The National Strength and Conditioning Association has released a position statement on long term athletic development. With the rise in youth sport participation, injury trends, sport specialization and long term inactivity of today’s adults, it is important to encourage youth to participate in physical activity. This tenet forms the cornerstone of the position statement.
            While long term athletic development is generally taken to mean the development of athletes, the NSCA broadened the term to include all youth and to consider all youth ‘athletic’. In this manner, they address the concern and health implications of physical inactivity and they believe that all youth should be encouraged to be active.
            There are 10 pillars for successful long term athletic development:

1. LTAD pathways should accommodate for the highly individualized and non-linear nature of the growth and development of youth.
2. Youth of all ages, abilities and aspirations should engage in LTAD programs that promote both physical fitness and psychosocial wellbeing.
3. All youth should be encouraged to enhance physical fitness from early childhood, with a primary focus on motor skill and muscular strength development.
4. LTAD pathways should encourage an early sampling approach for youth that promotes and enhances a broad range of motor skills.
5. Health and wellbeing of the child should always be the central tenet of LTAD programs
6. Youth should participate in physical conditioning that helps reduce the risk of injury to ensure their on-going participation in LTAD programs
7. LTAD programs should provide all youth with a range of training modes to enhance both health, and skill, related components of fitness
8. Practitioners should use relevant monitoring and assessment tools as part of a LTAD strategy
9. Practitioners working with youth should systematically  progress and individualize training programs for successful LTAD
10. Qualified professionals and sound pedagogical approaches are fundamental to the success of LTAD programs

When working with youth it is important to remember that they grow and mature at different rates. Customizing a program specific to each individual is preferable to implementing a general ‘one size fits all approach’. Programs also need to take into consideration each individuals specific movement patterns and volume of activity. Many individuals are not engaging in free play prior to organized activity and, as such, are not prepared for the volume of training that occurs. Coaches, athletic trainers, personal trainers and strength coaches need to understand that fatigue and recovery are important aspects of a successful long term plan. By engaging in a well-rounded movement based training plan, youth can become acclimated to the rigors of sport and physical activity.

It is also of vital importance to maintain physical and mental health of young individuals. Programs should incorporate neuromuscular control, movement training and injury prevention exercises to reduce the risk of injury. Programs should also strive to be inclusive and foster a community of acceptance for all the participants, regardless of age or physical ability.

Due to the long term health consequences of physical inactivity, we need to encourage all youth to participate in some form of physical activity. Programs that encourage movement, play, control and strength can be an enjoyable experience for all those that participate.
 
Reference:
Lloyd, R.S, et. al. (2016). National strength and conditioning association position statement on long-term athletic development. Journal of Strength and Conditioning Research, 30 (6). https://www.nsca.com/long-term_athletic_development_position_statement/

The American College of Sports Medicine (ACSM) recently released a consensus statement on injury prevention geared to the team physician. Their conclusions, however, are beneficial for coaches, athletes, parents and other health care professionals to be aware of. In the statement, the authors focus on ankle, patella femoral syndrome, ACL, shoulder, elbow, head and neck injuries in high school and college athletes. They also touch upon sudden cardiac death, heat illness and skin infections. The article systematically addresses the mechanisms of injury and injury reduction strategies of each injury. I will include a brief summary with action items of the statement and refer those interested to the complete article.
 
Ankle:
Ankle sprains have a high risk of repeat injury and are the most commonly suffered injury in athletics. Key prevention strategies include balance training, neuromuscular training to include jumping, landing and cutting exercises and technical training. Once an ankle is injured, bracing is an effective way to provide support while the athlete is performing rehabilitation.
 
ACL:
Although not a very common injury, it does account for significant time lost from activity and long term joint health. In High School the sport with greatest risk of injury is football and in College it is Women’s soccer with females being at increased risk of injury in general over their male counterparts. Adopting an injury prevention program that addresses strength, core strength, neuromuscular control, cutting, jumping and landing can effectively reduce the risk of injury. Bracing is not an effective means of reducing injury risk.
 
Patellofemoral pain:
Patellofemoral pain is characterized as pain around the front of the knee.Contributing factors include muscle weakness, previous injury, training error and improper movement patterns. Injury prevention techniques include assessing and training for proper jumping and landing form and implementing a structured training program to minimize muscle imbalances with an emphasis on quadriceps, hamstring and hip abductor strengthening.
 
Shoulder pain:
The ‘disabled throwing shoulder’ is a term to describe pain and dysfunction with overhead sports. Risk factors are muscle imbalances, previous injury and training error. Prevention is focused on following recommended pitch counts, optimizing form for throwing and serving, balancing activity with rest and strengthening the upper body to correct any imbalances in the shoulder, arm, and scapula.
 
Elbow injury:
There are no injury prevention programs developed for reducing elbow injury in throwing athletes. The main focus currently is on monitoring fatigue, incorporating adequate rest periods, monitoring total throwing volume to reduce overload, not throwing too many months out of the year and undertaking a general strength program to improve strength and reduce any imbalances.
 
Sudden cardiac death:
Luckily, this is a rare phenomenon and occurs for several different reasons, including genetics. From a prevention standpoint it is important that all athletes have a physical to determine their risk factors and follow up testing as indicated by their doctors. All athletic sites and sports should have a written and communicated emergency action plan in the event of a catastrophic injury. Access to an AED is essential, and one should be close by to provide care to a fallen individual within 3 minutes of collapse. Chest protectors do not prevent death from sudden impact (commotio cortis) but using a softer ball in youth sports might. It is also not recommended that athletes step in front of a shot due to risk of having a commotio cortis event.
 
Exertional heat illness:
The main risk factor for exertional heat illness is environmental and those that have a previous injury and some heritable traits such as sickle cell. The main prevention strategy is acclimatization. Ideally, athletes prepare for the environmental conditions that they will be playing in. Coaches can monitor and modify practice and equipment needs depending on the weather. In preparation for weather, athletes can pre hydrate and stay hydrated during activity and monitory weight loss between practice sessions. Having an emergency action plan in place in case of emergency is essential to management of heat illness.
 
Skin infections:
College wrestling has the greatest incidence of skin infections. Other risk factors include previous skin infection, reduced immune function, body shaving, facility cleanliness and sharing personal care items. Some general rules are important for reducing risk of skin infections and include good hygiene, immediately laundering of uniforms and practice garments, facility cleaning, not sharing equipment or care items and promptly reporting any wounds or lesion to the team athletic trainer or your physician.
 
Conclusion:
While this statement is geared for the team physician, the information is very valuable for those working in athletics to understand and implement.

• Pre participation physical exams to identify risk factors and assess health history prior to participation
• Instituting a school wide (or at least team wide) training program to improve strength, neuromuscular control, balance and technique is an effective means to reduce risk of injury.
•  Monitoring athletes to provide adequate recovery and early intervention can delay time lost from competition for musculoskeletal injuries and heat illness.
• Crafting an emergency action plan that is easy to understand and implement, in conjunction with quick access to an AED, can provide the best chances for survival in the event of a catastrophic injury.

 
Reference:
Special Communications. (2016). Selected issues in injury and illness prevention and the team physician: a consensus statement. Medicine and Science in Sports and Exercise, 48 (1). http://journals.lww.com/acsm-msse/Fulltext/2016/01000/Selected_Issues_in_Injury_and_Illness_Prevention.21.aspx
 

One of the newer trends in the fitness and sports medicine industry is to use movement screens when working with clients. The idea is that the screen will allow the clinician the ability to assess how a client moves and potentially predict who will have an injury. However, a new study published by the American Journal of Sports Medicine demonstrates that movement screens cannot accurately predict the risk of injury. Before we throw them out, though, let’s dive a little deeper.

We know that the greatest predictors of injury are previous injury and rate of increase. We also know that there are certain movements and postures that can lead to an injury depending on the joint. What we can’t do yet is look at a person moving and predict that they will get injured. We can see that they are at a higher risk for getting injured, but we can’t say when they will get hurt and what specific injury they will get. That does not mean that assessing movement does not have value. On the contrary, I believe that addressing movement dysfunction is essential to optimum health and performance.

As much as I enjoy science and research, we like to put all movement into a box in an attempt to eliminate individual variables, which does not happen in real life. We have what is considered the ‘ideal’ movement, but not everyone can achieve it. That doesn’t necessarily mean that individual is at greater risk for injury, it just means that we want to optimize movement in their body. Personally, I believe that injury screens are helpful the same way that testing is helpful; it provides baseline information that we can track for improvement over time. If individuals have movement compensations or asymmetries side to side that is something that we can correct, if need be, and optimize, along with improving strength, endurance and flexibility. When people move better, they tend to feel better and if they feel better they perform better.

So, while a movement screen may not predict specific injury risk, it can be a very helpful tool in crafting exercise and treatment programs geared toward achieving optimal individual movement quality. The value of the screen may not lie in the ability to predict injury, but in the ability to improve movement. The quantifiable score allows for objective information about how individuals are improving and can be integrated with standardized performance testing to assess ongoing progress.

Reference
Bushman, T. et. al. (2016). The functional movement screen and injury risk. American Journal of Sports Medicine; 44 (6). http://ajs.sagepub.com/content/44/2/297.abstract

If you’ve ever heard someone say that they are ‘double jointed’, they may have generalized joint hypermobility. Generalized joint hypermobility is a connective tissue phenomenon characterized as having loose connective tissue including joints and skin and is more common in adolescents and females. As we age, the collagen tends to stiffen up, but, for some people this extra joint motion can lead to various aches and pains.

The common screening tool for assessing general joint hypermobility is the Beighton score, which is a series of movements: 4 are performed bilaterally, with the last one being either yes or no. A scale of 4 or more out of 9 is indicative of having generalized hypermobility, but a score of 6 or higher is more indicative of having associated symptoms. The tests are pinky hyperextension done bilaterally, the ability to touch your thumb to your forearm bilaterally, hyperextension at the elbows and knees bilaterally and the ability to palm the floor from a standing position.

The reason we are concerned for joint hypermobility is the implication for injury and pain. Because the joints have some additional laxity (movement), symptomatic individuals have excessive joint motion. This additional motion can lead to a pain response as the joint moves beyond a ‘normal’ range. When I looked at the research to determine if the presence of general joint hypermobility can lead to injury risk, I was surprised that the answer was generally no. For most injuries, the risk of sustaining an injury increases if there has been a previous injury. For those with joint dislocations, the presence of generalized hypermobility was not as important as local hypermobility of that joint. There is a connection between generalized joint hypermobility and ACL risk in soccer players, however. This is probably related to the knee joint being loose and the fact that the individuals are not able to adequately stabilize during intense activity.

While the ability to predict injury based on generalized joint hypermobility does not seem evident, there are some interesting correlations when looking at different injury subsets. For people that suffer from musculoskeletal pain, back pain during adolescence, and fibromyalgia, there is a higher number of symptomatic individuals that have generalized joint hypermobility. Once again, the thought is that the joints have additional movement which causes a pain response. For many people that suffer from musculoskeletal pain, they have a hard time getting their pain receptors to calm down. The two main treatments for hypermobility related pain are exercise and massage or soft tissue work. The goal of exercise is to improve body awareness, positioning, control and strength. When the muscles are working properly, they have the ability to aid in joint stiffness and normal joint motion may decrease the pain response. Massage therapy and soft tissue work can help to ease pain through touch and by addressing specific problem areas. While the research is not definitive on the effectiveness of either exercise or massage, there are some observational studies that suggest it can help.

The key take home point is that generalized joint hypermobility is usually benign (there are other symptomatic forms), but can be involved with excessive motion that causes musculoskeletal pain. The main treatment and preventative technique is exercise to better stabilize joints, learn and reinforce proper movement and body control. In a flared up state, massage can help decrease the associated pain.

References:
Folci, M and Capsoni, F. (2016). Arthralgias, fatigue, paresthesias and visceral pain: can joint hypermobility solve the puzzle? A case report. BMC Musculoskeletal Disorders; 17 (58).
Pacey, V. et. al. (2010). Generalized joint hypermobility and risk of lower limb joint injury during sport: A systematic review with meta-analysis. American Journal of Sports Medicine; 38.
Palmer, S. et. al. (2014). The effectiveness of therapeutic exercise for joint hypermobility syndrome: a systematic review. Physiotherapy; 9 (002).
Scheper, M. et. al. (2015). Chronic pain in hypermobility syndrome and Ehlers-Danlos syndrome (hypermobility type); it is a challenge. Journal of Pain Research; 8.
Tobias, et. al. (2013). Joint hypermobility is a risk factor for musculoskeletal pain during adolescence. Arthritis and Rheumatism; 65 (4).
 

if you are involved with youth sports and have seen many injuries being suffered by the participants, you should know that it doesn't have to be that way. We have had several studies examine the effectiveness of implementing an alternative warm up specifically geared to decrease injuries, and they have been successful. Now, a study out of Canada also points out that decreasing injury risk in sport saves money for the health care system, too.

Depending on the injury that an athlete suffers, the financial, physical and mental cost can add up quickly. In the event that an injury requires a surgical repair, the costs can skyrocket and the athlete may not return to participation. This lack of participation can have profound health effects if they suffer early joint pain, arthritis and inactivity that leads to chronic illness or obesity. Obviously, this is a worst case scenario and the majority of injuries are relatively minor and easily treatable. Still, the possibility does exist for long term impairment. This is especially true for ACL injuries, medial elbow injuries in baseball players and shoulder labral tears.

So, if there is a chance that some of these injuries an be decreased, we should take it. The good news is that while preventing all injuries is not possible, there are steps that can be taken to decrease certain ones. We know some of the global and more specific risk factors for suffering an injury. When athletes increase the intensity of their activity too quickly they are more likely to get injured. Having already sustained an injury makes you more likely to suffer a recurrent injury. Prior to puberty, boys and girls demonstrate similar movement patterns that changes after puberty. Part of this divergence may be contributing to the increase in injuries suffered by female athletes after this time. We also know that females are more likely to suffer ACL injuries and that following a specific exercise program can decrease that risk. Many studies have been conducted with soccer teams to determine the effectiveness of these programs. But, there is nothing specific about the exercises that make it special for soccer. The exercises are more global neuromuscular movements that if performed properly can improve movement quality, strength and performance metrics while decreasing the risk of injury.

Many programs are readily available for implementation, or there are community resources that are able to help. Finding and working with a qualified athletic trainer, physical therapist, strength coach, personal trainer or coach who understands the sport, common injuries and conditioning is a great place to start. They are able to find the research studies and programs available, demonstrate and instruct teams in how to perform the drills and be available to assess ongoing progress. Taking the time to learn a few specific movement based exercises and drills can improve movement quality and strength and lead to better, more conditioned athletes that are able to stay healthy throughout the year. With the ever increasing cost of health care and percentage of people with obesity, we need to do everything we can to keep people healthy and active from an early age. Incorporating injury prevention programs into a practice is a simple way to have a large impact.

http://bjsm.bmj.com/content/early/2016/04/10/bjsports-2015-095666.short

If you play overhead sports or have shoulder discomfort, here are 3 band exercises to help improve posture and prevent/alleviate shoulder pain