CHAPTER 4: PREVENTING INJURIES THROUGH FITNESS TRAINING
PREVENTION THROUGH TRAINING
Fitness is critical for performance and injury prevention Improper conditioning is a major cause in sports related injuries but a well designed conditioning program can help reduce the likelihood of injury in a competitive athlete Areas of concern:
Flexibility Muscular strength, endurance, power Cardiorespiratory endurance
Exercise related injuries can be reduced
Improved fitness = more resistant to fatigue and stress
PERIODIZATION
PERIODIZATION IN TRAINING AND CONDITIONING
Traditional seasons no longer exist for serious athletes Conditioning is a year round endeavor Periodization is an approach to conditioning that attempts to:
Bring about peak performance Decrease/reduce injuries and overtraining Program that spans various sports seasons Takes into account athletes’ different training and conditioning during different seasons and modifies the program according to individual needs
MACROCYCLE: YEAR ROUND TRAINING CYCLE
Complete training cycle Seasonal approach based on preseason, in-season, and off-season Changes in intensity, volume, specificity of training occur in order to achieve peak levels of fitness for competition Broken into mesocycles (periods or phases) lasting weeks or months
MESOCYCLES OR PERIODS/PHASES
Transition period:
Follows last competition (early off-season) Unstructured (escape rigors of training) Encouraged to participate in recreational activity
Preparatory period:
Off-season Hypertropy/endurance phase (Low intensity with high volume)
Strength Phase
Allows for development of endurance base Lasts several weeks to 2 months Intensity and volume increase to moderate levels
Power Phase (High intensity/ pre-season)
Volume is decreased to allow adequate recovery
Competition period: May
last a week or several months for seasonal sports High intensity, low volume, skill training sessions May incorporate microcycles or weekly training cycles (1-7 days) Designed
to ensure peak on days of competition
CROSS TRAINING Training for a sport with substitutions of alternative activities (carryover value) Useful in transition and preparatory periods Variety to training regimen Should be discontinued prior to preseason as it is not sport-specific
PRINCIPALS OF TRAINING & CONDITIONING
PRINCIPLES OF CONDITIONING AND TRAINING
Warm-up/Cool-down
Motivation
Intensity Specificity
Overload and SAID principle
Individuality
Relaxation/Minimize Stress
Safety
Consistency/routine
Progression
The principles of conditioning should be applied to all training programs to minimize the likelihood of injury .
WARM-UP
A warm-up increases body temp, stretches muscles, increases ligament elasticity, and increases flexibililty Precaution against unnecessary musculoskeletal injury and soreness May enhance certain aspects of performance Prepares body physiologically for physical work Stimulates cardiorespiratory system, enhancing circulation and blood flow to muscles Increases metabolic processes, core temperature, and increases muscle elasticity (flexibility)
PRINCIPLES OF A WARM-UP
General
2-3 minutes of general activities which bring a general warming to the body (break a sweat) Not related to sport (light jogging) Follow general activity w/dynamic stretches
Sport Specific Activities
Should involve actions/ specific skills related to activity/sport being performed and gradually increase in intensity (ex: basketball player: shoot, layups, dribbling; tennis: serves, volley, back/forehand)
Stretching, jogging, running, throwing, catching
Should last 10-15 minutes resulting in effects that may last 45 minutes but it is recommended you begin activity within 15 min
COOL-DOWN
Essential component of workout often ignored Brings body back to resting state Stretching during cool-down decreases muscle soreness, returns muscles to resting length, returns blood to heart, and prevents pooling of blood in extremities which reduces stress on heart. 5-10 minutes in duration
OVERLOAD
Foundation for strength training Making muscles work harder than accustomed to SAID principle: Specific Adaptation to Imposed Demands
when the body is subjected to stresses and overloads of varying intensities, it will gradually adapt over time to overcome whatever demands are placed on it.
Stress must not be great enough to produce damage or injury before body has a chance to adjust to the increased demands
OTHER PRINCIPLES
Motivation: athletes are highly motivated b/c the want to be successful; vary training routines to keep enjoyable Consistency: exercise on a consistent regular schedule Progression: Increase intensity gradually and within the athlete’s ability Intensity: Stress the intensity rather than the quantity; increase tempo and workload, not duration Specificity: Identify specific goals for the training program; ability of particular muscle group to respond to targeted training of those muscles so increased strength occurs in that muscle group only Individuality: Adjust or alter workouts based on athlete’s level of ability, training etc. Safety: Take time to educate athletes on proper techniques related to sport and make the environment safe. Stress: train hard but allow time away when needed
FLEXIBILITY
IMPROVING AND MAINTAINING FLEXIBILITY
Flexability:ability to move a joint(s) smoothly through a full range of motion (ROM)
Good flexibility is essential for successful physical performance
Decreased ROM results in:
Decreased performance capabilities
(sprinter w/tight hamstrings may not be able to sprint at max speed b/c tight hamstring prevent hip flexion, which shortens stride length)
Uncoordinated/awkward movements Predisposes athlete to injury
Must be able to move through unrestricted range Must have elasticity for additional stretch encountered during activity
Evidence indicates that flexibility may be more important for participation in more dynamic activities (ballet, karate, diving, gymnastics, soccer, basketball) and not as effective for less dynamic activities like swimming, cycling, or running
High intensity stretch-shortening cycles Muscle/tendon unit requires storage of elastic energy Without necessary flexibility the tendon may exceed capacity causing Stretching can influence viscosity of tendons making it more compliant = injury reduction
Evidence indicates static stretching does not reduce overall injury rates but may reduce musculotendinous injuries No evidence that stretching prior to activity reduces injuries
FACTORS THAT LIMIT FLEXIBILITY
Bony structures (elbow) Excessive fat (abdominals) Muscle and tendon lengths (most common reason) Connective tissue (capsule, ligaments) can shorten w/immobilization (cast) Scarring and contractures Skin-inelastic scar from surgery Neural tissue tightness (nerves)
RANGE OF MOTION (ROM)
Active range of motion
Athlete moves the body part w/o assistance =Dynamic flexibility Ability to move a joint with little resistance through muscle contraction
Passive range of motion
Motion of joint when another person moves body part (no muscle contraction) =Static flexibility Begins at end of and continues beyond AROM
AGONIST VS. ANTAGONIST MUSCLES Joints are capable of multiple movements Example:
Quadriceps will extend knee with contraction Hamstrings will stretch during extension Quads (muscle producing movement) referred to as agonist Muscle undergoing stretch (hamstring) referred to as antagonist
Agonist and antagonist work together to produce smooth coordinated movements
ASSESSMENT OF FLEXIBILITY
Trunk hip flexion test
Trunk extension test
Sit w/legs together, knees flat on the floor, and feet against some vertical surface. Bend forward and reach as far forward as possible w/the fingers Measure the # of inches in front of or beyond the vertical surface Normal range is 3-8 inches past vertical
Lie in prone position on the floor. Have a partner hold your legs to the ground. Grasp your hands behind your neck, inhale, lift your upper trunk as high off the floor as possible. Measure distance from chin to floor Normal range is 19-24 inches
Shoulder extension test
Lie prone on floor w/arms extended over head, while holding a stick or pencil in the hands. Raise the stick as high as possible w/the face and chest kept flat on the floor Measure the distance from the stick to the ground Normal range is 23-27 inches
STRETCHING TECHNIQUES Ballistic Bouncing
movement in which repetitive contractions of agonist work to stretch antagonist muscle While effective in improving flexibility, caution should be exercised Increased motion is achieved through a series of jerks on resistant tissue Possible soreness and small muscle tears may result if jerks are greater than tissue extensibility http://www.youtube.com/watch?v=0zhHwv34Qvo
Dynamic
Stretching technique of choice in athletic populations Related to types of activity an athlete will engage in Tend to be more functional in nature Recommended prior to beginning an activity Stretches that mimic components of athletic activity http://www.youtube.com/watch?v=emw4_CV5eR8
Static stretching
Passively stretching Go to point of maximal stretch (end point resistance), back off slightly and hold for extended period
20-30 seconds (3 to 4 times)
Controlled, less chance of injury Not dynamic Recommended for untrained athletes http://www.youtube.com/ watch?v=dtX4sHfYOm0
Proprioceptive Neuromuscular Facilitation Techniques (PNF)
Combination of alternating contraction and relaxation of both agaonist and antagonist muscle 10 second push followed by 10 second relax phase Slow-reversal-hold-relax
Contract-relax
Isotonic contraction, relaxation
Hold-relax
Contract antagonist, contract agonist, relax
Isometric contraction, relaxation
Best technique to improve flexibility http://www.youtube.com/watch?v=791 XXiYzNbE
THE PILATES METHOD Conditioning program that improves muscle control, flexibility, coordination, strength and tone Enhances body awareness, improves body alignment and breathing, increases movement efficiency Designed to stretch and strengthen muscles through a sequence of carefully performed movements
PILATES
YOGA
Based on philosophy that illness is related to poor mental attitude, posture and diet Reduce stress through mental and physical approaches Used to unite mind and body Involves various postures and breathing exercises
Designed to increase mobility and flexibility
PRACTICAL APPLICATION FOR STRETCHING
Warm up before stretching Stretching after activity is more important than stretching before. Rely on dynamic activity before Ballistic stretching may cause muscle soreness but can be utilized in well trained athletes Full non-restricted ROM can be obtained through static and PNF stretching PNF can produces dramatic increases in ROM during one session and may be the best method but requires the use of a partner For best results, stretch 5-6x a week; minimum 3x week To increase flexibility, a muscle must be stretched beyond its normal range but not to the point of pain. Stretch only to the point at which tightness/resistance to stretch or perhaps some discomfort is felt. Should not be painful.
STRETCHING EXERCISES
Shoulder Towel Stretch Exercise
Anterior Abdominal Stretch
William’s Flexion Exercises
FLEXIBILITY VS. STRENGTH
Can co-exist Most believe that muscle bound = zero flexibility? Individuals who develop enough muscle bulk will have limitations due to the size of the muscle Strength training, when performed through full ROM, will provide individual with ability to develop dynamic flexibility through full range of motion If combined w/rigorous stretching program, can enhance powerful and coordinated movements
CRITICAL THINKING
A college swimmer has been engaged in an off-season weighttraining program to increase her muscular strength and endurance. Although she has seen some improvement in her strength, she is concerned that she also seems to be losing flexibility in her shoulders, which she feels is critical to her performance as a swimmer. She has also notice that her muscles are hypertrophying to some degree and is worried that this may be causing her to lose flexibility. She has just about decided to abandon her weight-training program altogether. What can the athletic trainer recommend to her that will allow her to continue to improve her muscular strength and endurance while maintaining or perhaps even improving her flexibility?
MUSCULAR STRENGTH, ENDURANCE, AND POWER
Muscles of the Body
MUSCLE STRENGTH, POWER, AND ENDURANCE
Athletes who do not possess sufficient levels of muscle strength, endurance, and power are more susceptible to injury
Strength: ability to generate force against resistance
Power: is the relationship between strength and time (speed); a large amount of force generated quickly
Muscular endurance: ability to perform repetitive muscular contractions against some resistance for a period of time (increase strength = increase endurance)
PHYSIOLOGICAL AND BIOMECHANICAL FACTORS THAT DETERMINE LEVELS OF MUSCULAR STRENGTH
Size of muscle Number of muscle fibers
the more fibers the greater the strength; # of fibers inherited
Muscle Fiber type:
Type I (slow-twitch) aerobic
vs
Type II (fast-twitch) anaerobic
Neuromuscular efficiency Biomechanical factors
muscle/tendon and bone create system of levers and pulleys
Overtraining (psychologically, physiologically)
Reversibility-cessation of training will result in rapid decrease in strength Level of activity
SIZE OF MUSCLE & # OF MUSCLE FIBERS
Size
Strength is proportional to size of a muscle; size is function of diameter and number of fibers
# of fibers
number of muscle fibers is inherited; the more fibers=more potential for hypertrophy Hypertrophy-enlargement of a muscle caused by an increase in the size of its cells in response to training; muscle adapts to training demands Atrophy-decrease in muscle size due to a decrease in the size of its cells resulting from inactivity
FIBER TYPE: FAST TWITCH VS. SLOW TWITCH FIBERS Fibers within a particular motor unit display distinct metabolic and contractile capability Slow twitch (Type I): Fatigue resistant Time necessary to produce force is greater Long duration, aerobic type activities Generally major constituent of postural muscles
Fast twitch (Type II) Fatigue quickly Anaerobic in nature High force in short amount of time Produce powerful movements
Fiber Type Individual make-up of muscle Muscles contain both types of fibers Muscle function impacts ratios in each muscle (postural vs. powerful movement) Genetically determined Any given muscle can contain both types and varies in each muscle depending on the person If ratio is genetically determined… Ability to play sports? Metabolic capabilities can change in response to training making a fiber go from one type to the other
Factors Affecting Muscle Strength Cont’ •
Improved Neuromuscular Efficiency • • •
•
Result in the initial strength gains with no hypertrophy/growth More effectively engage specific motor units More motor units fire causing stronger contraction
Biomechanics •
length of a muscle determines the tension that can be generated; bones and muscles create levers; longer lever =
less power/strength •
Levels of Physical Activity • •
Will influence increase/decrease in muscle strength Also impacts cardiorespiratory fitness, flexibility and increases in body fat
Factors Affecting Muscle Strength Cont’
Overtraining
Psychological and physiological breakdown
Signs
Apathy, loss of appetite, staleness, declines in performance, weight loss, inability to sleep Prevent through appropriate training protocol, proper diet and rest
CORE STABILIZATION
CORE STABILIZATION TRAINING
Core refers to the lumbo-pelvic-hip complex 29
muscles in the lumbar spine, hip, abdomen and around the hip and pelvis
Will help to improve: Postural
control and muscular balance Facilitate dynamic functional strength and dynamic stabilization of kinetic chain Improve neuromuscular efficiency throughout the body
Often a focus on functional strength, neuromuscular control and power relative to activity Core
training & spinal stabilization is often neglected
Optimal stabilization of the spine allows for effective utilization of strength, power and control of the prime movers If
core is weak, movement efficiency declines Could lead to injury
Progressive core training Exercises
must elicit maximal training
response Should be safe, challenging, stress multiple planes, and incorporate a variety of resistance equipment Begin with activities where you are able to maintain stability and optimal neuromuscular control
TECHNIQUES OF RESISTANCE TRAINING
Resistance Training Progressive resistance exercise (PRE)progressively increase in resistance= Overload Overload principle must be applied Must work muscle at increasingly higher intensities to enhance strength over time If intensity of training does not increase, but training continues, muscle strength will be sustained
TYPES OF SKELETAL MUSCLE CONTRACTIONS
Isometric contraction No
length change occurs during contraction
Isotonic contraction Concentric-
shortening of muscle with contraction in an effort to overcome more resistance Eccentric - lengthening of muscle with contraction because load is greater than force being produced Both are considered dynamic movements
Training Techniques
Isometric Exercises
Contraction where muscle contracts but length remains unchanged while maximum force is applied against an immovable object Muscle contraction that lasts 10 seconds and should be perform 5-10 times/daily Pro: quick, effective, cheap, good for rehabilitation Con: only works at one point in ROM, produces spiking of blood pressure due to Valsalva maneuver (holding breath)
TRAINING TECHNIQUES Progressive Resistance Training (Isotonic training) Strengthens muscle through a contraction that overcomes some fixed resistance produced by equipment (dumbbells, barbell, weight machines) through a ROM Muscle Shortening/lengthening Either Concentric (muscle shortens) or Eccentric (muscle lengthens) Various types of equipment can be utilized (free weights, machine weight) Spotter is necessary for free weight training to prevent injury, motivate partner and instruct on technique
PRE- PROGRESSIVE RESISTANCE EXERCISES Concentric and eccentric training should be incorporated for greatest strength improvement Concentric phase of lift should last 1-2 seconds, eccentric phase 2-4 seconds Variations exist between free and machine weight lifting
Machines are easy to use, safe, allow quick weight change, able to do more weight Free weights require spotter, muscle control, no restricted motion
Terminology associated with weight training
Repetitions- number of times a movement is repeated Repetition maximum- maximum reps at a given weight One repetition maximum- maximum amount that can be lifted at one time Set- particular number of reps Intensity- amount of weight or resistance lifted Recovery period- rest interval b/t sets Frequency- number of time an exercise is performed in a week
Strength Program Recommendations
The amount of weight selected should be sufficient to allow 68 RM range for strength gains If at least 3 sets of 6 reps cannot be completed the weight is too heavy and should be reduced If can do more than 3 sets of 8 reps, the weight is too light and should be increased Progression to heavier weights is determined by the ability to perform at least 8 RM in each of 3 sets Progress by increments of 10% from current weight being lifted – should still be able to do at least 6 RM in each of 3 sets 1 RM can be utilized to measure maximum amount of weight that can be lifted - must be very careful Training of a particular muscle group should occur 3-4 times per week (not on successive days)
MUSCULAR ENDURANCE VS. STRENGTH
Training for endurance enhances strength and vice versa When training for strength – use heavier weights with a lower number of repetitions When training for endurance – use lighter weights with a greater number of reps (12-15 reps)
OPEN VS. CLOSED KINETIC CHAIN EXERCISES
Anatomical functional relationship for upper and lower extremities OKC
When
foot or hand are not in contact with the ground or supporting surface
CKC Foot
or hand are weight bearing Widely used = more functional
ISOKINETIC TRAINING Muscle contraction at a constant velocity Maximal and constant resistance throughout the full range of motion Maximal effort = Maximal strength gains Rehab Never widely used in strength training Losing popularity in rehabilitation settings
Program Design Variables
Needs Analysis
Evaluation of sport- what are the requirements and characteristics of the sport: movement patterns and muscles involved, strength, power, hypertrophy, and endurance patterns, common joint and muscle injury sites Assessment of athlete- what are the athletes needs, goals, training status, and training goal
Exercise Selection
Exercise type- core and assistance exercises Movement analysis of sport- sport specific exercises Muscle balance Availability of equipment Available training time Athlete exercise experience
Training Frequency – number of training sessions in a given time period
Training status- beginner, intermediate, or advances At least 1 but not more than 3 days rest between training the same muscle group Sport season (periodization) Split routine, circuit
Exercise Order – sequence exercises are performed in
Power, core, assistance Upper- and lower-body alternated Push and pull alternated Superset – exercises that stress opposing muscles performed consecutively Compound – two different exercises for the same muscle group
Training Load and Repetitions – amount of weight assigned to exercise (handout) Volume (handout) a. Volume- total amount of weight lifted in training session (set x reps x wt.) b. Set- group of repetitions performed before resting Rest Periods – recovery between sets (handout)
Training Goals Strength Power Hypertrophy Endurance
12 reps 2-3 sets
