Unit 2 Chapter 7 - Prehabilitation and Preseason Conditioning.pptx

Upon completion of this chapter, the reader should be able to:
* Discuss how prehabilitation can decrease the chance of injury
* Explain how preseason conditioning helps the body adapt to the demands placed upon it
* Describe isometric, dynamic, and isokinetic exercise, and how they are used in a conditioning program
* Compare and contrast manual resistance training, circuit training, and special, individualized programs
* Describe the science behind progressive resistance exercise
* Explain the components of stretching and flexibility programs and how they relate to an overall fitness program
* Explain the benefits of cardiorespiratory conditioning
* Explain the importance of special individualized fitness programs
Key terms:
rehabilitation
prehabilitation
preseason conditioning
adaptation
hypertrophies
atrophies
progressive resistance exercise
overloaded
specificity
motor units
slow-twitch fibers
fast-twitch fibers


reversibility
isometric exercises
dynamic (isotonic) exercise
manual resistance training
isokinetic exercise
circuit training
stretching
flexibility
static stretching
ballistic stretching
proprioceptive neuromuscular facilitation (PNF)
cardiorespiratory conditioning

1. Chapter 7 Prehabilitation and Preseason Conditioning

2. Objectives Upon completion of this chapter, the reader should be able to: * Discuss how prehabilitation can decrease the chance of injury * Explain how preseason conditioning helps the body adapt to the demands placed upon it * Describe isometric, dynamic, and isokinetic exercise, and how they are used in a conditioning program * Compare and contrast manual resistance training, circuit training, and special, individualized programs * Describe the science behind progressive resistance exercise * Explain the components of stretching and flexibility programs and how they relate to an overall fitness program * Explain the benefits of cardiorespiratory conditioning * Explain the importance of special individualized fitness programs

3. Key Terms rehabilitation prehabilitation preseason conditioning adaptation hypertrophies atrophies progressive resistance exercise overloaded specificity motor units slow-twitch fibers fast-twitch fibers reversibility isometric exercises dynamic (isotonic) exercise manual resistance training isokinetic exercise circuit training stretching flexibility static stretching ballistic stretching proprioceptive neuromuscular facilitation (PNF) cardiorespiratory conditioning

4. 7-1 Prehabilitation Rehabilitation - meaning a programmed exercise program designed to return an athlete to fitness and competition after an injury has occurred. Prehabilitation attempts to prevent injuries before they occur, through a preventative management program. Addressing early on the concerns or deficits recognized by the athlete’s family physician or other sports medicine specialists prior to sports participation enables the athlete to participate with a greater chance of success and lower incidence of injury. Data: Each year in the United States, approximately 45.7 million children and teenagers participate in organized sports (Sports and Fitness Industry Association, 2016)). Children and adolescents are becoming more involved in sports at earlier ages and with higher levels of intensity. The Centers for Disease Control and Prevention estimates that one-half of all sports injuries in children are preventable with proper education and use of protective equipment.

5. 7-2 Preseason Conditioning The terms preseason conditioning and prehabilitation are similar, yet each has a slightly different focus. Preseason conditioning works on developing the athlete in the off-season. Athletes can work on overall conditioning as well as concentrating on specific weaknesses. A preseason conditioning program, beginning six to eight weeks prior to sports participation, allows the body to gradually adapt to the demands to be placed on it. Doing too much, too soon, at too high an intensity, denies the body to opportunity to adapt effectively and therefore increases the risk of injury. Sports medicine physicians, certified athletic trainers, and qualified youth coaches should prescribe a preseason conditioning program and provide athletes with information on the type, frequency, intensity, and duration of training. Sharing this information with parents can be helpful, as they can reinforce the importance of preseason conditioning at home.

6. Key Concept Prehabilitation decreases the chance of injury by addressing areas of concern or deficit identified before participation in a sporting event. A program can be implemented to strengthen and develop these areas, thus reducing the chance of injury during participation. Key Concept Preseason conditioning allows athletes to gradually build up to the level of activity that will be expected of them on the playing field. By starting slowly, the body is able to adjust to new demands. Once the body has accommodated, the athlete can increase the intensity of the conditioning. Thus, by working incrementally to adjust the body, the athlete prepares for the demands of the season.

7. 7-3 Strength Training Strength training is a highly adaptive process whereby the body changes in response to increased training loads. Adaptation is the whole purpose of strength training. Adaptation requires a systematic application of exercise stress. The stress should be sufficient to stimulate muscle fatigue, but not so severe that breakdown and injury occur. Periodization is the careful planning of specific performance goals spread out over a period of time , generally a year; whereas the exercise program can be tailored to meet specific objectives during preseason, in-season and postseason. Skeletal muscle is highly adaptable. If a muscle is worked beyond its normal limits, it adapts and becomes larger, or hypertrophies . In doing so, the muscle improves in strength, allowing it to accommodate an increased workload. The reverse is also true: If a muscle is worked less than normal, it atrophies , or becomes smaller, and therefore cannot accommodate the workload it once did. The purpose of progressive resistance exercise is to allow the body to adapt to the increased demands placed upon it by training. The nature of the muscles adapting must always be considered when designing the training program. Factors that determine the rate and type of strength gains include overload, specificity, reversibility, and individual differences.

8. 7-3a Overload Muscles increase in strength and size when they are forced to contract at tensions close to maximum. Muscles must be overloaded to improve strength and power. If consistent gains in strength are to occur, muscles must be overloaded at a progressively increased rate. Muscular tension must be attained at an adequate intensity and duration for optimal development of strength. Studies have found that the ideal number of repetitions is between four and eight. These repetitions should be done in multiple sets of three or more. Strength gains diminish when either fewer or greater numbers of repetitions are used. It is important to include proper rest intervals between sets. This allows the muscles to recover from exertion and prepare for the next work interval. The optimal period of rest between sets has not been scientifically determined.

9. 7-3b Specificity Muscles adapt specifically to the nature of the work performed= specificity . If the leg muscles are exercised, they hypertrophy, whereas the muscles of the shoulders remain the same. When muscles contract, they recruit different types of motor units to carry out the contraction. There are two different muscle fiber types (motor units). Each has different characteristics while contracting. Slow-twitch fibers are relatively fatigue-resistant; ecruited for low-intensity activities such as jogging fast-twitch fibers can contract more rapidly and forcefully, but also fatigue rapidly. for high-speed or high-intensity activities, such as sprinting or weight lifting

10. 7-3b Specificity cont… Increases in strength are very specific to the type of exercise, even when the same muscle groups are used. Specific motor units are recruited for specific tasks. If a person uses weight training to improve strength for another activity, the exercises should mimic the desired movements of that activity as closely as possible. Likewise, when one is attempting to increase strength after an injury or surgery, rehabilitation should include muscle movements that are as close as possible to those made in normal activities. Muscle fiber type appears to play an important role in determining success in some sports. Successful distance runners have a high proportion of slow-twitch muscles (the percentage of slow-twitch fibers is closely related to maximum oxygen consumption). Sprinters have a predominance of fast-twitch muscles. Several studies have shown that large numbers of fast-twitch fibers are a prerequisite for success in progressive resistance training. Not all sports have preferred fiber characteristics. For example, world-class shot-putters show surprisingly diverse muscle fiber composition. In these athletes, larger muscle fibers, rather than percent of fiber type, account for excellent performance. There are differences in the relative percentage of fast-twitch fibers in explosive-strength athletes. Having a high percentage of fast-twitch fibers is not necessarily critical for success. Many strength athletes have a higher fast-to-slow twitch fiber ratio than sedentary persons or endurance athletes. Individual differences in training intensity and technique can make up for deficiencies in the relative percentage of fast-twitch fibers in these athletes. Training programs designed to stimulate both strength and endurance have been found to interfere with gains in strength. Strength athletes may inhibit their ability to gain strength by participating in vigorous endurance activities. Muscles may be unable to adapt optimally to both forms of exercise.

11. 7-3c Reversibility Muscles will atrophy through disuse, immobilization, and starvation. Disuse leads to a decrease in strength and muscle mass, a process called reversibility . Fast-twitch and slow-twitch fibers do not atrophy at the same rate. If a joint is immobilized as a result of an injury, the slow-twitch fibers will atrophy faster. After immobilization, it is important to undertake a program of strength and endurance exercises that allow the atrophied muscle fibers to regain their pre-injury strength.

12. 7-3d Individual Differences As with other forms of exercise, people vary in the rate at which they gain strength. Some of these differences can be attributed to the relative pre-dominance of fast- and slow-twitch motor units in muscles. Usually, endurance athletes have more slow-twitch fibers ( Figure 7–1a ) in their active muscles. Strength athletes have more fast-twitch fibers ( Figure 7–1b ). Intense, progressive, resistance training mainly enlarges fast-twitch fibers. People who have more fast-twitch fibers will tend to gain strength faster than those who do not. Fast-twitch fibers tend to be stronger than other fiber types, so people who have more of them tend to be stronger and have greater potential for strength gains. Several studies have shown that fiber composition is genetically determined (Fahey, 1998). Genetics is not the sole determinant of individual differences in strength, though genetics exert a strong influence on the ability to gain strength. A good training program can make up for genetic deficiencies.

13. Key Concept Progressive resistance training allows the body to adapt to the demands placed on it through training. Four factors determine the rate and type of strength gain: Overload, the overwork of muscles at tensions close to their maximum. Specificity, the targeting of a particular muscle group to improve and gain strength in that muscle group alone. Reversibility, the characteristic of muscles that causes decreases in strength and mass with disuse. Individual differences, which account for an individual’s ability to strengthen certain muscles at a particular rate. Genetics have a strong influence on strength gain.

14. Figure 7–1A Endurance athletes have more slow-twitch fibers in their active muscles. Figure 7–1B Strength athletes have more fast-twitch fibers.

15. 7-4 Strength Training Exercises A variety of exercises and techniques can be used to build up strength based on the principles of progressive resistance training. The athlete should work with the certified athletic trainer or a personal trainer to determine the goals of the strength training program and the exercises and techniques that will best meet those goals. Fun Facts Strength training is not just for youngsters and athletes. Seniors involved in strength training age better and stay healthier. Seniors who strength-train are less likely to suffer serious injuries when they fall, and to recover from injuries sooner than seniors who are not as physically active.

16. 7-4a Isometric Exercise During isometric exercises , muscles contract but there is no motion in the affected joints. The muscle fibers maintain a constant length throughout the entire contraction. Isometric exercises are usually performed against an immovable surface or object, such as pressing the hand against the wall. The muscles of the arm are contracting, but the wall is not reacting or moving as a result of the physical effort. Isometric exercise is often used for rehabilitation because the exact area of muscle weakness can be isolated and strengthening administered at the proper joint angle. This kind of training provides a relatively quick, convenient method for overloading and strengthening muscles without the need for special equipment and with little chance of injury. Static exercise improves strength but also increases blood pressure quickly. People with circulation problems and high blood pressure should avoid strenuous isometric exercises.

17. (Not in book)- Isotonic Exercises Isotonic exercises, like squats, involve activating muscles while moving the joints and applying a constant amount of weight. Compared to Isometric exercises, like planks, involve activating muscles with no movement. Two types of isotonic exercise: Concentric (making angle smaller) Eccentric (making angle bigger)

18. 7-4b Dynamic/Isotonic Exercise Dynamic (isotonic) exercise differs from isometric exercise in that there is movement of the joint during the muscle contraction. Weight training with dumbbells and barbells is a classic example. As the weight is lifted throughout the range of motion, the muscle shortens and lengthens ( Figure 7–2A and B ). Calisthenics, including chin-ups, push-ups, and sit-ups, are isotonic exercises that use body weight as the resistance force. Blood circulation, strength, and endurance are improved by these continuous movements. Another form of dynamic exercise, plyometrics, involves rapid stretching and contracting of the muscle, such as jumping or rebounding, to increase muscle power. Figure 7–2A–B Dynamic exercise works muscle groups through the range of motion. → Not in book: Concentric vs. eccentric

19. Manual Resistance Training Manual resistance training is a form of dynamic exercise that is accomplished with a training partner. The training partner assists by adding resistance to the lift as the lifter works the muscles through the full range of motion ( Figure 7–3 ). The training partner, or spotter, adds enough resistance to allow the lifter to fatigue the muscles, then releases enough resistance so that the lift can be completed. Advantages of manual resistance training are: It requires minimal equipment. The spotter can help control technique. Workouts can be completed in less than 30 minutes. Training can occur anywhere. The disadvantages are that a spotter is required, and both lifter and spotter must be trained to keep the exercise safe and effective.

20. Key Concept Manual resistance training is done with a partner. The partner adds resistance to a lift, allowing the muscles to fatigue, and then releases enough resistance so the lifter can finish the range of motion. Circuit training uses 6 to 10 strength exercises, completed one after another and performed for a specified number of repetitions or time period. Athletes may choose to work with a personal trainer to develop an individualized training program that allows them to meet specific goals. A variety of exercise types can be used. These techniques can be used alone or in conjunction. The goals of the athlete determine the types of exercises needed to meet those goals.

21. 7-4c Isokinetic Exercise Isokinetic exercise uses machines that control the speed of contraction within the range of motion. isokinetic exercise attempts to combine the best features of isometrics and weight training. It provides muscular overload at a constant, preset speed while the muscle mobilizes its force through the full range of motion. For example, when an isokinetic stationary bicycle is set at 90 revolutions per minute, no matter how hard and fast the workout the isokinetic properties of the bicycle will allow the cyclist to complete only 90 revolutions per minute. Machines such as the Cybex and Biodex provide isokinetic results; they are generally used by physical therapists and not readily available to the general population. Key Concept In isometric exercise, the muscles maintain a constant length throughout the contraction. This type of exercise targets an exact area of weakness due to an injury. In dynamic isotonic or isotonic exercise, there is movement of the joint during muscle contraction. This type of exercise helps improve blood circulation, strength, and endurance. Isokinetic exercises use machines to control the speed of the contraction within a range of motion. These exercises provide muscle overload at a constant, preset speed and full range of motion.

22. 7-4d Circuit Training Circuit training , an excellent way to improve strength and stamina, utilizes 6 to 10 strength exercises that are completed as a circuit, one exercise after another ( Figure 7–4 ). Each exercise on the circuit is performed for a specified number of repetitions or a specific period of time before moving on to the next exercise. Each exercise is separated by a brief, timed rest interval. If more than one circuit is to be completed, the circuits will be separated by a longer rest period. The total number of circuits performed varies depending on the athlete’s training level. Another type of exercise similar to circuit training is interval training , which is an aerobic-based workout. You choose your aerobic exercise and add intervals of increased speed or resistance. For example, during a brisk walk, add a 1- to 2-minute sprint, then return to your brisk walking for an equal amount of time. In Farlek training the athlete runs fast for a period of time, slows down for a period of time, and speeds up again. For beginners it can be walking, jogging, and walking again. As endurance and cardiovascular conditioning improves, the intervals between the speed workout and resting period increase. Eventually the athlete would strive toward continuous training , where the rest interval is eliminated.

23. 7-4e Stretching and Flexibility Stretching means moving the joints beyond the normal range of motion ( Figure 7–5 ). Flexibility is the ability of a joint to move freely through its full range of motion ( Figure 7–6 ). Stretching is useful for both injury prevention and injury treatment. One of the benefits of stretching is that the athlete increases muscle length. This leads to an increased range of movement—meaning the limbs and joints can move further before they suffer an injury. Before doing stretching exercises, the athlete should warm up. Warming up is an essential component of stretching. Warming up increases the heart rate, blood pressure, and respiratory rate, which in turn increases the delivery of oxygen and nutrients to the muscles. This allows the muscles to prepare for strenuous activity. For most activities, the warm up period should be non strenuous but still cause the athlete to begin to perspire. It is known that: An active person tends to be more flexible than an inactive person. Females tend to be more flexible than males. Older people tend to be less flexible than younger people. Flexibility is as important as muscular strength and endurance. To achieve flexibility in a joint, the surrounding muscles must be stretched. There are three basic types of stretching: static, ballistic, and proprioceptive neuromuscular facilitation. Figure 7–5 The athlete is able to increase muscle length as a result of stretching.

24. 7-4f Static Stretching Static stretching is a gradual stretching of a muscle through the muscle’s entire range of motion. This proceeds slowly, until a pulling sensation occurs. This position should be held for 20 to 30 seconds. Stretching should not be painful; if it is, injury may occur. 7-4g Ballistic Stretching Ballistic stretching was popular a couple of decades ago. This method of stretching involves a rhythmical, bouncing action. Ballistic stretching was done 10 to 15 times, stretching the muscles a little further each time. This method has fallen out of favor as a result of an increased incidence of injury. It was found that the bouncing action activates the stretch reflex, resulting in small muscle tears, soreness, and sometimes injury. Key Concept Stretching and flexibility decrease the risk of injury. Stretching allows the athlete to actually lengthen the muscles, resulting in an increased range of motion. Therefore, joints and limbs can move further before they suffer an injury.

25. 7-4h Proprioceptive Neuromuscular Facilitation Proprioceptive neuromuscular facilitation (PNF) involves a combination of contraction and relaxation of the muscles. Proprioceptive refers to stimuli originating in muscles, tendons, and other internal tissues. Neuromuscular pertains to muscles and nerves. Facilitation is the hastening or enhancement of any natural process. This method requires an initial isometric contraction against maximum resistance at the end of the range of motion. This position is typically held for six seconds, followed by relaxation and a passive stretch. This is repeated several times. PNF is designed to be done with a qualified assistant.

26. 7-5 Cardiorespiratory Conditioning Cardiorespiratory conditioning , also known as aerobic or endurance training , refers to activities that put an increased demand on the lungs, heart, and other body systems. Aerobic training can improve performance in all types of sports and activities. Cardiorespiratory conditioning uses large muscle groups for activities such as walking, jogging, swimming, cross-country skiing, or cycling. Team sports such as soccer and water polo are excellent for aerobic conditioning. The goal of aerobic conditioning is to train the heart and other muscles to use oxygen more efficiently. Improved efficiency of the cardiovascular system allows the person to exercise for longer periods of time, therefore improving the overall fitness level. Muscular endurance is the ability of muscles to sustain high-intensity, aerobic exercise. An example is a weightlifter who has trained to complete 20 bench presses at 150 pounds in 60 seconds. Cardiorespiratory endurance relates to the whole body’s ability to sustain prolonged, rhythmical exercise. An example of this is a cross-country runner completing a five-mile run. The body adapts to prolonged cardiovascular exercise in many different ways. The heart increases in size, thereby increasing pumping volume. Because the size of the heart increases (as does any muscle with increased exercise), the resting heart rate decreases. This also contributes to a decrease in blood pressure. The lungs, too, adapt to aerobic conditioning. A well-conditioned athlete is able to increase the amount of air exchanged (lung volume), providing more efficient oxygen transfer to the blood. This allows the athlete to work, condition, and compete at a higher level. Cardiorespiratory conditioning has also been proven to increase resting metabolism.

27. 7-5a Cardiovascular Testing Several tests are used to quantify cardiovascular fitness, including the VO2 max, Harvard Step Test, Twelve-Minute Run Test, and the Borg Scale. The VO2 max test measures the volume of oxygen used during one minute of maximum exertion. The data gained helps determine the potential for endurance athletes. The Harvard Step Test helps to measure a person’s aerobic fitness. The test utilizes a step 20 inches high. The person steps up and down at a rate of 30 completed steps per minute, for 5 minutes or until exhaustion. A rating system evaluates overall cardiovascular fitness. In the Twelve-Minute Run Test the person runs or walks as far as possible in 12 minutes. An increase in the distance covered indicates an increased level of fitness. The Borg Scale utilizes a simple method of rating perceived exertion (RPE). This scale allows coaches and athletic trainers to gauge an athlete’s intensity in training and competition.

28. Key Concept Cardiorespiratory training conditions the heart and other muscles to use oxygen more efficiently. This allows the athlete to perform for longer periods of time. Additional benefits of cardiovascular conditioning include: Reduced fatigue Improved self-confidence Improved muscle strength and tone Increased endurance Reduced stress levels Reduced body fat Improved overall physical and mental health An aerobic conditioning program starts with a checkup by the family doctor, who assesses the individual’s overall health to assure that there are no physical limitations on beginning a conditioning program.

29. 7-6 Special, Individualized Programs Athletes who desire personalized assistance with their training program can contact a variety of individuals or organizations. The cost of a personal trainer depends on the type of program desired and the amount of time devoted to personalized instruction. Personal trainers can assist in strength training, cardiovascular fitness, speed, and endurance work, as well as help with body composition. Personal trainers should have the proven knowledge and expertise to set up a personal training program, or be certified by one of the following associations: The National Federation of Professional Trainers (NFPT) National Strength and Conditioning Association The International Sport Sciences Association (ISSA) The American College of Sports Medicine (ACSM) Personal trainers can set up programs to meet an athlete’s objectives in a safe, controlled manner ( Figure 7–7 ). Referrals are very important. Just because a person has a certification does not mean that he or she is the best choice. The athlete should “comparison shop” to find a personal trainer to fit his or her needs. Certified athletic trainers are allied health professionals with considerable knowledge of anatomy and physiology. They get involved in setting up personalized programs for athletes and are an excellent resource for training needs. Certified athletic trainers can be found at many high schools and most colleges and universities.

30. Chapter Review 7-7a Conclusion Trying to prevent injuries before they occur is known as prehabilitation. Personalized programs designed to address the total body, as well as sport-specific needs, are an integral component of the total athletic fitness program. There are many different ways to achieve fitness. The use of isometric, dynamic, and isokinetic exercises allows the athlete to develop a program tailored to fit his or her needs. Stretching and flexibility are important components of fitness. A well-thought-out stretching and flexibility program helps with injury prevention and treatment.

31. Chapter Review 7-7b Review Questions How can prehabilitation reduce the chance of injury once the season begins?Describe the elements of a well-rounded preseason conditioning program. Give three examples of isometric, dynamic, and isokinetic exercise. What is the importance of having a personal trainer help you achieve your conditioning goals? explain the science of progressive resistance exercise. Stretching and flexibility exercises are important components to a fitness program. Why? Explain the differences between static, ballistic, and PNF stretching. Describe the benefits of cardiorespiratory training.