If your training goal includes building strength and size there is new research that can help. Researchers compared the effects of low repetition training with a typical moderate repetition training routine with interesting results.

Both groups were comprised of resistance trained men who followed the same exercise training program with different rep ranges to failure. On Monday/Thursday they did 3 sets of leg press/seated row, bench press/hamstring curl, plank. On Tuesday/Friday they did Shoulder press/biceps curl, Tricep extension/lLat pull down, leg extension. One group did 8-12 reps and the second did 20-25 reps per workout. After the workout both groups consumed 30 grams of protein and then once more before bed.

At the end of the 12 week session both groups had similar increases in size and strength. The low rep group had a greater increase in bench press strength, but otherwise there was no difference. As the exercise science field continues to evolve we learn more about effective programming. For strength and size, high rep low load is just as effective as lower volume higher weight. For some trainees, the constant heavy training causes joint pain and dysfunction. If lifting lighter weights leads to the same gains, it can be much easier to stay consistent. I also think it's important to point out that all the subjects consumed 2 high protein shakes a day and that every set was performed to failure. Training to failure recruits maximal muscle units and is probably what led to the strength gains in both groups.

Conclusion:

• Performing higher repetition lifts is an effective means of increasing size and strength
• Consuming high protein diets can boost protein synthesis when exercising to failure
• It looks like the common key is performing each set to failure. This is somewhat contrary to what has usually been taught, but the lifting to failure appears to be what spurs the body to new gains.

For many people looking to improve their physique, the thought of lifting heavy weight can be a daunting process. If similar gains can be made by putting in maximum effort at light weight, it provides an appealing alternative. For strength and power athletes, it is still important to train with heavy loads, but for others, mixing up the repetition range and failure training is adequate to achieve results.

Reference:
Morton, R.W., et. al. (2016). Neither load nor systemic hormones determine resistance training mediated hypertrophy or strength gains in resistance trained young men. Journal of Applied Physiology. http://jap.physiology.org/content/early/2016/05/09/japplphysiol.00154.2016
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As the summer Olympics approach athletes and fans prepare for the athletic contests. One of the most popular sports in the summer is swimming, so with that in mind, we will take a look at some common swimming related injuries and some preventative approaches.

Shoulder:
When we think swimming injuries, the shoulder comes to mind as the most commonly involved joint. In fact, the term ‘swimmer’s shoulder’ was coined to discuss the unique anterior shoulder pain that swimmer’s experience as a result of their sport resulting from the triad of swimming biomechanics, muscular overuse and fatigue, and glenohumeral laxity and instability. The typical swim stroke of shoulder adduction and internal rotation leads to hypertrophy of the pectoralis major and lattisimus dorsi and the under recruitment or over exertion of the teres minor, pectoralis minor and serratus anterior. As the arm is in constant overhead motion, the inability of those muscles to provide adequate stability can lead to increased pain and pathology.

Knee:
Symptoms involving knee pain would not necessarily be thought to occur in swimming, but it is the second most common complaint amongst swimmers. The breaststroke is the most likely to result in pain and the usual area of concern is the medial knee compartment, with some anterior pain, as well. The unique whip like kicking motion of that stroke in conjunction with water resistance can lead to a variety of medial knee pathology including MCL tenderness, pes anserinus, or hip flexor and adductor strains. The patella may also be overloaded if swimmers are constantly kicking and maintaining tension on their patella tendon.

Back:
As swimmers propel themselves underwater they rely on hyperextension of their spine in order to streamline their bodies. Constant hyperextension can lead to developing extension based low back disorders, spondylolysis, and degeneration over time. Breaststroke and butterfly tend to place the most strain on the low back.

Prevention:
The common denominator in developing an injury as a swimmer is stroke mechanics. If the stroke movement deteriorates due to fatigue, muscle imbalance or stress, pain ensues. As athletic trainers, our job is not to change their stroke mechanics, but rather, to work with the coach and athlete to identify overload that is leading to pain. Once identified, the coach can correct the movement and reinforce proper stroke mechanics. To help swimmers increase their strength, endurance and shoulder stability, simple exercises can be performed as a ‘prehab’ strategy. Exercises that address the external rotators, rhomboids, lower trapezius and serratus muscles can effectively stabilize the head of the humerus and decrease strain as a result of their sport. Incorporating a core stability training program can help avoid low back pain and degeneration.

When athletes improve their underwater form, strengthen their shoulders and stabilize their core, they can better handle the high training loads that lead to success. Working with swimmers to address these areas can also keep them under the water and out of the athletic training room.

Reference:
Wanivenhaus, F., et. al. (2012). Epidemiology of injuries and prevention strategies in competitive swimmers. Sportshealth. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3435931/pdf/10.1177_1941738112442132.pdf

ACL injuries continue to be a hot topic in the sport world. A big reason is that even though they are still not very common, percentage wise, they have a large impact on long term joint health, recovery, cost and ability to return. As reconstruction techniques continue to evolve, athletes are able to return to play, but how successfully?

After surgery, the treatment consists of rehabilitation to regain motion, function, proprioception, strength and control. Once athletes have completed about 6-9 months of rehab, they return to sport. Here’s the sobering news, of those who suffer an ACL reconstruction, only 65% return to their pre-injury level of sport, with only 55% returning to competitive play. Even more discouraging is the fact that of those that return to sport, up to 1 in 5 will suffer a tear to their reconstructed knee, or the ACL on the non-reconstructed side.

In order to determine what risk factors existed, and ways to modify them, researchers looked at elite soccer players who had their ACL reconstructed and then followed them. They looked at the type of surgery they had, their rehabilitation process and their return to sport. What they discovered was that athletes who did not meet certain bench marks in rehab were 4 times more likely to have another ACL injury. The following shows the exercises and the discharge criteria that was deemed successful:
                     
                        Discharge tests and criteria used during the study period
6 part return to sport tests with Discharge permitted when criteria was met

1. Isokinetic test at 60, 180 and 300 degrees/sec  with Quadriceps deficit <10% at 60 degrees/sec
2. Single leg hop with Limb symmetry index >90%
3. Triple hop with Limb symmetry index >90%
4. Triple crossover hop with Limb symmetry index >90%
5. On field sport specific rehab with rehab Fully completed
6. T test completed in under 11 sec

In addition to the tests above, athletes that had lower hamstring to quadriceps strength ratio were also more likely to injure their ACL. Since strong hamstrings act as an assistant to the ACL, weakness there can mean more stress on the ligament.

Conclusion:
This study highlights a couple of key points when rehabilitating ACL injuries:

• Prior to return to play, athletes should be fully recovered with equal strength bilaterally
• They should be able to seamlessly perform multidirectional drills
• Athletes should have adequate hamstring strength. Most of us do not have access to isokinetic testing, but spending time having athletes perform hamstring strengthening during their rehabilitation is essential.

By incorporating some of these exercises into rehab, athletes and practitioners can gauge where they are in the rehab process and make informed decisions regarding return to play on an individual basis.

Reference:
Kyritsis, P. et. al. (2016). Likelihood of ACL graft rupture: not meeting six clinical discharge criteria before return to sport is associated with a four times greater risk of rupture. British Journal of Sports Medicine, 50. http://bjsm.bmj.com/content/early/2016/05/23/bjsports-2015-095908.abstract