Copyright Protected Property of Dr. Gabriel
Brooks 2016. Do not use or reproduce
without express written permission.
June 11 , 2016
Disclosure
The Young Athlete:
Injury Prevention Training
&
Exercise Prescription For Performance
Enhancement
UpToDate : author royalties
Gabriel Brooks, PT, DPT, SCS, MTC
June 11 , 2016
NEXT Conference and Exposition
Nashville, Tennessee, USA
Copyright Protected Property of Dr. Gabriel Brooks 2016. Do not use or reproduce
without express written permission.
1
Copyright Protected Property of Dr. Gabriel Brooks 2016. Do not use or reproduce
without express written permission.
2
Outline
Session Learning Objectives
1. Identify practical, screening tools to determine an
athletes readiness to play
• Screen Athletes
• Select Training Activities
• Strategically Manage The Athlete
2. Select the most appropriate training activities to meet
athletes’ goals based on age, physiology, and sport.
3. Provide best practice recommendations for managing the
young athlete across the continuum of care.
Copyright Protected Property of Dr. Gabriel Brooks 2016. Do not use or reproduce
without express written permission.
3
Copyright Protected Property of Dr. Gabriel Brooks 2016. Do not use or reproduce
without express written permission.
4
How to vote via the web or text messaging
Your Opinion Counts:
Live Audience Voting with Poll
Everywhere
from the web ,enter the address below; no log in needed. To vote via text
message , txt the word “Gabrielbrook623” to 37607 to join the session. You only
have to join the session once then you can vote for your favorite choice in each
poll
From any browser
From a text message
Pollev.com/gabrielbrook623
During the session you can participate in live
audience polls by using your web browser or
SMS text from your phone. Its easy and fun.
37607
The next slides will show you how to join the
session so you can vote.
Copyright Protected Property of Dr. Gabriel Brooks 2016. Do not use or reproduce
without express written permission.
APTA NEXT
Gabrielbrook623
then enter your response
5
Copyright Protected Property of Dr. Gabriel Brooks 2016. Do not use or reproduce
without express written permission.
6
1
Copyright Protected Property of Dr. Gabriel
Brooks 2016. Do not use or reproduce
without express written permission.
June 11 , 2016
Practice Poll:
What is your primary area of practice ?
From a text message
•
Sports/Ortho-A
•
Ped’s-B
•
Neuro-C
•
Generalist-D
37607
Remember to Press Send.
•
A
That’s It! You voted. Now lets see the results…
Copyright Protected Property of Dr. Gabriel Brooks 2016. Do not use or reproduce
without express written permission.
Self Assessment Scenario
8
VOTE:
VIA WEB AT
You are hired as a consultant to the public school
district to design a strength training program that is
safe and effective for improving performance and
reducing injury rates in their athletes.
POLLEV.COM/GABRIELBROOK623
OR
TXT YOUR ANSWER TO 37607
How will you explain the Program Principles to the
strength training staff?
Copyright Protected Property of Dr. Gabriel Brooks 2016. Do not use or reproduce
without express written permission.
Copyright Protected Property of Dr. Gabriel Brooks 2016. Do not use or reproduce
without express written permission.
7
Copyright Protected Property of Dr. Gabriel Brooks 2016. Do not use or reproduce
without express written permission.
9
10
Pediatric Considerations for
Resistance Training
•
•
•
•
•
•
•
Copyright Protected Property of Dr. Gabriel Brooks 2016. Do
not use or reproduce without express written permission.
APTA NEXT
11
Greater fatigability versus adults [1]
Greater variability of motor patterns (3)
Greater joint mobility; decreased muscle extensibility
Shorter attention span>> Plan More Activities
Require even more supervision than adults
Less likely to adhere to HEP regimens (neurodevelopmental)
Concrete operational [4]
Copyright Protected Property of Dr. Gabriel Brooks 2016. Do not use or reproduce
without express written permission.
12
2
Copyright Protected Property of Dr. Gabriel
Brooks 2016. Do not use or reproduce
without express written permission.
June 11 , 2016
Is Strength Training Safe for
Children?
•
Total Exercise Dose
•
Developing musculoskeletal systems
•
Maturity
•
Sufficient Recovery
•
Match the task to the athlete (capacity: demand)
SCREENING
Copyright Protected Property of Dr. Gabriel Brooks 2016. Do not use or reproduce
without express written permission.
14
Define the Pathway
Pre-program data
collection
Y balance Scores
Isokinetics
FMS score >14
Drop Jump
• PSE/PPE vs.. Functional Screening
• Purpose of screening
Athlete pre-tests
Letafatkar, A, Hadadnezhad, M, Shojaedin, S, Mohamadi, E. Relationship between functional movement
screening and history of injury. The International Journal of Sports Physical Therapy | Volume 9, Number 1 |
February 2014 | Page 21
Sanders, B, Blackburn, T, Boucher, B. Preparticipation Screening, the sports physical therapy perspective. The
International Journal of Sports Physical Therapy | Volume 8, Number 2 | April 2013 | Page 180
Copyright Protected Property of Dr. Gabriel Brooks 2016. Do not use or reproduce
without express written permission.
15
Screening Summary
APTA NEXT
Post-program
data collection
Y balance Scores
fail
Isokinetics fail
FMS Score <14
Drop Jump
Remediate Low
Score Sections.
Return /Follow
up testing.
Copyright Protected Property of Dr. Gabriel Brooks 2016. Do not use or reproduce
without express written permission.
16
AAP Position on Pediatric
Strength Training
• Optimal Performance is the result of optimal
training; Optimal training depends on proper
screening.
• Risk Reduction training begins with screening
• Assume Nothing, Test before training
Copyright Protected Property of Dr. Gabriel Brooks 2016. Do not use or reproduce
without express written permission.
Begin Prevention
Training
17
Copyright Protected Property of Dr. Gabriel Brooks 2016. Do not use or reproduce
without express written permission.
18
3
Copyright Protected Property of Dr. Gabriel
Brooks 2016. Do not use or reproduce
without express written permission.
June 11 , 2016
AAP Recommendations for
Pediatric Strength Training
Proper Supervision is Defined
An instructor-to-student ratio no more than 1:10 and an approved
PEDIATRIC SPECIFIC strength-training certification (* ACSM,
ACE preferred)
•Benefits (CV, bone mass, lean mass, DM, mental health)
•Appropriate *, properly supervised, strength-training programs have no
apparent adverse effect on linear growth, growth plates, or the cardiovascular
system
•
•
•
•
•Risk populations-HCM, uncontrolled seizures
•Patient friendly advice from AAP on strength training in children
www.aap.org/family/sportsshorts12.pdf
Teach Form first
Then Endurance
Then Strength
Then Power
From Pediatrics Vol. 121 No. 4 April 1, 2008 pp. 835 -840
Copyright Protected Property of Dr. Gabriel Brooks 2016. Do not use or reproduce
without express written permission.
19
20
AAP Recommendations on Strength
Training in Pediatrics
Emphasis on Form and Quality of Effort
• Demonstrate what it should
Look Like
-Kids are concrete; need to
see it done
• Explain what it should feel
like (and where)
• Slow vs.. Fast reps; control
the weight
• Contrasting may help
(smooth vs. jerky)
Copyright Protected Property of Dr. Gabriel Brooks 2016. Do not use or reproduce
without express written permission.
Copyright Protected Property of Dr. Gabriel Brooks 2016. Do not use or reproduce
without express written permission.
Frequency: 2-3x/wk
Duration: 20-30 min
Sets :per exercise 3*
Repetitions per set: 8-15 generally*
Mode: AAP does not support use of
1RM at any time, power lifting, or
body building for children
(skeletally immature).[5]
21
Copyright Protected Property of Dr. Gabriel Brooks 2016. Do not use or reproduce
without express written permission.
22
4 Tips for training Kids
1. Work in age-appropriate games
to keep practice/training fun.
2. Take time off (1 to 2 days per
week to allow the body to rest or
participate in other activities)
3. Permit longer scheduled breaks
from training and competition every
2- 3 months. focus on other activities
and cross-training to prevent loss of
skill or conditioning.
4. Focus on wellness and teaching
athletes to be in tune with their
bodies for cues to slow down or alter
their training methods.
Copyright Protected Property of Dr. Gabriel Brooks 2016. Do not use or reproduce
without express written permission.
APTA NEXT
SELECTING THE BEST
TRAINING ACTIVITIES
FOR YOUR TARGET
OUTCOME
Copyright Protected Property of Dr. Gabriel Brooks 2016. Do not use or reproduce
without express written permission.
24
4
Copyright Protected Property of Dr. Gabriel
Brooks 2016. Do not use or reproduce
without express written permission.
June 11 , 2016
Training Stimulus
SPORTS PHYSIOLOGY
Design of program should focus on recruiting
the maximum number of motor units first and
then recruitment of those motor units at the
desired speed
Strength, Power, Speed, and Agility
Copyright Protected Property of Dr. Gabriel Brooks 2016. Do not use or reproduce
without express written permission.
25
Dosing
Copyright Protected Property of Dr. Gabriel Brooks 2016. Do not use or reproduce
without express written permission.
26
Resistance Training is Good; We can Get
Great Results if We Get it Right
Time Under Load vs. Speed
Specificity
Muscle Protein synthesis (MPS) is greater with
slow reps vs. fast reps (7) J Physiol 590.2 2012. pp
351–362 )
MPS is greater with lower load/high volume
than high load/low volume. (8) PLOS1. August 2010 |
Volume 5 | Issue 8 | e12033 )
MPS is greater when a lower load is lifted to
failure vs. higher loads lifted to failure. (9) Appl.
Physiol. Nutr. Metab. 37: 551–554 (2012)
Copyright Protected Property of Dr. Gabriel Brooks 2016. Do not use or reproduce
without express written permission.
27
Copyright Protected Property of Dr. Gabriel Brooks 2016. Do not use or reproduce
without express written permission.
28
29
Copyright Protected Property of Dr. Gabriel Brooks 2016. Do not use or reproduce
without express written permission.
30
Is the Work Task Specific?
Copyright Protected Property of Dr. Gabriel Brooks 2016. Do not use or reproduce
without express written permission.
APTA NEXT
5
Copyright Protected Property of Dr. Gabriel
Brooks 2016. Do not use or reproduce
without express written permission.
June 11 , 2016
Trevor Cottrell, PhD
Copyright Protected Property of Dr. Gabriel Brooks 2016. Do not use or reproduce
without express written permission.
31
Copyright Protected Property of Dr. Gabriel Brooks 2016. Do not use or reproduce
without express written permission.
32
Is it An Age-Appropriate Mode of
Exercise?
this Soccer Season, Sarah is Starting at Center-Mid
LOWER EXTREMITY CASE
APPLICATION
Copyright Protected Property of Dr. Gabriel Brooks 2016. Do not use or reproduce
without express written permission.
APTA NEXT
33
6
Copyright Protected Property of Dr. Gabriel
Brooks 2016. Do not use or reproduce
without express written permission.
June 11 , 2016
Section summary
Summary Cont’d
– Athletes of any age can benefit from resistance training
– The Athletes physical requirements should be assessed
by sport and position played (and gender)
– Young athletes differ in responsiveness to training
–
New sport science supports a strength training regimen that uses BOTH:
• Full Range, Slow repetitions (5-6 s up,5-6s down) (7,8,)
– 3 sets at 30-60% predicted max (6, 8, 9)
– 3+ times per week (per muscle group) (5,6)
• And periodic, infrequent practice of higher intensities for neural
adaptation (10).
– New Science does not require frequent training at 70-90 % of 1RM.
(10,11)
– Time-under-load and speed specificity must both be considered
Copyright Protected Property of Dr. Gabriel Brooks 2016. Do not use or reproduce
without express written permission.
37
Copyright Protected Property of Dr. Gabriel Brooks 2016. Do not use or reproduce
without express written permission.
38
Real Results From Real Action
What I did, How I did It, and How You Can Do It Too
MANAGING THE ATHLETE
ACROSS THE CARE
CONTINUUM
Copyright Protected Property of Dr. Gabriel Brooks 2016. Do not use or reproduce
without express written permission.
Is the Program Effective To Improve
Strength ?
39
Copyright Protected Property of Dr. Gabriel Brooks 2016. Do not use or reproduce
without express written permission.
40
Is it Effective To Reduce the Injury Rate?
Injury Surveillance
Functional Scales (KJOC,
LEFS, etc.)
-Baseline
-Follow up
Sport specific skills without
risk factors present
Copyright Protected Property of Dr. Gabriel Brooks 2016. Do not use or reproduce
without express written permission.
APTA NEXT
42
7
Copyright Protected Property of Dr. Gabriel
Brooks 2016. Do not use or reproduce
without express written permission.
June 11 , 2016
Self Assessment Scenario
You are hired as a consultant to the public
school district to design a strength training
regimen that is safe and effective for
improving performance and reducing injury
rates in their soccer athletes.
How will you explain the Program Principles to the
strength training staff?
Copyright Protected Property of Dr. Gabriel Brooks 2016. Do not use or reproduce
without express written permission.
43
For Example…
Copyright Protected Property of Dr. Gabriel Brooks 2016. Do not use or reproduce
without express written permission.
44
Summary
Optimal sports performance in young athletes is
determined by:
• Screening Appropriately
• Matching the training to the athletic task
• Selecting the right training activities
• Tailoring the training program to the athlete
• Appropriately stressing the athlete (meaningful
resistance vs.. overdose)
• Supervising athletes
• Tracking outcomes
• Managing the Athlete across the continuum
• Having Fun!
Copyright Protected Property of Dr. Gabriel Brooks 2016. Do not use or reproduce
without express written permission.
45
Copyright Protected Property of Dr. Gabriel Brooks 2016. Do not use or reproduce
without express written permission.
46
Gabriel Brooks, PT, DPT, SCS, MTC
Gabriel Brooks, PT, DPT, SCS, MTC
Take The PT Challenge
Gabriel Brooks, PT, DPT, SCS, MTC
@DrBrooksPT
DISCUSSION FOLLOWS
Copyright Protected Property of Dr. Gabriel Brooks 2016. Do not use or reproduce
without express written permission.
APTA NEXT
47
Copyright Protected Property of Dr. Gabriel Brooks 2016. Do not use or reproduce
without express written permission.
48
8
Copyright Protected Property of Dr. Gabriel
Brooks 2016. Do not use or reproduce
without express written permission.
June 11 , 2016
References
10. J Appl Physiol. Jul 1, 2012; 113(1): 71–77
11 Behm DG, Anderson K, Curney RS. Muscle force and activation under stable and unstable conditions.
J Strength Cond Res. 2002;16:416-422.)
12.Thorborg K. Why hamstring eccentrics are hamstring essentials. Br J Sports Med .2012;46:463–5
13. Petersen J, Thorborg K, Nielsen MB, Budtz-Jørgensen E, Hölmich P. Preventive effect of eccentric
training on acute hamstring injuries in men's soccer: a cluster-randomized controlled trial. Am J Sports
Med. 2011 Nov;39(11):2296-303
14 BMC Musculoskeletal Disorders. 2010, 11:72
15 Physical Therapy November. 2005 vol. 85 no. 11 1128-1138
16 J Appl Physiol. 2012. 112: 1805–1813
17 Dwyer DB1, Gabbett TJ. Global positioning system data analysis: velocity ranges and a new definition
of sprinting for field sport athletes.
18 J Strength Cond Res. 2012 Mar;26(3):818-24. doi: 10.1519/JSC.0b013e3182276555.
1. Brenner, JS Pediatrics 2007;119;1242American Academy of Pediatrics,
Committee of Sports Medicine and Fitness. Intensive training and sports
specialization in young athletes. Pediatrics. 2000;106:154–157
2. Maffulli N, Chan D, Aldridge M. Overuse injuries of the olecranon in young
gymnasts. J Bone Joint Surg Br. 1992;74:305–308
3 Eur J Phys Rehabil Med. 2010 Jun;46(2):133-45. Epub 2010 Feb 18
4. McLeod, S. A. "Piaget | Cognitive Theory". Simply Psychology. Retrieved 18
September 2012
5 Pediatrics Vol. 121 No. 4 April 1, 2008 pp. 835 -840
6 J Physiol. 2010 Aug 15;588(Pt 16):3119-30. Epub 2010 Jun 25.
7 J Physiol 590.2 2012; pp 351–362 )
8 PLOS1. August 2010; Volume 5 . Issue 8 . e12033
9.Appl. Physiol. Nutr. Metab. 2012; 37: 551–554
Copyright Protected Property of Dr. Gabriel Brooks 2016. Do not use or reproduce
without express written permission.
•
•
•
•
•
49
Copyright Protected Property of Dr. Gabriel Brooks 2016. Do not use or reproduce
without express written permission.
50
19 Burd NA1, Andrews RJ, West DW, Little JP, Cochran AJ, Hector AJ, Cashaback JG, Gibala MJ,
Potvin JR, Baker SK, Phillips SM. Muscle time under tension during resistance exercise stimulates
differential muscle protein sub-fractional synthetic responses in men. J Physiol. 2012 Jan 15;590(Pt
2):351-62.
20 Meinhardt U1, Witassek F, Petrò R, Fritz C, Eiholzer U. Strength training and physical activity
in boys: a randomized trial. Pediatrics. 2013 Dec;132(6):1105-11. doi: 10.1542/peds.2013-1343.
Epub 2013 Nov 4.
21 Meylan CM, Cronin JB, Oliver JL, Hopkins WG, Contreras B.Th. effect of maturation on
adaptations to strength training and detraining in 11-15-year-olds.Scand J Med Sci Sports. 2013
Sep 30. doi: 10.1111/sms.12128. [Epub ahead of print]
22 Dotan R, Mitchell CJ, Cohen R, Gabriel D, Klentrou P, Falk B.Explosive sport training and
torque kinetics in children Appl Physiol Nutr Metab. 2013 Jul;38(7):740-5. doi: 10.1139/apnm2012-0330. Epub 2013 Jan 29. PMID:23980732 [PubMed - in process]
23 Barbieri D, Zaccagni L. Strength training for children and adolescents: benefits and risks. Coll
Antropol. 2013 May;37 Suppl 2:219-25. Review.
Copyright Protected Property of Dr. Gabriel Brooks 2016. Do not use or reproduce
without express written permission.
APTA NEXT
51
9