Injury Prevention and Rehabilitation in Sport

Ross Bennett

• Publisher: Crowood
• Year: 2015
• ISBN:
  9781847979582
• Topic: Education
• Subtopic: Physical Education

Injury Prevention and Rehabilitation in Sport examines the key factors at play in the reduction and prevention of injury to athletes at all levels of sport. The book combines the latest scientific research with a critical review of current literature and the author's own personal experience working in the field of strength and conditioning at elite level to explain why certain modalities should or should not be prescribed by strength and conditioning coaches. There are full colour sequenced photographs showing the correct techniques for a wide variety of essential strength exercises. Other topics covered include how to effectively manage recovery and avoid overtraining; techniques for range of movement and corrective exercise; the most effective methods for shoulder and trunk stability; the theory and practice of propioception and plyometrics and how they can improve performance; the different methods employed when working with female or maturing athletes and the physiological impact of factors such as sleep patterns, travel, climate and illness on performance. The book concludes with a series of case studies that illustrate how to put theory into practice. Fully illustrated with 110 colour sequenced photographs and diagrams.

1	THE IMPORTANCE OF MAXIMAL STRENGTH

I t is an often neglected consideration in strength and conditioning that a well-constructed strength programme can act as a key factor in injury prevention as well as a tool for performance enhancement. Increasing the strength of key musculature and connective structures causes an increase in their integrity and robustness. This in turn enables larger acute forces or greater volume and an increasing training stimulus to be applied without a potential breakdown. Furthermore, depending on the anatomical region of strength increase, this will elicit injury prevention benefits by increasing the stability of a joint. For example, strengthening the hamstrings will directly result in increased stability of the knee joint, thus illustrating the important role the hamstrings play in stabilizing the knee (Olsen et al., 2005). Therefore, stronger hamstrings in particular will in turn reduce direct hamstring injuries such as tears, and consequently knee injuries, especially reducing injuries involved in rotation of the knee. (The importance of posterior chain strength and benefits will be explained in greater detail in a later section of this chapter.)

It may seem that this chapter is placed out of order in injury prevention programme design, as there are essential components of reducing injury that might be prescribed prior to strength training. For example, an athlete’s ROM (range of movement) and stability around particular joints could be a focus prior to heavier strength training, and a later chapter within this book will specifically discuss the importance of corrective exercise to the athlete. However, this chapter was selected to appear first, as I believe (particularly in the sport in which I work – football) maximal strength is often neglected and misunderstood, including the benefits it can have in reducing injury rates.

Many practitioners within the field of strength and conditioning are over-cautious when applying strength training programmes to athletes, either because they are concerned for their safety, or they are worried that it might create a physiological adaptation of hypertrophy that is deemed detrimental to athletic performance. To combat this, a strength development programme is given in this chapter, which enables a modified long-term athletic development (LTAD) programme to ensure a safe and steady progression to increased strength. Guidelines are given in this chapter to create strength adaptation without necessarily causing an increase in any unwanted hypertrophy.

A progression/continuum for strength development is given below. Note that coaches and sports scientists will not always have access to athletes as young as nine, so the following steps can be applied and adapted to athletes at any age. LTAD is examined in much greater detail in Chapter 8 (Maturing and Youth Athletes).

STAGE 1 (AGE 9–12): INTRODUCTION TO FUNDAMENTAL MOVEMENT PATTERNS

Create mobility drills that will ensure an athlete is able to generate full ROM. Body weight exercises are essential; ensure that movement occurs with no dysfunction or compensation. If you have access to players at this age group, then this stage is essential and conforms to the high flexibility and ROM an athlete has at this age (this naturally decreases as chronological age increases). The aim is to provide a wide range of exercises, to broaden an athlete’s skills set and to challenge them from a motor skill development point of view.

STAGE 2 (AGE 13–14): INCREASING MOTOR CONTROL

Still prescribing a combination of bodyweight and loaded exercises, exercise prescription should be restricted to those that will be more essential for functional strength development, although variation at times is essential for psychological/physiological benefit. A list of key exercises and the benefit of each one will also be included in this section. We can now start to increase the intensity and volume a bit more, but ensure the movement is under good control. Take extra care when working with this age group: as they go through greatest peak height velocity phases (growth spurt) some athletes can experience movement issues or difficulties. This phase should also start to look at individuals who need specific ROM or stability work. Commonly, supplementary glute strength and ankle ROM training is required to enhance movement quality.

STAGE 3 (AGE 15–16): HIGH VOLUME LOAD TIME (WORK CAPACITY STRENGTH)

After previous technical phases and motor control work, it’s time to increase the intensity in the gym. Based on previous experience, keeping volume relatively high post growth spurt and gradually increasing intensity seems to bridge the gap between motor control phases and general maximal strength work. Remember: if the load is higher than what the athlete is used to or has lifted before, an overload is created, which is essential for adaptation. If you are fortunate enough to be working with your athletes from a younger age, at this stage of their development there is often a natural increase in circulating hormones such as testosterone to assist further neurological gains and is thus an appropriate time to apply strength work. However, all athletes develop and mature at different times, and some may still have late growth issues as they go though PHV phases. Athletes go through their optimal strength/weight gaining phase approximately 18 months after PHV. It is therefore the responsibility of the coach and practitioner to assess the appropriate timing for the implementation of this phase.

STAGE 4 (AGE 17+): TRADITIONAL MAXIMAL STRENGTH PHASE

After the three previous phases, your athlete should now be technically and physically competent, and can be prescribed a well-constructed traditional periodized strength programme to maximize their strength over a period of time. A guide to recommended repetitions is given; there will also be a section on periodization later in this textbook to demonstrate the importance of volume and intensity and how it should be fluctuated.

It is essential to note that if you are working with an athlete that you haven’t had from a young age, the stage length does not have to be exactly as suggested above, where the ages are given in brackets. It is up to the coach to determine when the athlete should move into the next phase. Moreover, players develop at a vast range of different rates: the age ranges are given merely as a guide.

The table provides recommendations within each phase of strength development; it provides a guideline based on my experience and scientific research (see for example Baechle and Earle, 2000; Siff, 2003). Certain variables must be adjusted for individuals, taking into account other forms of training load they are undertaking. For example, you may have a scheduled work capacity phase and session to do with a particular athlete or team. An aspect to consider within this framework is the differences between certain athletes, as some will be able to tolerate more load than others. Although we need to hit a certain threshold for adaptation, that threshold will depend on each athlete individually. Identifying this threshold is an important skill in its own right for a coach/practitioner to develop, to know your athlete well and what should be prescribed for them in order to get the balance right for getting your athletes stronger and more robust, but not acutely causing them to break down. The idea is to apply the minimal dose possible for adaptation, although over reaching techniques are required at times. Again, this depends upon a particular athlete’s genetic make-up and potential, in what is known in the scientific research as being a responder or non-responder to various stimuli (Davidsen et al., 2011). Unfortunately, the genetic make-up of athletes is out of anyone’s control, so it is once again up to the coach to ensure that maximum adaptation can be made with their athletes. Another thing to consider is the workload and schedule the athletes are going through beyond the strength and conditioning (S&C) programme. It may be that the S&C does not cause any injury concerns, but the overall load may contribute to overload injuries.

Strength development phase	Recommended sets	Recommended repetitions	Recommended recovery time
Fundamental movement patterns	Incorporate in games or warm-up drills	8–12	n/a
Motor control/intro Work capacity/high volume strength	2–4 2–5	6–12 6–10 (sub-maximal level)	30–90 seconds 15–45 seconds
Increasing maximal strength	3–6	2–5 (progressing to maximal lifts) 6–8 (functional hypertrophy)	2–4 minutes

Note that there is an extra repetition range in the strength section for functional hypertrophy, which could be used in certain aspects of the season or cycle. (Functional hypertrophy means there is an increase in muscle cross-sectional area that relates to a direct increase in force production.) My recommendation is that repetition range should never exceed this in a functional hypertrophy phase, otherwise the intensity and percentage of maximal load will have to decrease too much, eliciting a decrease in force production. It would also cause an increase in hypertrophy that is not functional, therefore producing size that would inhibit performance. In the earlier stages of strength development when motor control/work capacity is being performed, coaches do not need to worry about any unwanted hypertrophy as athletes are still learning motor skills and greater repetitions are potentially required (Stafford, 2005). However, there is definitely scope to prescribe higher repetition ranges to an athlete within an anatomical adaptation phase, or when the athlete is new to strength training. If done correctly it can also be implemented as a variation within a strength cycle to provide a two-week shock for the athlete and reduce the neurological stress. It can also complement a corrective exercise type programme, where a particular dysfunction is being fixed and then patterned into an integrated movement.

VOLUME VS. INTENSITY

There is a real debate in S&C literature and amongst practising coaches about whether a programme that is high-volume, high-intensity, or somewhere in between is the ideal prescription for optimal strength development; much depends on the coach’s personal philosophy and experience within the field. There is no doubt that the fluctuation of training load is imperative not only for strength adaptation but for recovery (Stone et al., 1999a; 1999b), although this periodized tool will be discussed in greater detail later on this textbook.

Furthermore, much depends on the type of sport, athlete and perception of high intensity/volume programmes. For example, there may be a need for greater strength volume throughout the week if strength is a greater priority in your sport. For example, a rugby player will have a number of consecutive sessions based on strength throughout the week; other team invasion sports such as football or hockey, although benefiting greatly from strength sessions, need to develop other physical qualities, so a lower volume of weekly and total strength work will therefore occur for these sports.

This book is not designed to specify how many strength sessions should be included in a particular sport or cycle phase, but instead to give careful consideration to the notion that there is more than one way of constructing and performing a well-implemented strength programme. The key exercises that follow provide an important stimulus for certain musculature and connective structures, and are necessary to optimize force production, essential for increasing strength and therefore reducing the potential for injury. Some of these exercises will be discussed in depth; others will be dealt with in general terms or listed within a key category.

Please note that although the exercises are prescribed with good scientific rationale, there will be cases where some athletes ma...