by NSCA's Guide to Program Design
Kinetic Select May 2017
The following is an exclusive excerpt from the book NSCA's Guide to Program Design, published by Human Kinetics. All text and images provided by Human Kinetics.
Regardless of the sport, a cascade of events often eventually leads to injuries (see Figure 1.4). For example, for wrestlers, reducing fatigue or learning to better tolerate the fatigue processes during practice and competition is the easiest way to prevent injury (29,36,37). By understanding the means by which athletes encounter risk, strength and conditioning professionals can integrate exercise programs that may offset one of the steps toward injuries (e.g., short rest circuits for wrestlers help them develop buffering capacities to offset the decreases in pH that are related to fatigue).
When determining how injury prevention fits within the needs analysis of a sport, strength and conditioning professionals must ask the following questions. First, how likely is an injury to occur in the sport? Second, what are the common injury sites and how are these injuries most likely to occur? Third, which athletes are most prone to these risks for injury? Fourth, how can an exercise program be developed that will diminish these risks? This is where strength and conditioning professionals can work with athletic trainers and team physicians to get a handle on each athlete’s injury or medical status and to integrate a training program for injury prevention.
The role of prevention within athletics is to design programs that address the need for reducing the risk of injury during competition. This is truly a team approach. It needs to combine the skills and knowledge of the team physician, the sports medical staff (i.e., athletic trainer and physical therapists), the strength and conditioning professional, and the sport coaching staff. Within this team approach, the overall needs analysis should focus on the general concept of what an injury is and how it occurs for a particular athlete, all the while addressing the following questions as they relate to that specific person:
• How is the athlete predisposed to injury within the sport?
• Is this athlete at greater risk based on a predisposition to injury?
• When will injuries most likely occur during the athletic event?
• Is the athlete recovering from an acute or chronic injury that can affect athletic performance?
Biomechanical observations show where the athlete is most at risk for injury, based on the demands of the sport. They will also demonstrate how to counteract the risk of injury through strength training. Strength and conditioning professionals must keep in mind that although different sports may have similar injury profiles, each sport has different demands that change the required training stimuli athletes need to encounter during training to decrease the risk for injury. Table 1.3 shows some common injuries by sport and position.
This part of the analysis should include a careful examination of the individual athlete’s injury and training history. Does the athlete reflect or deviate from the expectations of the sport in terms of past injuries? Some athletes are more or less prone to injury than others. In addition, evidence-based predictions of injury that use testing or profile parameters (e.g., body fat, exercise performances, core strength) are an emerging trend in athletic training that should be discussed with the athletic trainer and included in a needs analysis.
The strength and conditioning professional and athlete should also use the injury-prevention portion of the needs analysis to develop testing methods for aspects of sports performance that are not normally addressed in other phases. This additional portion should examine passive, static, and dynamic ranges of motion that the athlete is able to attain in many positions. Such analysis can be done by having the athlete perform various exercise-related movements while the strength and conditioning professional notes a deficit in the athlete’s ability to attain the desired range of motion.
Additionally, the strength and conditioning professional should take time to analyze the athlete’s movements during training in the weight room. This will provide insight on the athlete’s movement patterns, both statically and dynamically. The strength and conditioning professional will then be able to prescribe the exercises that will best address deficits in the desired muscle action, posture, or ROM (2).
When the risk of injury within a sport is combined with its biomechanical analysis, this information allows strength and conditioning professionals to set definable risks of injury based on the athletic position within a sport (2). For example, baseball pitchers are typically at a greater risk for elbow and shoulder injuries (primarily due to overuse) than first basemen. The relationship between gender and the risk of injury has left room for debate (4, 5, 28). However, trends for gender difference in injury rates within a sport do exist. Using the type of injuries that occur based on gender, sport, and position played, exercise protocols can be implemented to minimize the risk of properly periodized training programs.
With the advent of pretesting and training preparation for athletes, many strength and conditioning professionals have been pushed outside of their realm of expertise. They may need to work with members of a sports medicine team (e.g., team physician, athletic trainers, and physical therapists) to integrate measures that might allow them to better manage the chance of injury for each athlete by using evidence-based medical practices for identifying risk. As previously noted, this is an emerging science within athletic medicine. Strength and conditioning professionals should use this information to enhance the adaptations of each athlete at risk by incorporating exercises into the program to achieve higher adaptations (e.g., improved core strength, improved upper back strength, improved body composition, and so on) (10). This will provide the prehabilitation effect often referred to in the sports medicine community (30).
By using this information, any strength and conditioning professional can use a needs analysis to establish an injury-prevention program that will ultimately improve the strength and endurance of athletes’ musculoskeletal and cardiorespiratory systems. This approach will also prevent fatigue and injury within the body.
Athletes recovering from an existing injury may require the manipulation of training stimuli in multiple directions within a single program (21,23). For example, the program may be able to make athletes bigger, faster, and stronger, despite their inability to perform full squats due to a prior knee or ankle injury. Recovery from injury requires making adjustments in the training regimen that will allow healing from the tissue trauma. As previously stated, in this situation, sport coaches need to use the sports medicine team (team physician, athletic trainers, physical therapists, and the strength and conditioning professional) to appropriately recognize and apply the training stimulus that the athlete will need to both recover from the injury and to improve performance (21,23,35).
Strength and conditioning professionals must examine both the training history and the injury profile of each athlete. This examination should involve input from all members of the sports medicine team who are involved with the injury-prevention portion of the program. Furthermore, by knowing the training history and injury profile, the strength and conditioning professional can adjust exercises, as previously mentioned with the squatting example, so that the athlete can still participate in training without causing further stress to the body (25).
Developed by the National Strength and Conditioning Association (NSCA), NSCA's Guide to Program Design offers strength and conditioning professionals a scientific basis for developing training programs for specific athletes at specific times of year. The book is available in bookstores everywhere, as well as online at the NSCA Store.