOOK

In 2009, UC athletics established a Human Performance Center within its sports medicine and strength and conditioning departments. One of the primary objectives for this new facility was developing a comprehensive program to reduce the incidence of concussion suffered by our football players.

Over the past decade, the deleterious effects of concussion in football have become national news. In response, many efforts have been made to enhance player safety, such as changing the game’s rules, developing stricter guidelines governing contact during practice, and improving helmet technology. However, the documented number of head injuries continues to rise.

Fortunately, vision training shows promise for reversing this trend. Using exercises geared toward improving depth perception, athletes may develop the ability to better see and gauge other players approaching from multiple directions prior to impact. This would allow them to position themselves in a protected posture to absorb hits or adjust a hit they are about to make. Neurovisual training could also help football players react faster, evade hits better, and become more aware of the action on the field around them, all of which would contribute to increased safety.

Another goal for the Human Performance Center was to investigate whether vision training could enhance performance, beginning with our baseball team. Visual performance provides a decided advantage to baseball players, as it’s a critical factor for tracking a pitch or a batted ball.

To accomplish both of our goals, we partnered with the UC Medical Center and began our work by determining the demands of football and baseball. Each sport requires athletic ability, speed (both in movement and reaction time), dynamic strength, and above-average ocular-motor (eye-hand) coordination. In addition, they both require athletes to absorb a tremendous amount of visual information, process it seamlessly, and react rapidly. These demands served as the foundation for our vision training with the teams.

SIGHTS ON SAFETY

We began vision training with the football team during its 2010 summer conditioning and preseason camp. Our concussion mitigation program was designed to improve the athletes’ field awareness and stereopsis, a component of depth perception.

Players did vision training for 15 to 20 minutes each day over a period of two weeks. We integrated a vision training station into the team’s daily strength and conditioning sessions. The team’s athletic trainers and students from UC’s athletic training program instructed the athletes on the methods and tasks each day, including sets and time reps for each modality. Athletes were divided into groups based on position and rotated through the tasks either individually or in pairs.

When applicable, we modified the activities to make them position-specific. For example, wide receivers and defensive backs did eye-hand coordination tasks above their heads, while linemen did them at head level or lower. Because quarterbacks are concerned about blind-side hits, we emphasized training their peripheral visual fields. Our quarterbacks also usually completed the exercises in their throwing stance to improve backside vision.

As the training progressed, we increased the complexity of the tasks and altered the pattern of exercises to keep athletes interested and engaged. Here are the vision training modalities we used with the football team:

Tracking: Several different exercises fit into this category. One that we use often involves a spinning wheel with numbers on it. Players must call out the numbers in order as the wheel rotates.

Dynavision D2: The subject stands in front of the Dynavision board and hits a series of lights as they turn on. The athlete may have to simultaneously complete verbal and executive function tasks, such as calling out or adding numbers, word finding, or memory tests. These activities train multisensory input processing because the subject must continue to hit lights (working peripheral vision) while also targeting central vision and cognition with the extra tasks.

Tachistoscope: The tachistoscope is a computer-based device that trains the brain to recognize images faster. Numbers are flashed on a computer screen, typically starting with one every 0.3 seconds. As the athlete progresses, more numbers are placed randomly on the screen (up to four at once), with different backgrounds and increasingly frequent flashes. The athlete has to call out the numbers, remember the numbers, and remember where they were on the screen.

The tachistoscope works on contrast sensitivity, as well. It begins with simple contrasts, such as black numbers on a white background. As it advances, the contrasts become more difficult, such as dark green letters on a light green background.

Reaction-trainer ball: For eye-hand coordination exercises, we use a reaction-trainer ball—a non-round ball that bounces in an irregular and unpredictable manner. Players bounce it against a wall and catch it as it comes back in random directions. To make it more difficult, the athletes can change their distance from the wall, height of the throw, or texture of the wall.

Another option is to have an athletic trainer or strength coach bounce the ball in front of the athlete, which requires them to react to the bounce and catch it. As training progresses, the throws can become more challenging, forcing the athlete to exhibit a greater degree of dexterity to catch the ball.

Reaction-trainer ball exercises can also be done in groups with a competitive element. Players can bounce the ball to one another, either in random fashion or at the instruction of an athletic trainer or strength coach. When a player misses the ball, he or she is out, and the last player remaining wins. Our football players have a lot of fun with this game.

Pitch and catch: This activity can be performed by having an athletic trainer or strength coach toss any type of ball back and forth to an athlete or instruct the athlete to bounce the ball against a wall or on a mini trampoline. It’s beneficial for cardio, eye-hand coordination, and visual tracking. To make it more challenging, we will write letters, numbers, or shapes on the ball that athletes have to call out before they catch it.

Strobe glasses: Strobe glasses have LED lenses in them that appear to flash, completely blocking the signal to the eyes as objects are in motion. The lenses “blink” more rapidly in the initial training stages and are gradually slowed as the athlete adapts. The slower the blinking interval, the less visual input reaches the eye, making tasks more difficult.

Our players wear the strobe glasses while doing pitch and catch or working on the Dynavision light board. In addition, quarterbacks and receivers occasionally wear them during our seven-on-seven throwing program to improve their ability to pick out objects moving at variable speeds.

The gains made by utilizing vision training during preseason camp are maintained with weekly in-season work. Optional offseason sessions are also available once per week.

Since we started our concussion mitigation vision training program with the football team, we’ve seen some great results. In the four years before we began, the team suffered an average of 8.75 concussions per year. After the first preseason vision training cycle, only one player suffered a concussion during the football season. From then on, the rate has ranged between one and four concussions per season, with an average yearly rate of 2.2 concussions. In contrast, the national average for collegiate football teams is 12 to 16 concussions per season. We hypothesize that the skills developed during vision training have helped players better avoid or minimize hits that lead to head injuries.

In addition to an improved injury profile, our vision-trained football players enjoyed a secondary benefit—increased performance. We have measured significant shortening of reaction times, especially concerning peripheral vision. Our football players have also reported heightened field awareness and quickened reaction to the speed of surrounding objects and players.

GOOD EYE

We started incorporating vision training with the baseball team during its preseason practices and conditioning in January 2011. Our objective was to improve performance by increasing batting averages and make the game safer by reducing the risk of impact collisions.

Twice a week for six weeks, we rotated groups of players through a vision training circuit while their teammates took batting practice. During each 20-minute session, we instructed the athletes as they performed tasks and rotated through one-minute stations. As vision training progressed, we had them complete more complicated tasks at each station. Vision training was also offered once a week during the season.

We used the Dynavision D2, strobe glasses, pitch and catch, and tracking modalities as we had with football and included a few more activities for baseball-specific work:

Saccades: These are rapid, voluntary movements of both eyes in the same direction from one object to another. To train these movements, we set charts on a wall that displayed letters running both horizontally and vertically. Athletes stand at varying distances from the wall and shift their gaze from one chart to another, calling out the letters they see in order on a specific line for one minute. For added complexity, we have athletes look over their shoulders while switching between charts, which simulates baseball-specific actions like tracking a ball through the air.

Brock string: The Brock string is a visual training aid that uses a string and colored beads. Ours is 10 feet long with five colored beads on it, and it’s anchored to a wall at one end. To use this tool, athletes hold the loose end of the string next to their nose and back away from the wall, pulling the string taut and parallel to the ground. Then, they focus on one of the colored beads at a time, looking back and forth between beads for one-minute periods. This exercise requires accommodation and convergence of the eyes to find and focus on each target bead. It conditions the eye and lens muscles to adjust quickly and accurately.

When first using the Brock string, baseball players look straight ahead. As they progress, they turn their heads and bodies to a batting position. Thus, they are training their eyes and brains to move like they are tracking a pitch coming toward the plate.

Eyeport: Essentially an automated version of the Brock string, the Eyeport is a three-foot-long plastic bar that has colored lights in it. Athletes hold it to their nose and follow the lights to improve their eyes’ convergence and work on lateral and vertical saccades.

Accommodative flippers: This tool trains and strengthens the accommodative systems of the eye. It consists of a handle with two sets of lenses. The power of the lenses varies—one will typically make a target seem far away and the other will make it seem close. Accommodative flippers are often sold in sets with multiple different powers in the lenses. Each player’s unique pairings are determined with guidance from eye care professionals and therapists.

To use accommodative flippers, the therapist gives the athlete one lens and asks him to read numbers and letters on a chart from a constant distance. The player changes the lens (flips it) each time he has seen, focused on, and called out the alphanumeric on the chart. It is critical that the player be advised to obtain clear focus on the object before moving on in order to obtain maximum benefit. The muscles used to focus when switching between lenses are the same ones hitters use to track a pitch approaching the plate.

Accommodative flippers are used in one-minute blocks for a maximum of five minutes at a time. The distance the player stands from the chart can change from session to session, as can the power of the lenses.

Near/far training: This consists of an athlete focusing on two different cards that have rows of random letters on them. They hold one card approximately 18 inches from their eyes, and the second one is mounted about 10 feet away. Athletes must focus back and forth on the cards and count how many rows they can successfully call out in one minute.

Near/far training improves hitting performance in two ways. First, it helps the accommodative system focus on something at a distance and then shift to something up close. It also trains the extraocular eye muscles to remember where they were looking, which works on muscle memory. The better the eye’s muscle memory, the better it can track or scan.

After just one season of vision training, the team’s batting average improved to .285 from .251. We continued to conduct vision training with the baseball team over the next two seasons, before stopping it temporarily due to a coaching change. The new coach initially did not understand the relationship between vision training and hitting. However, once he saw a trial run completed with positive results, he allowed the program to resume.

SEEING IT THROUGH

For anyone who wants to implement a similar vision training program with their athletes, it’s important to get coach and athlete buy-in. One reason we’ve received support from coaches is because vision training does not take a lot of time away from practice—in fact, it blends seamlessly with other strength and conditioning activities. Another reason is the documented performance enhancement and injury prevention that vision training offers, especially concerning concussions. Positive results get coaches on board quickly.

We got athletes to buy in by educating them on how vision training could improve their performance. Our athletic training staff was coached on how to relate the exercises to what athletes do on the field. It also helped to mention some of our former athletes who are now in the pros and how well they performed at vision training tasks.

In addition, we try to make the vision training exercises fun by incorporating contests whenever possible. Athletes are competitive by nature, and they enjoy trying for a new personal high score in an activity or going against a teammate, with the winner getting bragging rights.

Now that vision training is an established program, the upperclassmen set a good example for the incoming athletes. It has become part of the preseason routine, which helps with getting buy-in.

Implementing a vision training program doesn’t have to be complicated. Before starting one, be sure to have a clear goal in mind. Then, pick what type of program you want. Some are computer-based, some use special vision coaches, and others can be purchased as a package deal. We recommend systems designed for a wide field of performance, since some of the computer or smaller peripheral systems may have limited applications.

Over the past seven years, our vision training initiative has expanded dramatically to include other teams on campus. For example, we’ve been working on a concussion prevention program with the women’s soccer team for the past two seasons. Anecdotally, we have seen an improvement in safety. Prior to beginning vision training, the team had approximately four concussions per season but only one total since we started working with the players.

We currently have 12 ongoing studies involving our athletes. Beyond our foundational findings on the effects of vision training on concussion reduction and performance enhancement, these studies encompass biomechanics, biomarker tracking, physiological adaptation, and ocular response to vision training. This research demonstrates that vision training can hold the key to greater safety and success for today’s athletes.

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