Chapter 4 preventing injuries through fitness training
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Chapter 4: Preventing Injuries Through Fitness Training. Reduce Injury Prepare the Athlete. Athletic Trainers and Strength and Conditioning Coaches. Cooperative relationship that serves to condition athletes in an effort to minimize injury and maximize performance

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Reduce injury prepare the athlete l.jpg

Reduce InjuryPrepare the Athlete

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Athletic Trainers and Strength and Conditioning Coaches

  • Cooperative relationship that serves to condition athletes in an effort to minimize injury and maximize performance

  • Knowledge of flexibility, strength, and cardiorespiratory endurance is necessary

  • Many strength coaches are certified through the National Strength and Conditioning Association

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  • Athletic trainer may be called upon to review programs/make suggestions

    • Take into consideration components of particular sport and injury prevention

  • Rehabilitation of injuries is the responsibility of the athletic trainer

  • Different settings (professional, college, high school) will require differing levels of supervision by the ATC

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Warm-up/Cool-down suggestions


Overload and SAID principle






Relaxation/Minimize Stress


Principles of Conditioning and Training

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Warm-up suggestions

  • 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 muscle elasticity

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General suggestions

  • Activities which bring a general warming to the body(break a sweat)

  • Not related to sport


  • Specific to sport

  • Stretching, jogging, running, throwing, catching

    Should last 10-15 minutes resulting in effects that will last 45 minutes

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Cool-down suggestions

  • Essential component of workout

  • Bring body back to resting state

  • 5-10 minutes in duration

  • Often ignored

  • Decreased muscle soreness following training if time used to stretch after workout

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Improving and Maintaining Flexibility suggestions

  • Ability to move a joint(s) smoothly through a full range of motion (ROM)

  • Good flexibility is essential for successful physical performance

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  • Decreased ROM results in: suggestions

    • Decreased performance capabilities

    • Uncoordinated/awkward movements

    • Predisposes athlete to injury

  • Recommended by athletic trainers to prevent injury

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Factors That Limit Flexibility suggestions

  • Bony structures

  • Tissue approximation

  • Excessive fat

  • Muscle and tendon lengths

  • Connective tissue

  • Scarring and contractures

  • Skin

  • Neural tissue tightness

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Active range of motion suggestions

Dynamic flexibility

Ability to move a joint with little resistance

Passive range of motion

Static flexibility

Motion of joint to end points without muscle contraction

Range of Motion(ROM)

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Range of Motion suggestions

  • Must be able to move through unrestricted range

  • Must have elasticity for additional stretch encountered during activity

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Agonist vs. Antagonist Muscles suggestions

  • Joints are capable of multiple movements

  • Agonist

    • Muscle producing movement

    • Quadriceps contract to produce knee extension

  • Antagonist

    • Muscle undergoing stretch during movement

    • Hamstrings will stretch during knee extension

  • Agonist and antagonist work together to produce smooth coordinated movements

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Stretching Techniques suggestions


  • Bouncing movement in which repetitive contractions of agonist work to stretch antagonist muscle

  • Spindles tighten instead of relax

  • Possible soreness due to repeated eccentric contractions of antagonist

  • Also referred to as dynamic stretching

  • May more closely mimic muscle activity during sport

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Static stretching suggestions

  • Passively stretching

  • 6-8 second hold

  • Go to point of pain and back off and hold for 30 seconds (3 to 4 times)

  • Controlled, less chance of injury

  • Not dynamic

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  • Proprioceptive Neuromuscular Facilitation Techniques suggestions

    • Used by physical therapists for neuromuscular paralysis

    • Slow-reversal-hold-relax

    • Contract-relax

    • Hold-relax

    • Best technique to improve flexibility

    • Autogenic inhibition (push = tension)

    • Reciprocal inhibition (pull = relax)

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  • Stretching Neural Structures suggestions

    • Must differentiate between musculotendinous tightness and neural tension

  • Stretching Fascia

    • Fascia can limit motion (pain, injury, inflammation)

    • Can be performed manually or using foam roller

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Neurophysiological Basis of Stretching suggestions

Stretch Reflex

  • Muscle is placed on stretch(muscle spindle)

  • Muscle spindles fire relaying information to spinal cord

  • Spinal cord relays message to golgi tendon and increases tension

  • After 6 seconds golgi tendon organ (GTO) relays signal for muscle tension to decrease

  • Prevents injury - protective mechanism

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  • With static stretching golgi tendons are able to override impulses from muscle spindle following initial reflex resistance

  • Allows muscle to remain stretched without injury

  • Using PNF = benefit greatly from these principles

    • With slow-reversal hold technique, maximal contraction of muscle stimulates GTO reflex relaxation before stretch applied

    • Relaxation of antagonist during contraction = autogenic inhibition

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The Pilates Method but assisted by agonist contraction to pull further

  • 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

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  • Utilizes specific breathing pattern for each exercise but assisted by agonist contraction to pull further

  • Goal

    • Develop a healthy self image through posture, coordination and flexibility

  • Generally begins with one-on-one session in order to assess client’s physical condition

  • Classes in a studio are also available

    • Very popular in health clubs and gyms

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Yoga but assisted by agonist contraction to pull further

  • 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

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Flexibility vs. Strength but assisted by agonist contraction to pull further

  • Co-exist

  • Believed that muscle bound = zero flexibility?

  • Strength training will provide individual with ability to develop dynamic flexibility through full range of motion

  • Develop more powerful and coordinated movements

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Measuring Range of Motion but assisted by agonist contraction to pull further

  • Various devices have been designed to accommodate joint sizes and complexities of movement

  • Goniometer most widely used device

    • Protractor (degrees) that utilizes alignment of two arms parallel to longitudinal axis of two segments involved in motion

  • Relatively accurate tool for measurement

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Flexibility, Muscular Strength, Endurance, and Power but assisted by agonist contraction to pull further

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Muscle Strength, Power, and Endurance but assisted by agonist contraction to pull further

  • Strength: ability to generate force against resistance

  • Power: is the relationship between strength and time

  • Muscular endurance: repetitive muscular contractions (increase strength = increase endurance

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Muscle Contractions but assisted by agonist contraction to pull further

  • Isometric contraction

    • No length change occurs during contraction

    • Pro: quick, effective, cheap, good for rehab

    • Con: only works at one point in ROM

  • 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

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Fast Twitch vs. Slow Twitch but assisted by agonist contraction to pull further

  • 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

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Fast twitch (Type II) but assisted by agonist contraction to pull further

  • Fatigue

  • Anaerobic in nature

  • High force in short amount of time

  • Produce powerful movements

  • A vs. B

    Individual make-up

  • Muscles contain both types of fibers

  • Muscle functioning impacts ratios (postural vs. powerful movement)

  • Genetically determined

    Metabolic capabilities can change in response to training

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Physiological and Biomechanical Factors that Determine Levels of Muscular Strength

  • Hypertrophy vs. Atrophy

  • Size of muscle: function of diameter and number of fibers

  • Neuromuscular efficiency

  • Biomechanical factors

  • Overtraining (psychologically, physiologically)

  • Reversibility

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Explanation for Muscle Hypertrophy Levels of Muscular Strength

  • Three theories of muscle hypertrophy:

    • Increase in number of fibers

    • Infusion of blood - transient hypertrophy

    • Increase in protein myofilament number and size

      • PROVEN

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  • Improved Neuromuscular Efficiency Levels of Muscular Strength

    • Early gains minus hypertrophy

    • Enhanced efficiency due to enhanced neural function

  • Other enhancements due to training

    • Increased non-contractile tissue strength, bone mineral content, aerobic/anaerobic enzymes, enhanced oxygen uptake

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Techniques of Resistance Training Levels of Muscular Strength

  • Progressive resistance exercise

  • 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

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Overload Principle Levels of Muscular Strength

  • Activity must be increased and upgraded constantly in order to gain a higher response from the body

  • Work at or near maximum capacity

  • Applicable to conditioning and training

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  • Isometric Exercises Levels of Muscular Strength

    • Contraction where muscle length remains unchanged

    • 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

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Progressive Resistance Exercises (Isotonic training) Levels of Muscular Strength

  • Shortening/lengthening

  • Concentric vs. Eccentric

  • 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

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  • 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

    • Motion restrictions, levels of muscular control required, amount of weight that can be lifted

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  • When training should be able to perform 3 sets of 6-8 repetitions

  • Increases should occur in increments of 10%

  • 1 RM can be utilized 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)

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Muscular Endurance vs. Strength repetitions

  • Training for endurance enhances strength and vice versa

  • Training for strength should involve lower repetitions at heavier weight

  • Training for endurance requires lower weight at 12-15 repetitions

  • Persons that possess greater strength also tend to exhibit greater muscular endurance

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Isokinetic Training repetitions

  • Muscle contraction at a constant velocity

  • Maximal and constant resistance throughout the full range of motion

  • Maximal effort = Maximal strength gains

  • Disadvantages

    • Cost

    • Need for maximal effort/motivation

  • Rehabilitation

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Circuit Training repetitions

  • Combination of exercise stations

  • 8 - 12 stations, 3 times through

  • Design for different training goals

    • Flexibility

    • Calisthenics

    • Aerobic exercise

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Calisthenic Strengthening Exercises repetitions

  • Free exercise

  • Isotonic training

  • Gravity’s involvement determines level of intensity

  • Full range of motion, may incorporate holding phase

  • Pull-ups, push-ups, back extensions, leg extensions

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Plyometric Exercise repetitions

  • Rapid stretch, eccentric contraction followed by a rapid concentric contraction to create a forceful explosive movement

  • Rate of stretch vs. magnitude

  • Jumps, bounds, medicine ball throws

  • Very technical training - skills must be learned with appropriate technique

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Training for the Female Athlete repetitions

  • Critical for female athlete

  • Significant hypertrophy is related to testosterone present within body

  • Remarkable gains are experienced initially due to enhanced nervous system and muscle interaction (efficiency-not muscle bulk)

  • Following initial gains, plateau occurs, with females

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  • Males tend to continue to increase strength with training repetitions

  • Critical difference is the ratio of strength to body fat

    • Females have reduced strength to body weight ratio due to higher percentage of body fat

    • Ratio can be enhanced through weight training and decrease in body fat percentage/increased lean weight

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Strength Training in Adolescents repetitions

  • If properly supervised young athletes can improve strength, power, endurance, balance and proprioception

  • Develop a positive body image

  • Results in improved sports performance while preventing injuries

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Cardiorespiratory Endurance hypertrophy

  • Perform whole body activities for extended period of time

  • Performance vs. fatigue vs. injury

  • System’s four components

    • Heart

    • Lungs

    • Blood vessels

    • Blood

  • Improvements in endurance are the results of improvements in these 4 components

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  • Aerobic capacity = VO hypertrophy2max

  • Increases in intensity require higher levels of oxygen consumption

  • Inherit certain range of maximum aerobic capacity

  • More active = higher capacity

  • Average value = 45-60 ml O2/min/kg

  • Three factors impact capacity

    • External respiration

    • Ventilatory process

    • Gas transportation (most limiting factor)

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Impact on Heart hypertrophy

  • Main pumping mechanism

  • Increase exercise = increased oxygen requirement=increase heart pumping

  • Heart must gradually adapt to imposed demands but will reach steady state after 2-3 minutes of training

  • Heart able to adapt through increases in heart rate and stroke volume which will enhance overall cardiac output

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  • A training effect results with regard to cardiac output. hypertrophy

  • Over the course of training, at a given intensity, stroke volume increases while heart rate is reduced

  • Cardiac functioning becomes more efficient (hypertrophy of heart occurs)

    Cardiac Output = Increased Stroke Volume x Decreased Heart Rate

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Energy Systems hypertrophy

  • Various sports entail different energy demands

  • Long distance running and swimming vs. sprinting and jumping

  • ATP: Immediate Energy Source

    • ATP produced from glucose breakdown

    • Glucose from blood or glycogen (muscle or liver) broken down to glucose converted to ATP

    • Fat becomes utilized when glycogen stores depleted

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  • Aerobic versus Anaerobic Metabolism hypertrophy

    • Both generate ATP

    • Initial ATP production from glucose occurs in muscle (without oxygen = anaerobic)

    • Transition to glucose and fat oxidation (requiring oxygen = aerobic) to continue activity

    • Generally both systems occur to a degree simultaneously

    • Type of ATP production relative to intensity

      • Short burst (high intensity) = anaerobic

      • Long duration (sustained intensity) = aerobic

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Types of Training for Cardiorespiratory Endurance hypertrophy

  • Level of improvement will be determined by initial levels

  • Continuous

    • Mode (type of exercise) - must be aerobic in nature

    • Frequency (at least 3 times/week)

    • Duration (at least 20 minutes)

    • Intensity (must elevate heart rate to 70% of maximum)

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  • Interval training hypertrophy

    • Intermittent activities involving periods of intense work and active recovery

    • Must occur at 60-80% of maximal heart rate

    • Allows for higher intensity training at short intervals over an extended period of time

    • Most anaerobic sports require short burst which can be mimicked through interval training

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  • Fartlek training hypertrophy

    • Cross-country running that originated in Sweden

    • Speed play

    • Similar to interval training in the fact activity occurs over a specific period of time but pace and speed are not specified

    • Consists of varied terrain which incorporates varying degrees of hills

    • Dynamic form of training

    • Must elevate heart rate to minimal levels to be effective

    • Popular form of training in off-season

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  • Equipment for Endurance Training hypertrophy

    • Cost can vary from $2- $60,000

    • Jump rope to treadmill and computers

  • Fitness Assessments

    • Provides coaching and athletic training personnel with information relative to fitness and preparedness

    • Pre-testing and post-testing format should be utilized

    • Can assess all facets of training and conditioning with established tests and protocols

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Periodization in Training and Conditioning hypertrophy

  • Traditional seasons no longer exist for serious athletes

  • Periodization

    • Achieve peak performance

    • Decrease injuries and overtraining

    • Program that spans various seasons

    • Modify program relative to athlete’s needs

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Macrocycle hypertrophy

  • 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 (lasting weeks or months)

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Mesocycles hypertrophy

  • Transition period:

    • Follows last competition (early off-season)

    • Unstructured (escape rigors of training)

  • Preparatory period:

    • Off-season

    • Hypertropy/endurance phase (Low intensity with high volume)

      • Allows for development of endurance base

      • Lasts several weeks to 2 months

    • Strength Phase

    • Power Phase (High intensity/ pre-season)

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  • Preparatory period (continued) hypertrophy

    • Strength Phase

      • 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 (1-7 days)

      • Designed to ensure peak on days of competition

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Cross Training hypertrophy

  • 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