Play Safe Strength and Conditioning: Presented by the NFL Youth Football Health and Safety Series

Strength and�Strength and�Conditioning 3b o o k t h r e e

Play Safe series produced inpartnership with:

American College of Sports Medicine401 West MichiganIndianapolis, Indiana 46202

American Red Cross8111 Gatehouse RoadFalls Church, Virginia 22042

National Athletic Trainers’ Association (NATA)2952 Stemmons FreewayDallas, Texas 75247

The Institute for the Study of Youth SportsMichigan State University East Lansing, Michigan 4882

NFL Players Association2021 L Street N.W., Suite 600Washington, D.C. 20036

National Football League280 Park AvenueNew York, New York 10017(212) 450-2000

Internet: www.NFL.com / AOL Keyword: NFL.comwww.NFLHS.com

©2003 National Football League. All rights reserved.

Series Editor: Barry Goldberg, M.D.

Series Consultants: Elliott Hershman, M.D.; Elliot Pellman, M.D.

NFL Project Editor: Jim Natal

Graphic Design: Morrissey Gage

Illustrations: Chris Choi

Cover photo by Al Messerschmidt

CHARACTERISTICS OF A SUCCESSFUL YOUTH FOOTBALL PROGRAMFROM THE SERIES EDITOR

Football is America’s passion, so it is not surprisingthat football is the number-one high school partici-patory sport among boys. And increasingly, girls areenjoying the game.

For youth, high school, and college players, it is agame loved for its challenge and competition.Parents watch their children play, and coaches helpteach the game. But no matter the level of involve-ment, all agree that football must be played safely.

The NFL and the NFL Players Association havedeveloped this Youth Football Health and Safetyseries to promote the awareness of health issuesrelated to sports participation and to maximize thesafety of young athletes. Play Safe! is a series offour books containing relevant and practical articles,along with instructional posters distributed toschool programs and youth football organizations.It is designed to help parents and coaches maximizethe benefits of football for young competitors whileminimizing the risks.

Four subject areas are discussed in this series: First Aid Communication and AwarenessStrength and ConditioningHealth Concerns For Young Athletes

Respectively, the information for this series isprovided by highly respected experts from:

• The American Red Cross• The Institute for the Study of Youth Sports at

Michigan State University• The National Athletic Trainers’ Association• The American College of Sports Medicine

In developing this program, the National FootballLeague and NFL Players Association are proud tohave enlisted the expertise of these four leadingorganizations in the field of health and medicine.For the first time, these nationally renowned organi-zations have pooled their knowledge and informa-tional resources to create an aggressive and excitingseries to help educate young football players,coaches, and parents on the subjects of health andsafety in football. The information will allow coach-es and parents to advise players how to Play Safe!as well as optimize their enjoyment and perform-ance.

Topics include important areas such as: immediaterecognition of injury and response to emergencies,psychological management, instructional tech-niques, training and conditioning techniques, andpregame meal preparation and proper nutrition.

All of us involved with this worthwhile projectappreciate the enthusiastic support and love of thegame expressed by its fans. We are committed toworking with our partners to ensure that youngfootball players continue to Play Safe!

Barry Goldberg,M.D.,series editorDr. Barry Goldberg is the Director ofSports Medicine, Yale UniversityHealth Service, and ClinicalProfessor of Pediatrics,Yale University School of Medicine.

Notice: Sports medicine is an ever-changing specialty. As research and clinical experience broadens, changesin the scope of information on medical treatment, conditioning, nutrition, etc. are always occurring. Theauthors, editors, and publishers of this publication have reviewed the presented information and feel it is inaccord with current standards at the time of publication. However, in view of the possibility of human erroror changes in the current informational standards, neither the authors, editors or publisher, or any partywho has been involved in the preparation of this publication warrants that the information contained hereinis in every respect accurate or complete, and they disclaim all responsibility for any errors or omissions orfor the results obtained from the information contained in this publication. Readers are encouraged to confirm the information with other sources and remain aware of any future advances in sports medicine.

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From the National Athletic Trainers’ Association . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4

General Strength and Conditioning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5

Overall Health Benefits of Training and Conditioning . . . . . . . . . . . . . . . . . . . . . . . . . . . .6

Psychological Benefits of Strength Training . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8

Dispelling the Myth: “No Pain, No Gain” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9

Practical Strength and Conditioning . . . . . . . . . . . . . . . . . . . . . . . . . . . .11

Easy Steps to Enhance Performance in Youth Football . . . . . . . . . . . . . . . . . . . . . . . . . . . .12

Components of a Strength and Conditioning Program . . . . . . . . . . . . . . . . . . . . . . . . . . . .14

Proper Warm-Up and Cool-Down . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17

Incorporating Flexibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19

Plyometrics Help Players Improve Muscle Power . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22

Agility Training in Youth Football . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24

Proper Fuel For Strength and Conditioning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26

Should Youth Football Players Lift Weights? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28

Injury Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30

Tips to Prevent Youth Football Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31

Prevention & Treatment of Overtraining Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34

Preventing Overuse Injuries in Youth Football . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .36

Selection, Fitting, Care, and Use of Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .38

Preventing Neck Injuries in Youth Football . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .40

Risks Associated With Spearing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .42

Muscle Balance: Considerations For Injury Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . .44

Designing and Maintaining a Safe Weight Room . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .46

Injury Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .48

The On-Field Evaluation of Acute Football Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . .49

Return-to-Play Guidelines For Youth Football . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50

Youth Football Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55

Aches and Pains in Developmentally Immature Athletes . . . . . . . . . . . . . . . . . . . . . . . . . . .59

Prevention and Treatment of Muscle Cramps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .62

TABLE OF CONTENTS

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FROM THE NATIONAL ATHLETIC TRAINERS’ ASSOCIATION

The National Athletic Trainers’ Association (NATA) is a not-for-profit organization dedicatedto improving the health and well-being of physically active people worldwide. The Association iscommitted to the advancement, encouragement, and improvement of the athletic training profession.Founded in 1950 with a membership of 200 athletic trainers, NATA has more than 29,000 membersworldwide. Approximately 92 percent of all certified athletic trainers (ATC) belong to the association.In 1990, the American Medical Association recognized athletic training as an allied health profession.Today, in cooperation with physicians and other allied health personnel, the ATC functions as anintegral member of the athletic health-care team in secondary schools, colleges and universities,sports medicine clinics, professional sports programs, and in other athletic health-care settings.

This series of articles is intended to educate theyouth football coach about issues pertaining tostrength and conditioning. The articles here tiedirectly to the National Standards for AthleticCoaches, including standards relating to: InjuryPrevention, Care, and Management; Training,Conditioning, and Nutrition; and Skills, Tactics, andStrategies. When properly implemented, the infor-mation in this book will enable youth footballcoaches to enhance the health, safety, and per-formance of players.

The information is divided into four sections.Each section contains a series of articles written byexperts in the specified topic areas.

General Strength and Conditioningcontains three articles designed to educate youthfootball coaches on the benefits of a successfulstrength and conditioning program (the why) andthe components such a program should contain(the what).

Practical Strength and Conditioningincludes eight articles that cover specific plans andprograms that youth football coaches can imple-ment to enhance players’ performance.

Injury Prevention contains eight articlesthat discuss specific ways that youth football coach-es can prevent injuries, both on and off the footballfield.

Finally, Injury Evaluation features five arti-cles designed to help youth football coaches recog-nize and evaluate football injuries.

Certified Athletic Trainers (ATCs) wrote all of thearticles. Most of these authors also hold the title ofCertified Strength and Conditioning Specialist(CSCS). These authors bring a vast sampling of real-world experience to their articles. Performing theirathletic training duties in a variety of work settings,these NATA members are well acquainted with thelatest information about strength and conditioningand are proud to share it for this series.

GO ONLINE AT WWW.NFLHS.COM/HEALTHMORE READINGGeneral Strength�General Strength�and Conditioning

Youth football coaches have a great opportunity toassist thousands of young football players by promot-ing active, healthy lifestyles. The activities learned byyouth football players can become training and con-ditioning habits that will last a lifetime. MostAmericans do not live active lives. Sedentary, inactivelifestyles often lead to long-term health problemssuch as heart disease, stroke, cancer, and obesity.Thus, youth football coaches should realize thepotential impact they will have on young athletes.

Participants in youth football often do not under-stand the reasons for strength and conditioningprograms. Youth football coaches should be awareof the overall benefits of conditioning and strengthactivities and be able to explain these to athletes.

■ Physical benefits: gains in muscular strength andendurance, flexibility, cardio-respiratoryendurance, increased lean muscle mass, anddecreased body fat

■ Emotional benefits: positive effects on the mind,emotions, and self-esteem

Youth football coaches can make a training andconditioning program successful by followingthese suggestions:

■ Be positive with athletes in regard to trainingand conditioning.

■ Do not use training and conditioning as apunishment but as a preparation forcompetition and to promote healthy lifestyles.

■ Foster training and conditioning activities thatathletes understand and have fun doing.

■ Take the time to explain what you hope toaccomplish through a training and condition-ing program and why athletes need it.

■ Discuss training and conditioning in theoffseason with athletes, and developreasonable fitness goals that will enhancetheir performance.

■ Discuss the concept of overtraining or exces-sive training that may result in physical prob-lems and even emotional burn out.

■ Have fun—after all, football is a game.

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Training and conditioning exercises, when done properly, will result inboth physical and emotional benefits for youth football players.

W H A T C O A C H E S S H O U L D K N O W

■ Youth football coaches can instill in their playersgood training and conditioning habits that will lasta lifetime.

■ Physical benefits include better heart efficiency,improved blood pressure, and more energy.

■ Emotional benefits include better stress-coping ability,less tension and fatigue, and improved self-esteem.

■ Training and conditioning activities should be both funand easily understood.

OVERALL HEALTH BENEFITS OF TRAINING AND CONDITIONING

BY PAUL KRAWIETZ, Ed.D., ATC, LAT

GO ONLINE AT WWW.NFLHS.COM/HEALTHMORE READING

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Physical Benefits of Training andConditioning

■ Increased strength of the heart muscle(thus the heart can circulate more bloodthroughout the body with fewer beats)

■ Decreased blood pressure or mainte-nance of normal blood pressure

■ Decreased heart rate (a sign of a well-conditioned athlete)

■ Decreased body fat■ Maintenance of body weight within

normal limits■ Improved sleep■ Greater energy reserve for work and

recreation■ Improved posture (better physical

appearance and the ability to withstandfatigue)

■ Greater physical ability to cope withillness

■ Increased healthy living habits (properattention to health and fitness)

■ Improved sports performance

Emotional Benefits of Training andConditioning

■ Better ability to deal with stress ■ Less anxiety (fear of the unknown),

less tension, and less fatigue■ Enhanced vigor and the ability to deal

with the negative aspects of stress■ Less likelihood of depression (by allowing

the body to release chemical endorphinsthat trigger a relaxed, pain-free stateof mind)

■ Improved self-image and self-esteem(athletes will look better and feel betterabout themselves by meeting fitness goals)

Suggested Websites:

http://www3.utsouthwestern.edu/library/consubj/fitness.htmThis University of TexasSouthwestern Medical SchoolWebsite provides a series of short,easy-to-understand articles on avariety of fitness-related topics suchas Football Safety, Kids and Exercise,Preventing Sports Injuries, Sprains,Active Kids are Healthy Kids, andmany more.

http://www3.utsouthwestern.edu/library/consubj/young.htmThis University of TexasSouthwestern Medical SchoolWebsite provides a series of short,easy-to-understand articles on issuesrelated to young people.

http://www.nata.org/main.htmThe Website of the NationalAthletic Trainers’ Association con-tains information on specificinjuries, minimizing risk in athletics,lightning safety, fluid replacement,and many other interesting topics.

http://www.ncaa.org/sportssciences/The NCAA Website contains asports medicine handbook that maybe useful in researching issuesrelated to sports medicine.

http://www.acsm-msse.org/The American College of SportsMedicine’s Website allows theyouth football coach to do searchesin certain areas of sports medicine.

Donatelle, R.J., Davis, L.G., Hoover, C.F., & Harding, A. (1991). Access to Health. 2nd Ed., Engelwood Cliffs: Prentice Hall. Edlin, G., & Golanty, E. (1988). Health and Wellness: A Holistic Approach. 3rd Ed. Boston: Jones and Barlett Publishers.

GO ONLINE AT WWW.NFLHS.COM/HEALTHMORE READING“Is Strength and Conditioning Necessary for the Youth Football Athlete?” by David Martinez in the August, 1997

Journal of Strength and Conditioning.”Preseason Conditioning for High School Athletes” by Dr. Avery Faigenbaum in the February, 2001

Journal of Strength and Conditioning.“Strength Training for Children and Adolescents” by Dr. Avery Faigenbaum in the October, 2000 Clinics in Sports Medicine.

The weight room can be a place of tremendous psy-chological benefit, for both the team and individualplayers. A properly supervised strength training pro-gram helps the team bond by being in the sameplace together, working hard to achieve a commongoal. Ideally, team members will help each other(such as with spotting). Individually, players learndedication and perseverance by realizing that bene-fits come only to those who stay with the programand are consistent in their attendance and effort.

Youth football players also develop self-esteem byachieving strength gains and realizing individualgoals set in the weight room. In addition, they gaina sense of discipline, and they’ll improve their confi-dence levels by feeling prepared to play. Thestronger, more confident player is more likely toenjoy football and stay on the team.

Many players will improve their social interactionskills as well. They are required to communicatewith teammates of various personalities and back-grounds. By learning to accept others, team unity isenhanced.

There are some important concepts in building a

winning strength-training program for the youngathlete:

■ Set goals for each player that canbe achieved. Unattainable goals can lead tofrustration. Goals that can be achieved willmake the player enthusiastic about returning tothe weight room and the football field. This isespecially true for the new weightlifter who isweaker than some of his older and biggerteammates.

■ Provide positive feedback. This can bedone in many ways, such as giving T-shirts tothe players who have good attendance or workhard, and publicly posting results. It is importantthat players not only understand the athleticbenefits to being stronger, but that improvedstrength is its own benefit. Acknowledging theindividual and team accomplishments will rein-force the hard work and dedication beingdemonstrated.

Remember: perseverance, dedication, and teamunity are all characteristics that can be transferredfrom the weight room to the football field.

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PSYCHOLOGICAL BENEFITS OF STRENGTH TRAINING

Strength training builds mind as well as body.

BY MICHAEL J. HANLEY, M.S., ATC/L

■ Strength training helps foster individual growth as well asteam growth.

■ Coaches should set attainable goals in the weight room toreinforce work.

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Do you recall your coaches shouting, “No Pain, NoGain”? The credo was to train players to the pointof exhaustion. This would make you “tough.” Thiswould make you “determined.” This would pushyou to work harder so you would be all you couldbe. That drill instructor approach may work for eliteprofessional athletes, but youth football playersshould never be pushed beyond reasonable limits.

Overtraining is defined as “overloading the (body)system without adequate recovery.” Thus, the morean athlete is pushed beyond a safe training zone,the greater the potential for pain and soreness.As a result, the pain limits strength gains in youngathletes.

There are several negative consequences of over-training. For example, heavy weightlifting couldinjure a child’s growth plates. Children grow taller

because of growth plates at the end of bones. Thisprocess continues until about age 17. Until then, aninjury to one of the growth centers can cause per-manent damage. Because tendons are strongerthan the growth centers to which they areattached, an injury from lifting heavy weights oftendamages the growth center.

Other examples of injury caused by overtraininginclude:

■ Overuse syndromes (i.e., tendinitis, bursitis)■ Fractured bones■ Heat-related illness■ Emotional and psychological conditionsYouth football players who are not prepared emo-

tionally or psychologically are also at risk. If pushedbeyond their limits, burnout and boredom mayoccur. This can lead to athletes missing practices or

The phrase “No Pain, No Gain” may apply to professional football players,but youth football players get stronger faster with “No Pain, More Gain.”

BY KEN LOCKER, M.A., ATC

DISPELLING THE MYTH: “NO PAIN, NO GAIN”


■ Athletes should not overtrain.

■ Youth football players should not perform certaintraining and conditioning activities to the point ofexhaustion.

■ An adolescent football player has physical, emotional,and psychological limitations.

■ When developing weightlifting programs for youthfootball players, coaches should recommend the use oflighter weights (50-75 percent) and fewer reps(six with minimal effort before increasing the weight).

■ Target heart rates for age-appropriate athletes shouldbe utilized for cardiovascular conditioning.

games because of increased illness from the stresson their immune systems. Athletes may quit or

make excuses not to participate. Sports should befun, not stressful.

According to documented research, adolescentathletes’ overall conditioning improves while trainingat far lower intensities than those of older athletes.

What Can a Coach Do?■ Do not overtrain athletes. Use lighter weights

(50-75 percent max) and more reps. Begin at aweight with which an athlete can performsix repetitions. Increase to 10-15 reps beforeadding 10 percent to the weight used for theexercise.

■ Always allow at least one day of rest betweenweightlifting sessions.

■ Use age-appropriate target heart rates whenperforming cardiovascular conditioning drills.Target heart rate is approximately 220 minusage in years. Endurance work can be performedat a target rate of 50 percent of the maximum,and sprint work at 80-90 percent of the maxi-mum expected heart rate. The maximum heartrate may be modified by specific medicationsand cardiac problems. The coach should beadvised of these problems and receive profes-sional medical advice for conditioning the youthfootball player with medical problems.

■ Implement a variety of drills that include hop-ping, skipping, running, and safe plyometrics.These are safer activities for adolescent athletes.Coordination, motor skills, and good bodymechanics all can be compromised during thegrowing years.

■ Use coaching psychology techniques appropri-ate for the child’s age. Children are sensitive topsychological stresses. Many feel unsure abouttheir body, and fear rejection or being singledout. If coaches push these kids too hard, theywon’t become “tougher”—they’ll restrict theirprogress.

“No Pain, No Gain” might be a good approachwith adult football players. But youth football play-ers are still developing and growing. For them, “NoPain, More Gain” is the best bet.

GO ONLINE AT WWW.NFLHS.COM/HEALTHMORE READINGStrength Training for Young Athletes. Published by Human Kinetics.The Young Athlete. American Academy of Orthopedic Surgeons Public Information. AAOS on-line service: www.aaos.org.www.wlinfo.com. Under the header “Articles.” Chapter 9: Exercise Prescriptions for Children.

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Practical Strength�Practical Strength�and Conditioning

When young people participate in sports, theyspend most of their time practicing only that specificsport. It is important to understand that there areother areas that need to be practiced. Warm-up,flexibility, balance, and speed are important ele-ments that need to be stressed with young athletes.Proper coaching in these areas will help reduceinjuries and improve young athletes’ skill levels.When asked, “How fast should I go?” coaches canrespond, “Go as fast as you can, not as fast as youcan’t.”

Youth football, for example, demands power, skill,quickness, and balance. A youth football player willnot excel at his sport if he is unable to adapt tothose requirements. An easy way to incorporatestrength and conditioning routines—and make themfun—is to make them part of ball or coaching drills.Here are some basic ways to start including theseareas in practices.

Core Strength All players, including youth players, should havegood core strength. Core strength means strongstomach muscles, but it also includes the musclesthat stabilize the hips and pelvis. Players should getused to keeping these muscles tight all the time.

Tensing up the stomach while exercising, stretching,and playing will result in better, stronger footballplayers. Crunches, leg lifts, and twisting movementswill go a long way toward improving a players’game.

Stretching and Flexibility Have players do a variety of stretches to target all ofthe main muscle groups. It is important to focus onthe quality of the stretches and not the quantity.Stretches allow the muscles to function more effi-ciently and allow for strength and power to develop.Young players should stretch before practices, afterpractices, and again at home to benefit the mostfrom it.

StrengthAfter core strength and flexibility, the next mostimportant component of development is strength.Coaches, however, are urged not to push weighttraining with young, pre-junior high school athletes.Many other exercises such as pushups, pullups, andlunges using their body weight will work just aswell. Balance, speed, and power exercises work wellfor youth athletes when they have developed a basiclevel of core strength and flexibility.

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■ Young athletes adapt quickly and learn to improvebalance, speed, and flexibility.

■ Balance, speed, and flexibility are the base upon whichstrength and athletic ability are built.

■ Increasing overall athletic ability will improve skillsin any sport.

Balance, speed, and flexibility training are important components ofa successful youth football program.

BY GAETANO SANCHIOLI, M.S., ATC, PES

EASY STEPS TO ENHANCE PERFORMANCE IN YOUTH FOOTBALL


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GO ONLINE AT WWW.NFLHS.COM/HEALTHMORE READINGGambetta, V. Everything in Balance. Training and Conditioning 1[2]15-21, 1996.Gray, G.W. Chain Reaction Festival. Wynn Marketing. Adrian, MI, 1996.Chu, D. Jumping into Plyometrics. Champagne, IL: Leisure Press, 1992.Gambetta, V. Building the Complete Athlete. Optimum Sports Training, Inc.

Balance Balance has great benefits for improving overall ath-letic ability. Start players standing on one leg andbalancing with their hands on their hips. Hold theposition for 10-15 seconds and repeat or switchlegs. Balance on each leg 5-10 times.

When this exercise can be completed withoutproblems, increase the difficulty of the exercise. Forinstance, have players hold one leg out in front forthree seconds, to the side for three seconds, andbehind for three seconds, then repeat. Tilt the head,close one eye, close both eyes, and/or swing the legto make the exercise harder and more challenging.

To work on upper-body balance, have players dovarious exercises in a pushup position. Two hands,two feet; two hands, one foot; two feet, one hand.While holding a position have another person tap orpush the player to make the balance exercise moredifficult. Gradually add catching and throwing afootball during the drills to make it harder, more fun,and more sport specific.

Speed and AgilityLine jumping, cone jumping, and the speed ladder arefun exercises that can be worked into practice drills orinto a special session at the beginning of practice.These exercises start with two-legged jumps, thenprogress to one-legged hops, then alternating feet.Jumps and hops are done as quickly as possible for 20jumps or about 10 seconds. These exercises should bedone in a forward/backward direction. Then add side-to-side movement, diagonal movement, and variousturns (90-degree, 180-degree, etc.).

CoordinationCoordination will be enhanced by gradually increas-ing the speed of any exercise while focusing on thequality of the exercise. The speed ladder is a greattool for developing foot speed and coordination.Invent different patterns for young athletes to per-form (e.g. squares, diamonds, zig/zags). Performthem fast with good form and speed; agility andcoordination will improve. Don’t forget to add a ballor make them more sport specific.

Reaction TimePlayers need the ability to initiate a movement at ahigh rate of speed and then perform the movementat a high rate of speed. However, fast movementsmust be done under control to be useful. A goodway to work on improving reaction time is throughpracticing the skill desired often and at full speed.Some drills call for quick reaction without the aid ofone of the senses such as throwing a ball at a receiv-er while his back is turned, then telling him to turn,find the ball, and catch it. Another drill involves hav-ing linemen react to the movement of a ball that issnapped without a verbal snap count, so that theyrely less on hearing. Many computer games that kidsplay are helpful for improving reaction time, too.

PowerThe final aspect of player development is power.Power comes from taking the strength and speedthat have been developed and combining themin one movement. As with the previous elements,power is best developed through practice. Someexamples include long jumping, high jumping,power skipping, and striding for the lower body,and medicine ball passing (forward, rotational,and overhead) and throws for the upper body.

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Youth sports programs should focus not only ondevelopment of sport skills, but fundamental fit-ness. Football is a collision sport with inherentrisk of injury. However, it is well known thatpoorly conditioned athletes are more prone tofatigue and the injuries that can result fromfatigue.

At the youth sport level, the initial fitness levelof a young person just entering an organizedsports program may not be adequate to meetthe demands of football practice or games.Preparatory conditioning (4-8 weeks prior to the

start of the sport) aimed at improving generalmuscle strength, flexibility, cardiovascularendurance, coordination, and agility can enhanceskill development and prevent injury.

Strength and conditioning sessions shouldbegin with a general warm-up and end withcool-down exercises consisting of light cardiovas-cular exercise and stretching. Strength and condi-tioning activities in the youth sports populationshould offer variety and fun, and promote a posi-tive attitude toward physical fitness. They areoptimally performed 2-3 times per week, on

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A balanced strength and conditioning program foryouth football should include activities that promote:

■ Aerobic fitness through low to moderate intensityand long-duration cardiovascular activities(e.g. running, bicycling, swimming).

■ Anaerobic Fitness through short burst activities(e.g. sprints).

■ Muscular strength through repetitive, submaximalresistive exercises. Resistive exercises should addressall major muscle groups, and should be balancedbetween opposing muscle groups (e.g. biceps vs.triceps, quadriceps vs. hamstrings)

■ Flexibility through stretching to promote full rangeof motion and prevent injury. Stretching exercisesshould be performed prior to strenuous activity (butafter warm-up) and again at the end of the workout.

■ Coordination and agility through general andsport-specific drills that develop quickness, balance,and movement efficiency with changes in direction.

Strength and conditioning programs are an essential part of preparingyouth football players for the demands of the sport.

BY SANDRA J. SHULTZ, Ph.D., ATC, CSCS

COMPONENTS OF A STRENGTH AND CONDITIONING PROGRAM


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alternating days. Progressions or increases inweight, intensity, or duration should not exceed 5-10 percent of current capacity. It is important thatonly one component (intensity or duration) beincreased at any one time. Emphasize skill develop-ment and proper technique rather than theamount of weight lifted. Maximal effort exercisesshould be discouraged. Certified athletic trainersand certified strength and conditioning specialistscan serve as valuable resources to youth footballcoaches who are developing a strength and condi-tioning program.

Here are the essential parts of asound strength and conditioningprogram:

Aerobic Training improves cardiovascular fit-ness and provides a strong endurance base uponwhich all other fitness components (strength, speed,coordination, and agility) can be developed andimproved. An athlete who is aerobically fit will havebetter stamina and less fatigue toward the end ofpractice or games, and will recover quicker from anexercise session. To improve aerobic fitness, continu-ous activities utilizing large muscle groups (e.g.jumping rope, jogging, swimming, or any continu-ous sport activity) should be performed at a moder-ate intensity (60-70 percent of max heart rate:approximately 220 beats minus age in years) thatcan be sustained for a minimum of 15-20 minutes.

Anaerobic Training will improve energydelivery and recovery with short intense sessions ofhigh-intensity (75-85 percent of max heart rate)activities or quick bursts of movement (e.g. sprint-ing off the line, running pass plays, tackling, andblocking). Football is primarily an anaerobic sport,in which a play might last 5-10 seconds, with shortrest periods following each play. Training in shortbursts—such as line sprints or bleacher runs—iseffective in preparing for the demands of the sport.Plyometric drills (e.g. leg hops, box jumps, squat,and tuck jumps) also are excellent anaerobic train-ing activities to improve speed and power, butshould only be incorporated once a good strengthand conditioning base has been developed.

Strength Training refers to exercises thatincrease the ability to exert or resist force. Strengthtraining is safe and effective when properlydesigned and supervised. Strength training doesnot require heavy weights or expensive machinery.Moreover, young athletes often do not fit properlyin these machines. Rubber tubing, medicine balls,

small free weights, and body-weight exercises areoften more appropriate for this age group. Inyouth football players, the frequency, intensity, vol-ume, and progression of strengthening exercisesmust be carefully monitored. Generally speaking,strength training in young athletes should consistof 2-3 sets of high repetition and moderate loads(i.e., a resistance exercise that can be performedfor 10-15 repetitions) rather than low repetitionand high loads (i.e., resistance able to be per-formed for fewer than 8 repetitions).

For the youth football participant, strength work-outs should be limited to two times per week, withtwo days of rest in between workouts. Upper- andlower-body exercises can be performed on thesame day (e.g. Monday and Thursday), or in a splitroutine (e.g. upper body on Monday and Thursday,lower body on Tuesday and Friday). As the athletebecomes stronger and more mature, strengthworkouts can progress to three times per weekwith one day of rest in between. Specific guidelinesand recommendations for safe and appropriateyouth strengthening programs are available fromthe American College of Sports Medicine, theAmerican Academy of Pediatrics, and the NationalStrength and Conditioning Association.

Coordination and Agility exercises areaimed at improving balance, movement efficiency,and reaction time. Improving balance and coordi-nation is particularly important in young athletes.Activities should include football-specific skills andmovements that improve speed off the line, lateralquickness and agility to ward off tacklers, and theability to change directions quickly. Examples ofcoordination and agility exercises include dot drills,figure-eight running, cone and cutting drills, jump-ing rope, side shuffles, and carioca runs.

Strength and conditioning activities at the youthsport level should emphasize proper techniquerather than volume or intensity. Program develop-ment should be undertaken in consultation with atrained professional experienced in strength andconditioning of prepubescent and adolescent ath-letes, and all activities should be properly super-vised. A complete physical examination from aqualified physician should be completed prior tothe start of any strength and conditioning pro-gram. If areas of weakness, deficiencies, or imbal-ances are noted in the examination, they often canbe addressed and corrected prior to the seasonthrough proper strength and conditioning.

DAY CONDITIONING ACTIVITY SUGGESTED PLAN

Monday Lower-Body Strength Workout Warm-Up & Stretch Core Lifts For Lower Body

(2-3 sets of 8-12 reps)Cool-Down & Stretch

Tuesday Upper-Body Strength Workout Five-Minute Bike Warm-UpStretching ExercisesCore Lifts For Upper Body

(2-3 sets of 8-12 reps)Coordination & Agility Agility Drills (2-5 Drills)Speed Work (Anaerobic) Sprint Drills (2-5 Drills)

Cool-Down & Stretch

Wednesday Rest or Light Aerobic Activity 20-30 minutes

Thursday Lower-Body Strength Workout Warm-Up & Stretch Core Lifts For Lower Body

(2-3 sets of 8-12 reps)Cool-Down & Stretch

Friday Upper-Body Strength Workout Five-Minute Bike Warm-UpStretching ExercisesCore Lifts For Upper Body

(2-3 sets of 8-12 reps)Coordination & Agility Agility Drills (2-5 Drills)Speed Work (Anaerobic) Sprint Drills (2-5 Drills)

Cool-Down & Stretch

Saturday Rest or Alternative Ensure variety and funSport Activity

Sunday Rest

GO ONLINE AT WWW.NFLHS.COM/HEALTHMORE READINGAmerican Academy of Pediatrics Committee on Sports Medicine and Fitness. Strength Training by Children and Adolescents.

Pediatrics. 107 (6), 1470-1472, 2001. Also available on the AAP Website: http://www.aap.org/policy/re0048.html.Baechle, T.R. (Ed.). Essentials of Strength and Conditioning. National Strength and Conditioning Association. Human Kinetics

Publishers; Champaign, IL. 1994.Faigenbaum A.D., Kraemer W.J., et al. Youth Resistance Training: National Strength and Conditioning Association Position

Statement. Strength and Conditioning 18 (6); 62-75, 1996.in

16

SAMPLE PROGRAMWhile there are many variations in program design, the following offers ageneral framework. For specific strength and conditioning activities andappropriate progressions, please consult an athletic trainer, strength andconditioning specialist, or suggested reading.

17

No youth football conditioning program or practice is complete without aproper warm-up and cool-down period. Both are important to enhancingperformance and muscle recovery, and preventing muscle soreness and injury.


PROPER WARM-UP AND COOL-DOWN


■ Warm-up and cool-down function as transitional exerciseperiods that allow for a gradual increase and decrease inactivity levels.

■ Before engaging in any strength and conditioningexercises, practices, or competitions, a brief warm-upperiod is vital to preparing young football players bothphysically and psychologically. A general warm-up shouldconsist of exercises aimed at increasing heart rate,blood flow, and muscle temperature (e.g. jogging,bicycling, jumping jacks). Optimal warming is achievedwithin 5-15 minutes, or when the athlete breaks a sweat.

■ Stretching exercises should follow the general warm-up, asmuscles and tendons that are warm will be more pliable andready to stretch.A sport-specific warm-up can follow thegeneral warm-up and stretching exercises, using exercisesand drills that mimic the movement and skills needed forthat day’s football conditioning or practice.The sport-specific warm-up period should begin with slowand controlled activities, and progressively increase inintensity.

■ The warm-up should be timed so that it is completedimmediately prior to the beginning of the conditioning orsport activity. If more than 15 minutes elapses between thewarm-up and activity periods, warm-up activities should berepeated to return the athlete to a ready state.

■ To aid muscle recovery and reduce muscle soreness afterintense workouts, a cool-down period should conclude thesession to allow cardiovascular and muscle function toreturn slowly to resting levels. The cool-down periodshould consist of 5-10 minutes of continuous, largemuscle group activities (moderate to mild aerobicactivity) followed by 5-10 minutes of gentle stretchingof the major muscle groups.

Warming-UpWarm-up refers to a general warming of the bodythrough large muscle group activities in an effort toready the body for more strenuous activity.

Cardiovascular benefits include increased heartrate, blood flow, and breathing rate, which willimprove oxygen delivery to the working muscles.Muscle temperature also will increase, which willmake the muscles and tendons more pliable andallow them to stretch further without tearing.Collectively, these physiological changes allow thebody to handle more work and reduce the potentialfor injury or muscle soreness.

Warm-up activities should always include a generalwarm-up component, and may also include a sport-specific component. The general warm-up consists of5-10 minutes of jogging, cycling, or any continuousactivity that uses large muscle groups. A good indica-tion that the heart rate and body temperature havebeen raised sufficiently is when the athlete begins tobreak a sweat. Once sufficient warming has beenachieved, flexibility (stretching) exercises should fol-low for the muscle groups that will be used in thesport activity. For football, this should include bothupper-body and lower-body stretches.

A specific warm-up can follow, which involvesactivities that closely resemble the sport activity.Football-specific warm-up activities can progressivelyready the muscles and joints for more ballistic orintense movements, and can begin to focus the ath-lete on football skills. For example, there is a big dif-ference between general warm-up activities andexploding off the line when the ball is snapped.Sport-specific movements or skills can bridge this gapby gradually increasing the tempo and intensity ofthe desired skill or activity. Examples of sport-specificwarm-up activities include cariocas, side shuffles, lineand cone drills, and pass and run drills. Many foot-ball-specific agility activities can serve as warm-upexercises, so long as each activity is begun at a sub-maximal level, and the tempo and intensity are grad-ually increased during a 10- to 15-minute period.

At the completion of the sport-specific warm-up,the youth football player should be ready to beginsport activity. Warm-up activities can be usedthroughout practice and competition as needed toreturn the muscles and cardiovascular system to aready state after periods of rest or inactivity. This isparticularly important in football, where an athleteplays only one side of the line (offense or defense)or on special teams. For example, a kicker waitingon the sidelines can keep his leg flexible, warm, andready by periodically jogging along the sideline,performing leg swings, and kicking a ball into a net.

Cooling DownA cool-down period is just as important as thewarm-up period and should follow any intenseexercise session. When exercise is suddenlystopped, blood that has been sent to the workingmuscles can pool in the extremities and cause anathlete to feel dizzy or lightheaded. Cool-downactivities can prevent this pooling from occurring.Also, metabolic by-products (such as lactic acid) areproduced in the muscle with intense or fatiguingexercise. The longer these metabolic waste prod-ucts remain in the muscle, the slower the recoveryand the greater the chance for muscle soreness thenext day. Because metabolic by-products areremoved from the muscle via the blood, a cool-down session will help the muscle pump or flushwaste products from the muscle more rapidly.

A cool-down should consist of general, continu-ous activities that progress from moderate (such asjogging, swimming, or cycling at 50 percent maxi-mum pace) to mild (such as walking, swimming, orcycling at 30 percent maximum pace), graduallyreducing heart rate and muscle function to restinglevels. For example, if practice ends for the daywith 10 all-out wind sprints, before players head tothe showers, 1-2 minutes of light jogging, followedby two to three minutes of walking, and then gen-tle stretching, may be all that is required to aidmuscle recovery.

GO ONLINE AT WWW.NFLHS.COM/HEALTHMORE READINGArnhiem, D.D., & Prentice, W.E. Training and Conditioning Techniques in Principles of Athletic Training. 10th Edition.

McGraw Hill Publishers; Boston, pp. 78-79, 2000.Baechle, T.R. (Ed.). Essentials of Strength and Conditioning. National Strength and Conditioning Association. Human

Kinetics Publishers; Champaign, IL. 1994.Brown, L.E. (Column Editor). Warm Up or No Warm Up. Strength and Conditioning Journal. 23(6): 36, 2001.

18

19

Flexibility plays a vital role in strength training, butincorporating it into a strength and conditioningprogram often can be a challenge. For many youthfootball coaches, it’s a time factor—they think flexi-bility training is too time consuming. However,stretching during the warm-up and cool-down peri-od takes only minutes; stretching major musclegroups can take as little as five minutes. Flexibilityworks hand in hand with strength training to pro-duce a more competent athlete. Together, the twocomponents improve range of motion and the ath-lete’s ability to exert force at each attempt—benefitsthat are well worth the practice time. A flexibilityprogram often reduces or eliminates muscle spasms,

delayed-onset muscle soreness, and musclecramps—additional benefits that make flexibilityworth the coach’s time and effort.

The objectives of flexibility training are to increasethe range of the athlete’s motion, and to reduce thepotential for injuries. Flexibility is specific to each jointin the body. This simply means that just because ayoung football player is flexible at one joint, he isn’tnecessarily flexible at another. Thus, flexibility train-ing, or stretching—in combination with strength andconditioning—is necessary for the youth footballplayer to perform at an optimal level.

For youth football, static stretching is safestbecause the athlete stops lengthening the muscle

Flexibility is key to long-term injury prevention, and it allows young athletesto perform at peak levels.

BY DANA CRAVEY, M.S., ATC

INCORPORATING FLEXIBILITY


■ Flexibility should not be overlooked as part of strengthtraining.

■ A flexibility-training program should only take about 20minutes during regular practice.

■ Flexibility improves range of motion, improves theathlete’s ability to exert force, and reduces thepotential for injuries.

■ Just because an athlete is flexible at one joint doesn’tnecessarily mean he is flexible at another—thus, the needfor overall flexibility training.

■ Static stretching is safe because the athlete stopslengthening the muscle before it becomes painful.

■ A good protocol for football practice is jogging orcalisthenics, stretching, and sport-specific practice,followed by a cool-down period that also includesstretching.

before it becomes painful. A static stretch, oftencalled a hold, is a gradual stretch that is held to thepoint of feeling the stretch but not feeling pain.Static stretching is effective because muscles containreceptors—known as proprioceptors—that relaymuscle activity to the central nervous system. Whena muscle reaches a point of maximum stretch, theseproprioceptors signal the nervous system to cause areflex contraction of the muscle. After a few sec-onds, another set of proprioceptors signal a reflexrelaxation of the muscle. This is the body’s methodof preventing overstraining and tearing musclefibers. Dynamic or ballistic stretching involves the useof quick, bouncing movements and is not recom-mended as an effective stretching technique becauseof the risk of muscle strain.

In static stretching, each muscle is graduallystretched three to four times, and the stretch is heldfor 10 to 30 seconds. A slow static stretch, mostcommonly used by fitness experts, allows the muscleto stretch farther and more safely. The key to thistechnique is to stretch muscles and joints to the

point a pull is felt, but not to the point of pain.When stretching for a game or practice, it is often

best to do the program both before and after theactivity. After a general warm-up, athletes shouldstretch the major muscles of the shoulders, arms andforearms, trunk (including the back and abdominalareas), thighs, and lower legs. The purpose of thewarm-up stretching is to loosen the muscles foractivity. Consequently, during cool-down the musclesare very warm, so the muscles stretch more easilyand maintain the stretched position longer. Ingeneral, muscles need to be stretched for a total of2 to 5 minutes a day to obtain lasting improve-ments. A flexibility program should increase therange of motion gradually, and, for optimal flexibili-ty, all major muscle groups the athlete uses duringthe football season should be worked. This includesboth the upper and lower extremities.

While you train youth football players for strength,don’t forget that flexibility training often reduces therisk of injury while it increases the athlete’s range ofmotion—benefits that keep athletes in the game.

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HamstringStretch

A hamstringstretch is anexcellentexample of staticstretching for thelower extremities.

To perform this stretch, theathlete should cross one legover the other while stand-ing. Then, the athlete slowlybends the back, loweringout-stretched hands towardthe ground. The athleteshould hold the positionwithout bouncing for 10 to30 seconds.

StandingStretch

A standingstretcheffectivelystretchesthe calf andlower leg.To perform

this stretch, the athlete shouldposition one foot ahead of theother, and place his hands on awall or fixed object. The athleteleans forward, keeping weight onthe heel of the back foot untilthe stretch is felt in the uppercalf.

ShoulderStretch

For the upperextremities, ashoulder stretchis effective. Whileholding theshoulder level, theathlete places his or

her left hand on the right elbow,and then pulls the right armacross the chest. Theathlete should hold the positionfor 10 seconds and then repeatthe stretch with the oppositearm.

Football Flexibility Exercises These exercises make the body’s tissues warmer and more flexible. Each exercise should be preceded bya 10-minute cardiovascular warm-up. Hold each stretch in a slow, static manner for 15 seconds, with threerepetitions. It is a small investment in time for a large return on injury prevention.

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GO ONLINE AT WWW.NFLHS.COM/HEALTHMORE READINGAppleton, B.D. (1994). Stretching and Flexibility: Types of Stretching. www.bath.ac.uk/~masrjb/Stretch/stretching_1.html.Beaulieu, J.E. (1980). Stretching for All Sports. Pasadena, CA: Athletic Press.Fahey, T.D., Insel, P.M., & Roth, W.T. (2000). Fit & Well: Core Concepts and Labs in Physical Fitness and Wellness (Fourth

Edition). Mayfield Publishing Co.

Seat Straddle LotusSit down, place soles offeet together, and dropknees toward floor.Place forearms on insideof knees and push kneesto the ground. Leanforward, bringing chinto feet. Hold for 15seconds. Repeat threetimes.

Seat Side StraddleSit with legs spread;place both hands onsame ankle. Bring chinto knee, keeping theleg straight. Hold for15 seconds.Repeat three times.Repeat exercise onopposite leg.

Seat StretchSit with legs together,feet flexed, hands onankles. Bring chin toknees. Hold for 15seconds.Repeat three times.

Knees to ChestLie on back with kneesbent. Grasp tops ofknees and bring themout toward the armpits,rocking gently.Hold for 15 seconds.Repeat three times.

Forward LungesKneel on left leg; placeright leg forward at aright angle. Lunge for-ward, keeping the backstraight. Stretch shouldbe felt on the left groin.Hold for 15 seconds.Repeat three times.Repeat on opposite leg.

Side LungesStand with legs apart;bend the left kneewhile leaning towardthe left. Keep the backstraight and the rightleg straight.Hold for 15 seconds.Repeat three times.Repeat on opposite leg.

Cross-OverStand with legs crossed;keep feet close togeth-er and legs straight.Touch toes. Hold for15 seconds. Repeatthree times.Repeat withopposite leg.

Standing QuadStretch

Stand supported. Pullfoot to buttocks. Holdfor 15 seconds.Repeat three times

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Young players need strength and flexibility to suc-ceed on the football field. But strength is one thing,and the ability to generate it quickly and exposivelyis power. And it’s power that’s necessary for a ballcarrier to accelerate quickly through the defensiveline, or for a defender to tackle an opponent.Plyometrics can help youth football players developthat power.

What Are Plyometrics?Plyometrics, sometimes called jump training, becamepopular during the 1970s. Eastern European athleteswho incorporated plyometrics in their training pro-grams excelled in Olympic track and field events,weightlifting, and gymnastics, and many attributedthat success to their training methods. Since then,coaches in a variety of sports—including football—have used plyometrics to improve muscle power andspeed, and even to prevent injuries. Studies show

athletes who do plyometrics are four times less likelyto get hurt while playing sports.

Lower body plyometrics include jumps-in-place,multiple hops, and box drills. One example is thefront cone hop. In this drill, the athlete hops for-ward over five cones spaced a few feet apart asquickly as possible. Examples of upper body plyo-metric exercises include medicine ball tosses,throws, and trunk twists. A typical beginner’sprogram may look like this:

■ Ankle jumps—2 sets of 10 repetitions■ Lateral cone hops—2 sets of 8-10 repetitions■ Two-legged horizontal jumps—4 sets of 5 repeti-

tions■ Medicine Ball Chest Pass—2 sets of 10

repetitionsConsult one of the suggested readings at the end

of this section for descriptions of these and otherplyometric exercises.

Plyometrics help youth football players improve performance by increasingexplosive muscle power and speed while reducing injuries.

BY CASEY CHRISTY, ATC, CSCS

PLYOMETRICS HELP PLAYERS IMPROVE MUSCLE POWER


■ Plyometrics are special jump training and medicine ballexercises that can help youth football players improvemuscle power and speed.

■ Players need a solid baseline of strength before startinga plyometric program to prevent training injuries.

■ Youth football coaches should become familiar with safe-ty considerations before initiating a plyometric pro-gram. These include adequate and appropriate trainingprogression, warm-up, technique, landing surface, andtraining volume.

How Do Plyometrics Work?Plyometrics are based on the rubber band principle.Your muscles are elastic, just like a rubber band,and when they are placed in a stretched position,your muscles develop stored energy—energy thatcan be used for a powerful contraction.

To illustrate, let’s compare a plyometric exercise toshooting a rubber band. Before you can shoot arubber band, you must first stretch it out (thestretch phase). Then once you let it go, the rubberband quickly recoils (contraction phase), thus, givingit the power to fly. The same thing happens in yourmuscles during a plyometric exercise.

For example, during the front cone hop, the frontthigh muscles stretch as the knees bend to absorbthe shock with each landing (stretch phase). Themuscles then quickly recoil (the contraction phase)as with the rubber band. The result is a powerful,explosive muscle contraction that propels the ath-lete to the next jump. Using these types of exercisesteaches muscles to fire explosively, which translatesinto more speed and power on the playing field.

Safety ConsiderationsBefore starting youth football players on plyomet-rics, coaches need to learn some safety precau-tions. Plyometrics can be dangerous if not per-formed properly. Safety considerations includeappropriate training progression, adequate warm-up, proper technique, the right landing surface,and monitored training volume. Let’s take a look ateach of these.

■ Progression Players can’t just begin a plyo-metric program—some prerequisites are neces-sary. A football player needs a good baseline ofstrength first. Four to six weeks of generalstrength training exercises are recommendedbefore an athlete starts any plyometric exercises.

Beginners should start with low-level plyo-metrics, such as double-leg jumps in place andmultiple hops and jumps. Athletes should startwith jumps with two-foot landings first, tominimize stress to the ankles, knees, and hips.

Gradually, athletes can progress to moreintense exercises such as single-leg landings,double-leg box drills, and depth jumps. Depthjumps involve stepping down from a box andthen immediately jumping up onto another box.However, these jumps are intense and not foreverybody. Only those players with extensivetraining experience and a sufficient strengthbase should perform depth jumps. Overweightathletes should avoid them altogether.

■ Warm-up Players should perform a five- toeight-minute light jog and then stretch out allmajor muscle groups before a plyometricexercise session. Power skipping (an exaggeratedskipping motion emphasizing a forceful push-offwith each skip) is also suggested.

■ Technique To prevent training injuries, coach-es and athletes should learn plyometric tech-niques from a qualified expert such as a CertifiedAthletic Trainer (ATC) or Certified Strength andConditioning Specialist (CSCS). Instructionalbooks and videos are also available.

■ Landing surface To minimize joint stress,perform jumps only on a padded surface or onsoft grass. Training on hard surfaces such as agym floor or a dirt field can lead to injury.

■ Training volume Coaches must also mon-itor foot contacts—the number of times thefeet strike the ground—during training ses-sions. Too much jumping too soon can result inoveruse injuries such as ankle and knee tendini-tis. Limit beginners to 60-100 foot contacts pertraining session, and advanced athletes to 100-150. Perform plyometrics a maximum of twicea week during the offseason and once a weekduring the season. And allow at least 72 hoursrecovery between sessions.

Plyometrics can improve a youth football player’smuscle power and speed, and even prevent gameinjuries. However, to avoid injury during training,players must have a good strength base beforestarting a program, learn proper technique, andfollow recommended safety precautions.

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GO ONLINE AT WWW.NFLHS.COM/HEALTHMORE READINGJumping into Plyometrics 2nd edition, by Donald Chu (Human Kinetics Publishers). Video also available.The Complete Guide to Medicine Ball Training, by Vern Gambetta and Steve Odgers (Optimum Sports Training Publishers).

Video also available. High Powered Plyometrics, by James Radcliffe and Robert Farentinos (Human Kinetics Publishers). Video also available.

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Warm-UpA warm-up consisting of both static (typical stretch-ing of individual muscles by holding a specific posi-tion) and dynamic stretching (movements that runmuscles and joints through their full range ofmotion), approximately 15-20 minutes in length, isnecessary before participating in these drills.Jogging should start the warm-up, followed by afull-body static stretch, paying special attention tothe calves, quadriceps, hamstrings, and hip muscu-lature. Athletes should find a position that causesthem to feel a gentle stretch on the muscle andhold that position for 20 seconds. Young athletesshould not force a stretch, as it could take its toll ontheir already pliable joints. After the static stretchingis complete, athletes should do a dynamic warm-up. Toe walks, heel walks, walking knee to chest,

walking straight leg kicks (Frankensteins), butt kicks,and walking hip circles should be among the exer-cises included.

DrillsMake sure athletes stay balanced and controlled inthese activities. In general, good athletic position(on toes, knees bent, head up, hands ready) shouldbe maintained.

These drills can be done in any order. If certain drillsare easier than others for youth football players,those drills should be done first. Start with the basicdrills described. As young athletes become moreproficient, the speed of the drill should beincreased, with proper form maintained. Drills canthen be made more position-specific as notedbelow.

Agility is an important component of strength and conditioning. The agileathlete is quicker on his feet, more effective as a football player, andbetter able to avoid situations that may cause injury

BY PATTI FLYNN, ATC, CSCS

AGILITY TRAINING IN YOUTH FOOTBALL


■ The drills that follow, appropriate to age and youthfootball demands, will aid in developing agile movement.

1. Fast FeetStep forward with one foot, followed by the other foot to meet it. Steps should be quick and quiet. Leadfirst with the left foot each step, then with the right. This drill can be done on the ground, through aspeed ladder, or over hurdles or cones. Perform drill forward, backward, and sidestepping.

Diagram I: Foot placement for sidestep fast feet in speed ladder

25

GO ONLINE AT WWW.NFLHS.COM/HEALTHMORE READINGNational Strength and Conditioning Association. nsca-lift.org.Essentials of Strength and Conditioning (available through Human Kinetics Publishing) National Strength and

Conditioning Association.Training & Conditioning magazine (available through MAG, Inc., 2488 N. Triphammer Rd., Ithaca, NY 14850).

2. Skating DrillStart on one foot and push sideways to land on other foot.Landing should be soft and controlled. Push back to otherfoot right away. Continue hopping from foot to foot for 20seconds. Gradually widen the distance of jump.

4. MirrorAthletes face each other, one as offense, one as defense. The offensive player performs the drill (e.g.grapevine, sidestep fast feet), changing direction (laterally or forward/backward or both) randomly. Thedefensive player reacts to maintain position opposite the offensive player at all times.

3. Stops/StartsWhile performing agility drills or while running, stop and start orchange direction on command. Voice commands or ball movement (e.g. simulating a snap) can be used astriggers. Athletes should stop, restart, and change direction with a minimum number of steps.

Position Specific DrillsOnce youth football players have mastered agilitydrills, the drills can be made position specific.Remember that the speed of the drill will have toslow down at first.

Defensive Backs/Receivers: Perform drillsover greater distances. Catch the ball to cue chang-ing direction. Defensive backs should go in theopposite direction they are heading (as if returningthe ball after an interception) and receivers shouldturn 180 degrees and continue (as if catching apass and heading upfield).

Quarterbacks: Perform drills with ball inhand. Throw or handoff in the middle of a drill.

Running Backs: Perform drills carrying thefootball. Change the arm with which they arecarrying the ball when they change direction with

their feet. Using cones or hurdles helps reinforcehigh knees.

Linebackers: Use a combination of back andlineman position-specific drills.

Linemen: Use football motion or voice com-mands with varying cadence to cue. Use shorterdistances. Use arm movements as in a game duringdrills (e.g. blocking).

EquipmentReference has been made to speed ladders andhurdles or cones. These pieces of equipment can bepurchased through strength and conditioning sup-pliers. If your budget is limited, there are somealternatives. Ladders can be made out of thin ropeor webbing purchased at a sporting goods store.Lines painted on the ground are also an option.

Diagram II: Skating drill

Diagram III: Mirror drill

Offensive player Defensive player

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Proper nutritional care is essential to strength andconditioning. The best eating plan for young foot-ball players does not differ much from a regular andbalanced diet plan for other youth athletes. It shouldinclude adequate fluids and plenty of low-fat, medi-um-protein, and high-carbohydrate foods that pro-vide energy and replenish the fuel and fluids usedduring physical activity.

Carbohydrates are one of the main sourcesof energy for muscles. It is important that at least65-70 percent of a young athlete’s eating plan con-sist of foods high in carbohydrates and low in fat,such as breads, pastas, fruits, and vegetables. Fruitjuices and juice drinks are also high in carbohy-drates. Muscles replenish stored carbohydrates bestwithin 1-2 hours after exercise. It is important thatyoung athletes eat or drink 200 to 400 carbohy-drate calories soon after exercise and then a fewhours later. Here are a few 200-400 carbohydratecalorie suggestions:

❶ Two pieces of fruit (banana, apple, orange)❷ One cup frozen yogurt with fruit topping❸ A bagel with jelly

❹ A muffin (blueberry) with one cup1 percent milk.

➎ Bowl of cereal with 1 percent milk andfruit topping

❻ Bowl of vegetable soup with 1 pita bread pocket❼ Fruit juice or fruit drink (12-16 ounces)Proteins are important for the growth of mus-

cle and the maintenance of all body tissues. It is nota major form of energy for the body, but proteindoes help with the development of certain chemi-cals that help fight infection and illness. Protein isan essential nutrient found in many foods.

It is thought that extra protein will be useful forendurance athletes as a means of replacing muscleprotein used during training. Athletes require moreprotein than the average person; however, excessiveamounts of protein will overwork the liver and kid-neys, interfere with calcium absorption in bone, andwill convert to fat for storage. A well-planned dietwill usually supply all of the daily protein a youngfootball player needs.

Recommendations for proper protein intake in theyoung athlete vary, but range from 1-2 grams/kilo-

Proper nutrition plays a vital role in youth football strength andconditioning. For a young athlete to perform at his best, he needs abalanced eating plan, and he needs to replenish fluids.

BY KEITH M. GORSE, M.Ed., ATC

PROPER FUEL FOR STRENGTH AND CONDITIONING


■ A balanced eating plan properly fuels a youth footballplayer to perform strength and conditioning activities.

■ Carbohydrates play an important role in strength andconditioning.

■ Proteins and fats also play a key role in building strength.

■ Proper fluids are critical to a successful strength andconditioning program.

gram of body weight. Proteins should account for15-20 percent of a young athlete’s eating plan.Foods that are high in protein are meat, poultry,cheese, and eggs. Proteins should be included in asound diet plan that includes 3-4 meals per day.Proteins should be consumed at least 3-4 hoursbefore physical activity. They should be eaten insmall quantity with other forms of nutrients (i.e.,carbohydrates) to facilitate digestion. Here are afew suggestions for a protein and carbohydratepregame meal:

❶ One six-ounce baked chicken breast with pasta❷ One six-ounce grilled hamburger with light

vegetable❸ One scrambled egg with bowl of cereal and fruit

topping ❹ One American cheese-on-wheat pita bread

sandwich with fresh fruit ➎ Broiled chicken tenders with fresh fruit or

vegetableFat is an essential nutrient, but it should not be

consumed in great amounts. Fats serve as a carrierfor the fat-soluble vitamins A, D, E, and K. It helpsprotect vital organs, and is a good energy source forskeletal muscles in high endurance activities.

Fats come in two different forms: saturated andunsaturated. Saturated fats are primarily found inanimal products such as meat, butter, and cheese.Unsaturated fats are primarily found in plant prod-ucts such as vegetable oil, nuts, and seeds.Unsaturated fats are recommended in a diet becausethey tend to maintain blood cholesterol levels. Totalfat consumption should be 10-15 percent of ayoung athlete’s eating plan.

More than 20 micro-nutrient elements (minerals)play an essential role in the body and must be sup-plied in the young athlete’s diet. Below are the mostessential minerals needed by young football athletesand where they are found in their diets:

❶ Calcium is needed for bone and tooth forma-tion, blood clotting, and muscle contraction. It isfound in most dairy products.

❷ Sodium is needed for maintenance of fluidbalance. It is found in salt.

❸ Iron is needed for metabolism and formation ofhemoglobin in the blood. It is found in redmeats, breads, dark green vegetables, andcereals.

❹ Zinc is needed for normal growth and develop-ment. It is found in seafood and meats.

➎ Fluorine is needed for strengthening bones andteeth. It is found in most drinking water.

Young football athletes need between 2,500-3,000 calories per day, and typically expend 600-900calories per day on football activity. The typical dietplan should include 3-4 high-quality meals per daythat provide the proper percentage of all nutrientsneeded.

It’s important that athletes, parents, and coachesknow that if an athlete loses weight that is notrecovered with simple fluid intake, a greater num-ber of calories should be recommended in his diet.If a weekly weight gain of one pound is desired,an exercise program that includes a diet plan of3,500 extra calories per week might be recom-mended. Athletes and their parents should alwaysread the nutrient labels on all food packages todetermine the amount of calories found in thosefood items.

For more advice on proper nutritional care as itrelates to strength and conditioning, contact a cer-tified athletic trainer or a sports nutritionist. Propereating habits with proper fluid intake at all timescan make a young athlete strong, fast, andhealthy.

Other reliable sources of nutritional informationfor the strength and conditioning of young foot-ball players are:

■ Food and Drug Administration 888-SAF-EFOOD(723-3366)

■ Food and Nutrition Information Center(301) 504-5719

■ American Academy of Pediatrics (847) 228-5005■ American Dietetic Association (800) 877-1600 ■ ADA Nutrition Hotline (800) 366-1655 or

www.eatright.org■ President’s Council on Physical Fitness and Sports

(202) 690-9000

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GO ONLINE AT WWW.NFLHS.COM/HEALTHMORE READINGPainter, S.B., & Evans, D.M. Sports Medicine and Athletic Training. Gaithersburg, MD: Aspen Publication; July 2000; 10: 1-10: 24. Sullivan, J.A., & Grana, W.A. The Pediatric Athlete. Park Ridge Ill: American Academy of Orthopedic Surgeons;

November 1998; 33-43.Brown, J.E. Nutrition Now. Belmont, CA. International Thompson Publishing Co.; July 1999; 29: 1-29: 16.

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Strength training programs can help football players safely strengthenmuscles, prevent injury, and improve performance, but only if the programsare properly designed and adequately supervised.


SHOULD YOUTH FOOTBALL PLAYERS LIFT WEIGHTS?


■ Pre-adolescent football players can get stronger,prevent injury, and improve performance through astrength training program, using either lightweights, body-weight exercises, or resistance bands.

■ When properly designed and supervised, weight trainingfor pre-adolescents carries no greater injury risk thanparticipating in sports such as football, baseball, orsoccer.

■ Football players should undergo a physical examination bya physician before starting an exercise program and theyshould seek advice from a health or fitness professional,such as a certified athletic trainer (ATC).

■ Coaches should emphasize proper technique, use of lightresistance, and supervised training sessions.

Strength Training vs. Weight TrainingEmphasize to youth football players that gettingstronger doesn’t have to involve using weights.Although some experts say kids as young as 9 or 10years old can start with light weights, rememberthat other resistance options are available.

For example, young football players can usebody-weight exercises (pushups, abdominalcrunches, etc.) and resistance bands to build strength.

Benefits of Strength TrainingTraining not only strengthens muscles, but tendons,joints, and bones—even for pre-adolescents. Astronger body not only improves football perform-ance, it also helps prevent injury.

However, strength training will produce very lit-

tle—if any—increases in muscle size until a boy isolder. That’s because pre-adolescent boys have notbegun to produce hormones such as testosterone.Because testosterone is necessary for developing big-ger muscles, they will get stronger, but they won’tsee bigger muscles until they reach puberty.

Strength Training SafetyStrength training, when done correctly, is safe.According to research studies, a properly designed andsupervised weight training program carries no greaterinjury risk than playing sports such as football, base-ball, or soccer. Here are some Do’s and Don’ts:

■ Do ensure that parents consult aphysician before their child begins anyexercise program.

■ Do seek the advice of a health orfitness professional such as a CertifiedAthletic Trainer (ATC) or a Certified Strength andConditioning Specialist (CSCS).

■ Do emphasize proper exercisetechnique. Never allow the lifter to sacrificegood form for heavier weight.

■ Do teach proper breathing. Lifters shouldbreathe out as they lift and breath in as they lowerthe weight. They should never hold their breath.

■ Do use light resistance and stay inthe 12-15 repetition range. Perform1-3 sets for each exercise. Remember, beginnerscan use body weight exercises or resistancebands to build a baseline of strength beforeusing light weights. And remember, body weightexercises may be too intense for some over-weight athletes, so resistance bands arerecommended.

■ Don’t use weights that are too heavy.When the athlete is ready to start using weights,have him begin with a weight with which hecan do at least 12 repetitions for that particularexercise. If he can’t, then the weight is tooheavy. Don’t let an athlete try a heavier weight ifhe’s not ready for it.

■ Don’t overdo it. Exercises need to be doneonly two to three days a week on alternate days.Resting a day between workouts is essential foradequate recovery. Workouts should last only30-45 minutes.

■ Don’t allow youth football players tolift alone. All workout sessions must besupervised by a qualified adult. Use one or morespotters to assist the lifter when necessary.

■ Don’t allow your youth footballplayer to lift maximal weights until heis at least 16 years old. Heavy lifting (especiallyoverhead lifts) can injure an athlete’s fragilegrowth plates—areas of cartilage near thejoints—impairing normal bone development.

■ Don’t allow youth football playersto begin a weight training program unlessthey are mature enough to follow directions.

In summary, remember that getting stronger notonly improves performance but also helps preventinjuries. Kids can work out as long as coaches, ath-letes, and parents follow the proper precautions.Young football players need to take it slow at first,but as they reach physical maturity, they canprogress into more advanced programs with greaterresistance.

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GO ONLINE AT WWW.NFLHS.COM/HEALTHMORE READINGSportsWise: An Essential Guide for Young Athletes, Parents and Coaches, (Houghton Mifflin Publishers) by Dr. Lyle Micheli.Strength and Power for Young Athletes, by Avery Faigenbaum and Wayne Westcott (Human Kinetics Publishers).Total Training for Young Champions, by Tudor O. Bompa (Human Kinetics Publishers).

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Injury Prevention

Protective EquipmentProtective equipment is one of the most importantfactors in minimizing the risk of injury in youth foot-ball. Youth football leagues recommend the follow-ing items for each player: helmet; mouth guard;shoulder pads; athletic supporters for males;chest/rib pads; forearm, elbow, and thigh pads; shinguards; proper shoes; sunscreen; and water. Theequipment provided should be safe, properly fitted,in good repair, and inspected regularly. Equipmentthat is damaged should be discarded.

Conditioning ProgramsTop physical performance can only be achieved byan athlete who is in top physical condition. Lack ofphysical fitness impairs the performance of an ath-lete. Coaches should know the physical condition oftheir athletes and set practice schedules accordingly.Supervised preseason, in-season, and out-of-seasonconditioning programs should be available to allathletes. A person who is educated in the condi-tioning of the adolescent athlete should design andmonitor these programs utilizing up-to-date, scien-

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There are many things to consider in preventing youth football injuries.Here’s how coaches and parents can play a role in keeping the game andpractice arena safe.

BY MARY KIRKLAND, M.S., ATC/L, CSCS KENNEDY SPACE CENTER

TIPS TO PREVENT YOUTH FOOTBALL INJURIES


■ Make sure each child is in proper physical condition toplay football.

■ Know and abide by the rules of the sport.

■ Ensure the players wear appropriate protective gear.

■ Make sure the players know how to use athletic equipment.

■ Players should always warm up before playing.

■ Players should avoid playing when very tired or in pain.

■ Players should get a preseason physical examination.

■ Make sure there is adequate water or other liquidsavailable to maintain proper hydration..

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tifically sound advice. Cardiovascular, strength, andflexibility exercises that address the specific condi-tioning needs of the football player are essential toinjury prevention. Conditioning also involves mentalpreparation, as well as developing the discipline topractice regularly, eat properly, and maintain goodsleeping habits.

When playing or practicing in hot weather, playersmust acclimatize to the heat. It is essential that thisbe done gradually. With the proper conditioningprogram, a player can expect to be 80 percent accli-matized within 7-10 days. Final stages of acclimati-zation to heat are marked by increased sweatingand reduced salt concentration in the sweat.

Warm-UpsA proper warm-up is an integral part of a goodconditioning regimen and should precede anystrenuous physical activity. The National AthleticTrainers’ Association (NATA) recommends a mini-mum 15-minute warm-up period before any gameor practice and a cool-down period afterward.Athletes should warm up for five minutes duringany prolonged breaks.

When done properly, stretching increases theblood supply to the muscles, tendons, and liga-ments, and makes them more flexible. A stretch-ing routine should include all of the major musclegroups of the body, with special attention given tomuscle groups particularly stressed by thedemands of the sport. Each stretch should bedone smoothly and slowly, avoiding jerkingmotions. It should be held until tension, not pain,is felt in the muscle. See “Football FlexibilityExercises” on pages 20-21.

HydrationThe notion that water should be withheld from ath-letes is not only wrong, it can be harmful. The mostimportant safeguard to the health of the athlete isthe replacement of water. What is lost throughsweat must be replaced.

Make sure athletes drink plenty of fluids before,during, and after practices and games in order tostay hydrated and avoid overheating. Water mustbe on the field and readily available. It is recom-mended that a minimum 10-minute water break bescheduled for every half hour of heavy exercise inthe heat. Athletes should rest in a shaded area dur-ing the break. Dehydration of even as little as 1-2percent of an athlete’s body weight can hinder per-formance. More than 3 percent puts the athlete atrisk for heat cramps, heat exhaustion, or heat stroke.One precautionary measure is to advise athletes todrink 2-3 cups of water for every pound lost duringactivity. Their body weight should be back to normalbefore the next workout.

Have athletes pay attention to the amount andcolor in their urine. They should excrete a large vol-ume that is nearly colorless. Small amounts or darkcolored urine can indicate dehydration. Appropriatesports drinks are key to limiting energy loss whileremaining hydrated. They replace the electrolytesand fluid lost by the body during activity, and areespecially important when exercising in hot, humidclimates.

Annual Physical Evaluation For AllProspective Athletes

A qualified physician should perform an annualphysical evaluation prior to athletic participation.

Both the coach and parent should review the physi-cian’s documention, as it will bring to their attentionany potential medical alerts (such as asthma, dia-betes, etc.). Guidelines should be established for ath-letes with medical alerts to insure that emergencylife-sustaining medications are readily available andadministered properly when needed. Any cardiac riskfactors should be identified and reviewed by a physi-cian prior to participation. In addition to the generalexamination, an orthopedic examination is recom-mended. This exam should focus on joint flexibilityand range of motion, as well as an evaluation of anypast injuries to the bones or joints.

Team Physician/Consulting PhysicianEvery team should have a qualified physician wellversed in sports medicine available for immediateconsultation.

Appropriate Matching of CompetitorsChildren of the same age can vary dramatically inphysical development, so health professionals oftenmake a distinction between a child’s chronologicalage and developmental age. In sports, a physicalmismatch between competitors can lead to seriousinjury. Common sense dictates that young athletesbe grouped according to their developmental ageas much as possible, to reduce the likelihood ofinjury and help ensure fair competition.

Proper TechniqueCoaches should drill athletes in the proper execu-tion of fundamental football skills, particularlyblocking and tackling. This will significantly reducethe incidence of head and neck injuries.

High-Quality RefereesTry to insure that each official is certified by theNational Association of Sport Officials (NASO). Everyofficial must be fair and unbiased, and ensure thateach event is played with the highest level ofsportsmanlike conduct.

Safe Field/Facility ConditionsEnsure that playing facilities are properly cared for,inspected regularly, and repaired in a timely manner.Uneven terrain can contribute to sprained kneesand ankles. For games played in thunderstorm con-ditions, follow the NATA’s 30/30 rule for lightningsafety, which uses the Flash-to-Bang count to deter-mine when to go to safety. If 30 or fewer secondselapse between the time a lightening flash is seenand thunder is heard, all individuals should beremoved from the field and taken inside a safestructure. Once activities have been suspended,wait at least 30 minutes following the last soundof thunder or lightning flash prior to resuming anactivity or returning outdoors. Also, try to contactthe local weather service for additional advice onconditions.

Basic First Aid/EmergencyPreparedness

Each coach should make an effort to have CPR andFirst Aid training. Coaches often are the first torespond to any emergency and they will need totake the proper steps to safeguard the injured ath-lete. Know what to do in case of an emergency,and have your emergency plans written with copiesprovided to all coaches. Have prearranged proce-dures for obtaining medical care for the injured ath-lete, including initiating the EMS system and arrang-ing for ambulance service. Have a well-stocked first-aid kit on the sidelines, as well as ice for immediatecare of acute injuries.

Protocol For ReturningFollowing Injury

An injured player should be allowed to return toaction only after adherence to a standard protocolestablished with a qualified athletic health-careprovider. Communication is imperative among ath-letes, coaches, parents, team physicians, familyphysicians, certified athletic trainers, and othersregarding the status of the athlete’s injury.

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GO ONLINE AT WWW.NFLHS.COM/HEALTHMORE READINGChildhood Sports Injuries and Their Prevention – A Guide for Parents with Ideas for Kids.

http://www.niams.nih.gov/hi/topics/childsports/child_sports.htmNational Athletic Trainers’ Association. What happens if your child is injured on the sports field? Press release. 9/23/99. Lightning Season Is Here, Learn to Protect Yourself http://nata.org/publications/press_releases/lightningseason.htm.Heat Stress and Athletic Participation http://www.nfhs.org/sportsmed/heat%20stress.htm.O’Connor, D. Preventing sports injuries in kids. Patient Care, 6/15/98, pp. 60-83.

The overload principle is based on thepremise that doing more work than an athlete’sbody is accustomed to will cause physiologicaladaptations. These adaptations will allow morework to be done in the future and with greaterease. However, there are potential risks associatedwith overloading without allowing for adequaterecovery. Overreaching occurs when an ath-lete does not allow adaptation to occur betweenbouts of intense training. This results in a

decrease in performance that might be accompa-nied by other psychological and physiologicalsigns and symptoms.

If the intensity and duration of training are notreduced, overreaching will lead to overtrain-ing syndrome. Recovery for overreaching cantake two to three weeks, and recovery from theovertraining syndrome can take several months.Overtraining, also know as maladaptation, is along-term imbalance of physical training and

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Overtraining syndrome is an illness associated with seriousconsequences. However, overtraining can be prevented with properrecovery between exercise sessions.

BY KELLY FIALA, M.S., ATC, CSCS

PREVENTION & TREATMENT OF OVERTRAINING SYNDROME


■ Overloading results in physiological adaptations,including increased strength.

■ Overreaching occurs when an athlete does not allow foradaptation between intense training sessions.

■ Overtraining syndrome is an extension of overreaching.

■ Overtraining often results in diminished performance inconditioning drills and competitions.

■ Different characteristics predispose an athlete toovertraining syndrome.

■ Several signs and symptoms can help identify an athlete inan overtrained state.

■ A physician’s diagnosis is necessary to determine if anathlete is in an overtrained state.

■ Treatment for overtraining syndrome includes severalweeks of rest.

■ Prevention and early identification are the keys to dealing with overtraining syndrome.

recovery. A physician’s diagnosis of overtraining isbased on the patient’s history and laboratory find-ings, carefully ruling out other diseases. Table 1lists several of the signs and symptoms associatedwith the overtrained state.

Some youth football players are more susceptibleto overtraining syndrome than others. Adaptation

capacity, coping strategies, andphysiological properties help todetermine the athlete’s ability totolerate stress. It is important foryouth football coaches and play-ers to be aware of the factorsthat make athletes more vulnera-ble to overtraining. Table 2 listsboth internal and external factorsthat may predispose an athleteto overtraining syndrome.

The best way to combat over-training syndrome is preventionTable 3. Many measures can betaken to prevent overtraining.Periodization—varying intensityand volume of training, withadequate rest—is essential inpreventing overtraining.Adequate rest varies; however, itshould be a minimum of 1-2days, and as intensity increases,the number of days of restshould also increase. Adequatenutrition and sleep also con-tribute to the prevention of over-training.

However, if overtraining doesoccur, the best treatment is restand avoiding sports activities forapproximately two weeks. Aftertwo weeks, the youth footballplayer can resume light training.It is recommended that theplayer try different sports andabstain from the activity thatled to overtraining. A slow pro-gression of training shouldoccur with careful considerationof the athlete’s mental statusand an alertness for signs ofovertraining. Proper nutritionand sleep are required toincrease the speed of recovery.

For overtraining syndrome, as with any injury orillness, prevention is the key. However, in the eventthat the syndrome occurs, it is important for play-ers and coaches to be able to identify signs andsymptoms of the overtrained state. If overtrainingis identified early, the required recovery time isreduced.

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■ Loss of appetite ■ Anger■ Fatigue ■ Tension■ Sleeping problems ■ Muscle fatigue■ Depression ■ Abnormal sense perceptions■ Long-term muscle soreness ■ Inability to relax, twitchy, fidgety■ Insatiable thirst, dehydration ■ Lower resistance to common

illnesses (colds, sore throats, etc.)

Table 2. Factors that can increase vulnerability to an overtraining state

Internal External■ General health ■ Intensity of physical training■ General nutrition ■ Volume of physical training■ Mood state ■ Social, economic, and psychological

stress ■ Hereditary factors ■ Training history■ Age ■ Environmental conditions and time ■ Sex of year

■ Food intake■ Sleep (quality and quantity)■ Infections■ Medication, alcohol, and tobacco■ Travel (jet lag, altitude)

Table 3. The prevention of theovertraining syndrome

■ Incorporate periodization■ Allow adequate recovery time■ Progress slowly with increasing intensity and duration■ Encourage alternative activities

Table 1. Signs and symptoms of overtraining

Several studies indicate nearly half of all youthsports injuries are caused by overuse, suggestingkids often try to do too much too soon.

Coaches and parents can prevent many of theseinjuries by following a gradual training progression,instructing athletes not to ignore pain, and recog-nizing the unique physical traits of a child’s growingbones.

Follow the 10-Percent RuleOne way to prevent overuse injuries is by followingthe 10-percent rule. This rule simply states that eachof the FIT components of any athletic activity shouldbe increased by no more than 10 percent a week: Frequency—how often athletes train, practice,or playIntensity—how hard athletes train, practice,or play

Time—how long athletes train, practice, or play.The 10-percent rule started out as a recommenda-

tion for long-distance runners regarding their weeklyincreases in training mileage. Coaches and parentscan apply this rule to football, too. For example, tobuild youth athletes’ cardiovascular endurance withjogging activities, increase the amount of time ordistance they run by only 10 percent a week.Accelerated increases are likely to lead to injury.

Other Preventative MeasuresMake all changes in athletes’ routines gradual. Forexample, adding hill running is a great way toincrease workout intensity, but not if it adds toomuch too soon. Training surface is also important.Suddenly changing from running on grass all thetime to a harder surface such as asphalt can bringabout injury.

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Overuse injuries in youth football players are preventable throughproper training progression.


PREVENTING OVERUSE INJURIES IN YOUTH FOOTBALL


■ Overuse injuries such as tendinitis, shin splints,and other aches and pains are common in youthfootball players, especially at the beginning ofthe season.

■ Coaches and parents should teach athletes thedifference between getting-in-shape pains andinjury pain.

■ Coaches can prevent many overuse injuries througha gradual training progression and by recognizingthe unique characteristics of a child’s growingbones.

■ Aches and pains that last more than a few days shouldbe evaluated by a physician or certified athletictrainer (ATC).

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GO ONLINE AT WWW.NFLHS.COM/HEALTHMORE READINGSportsWise: An Essential Guide for Young Athletes, Parents and Coaches (Houghton Mifflin Publishers) by Dr. Lyle Micheli.Overuse Injuries in Children and Adolescents by Dr. John DiFiori, M.D. (The Physician and Sportsmedicine, January 1999).Combating Overuse Injuries: A Focus on Children and Adolescents (The Physician and Sportsmedicine, January 1993)

by Carl Stanitski, M.D.

Listen to Your BodyTeach athletes the difference between getting-in-shape pains and pain that indicates an injury orpotential injury from overuse. For example, generalmuscle soreness on both sides of the body (both legs,both arms) can be expected when young athletesstart a new season. But if it’s only soreness, the painshould go away after a few days of rest and gentlestretching exercises. However, pain only on one sideof the body—or pain on both sides that doesn’t goaway after a few days—can indicate an injury.

Don’t Ignore PainTo prevent an overuse injury from snowballing intoa condition that can sideline an athlete for an entireseason, don’t ignore pain. If a painful condition per-sists after a few days or affects the athlete’s playingability, remove him from participation. Then havethe injury evaluated by a physician or certified ath-letic trainer (ATC).

Many minor overuse injuries can be managed with-out losing much playing time if caught early enough.

Watch Out For Growth Plate ProblemsChildren have fragile growth plates—areas of carti-lage that eventually harden into mature bone—near all of their joints. These areas are prone toinjury when athletes are young and growing. Somegrowth plates—such as those on the back of theheel or below the kneecap—are especially prone toinjury. These areas serve as attachment sites for theyoung athlete’s muscles and tendons. Excessivephysical activity can inflame the growth centers,leading to pain and swelling. Ignoring such paincan have long-term consequences, as untreatedinjuries to growth plates can affect normal bonegrowth, cause permanent arthritis, and abnormalmuscle function.

Remember: don’t train kids like miniature adults.Their young and growing bodies need time toadjust to new physical activities. And when achesand pains do occur, don’t treat them lightly.Young athletes are susceptible to unique injuriesthat, when left untreated, can lead to long-termproblems.

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Along with proper conditioning and technique, no other component is asimportant to safe youth football participation as high-quality protectiveequipment. Today’s youth football equipment allows for maximal protection,with minimal negative impact on performance. Using properly fittingquality equipment that is correctly maintained ensures maximal safety.

BY ROBERT D. KERSEY, Ph.D., ATC, CSCS

SELECTION, FITTING, CARE, AND USE OF EQUIPMENT


■ Protective equipment is designed to minimize externalforces to the body.

■ Purchase high-quality youth football equipment fromreputable dealers.

■ Use qualified personnel and always follow recommendedfitting instructions. Never let young athletes determineproper fit.

■ Know and follow the manufacturers’ requirements,which often limit equipment alterations.

■ Teach and require proper use of all protectiveequipment.

■ Teach athletes to conduct daily equipment checks, inaddition to frequent and regular equipment checks bythe coaching, athletic training, or equipment staff.

■ Always know and abide by the equipment rules for yourspecific area and league.

■ Whenever protective equipment directions/instructionsare missing, contact the manufacturer for guidance.

■ Contact a properly qualified sports health-careprofessional, such as a certified athletic trainer(ATC), for additional assistance and/or information.

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GO ONLINE AT WWW.NFLHS.COM/HEALTHMORE READINGAthletic Protective Equipment: Care, Selection, and Fitting, by Scott Street and Debrah Runkle (McGraw-Hill, 2000). Principles of Athletic Training, by Daniel Arnheim and William Prentice (McGraw-Hill, 2000).Introduction to Athletic Training by Sue Hillman (Human Kinetics, 2000).

Although rules vary with the level of competitionand geographic region, certain equipment isrequired, while other gear is optional. Requiredyouth football equipment generally includes: a hel-met with facemask, mouthguard, shoulder pads,hip pads, thigh pads, knee pads, and a tailbonepad. Optional protective equipment may include:neck collars and knee braces. Items not detailedhere include: jerseys, pants, footwear, protectiveeyewear, rib pads, and upper extremity padding.

Required EquipmentHelmet and Facemask: All helmets used in

youth football should meet minimum safety stan-dards and be labeled as such (NOCSAE). The helmetand facemask protect the bones and soft tissues ofthe head, face, and, most important, the brain.Always follow manufacturer guidelines. Each athletehas unique head dimensions, so individual fit is criti-cal. Generally, helmets should fit comfortably snug.Check regularly for proper fit, including bladderinflation. Always inspect the helmet shell for cracks,and for excessive wear on interior padding, chinstraps, rivets, screws, and snaps. Check the face-mask for exposed metal. Recondition all helmets asspecified by the manufacturer (typically every twoyears for youth helmets).

Shoulder Pads: Shoulder pads shouldprotect the upper torso and shoulder regions.As with helmets, proper fit of shoulder pads iscritical to their effectiveness and should alwaysfollow manufacturer guidelines. Athletes should beable to reach up and out without impinging theirneck. Be sure the inner padding covers the shoul-der tips (acromions), and the outer shellprotects the front and sides of both shoulders.The pads must completely cover both shoulderblades (scapulae) and the breast plate (sternum).Regular inspections should identify problemequipment. Annual reconditioning is recommended.

Mouthguards: A properly fitted, high-qualitymouthguard assists in preventing many oral andfacial injuries, as well as limiting concussions.Most youth football athletes use the boil and bite

(thermoplastic) mouthguard. These relatively inex-pensive items are generally effective. After select-ing the appropriate-sized mouthguard, do notallow over-trimming as this practice may limit itseffectiveness. Custom mouthguards are efficientoptions, but costly.

Padding: Youth football leagues typicallyrequire hip, thigh, and knee pads, as well as atailbone pad for all participants. When properlyfitted and used, these effectively protect specificbody regions from contusion. Proper placement ofthese pads is imperative.

Optional EquipmentNeck Collars: Various forms of prophylacticand postinjury neck collars are available tofootball athletes. Fitted correctly, neck collarsmay effectively limit hyperextension (head back),but may not properly limit lateral flexion (side toside) or rotation (twisting). Always follow manu-facturers’ guidelines for fitting and application.

Knee Braces: Prophylactic knee braces havebeen in use for more than 20 years. Whenapplied properly to adult football players, theycan reduce knee sprains. Little research has beendone with regard to the use of knee braces inyouth football.

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Serious neck injuries in football are rare—about 1in every 100,000 players. Even one neck injury isone too many. That’s because neck injuries canresult in paralysis and even death. Here’s how youcan protect youth football players.

Teach Proper Tackling Technique Instruct players to keep their heads up and initiatecontact with their shoulder when making a tackle.Lowering the head and using it as a battering ramis asking for trouble. The reason for this is simple:When your head is upright, your seven neck bonesare aligned in a natural, curved pattern, which pro-tects you from injury. That’s because your neck canbetter absorb impact in this position.

However, when you put your head down, yourneck bones become stacked. And when a playermakes a headfirst tackle in this position, the headstops but the rest of his body keeps moving, com-pressing his stacked neck bones. If the force isstrong enough, the neck bones buckle and seriousdamage to the spinal cord can occur. Remind

Proper tackling technique, strong neck muscles, and the rightequipment can help youth football players avoid serious neck injuries.


PREVENTING NECK INJURIES IN YOUTH FOOTBALL


■ Neck injuries in youth football can result in paralysisand even death.

■ Players should avoid lowering the head when making atackle as this can result in serious injury. Instructplayers to keep their heads up when tackling and initiatecontact with the shoulder.

■ Youth football players must also strengthen their neckmuscles and wear an approved, properly fitted helmet toavoid injury.

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GO ONLINE AT WWW.NFLHS.COM/HEALTHMORE READINGMinimizing Liability Risks of Head and Neck Injuries in Football, by Jonathon Heck et al. (Journal of Athletic Training,

Volume 29, No. 2, 1994). Recommended Procedure for Football Helmet Fitting Session is available from Schutt Sports (1-800-637-2047),

manufacturer of football helmets. Prevention of Cervical Spine Injuries in Football, by Kenneth Fine, et al. (The Physician and Sports Medicine, Vol. 19, No., 10,

October 1991).

players to hit with their heads up. They should seethe jersey number of the player they are tackling.

Strengthen Neck Muscles The stronger a player’s neck muscles are, the lesslikely it is that he will be injured. But point out toyour players that doing neck exercises is in no waya substitute for proper tackling technique.Although neck machines are available, you reallydon’t need any special equipment.

Here are some tips on how to strengthen the necksimply by using a towel.

Neck Flexion—With the player in a seatedposition, stand behind him, roll up a towel, andplace it across his forehead. Holding on to bothends of the towel, instruct the player to bend hisneck forward slowly, bringing his chin toward hischest while you offer mild resistance. Have himpause and slowly return to the starting position.Don’t allow him to hyperextend the neck whenbringing the head back up. He should simply stopwhen the head is in its natural, upright positionand repeat. Perform 2-3 sets of 10 repetitions.

Neck Extension—Have the player begin withthe neck in a partially flexed position by loweringhis chin toward his chest. Stand in front of himand place the towel across the back of his head.Have him lift his head back into the upright posi-tion while you apply mild resistance. Don’t allowhim to hyperextend his neck. Have him stop whenhis head is in its natural position and then repeat.Perform 2-3 sets of 10 repetitions.

Lateral Neck Flexion—With the playerseated and his head in its natural, upright posi-tion, stand on the right side of him facing the sideof his head. Place the towel across the left side ofhis head, over his ear. While applying mild resist-ance with the towel, have him tilt his head to theleft, bringing his left ear toward his left shoulder.Return to the starting position and repeat.Perform 2-3 sets of 10 repetitions, then repeatwith the other side.

Finally, make sure players use only helmetsapproved by the National Operating Committeeon Standards for Athletic Equipment (look for the“NOCSAE” label on the back), and make surethese helmets are properly fitted.

Remember, although not all neck injuries are pre-ventable, proper tackling technique, keeping theneck muscles strong, and using the right equip-ment will greatly reduce players’ chances of seri-ous injury.

For more information on preventing neckinjuries in youth football, consult a physician or acertified athletic trainer (ATC).

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Youth football coaches should educate players about fundamentalfootball skills, particularly the proper execution of blocking and tackling.


RISKS ASSOCIATED WITH SPEARING


■ Spearing, defined as headfirst contact with the headlowered and the neck flexed, is illegal and dangerous.

■ Spearing is the major cause of cervical spine injury(cervical fracture, dislocation, and quadriplegia)in football.

■ Coaches who teach their athletes to tackle or block withthe helmet are placing their athletes at extreme risk forspinal injury, permanent paralysis, and even death.

■ Teaching proper tackling and blocking techniques is thekey to prevention of head and spine injuries in football.

The following recommendations are proven to reduce therisk of spinal injury during blocking and tackling:

■ Educate players on the potential risks associatedwith tackling an opponent with the head lowered.

■ Coaches should instruct players to make contact withthe head up (“See what you hit” approach) and neverwith the top of the head or helmet.

■ Initial contact should never be made with thehelmet/head. Instruct players never to lower theirhead in an attempt to deliver a blow to an opponent.

■ Coaches and officials should instruct players neverto use their heads as battering rams when blockingor tackling.

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The risk of spinal injuries in football has decreaseddramatically since 1976, when rule changes eliminat-ed the head as the primary and initial contact pointfor blocking and tackling. However, it is natural for ayoung athlete—especially one who is smaller—todevelop a head first-tackling technique to improve hisleverage against large players if he is unaware of therisks and not properly instructed.

Although death or quadriplegia at the youth sportlevel are rare, the risk steadily increases with inten-sifed impact forces as the athletes get bigger andstronger. Education and instruction should beginearly to teach proper skills before bad habits develop.

Spearing is characterized by headfirst contact,with the head lowered and the neck flexed. Whencontact is made in this fashion, the neck is straight-ened without the normal curvature of the spine. Asa result, vertical forces through the head that arenormally dissipated by the neck muscles are insteadtransmitted through the spinal column.

If the vertical force exceeds the tensile or com-pressive strength of the straightened spine, the ver-tebral column can collapse or buckle, resulting incompression fractures or fracture dislocations. If afractured or dislocated vertebra intrudes into thespinal canal, permanent spinal cord injury and paral-ysis can result.

According to the National Center for CatastrophicSport Injury Research, this method of tackling orblocking—resulting in axial loading of the spine—was found as the direct cause for 36 football fatali-ties and 30 permanent paralysis injuries in a singleyear before new rules and instruction had beenintroduced.

The key to avoiding catastrophic neck injury asso-ciated with spearing is prevention. Since 1976, rulechanges, improved equipment, improved strengthand conditioning programs, and athlete educationhave greatly reduced the incidence of neck injuries.Experts agree that the most effective preventionstrategy is teaching proper technique.

The Inter-Association Task Force for AppropriateCare of the Spine-Injured Athlete recommends that

players, parents, and coaches all participate in edu-cational programs, beginning in youth leagues andother football developmental programs and empha-sizing a “see what you hit” technique for blockingand tackling. The task force also recommends thatthese educational programs be repeated at regularintervals and constantly reinforced.

Football is one of four sports that represent thegreatest risk for head and spine injury of all of youthsports. Although it is recognized that football is acontact sport and not all injuries can be avoided,many serious injuries can be prevented through prop-er education. Research clearly indicates that the inci-dence of catastrophic head and neck injury hasdecreased dramatically through prevention strategies.

GO ONLINE AT WWW.NFLHS.COM/HEALTHMORE READINGProctor, M.R., & Cantu, R.C., Pediatric and Adolescent Sports Injuries: Head and Neck Injuries in Young Athletes.

Clinics in Sports Medicine. 19(4); 693-715, 2000.Mueller, F.O., & Diehl, J.L. Annual Survey of Football Injury Research 1931-2001. From the National Center for Catastrophic

Sport Injury Research. Chapel Hill, NC. http://www.unc.edu/depts/nccsi/SurveyofFootballInjuries.htm. Kleiner, D.M., Almquist, J.L., Bailes, J., Burruss, T.P., Feuer, H., Griffin, L.Y., Herring, S., McAdam, C., Miller, D., Thorson, D.,

Watkins, R.G., & Weinstein, S. Prehospital, Care of the Spine-Injured Athlete: A Document from the Inter-Association Task Force for Appropriate Care of the Spine-Injured Athlete. Dallas, Texas. National Athletic Trainers’ Association, March 2001.

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In youth football, muscle balance is essential for injury prevention andenhanced performance.

BY KELLY FIALA, M.S., ATC, CSCS

MUSCLE BALANCE: CONSIDERATIONS FOR INJURY PREVENTION


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■ Muscle balance is the strength, power, or endurance ofone muscle group relative to another muscle group.

■ Recommended ratios have been established for severalmuscle groups that work in opposition (e.g. biceps andtriceps).

■ No more then a 10-percent deficit should exist betweenmuscle groups of the right and left sides.

■ Leg strength to body weight ratios indicate potentialbody speeds.

■ Ratios are not absolute guidelines.

■ Differences in muscle balance should be based onindividual variations, sports played, and previous injuries.

Muscle balance plays a critical role in injury pre-vention and performance enhancement. As a youthfootball coach, you should consider three types ofmuscle balance: agonist and antagonist muscles,contralateral muscles, and lower body strength tobody weight ratios.

An antagonist muscle works in opposition to theprime mover, also called the agonist. Agonist andantagonist muscle groups (e.g. biceps and triceps)are not always equal in strength. Several studieshave been conducted to determine appropriatestandards for agonist/antagonist muscle strengthratios. These recommendations are listed in Table 1.

For example, a youth football player who can lift100 pounds with his quadriceps during knee exten-sion should be able to lift 66 pounds with his ham-string during knee flexion (see Knee [Extension:Flexion] in Table 1). In addition, this athlete shouldbe able to lift equal amounts with his triceps duringelbow extension and biceps during elbow flexion

(see Elbow [Flexion: Extension]). Here’s another way to look at the information:

The gastrocnemius (the largest muscle of the calf ofthe leg) and soleus (a broad flat muscle of the calfof the leg, situated under the gastrocnemius)should be able to lift three times as much duringplantar flexion (extension of the ankle) as the tibialisanterior (the shin) does during dorsiflexion (footflexion) (see Ankle [Plastar flexion: Dorsiflexion]).

However, it is not advised for adolescents to per-form a 1RM, the maximum amount of weight an ath-lete can lift only one time. Therefore, it is best to usea predicted 1RM. After warming up, a youth footballplayer can predict his 1RM by selecting a weight hefeels he can lift 6-8 times. After performing the maxi-mum amount of lifts for that weight, he can plug theweight and repetitions into the following equation:

Predicted 1RM = lbs or kg / [100% - (number ofreps x 2)]

For example, if an athlete can lift 80 kg for 10

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repetitions, the following is true:Predicted 1RM = 80 kg / [100% - (10 x 2)]Predicted 1RM = 80 kg / [100% - 20%]Predicted 1RM = 80 kg / [80%]Predicted 1RM = 80 kg / [0.80] Predicted 1RM = 100 kgAfter making the calculations, comparisons

between muscle groups can be made. In youth football, it is important to remember

that these values should be used as general guide-lines and not absolute standards.

The term contralateral refers to both rightand left sides of the body. Contralateral musclesshould be similar in strength. However, some con-tralateral muscles or muscle groups have discrepan-cies in their strength. These discrepancies shouldnever exceed a 10-percent difference.

The final standard of muscle balance that youthfootball coaches should be aware of is the relation-ship of lower-body strength to body weight.The guidelines established for lower-body strengthare based on leg press and squat performances.

Youth male football players should be able to legpress about 1.5 times their body weight and squatweights equal to their body weight. Again, theseguidelines are based on the outcomes of a fewstudies and should not be viewed as absolute stan-dards. Differences in muscle balance should bebased on individual variations, sports played, andprevious injuries. This testing should be done onmature adolescents only.

In addition to strength, muscular endurance isa key factor in injury prevention. Muscular enduranceis the ability to perform repetitive muscular contrac-tions for an extended period of time. Typically, asstrength increases, endurance increases as well.

A clear understanding of a youth football player’sgeneral trends of strengths and weaknesses ofmuscle groups is essential to the design of anappropriate resistance-training program. Weakmuscles should be strengthened by exercising withgreater frequency and volume. Give these weakermuscle groups priority by placing them at thebeginning of the workout.

Table 1. Recommended Strength RatiosJoint (Action) Muscles Strength Ratio

Ankle (Plantar flexion: Dorsiflexion) Gastrocnemius, soleus: tibialis anterior 3:1

Ankle (Inversion: Eversion) Tibialis anterior: peroneals 1:1

Knee (Extension: Flexion) Quadriceps: hamstring 3:2

Hip (Extension: Flexion) Spinal erectors, gluteus maximus, hamstring: iliopsoas, 1:1rectus abdominus, tensor fascia latae

Shoulder (Flexion: Extension) Anterior deltoid: trapezius, posterior deltoids 2:3

Shoulder (Internal rotation: External rotation) Subscapularis: supraspinatus, 3:2infraspinatus, teres minor

Elbow (Flexion: Extension) Biceps: triceps 1:1

Lumbar Spine (Flexion: Extension) Psoas, abdominal: spinal erectors 1:1

GO ONLINE AT WWW.NFLHS.COM/HEALTHMORE READINGBaechle, T. (Ed.). Essentials of Strength Training and Conditioning. Human Kinetics: Champaign. 2000.

(Chapter 24: Muscle Balance by D. Wathen). Moore, J., & Wade, G. Prevention of Anterior Cruciate Ligament Injuries. National Strength and Conditioning

Association Journal. 11(3): 35-40. 1989. Grace, T. Muscle imbalance and extremity injury. A perplexing relationship. Sports Medicine. 1985 Mar.-Apr.; 2 (2): 77-82.

Safety must be the primary concern when design-ing the layout of a weight room for youth footballplayers. Injuries can occur not just from lifting, butalso from tripping over loose weights or collars,horseplay, or lifting stations being too close to eachother. As you develop a strength-training program,consider these factors:

Floor SurfaceWood, tile, rubber, and carpet are all surfaces thatmay be in your weight room—and each has its ownpotential for injury. With wood floors, inspect tomake sure there are no splinters, loose boards, orloose or protruding nails or screws. Tile should bekept clean and dry. Moisture from drinks or waterbeing tracked in, or chalk dust, can make the floorslippery. Rubber floors, particularly those that haveinterlocking pieces, can develop gaps and become atripping hazard. If the weight room is carpeted, seethat the carpet is free of tears and protect highimpact areas with throw mats and padding.

CleanlinessMake sure all loose weights, plates, and collars are

off the floor and stored on the appropriate racks ortrees. Do not allow athletes to throw their gymbags, jackets, or towels on the floor in the liftingarea. The lifting area should be mopped and vacu-umed daily. Weight benches should be sprayed witha disinfectant daily. To prevent spills, do not allowfood or drink (except water in an appropriate areaaway from the lifting stations).

Equipment LayoutThere should be adequate room for both lifters andspotters. A lifter should have room to land in casehe needs to bail out of a lift. For example, whenusing eight-foot-square Olympic platforms, allow atleast four feet between platforms.

Proper InstructionBoth the lifter and spotter should receive instruc-tions and demonstrate understanding of what todo for each lift they are asked to perform or spot.Have instructions on how to perform each lift atthe different stations. Many strength machinesalready have a diagram and instructions on theproper technique. Post safety guidelines prominent-

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Planning, proper supervision, and attention to detail are all part of keeping the weight room safe and free from injury hazards.

BY MICHAEL J. HANLEY, M.S., ATC/L

DESIGNING AND MAINTAINING A SAFE WEIGHT ROOM


■ Stations for exercises must be spaced apart far enoughto allow for adequate flow and have enough room forboth the lifter and spotter.

■ The weight room floor must be clean and free frommoisture and loose objects.

■ All weights and machines must be checked regularly.

■ Rules should be posted and enforced to create a safe anddisciplined atmosphere.

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ly around the weight room. Instruct the athletes tounload the weight bar after each lift. Have themunload the bar evenly from each side to preventthe bar from tipping over and having the weightsfall off the opposite side. Always use collars withbarbells, and have lifters wear weight belts—espe-cially for heavy lifts.

It’s a good idea to match up players of similar sizeand lifting ability, so the spotter can safely handlethe weight if the lifter gets in trouble. Instruct thelifters not to drop or throw the weights unless theyneed to bail out, and have them return the weightsand dumbbells to their proper racks immediatelyafter completing their lift. Be sure to have each ath-lete do an individulized program and to stay awareof the special precautions and programs for playerswho are not physically mature.

Proper SupervisionNever allow youth football players to lift unsuper-vised or without a spotter for those lifts requiring

one. All of the coaches supervising should try to becertified in CPR, First Aid, and Disease Transmission.

Attire and ConductDo not allow horseplay. More players will getinjured in the weight room from fooling aroundthan from lifting. Stress to your football team thediscipline necessary to lift properly and safely. Onlyproper clothing such as shorts, T-shirts, and sneak-ers should be worn while lifting.

Equipment CheckIn addition to inspecting the floor surface, check allweights and machines daily. Be attentive to frayed orsqueaky cables. Make sure that all floor- or wall-mounted machines are secure. Look for any loosenuts or bolts. See that none of the plates have cracksin them. All equipment should be regularly manin-tained—oiling the machines and pulleys, checkingthe grips and pads, etc. Trained personnel should doany repairs to the machines or equipment.

GO ONLINE AT WWW.NFLHS.COM/HEALTHMORE READINGwww.fitnessworld.com.The Strength and Conditioning Journal.www.strengthtech.com.

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Injury Evaluation

When a youth football player incurs an acute injury,the coach’s ability to assess the situation properlyand make the right decisions often can minimize theseverity of the situation.

The chart beginning on page 51 will assist theyouth football coach in determining the best courseof action when presented with an acute, on-fieldinjury. Here are some important considerations:

❶ Stabilize is defined as immobilizing (preventing movement) of the athlete or injuredbody part.

❷ Minor injuries equate to no swelling;full, pain-free range of motion (movement);and no pain with use of the injured bodypart, including full weight bearing duringsport-specific activities.

❸ When in doubt, always await medical assistancein order to move or stabilize the injured athletesafely.

❹ Having a certified athletic trainer (ATC) orphysician on the sidelines, when possible, is ofsignificant value.

ALL UNCONSCIOUS ATHLETES SHOULD BEMANAGED AS IF A FRACTURE OR DISLOCA-TION OF THE CERVICAL SPINE EXISTS UNTILTHESE INJURIES CAN BE RULED OUT.

For more information, read the first book in thisseries, First Aid.

Here are some tips for rapid assessment of on-field injuries and actionsto take for proper care of the youth athlete.

BY MARY KIRKLAND, ATC, KENNEDY SPACE CENTER

THE ON-FIELD EVALUATION OF ACUTE FOOTBALL INJURIES

W H A T C O A C H E S S H O U L D K N O WIn order of their importance, the coach’s on-fieldevaluation must rule out:

❶ Cardiovascular and respiratory distress/cessation

❷ Head or spinal column life-threatening trauma

❸ Excessive bleeding

❹ Fractures

➎ Joint dislocations

❻ Other soft tissue trauma (sprains, strains,contusions, lacerations)

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The youth football coach should use a common-sense approach whendetermining when it is safe for a player to return to active status.

BY MARY KIRKLAND, ATC, KENNEDY SPACE CENTER

RETURN-TO-PLAY GUIDELINES FOR YOUTH FOOTBALL


■ Youth football coaches should try to involve a certifiedathletic trainer (ATC) or physician when deciding if anathlete should remain in the game or be removed from play.

■ Coaches must place the player’s health and safety above anypressures from parents or the athlete to return to play.

■ A player should have full flexibility and strength restoredin the injured area—equal to the uninvolved side—beforereturning to play.

■ Several factors can slow healing and delay return to play.

■ A well-balanced preseason conditioning program willdecrease the youth football player’s risk of injury, anddecrease the rehabilitation time if an injury occurs.

After a youth football player has sustained an injury,the coach will determine his ability to return to playwith the assistance of a certified athletic trainer(ATC) or a physician. The following guidelines willhelp the coach determine how and when to bringthe player back to full competition only if the injuryis minor. With any serious injury, the finaldetermination must lie with the athlete’sphysician.

■ The player’s health and safety is the coach’snumber-one priority.

■ The coach must not be swayed by pressurefrom parents or the athlete. The decision mustbe based on whether the athlete can partici-pate in a healthy, pain-free condition.

■ Full range of motion, flexibility, and strengthequal to the uninvolved side are the idealreturn-to-play requirements. Normal functionmust include pain-free motion of the injuredarea while the athete is at rest and while per-

forming the required motions of his position. ■ When in doubt, keep him out—If you are

unsure of when to return the youth footballplayer safely to the practice/competition, seekthe advice of a certified athletic trainer (ATC)or physician to determine his playing status.

Helpful guidelines are provided beginning onpage 51.

The coach’s best plan of action in an injurysituation is to have an allied health profes-sional such as a Certified Athletic Trainer(ATC) or a medical physician to evaluate theinjury, assess its severity, and determinewhether the player can safely return to play.

If there is any doubt as to the severity ornature of the injury, refer to a physician.

“When in doubt, keep him out” If you are unsure of when to return the youth

football player safely to the practice/competition,the best decision is the most prudent one.

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INJURY SIGNS AND SYMPTOMS INTERVENTION & RETURN TO PLAY

AIRWAY BREATHING OR -LACK OF BREATHING -CHECK AREA FOR SAFETYCIRCULATION -LACK OF PULSE -CALL EMSDIFFICULTIES/CESSATION -LOSS OF CONSCIOUSNESS -INITIATE CPR

(SEE PLAY SAFE, BOOK 1: FIRST AID)

CONCUSSION -LOSS OF CONSCIOUSNESS -STABILIZE THE NECK-AMNESIA -CALL EMS-MENTAL CONFUSION/DISORIENTATION -REMOVE FACEMASK IF CONDITIONS -LOSS OF COORDINATION DETERIORATE-DIZZINESS -DO NOT REMOVE HELMET OR-RINGING IN THE EARS SHOULDER PADS-OBVIOUS MOTOR IMPAIRMENT -BE PREPARED TO INITIATE CPR WITH -HEADACHE JAW THRUST-NAUSEA/VOMITING -FOR “MOBILE CONCUSSION” (PLAYER-VISUAL DISTURBANCE COMES TO SIDELINE)—OBSERVE UNTIL

EMS ARRIVES-AWAIT TRANSPORT BY EMS-PHYSICIAN ASSESSMENT REQUIRED-PHYSICIAN CLEARANCE REQUIRED FOR

RETURN TO PLAY

HEAD AND NECK TRAUMA -PAIN IN SPINE AT LEVEL OF INJURY -STABILIZE THE NECK-NUMBNESS, TINGLING, OR BURNING -CALL EMSSENSATION RADIATING THROUGH ARMS -REMOVE FACEMASK IF CONDITIONS

-SENSATION OF WEAKNESS IN ARMS DETERIORATE-BLURRED VISION -DO NOT REMOVE HELMET OR -CONFUSION SHOULDER PADS-HEADACHE -BE PREPARED TO INITIATE CPR WITH-DISORIENTATION JAW THRUST-DIZZINESS -AWAIT TRANSPORT BY EMS-LACK OF COORDINATION -PHYSICIAN ASSESSMENT REQUIRED-NAUSEA -PHYSICIAN CLEARANCE REQUIRED FOR -UNCONTROLLED EYE MOVEMENT RETURN TO PLAY-RINGING IN THE EARS

BURNER -IMMEDIATE PAIN -NO IMMEDIATE RETURN TO PLAY UNLESS -BURNING OR “ELECTRIC SHOCK” SENSATION THERE IS COMPLETE RESOLUTION -INVOLVED ARM HANGS LIMPLY AT PLAYER’S SIDE OF SYMPTOMS AS DETERMINED BY ATC -DECREASED STRENGTH ON INVOLVED SIDE OR PHYSICIAN-DECREASED SENSATION ON INVOLVED SIDE -PHYSICIAN ASSESSMENT REQUIRED

-PHYSICIAN CLEARANCE REQUIRED FOR RETURN TO PLAY

ON-FIELD INJURY EVALUATION AND RETURN-TO-PLAY CRITERIA

INJURY SIGNS AND SYMPTOMS INTERVENTION & RETURN TO PLAYLACERATION WITH -OBVIOUS OPEN WOUND -CALL EMS; WEAR PROTECTIVE GLOVESEXCESSIVE BLEEDING -PROFUSE BLEEDING -CONTROL BLEEDING WITH COMPRESSION

-PAIN -REMOVE FROM FIELD WITH MEDICAL-PALLOR ASSISTANCE-WEAK PULSE -CONTINUE COMPRESSION WHILE-WHITE OR BLUE AREA DISTAL TO THE INJURY AWAITING EMS TRANSPORT

-WATCH FOR PALLOR, WEAK PULSE-BE PREPARED TO INITIATE CPR-PHYSICIAN ASSESSMENT REQUIRED-PHYSICIAN CLEARANCE REQUIRED FORRETURN TO PLAY

FRACTURE -PAIN AT FRACTURE SITE -STABILIZE WITH SPLINT-CREPITUS (CRACKING/CREAKING SOUNDS) -CALL EMS-POSSIBLE DEFORMITY -REMOVE FROM FIELD ONLY WITH MEDICAL -LOSS OF FUNCTION SUPPORT

-APPLY ICE FOR 15 MINUTES WHILEAWAITING EMS TRANSPORT IF NO BONEIS VISIBLE

-PHYSICIAN ASSESSMENT REQUIRED-PHYSICIAN CLEARANCE REQUIRED FORRETURN TO PLAY

-PHYSICIAN MAY APPROVE USE OF PADDING TO PROTECT INJURED AREA ON RETURN TO PLAY

JOINT DISLOCATION -PAIN -STABILIZE WITH SPLINT OR SLING-DEFORMITY -DO NOT TRY TO REPLACE DISLOCATION-LOSS OF JOINT FUNCTION (MOVEMENT) -CALL EMS-SENSATION/CIRCULATION DEFICITS BELOW -REMOVE FROM FIELD WITH MEDICALSITE OF DISLOCATION SUPPORT

-APPLY ICE FOR 15 MINUTES WHILEAWAITING EMS TRANSPORT

-PHYSICIAN EVALUATION REQUIRED-PHYSICIAN CLEARANCE REQUIRED FORRETURN TO PLAY

ACROMIOCLAVICULAR -PAIN AND TENDERNESS OVER AC JOINT -STABILIZE WITH A SPLINTSEPARATION (SHOULDER) -CALL EMS

-ELEVATION OF AC JOINT -REMOVE FROM FIELD WITH MEDICAL-MOVEMENT OF AC JOINT IF DOWNWARD SUPPORTPRESSURE APPLIED -APPLY ICE FOR 15 MINUTES WHILE

AWAITING EMS TRANSPORT-PHYSICIAN EVALUATION REQUIRED-PHYSICIAN CLEARANCE REQUIRED FORRETURN TO PLAY

-PHYSICIAN MAY APPROVE USE OFPADDING TO PROTECT INJURED AREA ON RETURN TO PLAY

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INJURY SIGNS AND SYMPTOMS INTERVENTION & RETURN TO PLAYSIGNIFICANT JOINT -GROSS DEFORMITY -STABILIZE JOINTSPRAINS (LIGAMENTS) -SUSPECTED FRACTURE/DISLOCATION -CALL EMS

-SIGNIFICANT SWELLING -REMOVE FROM FIELD WITH MEDICAL-SIGNIFICANT OR PERSISTENT PAIN SUPPORT-SIGNIFICANT LOSS OF MOTION -APPLY ICE FOR 15 MINUTES WHILE-DECREASED SENSATION AWAITING EMS TRANSPORT-JOINT INSTABILITY -PHYSICIAN EVALUATION REQUIRED-SUSPECTED MALALIGNMENT OR STRUCTURAL -PHYSICIAN CLEARANCE REQUIRED FOR ABNORMALITY RETURN TO PLAY

-PAIN WITH MOVEMENT

MINOR JOINT SPRAINS -NO SWELLING -IF NOT SYMPTOMATIC, ATHLETE MAY (MUSCLES, TENDONS) -FULL, PAIN-FREE RANGE OF MOTION RETURN TO PLAY

(MOVEMENT) AND STRENGTH -CONTINUE TO OBSERVE FOR DEVELOPMENT-MINIMAL PAIN WITH USE OF THE INJURED OF SIGNS/SYMPTOMSBODY PART, INCLUDING FULL WEIGHT -IF SIGNS/SYMPTOMS OF MORE SIGNIFICANT BEARING DURING SPORT-SPECIFIC ACTIVITIES SPRAIN OCCUR, STOP PARTICIPATION—

PHYSICIAN EVALUATION AND CLEARANCE REQUIRED

SIGNIFICANT STRAINS -POPPING, SNAPPING, OR TEARING -STABILIZE THE AREA(MUSCLES, TENDONS) SENSATION -CALL EMS

-SUDDEN PAIN -REMOVE FROM FIELD WITH MEDICAL-MUSCLE WEAKNESS SUPPORT-DISCOLORATION -APPLY ICE FOR 15 MINUTES WHILE-DIMINISHED FLEXIBILITY AWAITING EMS TRANSPORT-PAINFUL MOVEMENT -PHYSICIAN EVALUATION REQUIRED-DEFECT IN MUSCLE -PHYSICIAN CLEARANCE REQUIRED FOR

RETURN TO PLAY

MINOR STRAINS -NO SWELLING -IF NOT SYMPTOMATIC, ATHLETE MAY(MUSCLES, TENDONS) -FULL, PAIN-FREE RANGE OF MOTION RETURN TO PLAY

(MOVEMENT) AND STRENGTH -CONTINUE TO OBSERVE FOR DEVELOPMENT -MINIMAL PAIN WITH USE OF THE INJURED OF SIGNS/SYMPTOMSBODY PART, INCLUDING FULL WEIGHT -IF SIGNS/SYMPTOMS OF MORE SIGNIFICANT BEARING DURING SPORT-SPECIFIC ACTIVITIES STRAIN OCCUR, STOP PARTICIPATION—

PHYSICIAN EVALUATION AND CLEARANCE REQUIRED

INJURY SIGNS AND SYMPTOMS INTERVENTION & RETURN TO PLAYSEVERE ABDOMINAL -PAIN OR DISCOMFORT THAT INCREASES -STABILIZE ON THE FIELDINJURIES IN ABDOMEN -CALL EMS

-RIGIDITY AND SPASM OF ABDOMINAL MUSCLES -REMOVE HELMET IF NO HEAD OR NECK -BLOOD IN URINE OR STOOL INJURY SUSPECTED-VOMITING -BE PREPARED TO INITIATE CPR-PAINFUL URINATION -PHYSICIAN EVALUATION REQUIRED-SHOULDER PAIN OR DIFFICULTY BREATHING -PHYSICIAN CLEARANCE REQUIRED FOR -DIZZINESS RETURN TO PLAY-PALLOR, WEAK PULSE

SEVERE CHEST INJURIES -DIFFICULTY BREATHING -STABILIZE ON THE FIELD-SHORTNESS OF BREATH/INABILITY TO -CALL EMSCATCH BREATH -REMOVE HELMET IF NO HEAD OR NECK

-PAIN INCREASING IN CHEST INJURY SUSPECTED-VOMITING/COUGHING UP BLOOD -BE PREPARED TO INITIATE CPR

-PHYSICIAN EVALUATION REQUIRED-PHYSICIAN CLEARANCE REQUIRED FOR RETURN TO PLAY

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It’s important to be able to recognize the most com-mon injuries in order to have them evaluated by acertified athletic trainer or physician, then progresswith treatment.

ACUTE (RAPID ONSET) INJURIES

Contusions (Bruises) Definition—A direct blow or repeated blows to aplayer’s body, crushing underlying muscle fibers andconnective tissue without breaking the skin. Theunderlying blood vessels are damaged, causing pain,muscle spasm, ecchymosis (bruising), tenderness,swelling, and decreased range of motion (ROM) andfunction.

Severity—Is determined by the force of theimpact, the size and shape of the object causing thebruise, and the part of the body receiving the blow.Most contusions are minor and heal quickly withouttaking the player out of the game—but severe con-tusions can cause deep tissue damage and lead tocomplications and/or keep the player out of play formonths. A common rule of thumb is that thegreater the pain and loss of function, the greater theseverity of injury.

Treatment—To control pain, bleeding, andinflammation, use the RICE (Rest, Ice, Compression,Elevation) formula. If possible, have a CertifiedAthletic Trainer (ATC) or physician evaluate the injury.

Return to Play— Look for return of normalrange of motion and strength equal to the unin-volved side during both rest and sport activities. Theuse of some type of padding to protect the area isrecommended to avoid reinjury. For severe contu-sions, an evaluation by an athletic trainer or physi-cian is required so that proper rehabilitation can beinstituted. Return to play should be decided by amedical professional.

Potential Complication—Myositis ossifi-cans. The formation of bone (calcium deposit) withinor around a muscle can occur as a result of chronic,repeated irritation of the bruised area. If a contusionis not healed and pain free within 2-3 weeks, med-ical assessment is essential.

Strains (Muscle Tendon Pulls/Tears)Muscles or their tendon attachments are stretchedto the point that their fibers start to tear. This canhappen when the athlete lifts a heavy weight orsuddenly overextends a muscle. It results from the

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If they know what to look for, youth football coaches can recognize themost common football strength and conditioning injuries—and help the player.

BY MARY KIRKLAND, ATC KENNEDY SPACE CENTER

YOUTH FOOTBALL INJURIES


■ Youth football coaches should be able to recognize themost common injuries.

■ Injuries may be either acute (occurring suddenly)or chronic (often resulting from overuse).

■ Coaches can look for several things when determiningthe severity of a young football player’s injury, andwhether the athlete should be removed from play.

■ Use the RICE (Rest, Ice, Compression, Elevation)approach when treating acute youth football injuries.

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overstretching or overstressing of a muscle, sustain-ing a violent/strong contraction against heavy resist-ance, or muscle imbalance between the agonist andthe antagonist muscle groups (Example: Quads vs.Hams). The most common sites for strains are theback, thigh, groin, and shoulder—typically large mus-cle groups used for sudden, powerful movement.

Recognizing Levels of Severity—Mild(first degree), Moderate (second degree), andSevere (third degree). Strains are graded into threegroups by level of severity:

❶ Mild strains—The muscle/tendon isstretched or pulled slightly (microscopic tears).The athlete will experience some discomfortduring use of the involved muscle, but willretain normal or near-normal range of motionand strength. These strains are usually only anuisance, and with rest and RICE therapy (seeabove) repair themselves easily.

❷ Moderate strains—These involve a greaterdegree of muscle fiber destruction and producenot only sharp pain, but also loss of power andmovement. Usually the athlete hears or feels asnap or tear. Symptoms include pain, spasm,weakness, swelling, inflammation, and loss offlexibility.

❸ Severe strains—These result when the mus-cle or tendon is completely ruptured, often inca-pacitating the youth football player. A snap ortear is felt, along with significant pain and lossof function. Signs and symptoms are the sameas with a moderate strain, but with greater

intensity. A visible or palpable gap or defect isnoted in the muscle.

Treatment and Return-to-Play—Mildstrains require only RICE therapy (see above).Athletes may return to play when range of motionand strength have been recovered, and sport-specificfunction is normal. When more severe strains occur,physician evaluation and specific rehabilitation arerequired. Severe strains may require immobilizationor surgical correction. Return to play then should bedictated by a physician.

Potential Complication—In younger ath-letes, the muscles and tendons are stronger thantheir growth plates (epiphyses), which have notclosed. An epiphyseal fracture, which can causegrowth disturbance, may appear to be a strain orsprain. The tendon attachments to the bones mayfail, causing an avulsion (breaking off) of a piece ofbone along with the tendon.This requires immediate intervention by aphysician.

Sprains (Ligament Tears)Sprains involve the tearing of ligaments (the bandsconnecting bones). Sprains are most often the resultof sudden force—typically a twisting motion—thatthe surrounding muscles aren’t strong enough tocontrol. As a result, the ligaments, which usuallywrap around a joint, get stretched or torn. Likestrains, sprains can range from minor tears to com-plete ruptures. But sprains tend to be more seri-ous: Not only do they often take longer to heal, but

R = Rest Resting an injured area is necessary to allow the body time to get the effects of trauma undercontrol and to avoid additional stress and damage to the injured tissue. Slings, braces, boots, and crutchesare devices commonly used to assist resting the injured body part. The period of rest required will varydepending on the severity of the injury. Youth football players who do not rest an acute (sudden, traumatic)injury can prolong the inflammation period and increase the healing time required, thereby delaying recovery.

I = Ice Ice applied promptly to an injury can slow down or minimize some of the inflammation (the redness,swelling, and pain that follow an injury). Examples of ice treatment include using an ice bag or ice bucket for15 minutes or an ice massage for 7-10 minutes. If there exists a hypersensitivity to cold, a thin, damp towelcan be used between the skin and the ice. In order to avoid frostbite, be aware of the time elapsed; ice applica-tion must not exceed 20 minutes. When using an ice pack, use light to moderate compression. NOTE: Heat shouldonly be applied after you are sure bleeding and swelling have stopped completely. Otherwise, a player’s recoverytime will be prolonged.

C = Compression Compression involves the application of an elastic wrap or similar item around theinjured area. Its purpose is to help control swelling and to provide mild support. NOTE: Any wrap should beapplied carefully. Too tight a bandage can constrict or interrupt vital circulation to the area.

E = Elevation The injured area should be raised as much as possible above the level of the heart.This elevation promotes the lessening or elimination of swelling.

USE RICE FOR ACUTE INJURY

a torn ligament can throw bones out of alignment,causing damage to surrounding tissues. The ankle isthe most frequently sprained joint. The knee, too, isvulnerable—because it must absorb twisting stressesevery time the body rotates from the hips.

Recognizing Levels of Severity—Mild (first degree), Moderate (second degree),

and Severe (third degree). ❶ Mild sprains—These involve minor stretch-

ing or tearing of the ligament. The athlete willexperience some discomfort during use of theinvolved joint, but will retain normal or near-normal range of motion, strength, and func-tion. The ligament is not weakenedsignificantly, and treatment is symptomatic.

❷ Moderate sprains—These involve a greaterdegree of ligament destruction, producing vary-ing degrees of pain, swelling, and instability.The athlete may hear or feel a snapping or pop-ping sensation as well as having a sense ofsomething giving way at the time of injury.Symptoms include localized pain, swelling,instability, weakness, inflammation, and loss offunction.

❸ Severe sprains—These result when the liga-ment is completely ruptured, causing significantjoint instability. A snap or tear is felt, along withloss of function. The signs and symptoms arethe same as with a moderate sprain, but withgreater intensity. With third-degree sprains, ini-tial pain may be felt, but as swelling and inflam-mation increase, pain will increase.

Treatment and Return to Play—Mildsprains require early RICE therapy. Athletes mayreturn to play when motion, strength, and sport-specific function have returned to normal. Whenmore severe sprains occur, physician evaluation isrequired to determine the degree of damage andpotential associated injury. Initial immobilization andrehabilitation may be required. Severe sprains mayrequire surgical intervention and bracing to establishstability. Physician permission is required beforereturn to play is permitted.

Potential Complication—Avulsion fracture.The tearing of a piece of bone along with the liga-ment can occur with severe sprains. Immobilizationwill be required along with weeks of rehabilitation.

FracturesDefinition—A direct blow or impact to a bone

that causes it to break. The break may occur to the

long bone, or a piece of bone may be torn away(avulsed). In younger athletes, a fracture to thegrowth plate can occur.

Recognizing Levels of Severity—A bonemay break and remain in normal position or it maybe pushed to an abnormal alignment, sometimescausing an obvious deformity. The broken bone alsocan cut through the skin, which will expose thebone to infection.

Treatment—To control pain, place ice over thearea for 15 minutes unless the bone is exposed.Splint the site, including the joint above and belowthe break if this can be done without pain. Be surethe splint allows for blood circulation. Fracturesrequire immobilization in a cast followed by rehabili-tation. Some fractures require surgery to establishcorrect alignment.

Return to Play—Complete healing of thebone, with a return of full joint motion and muscu-lar strength, is required. A physician must clear areturn to participation.

Potential Complications—Bone deformitycan occur, causing abnormal function. Fractures ofthe growth plate can cause abnormalities of growth.Open fractures can cause bone infection.

DislocationsDefinition—A direct force or impact can dis-

lodge a bone from its normal position in a joint. Thebone may come out only partially; this is called asubluxation. If the bone comes completely out ofthe joint, a true dislocation has occurred.

Recognizing Levels of Severity—A disloca-tion will tear the surrounding structures that main-tain the bone’s normal position. A fracture also mayoccur in the joint or in the bone. Blood vessels andnerves can potentially be injured.

Treatment—To control pain, apply ice to thearea and attempt to immobilize the site if this canbe done without pain. Do not try to replace thebone in proper position. This should only be done bya medical professional. Dislocations may requireimmobilization and surgical intervention.Rehabilitation is essential after the injury, andprotective bracing may be required.

Return to Play—The dislocated bone mustheal after being replaced in its normal position. Allmotion needs to be returned to the joint and musclestrength regained. A certified trainer can assist withthe rehabilitation. A physician must determine whenthe athlete is ready to return to active participation.

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Potential Complications—Dislocated jointsmay remain unstable and require bracing and surgi-cal repair.

CHRONIC (DELAYED ONSET) INJURIES

Overuse injuries occur from the repetitive applicationof submaximal stresses to otherwise normal tissues.Overtraining and exposure to excessive levels ofphysical activity can present an increased risk ofinjury. If not managed properly and efficiently, over-use injuries can affect normal physical growth andmaturation. Prevention is the key. Gradual ratherthan sudden increases in stresses and intensity canusually avoid physical breakdown. Early identificationand modification of the training program can mini-mize time lost from sport.

Stress Fractures—These are micro fracturesthat occur when bone is subjected to frequent,repeated stresses, such as in running, and the rate ofbone breakdown exceeds the rate of bone repair.Stress fractures are a form of overuse injury, andthey occur most frequently in the tibia, fibula, andpars interarticularis (part of the vertebra) in youngathletes. Focal bone pain with impact or activity isthe primary complaint. Ignored, a stress fracture canbreak and cause a true fracture.

Tendinitis—This involves inflammation of a ten-don, usually caused by overuse.

Examples include: ❶ Patellar or Quadriceps Tendinitis—

increased pain in the front of the knee withrunning, jumping, and squatting activities.

❷ Shoulder Tendinitis—increased pain inthe shoulder with throwing or weightlifting.

❸ Achilles Tendinitis—increased pain alongthe Achilles tendon (posterior ankle/heel) withrunning/jumping activities.

❹ Epicondylitis—inflammatory response tooveruse of either an elbow flexor or an extensormuscle group (attachment to the medial or later-al epicondyle of the humerus at the elbow); painincreases during throwing, blocking, or grippingactivities.

Shoulder Impingement—This is a condition inwhich the rotator cuff impinges on the acromionand coracoacromial ligament. The weakened rotatorcuff allows the humeral (shoulder bone) head tomove upward in the socket rather than remainingcentrally located in the shoulder joint. The result isinflamation of tendons, muscles, and bursae of the

shoulder. Pain with motion, particularly with thearms above the shoulder, occurs.

Osgood-Schlatter Disease—This is the par-tial avulsion of the tibial tubercle below the knee atthe insertion of the pateller tendon). It results whenthe tubercle is subjected to traction forces by thepatellar tendon insertion, causing painful swelling inthe area of the tubercle.

Osgood-Schlatter Disease sometimes occurs spon-taneously without excessive traction. A similar prob-lem can occur in the area where the Achilles tendoninserts in the heel.

Periostitis (shin splints)—This is an over-use injury that occurs in athletes involved in ballisticactivities and those that involve rapid deceleration. Itmay be caused by a strain of the anterior or posteri-or tibialis muscles at their tibial origin. Pain is usuallydiffuse along the front of the lower leg.

Lower back injuries—examples include:■ Spondylolysis—Stress fracture of the pars

interarticularis, located on the vertebrae of thespine. Local persistent back pain results. Whenspondylolysis occurs bilaterally, a secondary con-dition known as spondylolisthesis may result.

■ Spondylolisthesis—The forward slipping ofone vertebra over another. Typically found inlinemen secondary to repetitive flexion andhyperextension forces on the lumbar spine.

Signs and symptoms associated with these twoinclude lower back pain, possibly radiating into thebuttocks/posterior thigh, swelling, muscle spasm,decreased range of motion of the back, and painwith back hyperextension.

There are many factors contributing to athleticinjuries. These include, but are not limited to, theathlete’s growth, prior injury history, inadequate con-ditioning, muscle/bone anomalies, and the athlete’smaturity level. Additional factors that can contributeto an injury include doing too much too soon, inad-equate rest between practices/games, impropertechnique, and running on uneven or hard playingsurfaces. When the coach has questions regardingrecognition, care, treatment, and rehabilitation ofthese common strength and conditioning injuries, heshould seek the advice of a certified athletic trainer(ATC) and/or a physician familiar with sports injuries.

Overuse injuries will heal completely with earlyrecognition, appropriate rest, rehabilitation, and acorrection of the cause of the injury. Ingnoringthe symptoms of an overuse injury can causepermanent injury.

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In developmentally immature athletes, overuse injuries are becomming morecommon than acute injuries. Pain and other symptoms may appear graduallyand there is not always a known event as the cause. With a young athletewhose bones are still growing, coaches need to be alert for bone and jointinjuries. Bone and joint injuries resulting from repetitive stress may haveconsequences on later growth and development.


ACHES AND PAINS IN DEVELOPMENTALLY IMMATURE ATHLETES


Athletes should be referred for medical evaluation if theyexhibit any of the following:

■ Consistent or increasing pain or discomfort lasting morethan three to five days

■ Pain, swelling, tenderness, or the formation of a raisedbump on the bone surface near the attachment of muscle

■ Pain near the attachment of the muscle when the muscle isstretched or contracted

■ Acute or intermittent joint pain or swelling

■ Clicking or catching in a joint

■ Recurring hip or groin pain with no recall of aspecific injury

■ Pain that increases with weight bearing or loading of ajoint (such as jumping, landing, or running)

■ Any tenderness noted over the bone following a ligamentinjury or joint sprain

■ Any moderate or severe ligament injury

■ Back pain that comes on gradually or occurs withactivity

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The youth football player who is still growing ismore susceptible to bone and joint-related injuriesbecause of an immature skeleton. During growth,bones grow faster than tendon and ligaments,which can cause decreased flexibility. Decreasedflexibility can lead to increased risk for muscle, ten-don, and ligament injury.

Youth football coaches should be educated aboutgeneral bone growth and development, and appre-ciate the musculoskeletal areas susceptible to injuryin young athletes. Musculoskeletal areas that areparticularly susceptible to acute and chronic injury inyoung athletes include:

■ The growth plate at the end of long bones (epi-physis)

■ The joint surface (articular cartilage)■ The insertion site of major tendons to the bone

(apophysis)■ All bones■ Because some athletes fail to report their pain

or symptoms, coaches should carefully watchfor changes in behavior (motivation and attitudetoward participation) and performance (e.g.limping, favoring one side or body part, etc.)

The adolescent athlete who has yet to reach fullskeletal maturity represents unique injury concerns

not seen in the older adolescent and adult popula-tion. If these injuries are not recognized and treatedearly, they can result in long-term disability andaffect growth and development. Common growthinjuries include:

Apophysitis is an inflammation of the bonewhere a muscle attaches. In the skeletally immatureathlete, this insertion point can become inflamedand painful as a result of repetitive muscular con-traction and stress. In early stages, these injuries canbe mistaken for muscle strains or tendinitis. If symp-toms are ignored or unrecognized, a portion of thebone can be avulsed (i.e., pulled off) following aforceful contraction of the muscle. Common sitesfor these injuries include muscle attachments at theelbow, hip, front of the knee below the knee cap(commonly known as Osgood-Schlatter’s disease),and the groin. Symptoms include pain, swelling,tenderness, or the formation of a raised bump onthe bone near the attachment of the muscle. Thearea may also be painful when the attaching muscleis stretched or contracted.

Epiphyseal Injuries include fracture or sepa-ration of the bone’s growth plate. Growth platesare found primarily in the long bones of the upperand lower extremities (arms and legs). Forces thatwould normally result in joint sprains (i.e., ligamentinjury) in an adult can result in disruption of thebone’s growth plate in an adolescent. As a result,any moderate or severe ligament injury in a youthplayer should be evaluated by a physician to ruleout injury to the bone. Injuries to the growth platerequire immediate medical attention. Disruption ofa growth plate can stunt limb growth or result inbone deformity. Symptoms include joint pain andswelling, bone tenderness, crepitus (crackling, grat-ing, or grinding sensation) with joint movement,and deformity.

Cartilage Injuries The cartilage surfaceoverlying the end of a growing bone is also suscep-tible to injury as a result of repetitive stress (e.g.chronic compression of a joint surface caused byimproper throwing, lifting, or running mechanics).Conditions at the elbow and knee, known as osteo-chondritis dessicans, are often seen in young ath-letes. These are characterized by degeneration ofthe joint surface leading to avascular necrosis (tissuedeath). The specific cause is often unknown. Theathlete may complain of gradual onset of pain, peri-odic joint swelling, clicking or catching in the joint,or tenderness near the joint surface.

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GO ONLINE AT WWW.NFLHS.COM/HEALTHMORE READINGMicheli, L.J., Glassman, R., & Klein, M. Pediatric and adolescent sports injuries: The prevention of sports injuries in children.

Clinics in Sports Medicine. 19(4); October 2000.Patel, D.R., & Nelson, T.L. Adolescent Medicine: Sports Injuries in Adolescents. Medical Clinics of North America. 84(4); 2000. Shultz, S.J., Houglum, P.A., & Perrin, D.H. Assessment of Athletic Injuries. Human Kinetics Publishers, Champaign IL. 2000. Sideline Preparedness for the Team Physician http://www.sportsmed.org/pdf/sideline_preparedness_2001.pdf

Chronic Synovitis of the Hip Joint ischaracterized by chronic irritation and inflamma-tion of the joint capsule. There often is no specificincident of injury, and symptoms can appear grad-ually. With chronic swelling of the joint capsule,blood flow can be compromised and cause degen-eration of the surface of the hip joint. Becauseswelling is deep in the joint, it is not easilyobserved or recognized. Pain may feel like a groinstrain, or appear to be a dull ache or pain aroundthe knee.

Muscle and Tendon Injuries: Duringgrowth spurts, the bone grows first, followed bylengthening of the muscles, tendons, and liga-ments. As a result, growing football players willoften go through a period of decreased flexibility.Inflexibility may increase the risk for muscle andtendon strains, particularly overuse type injuries.Symptoms of muscle and tendon injuries includepain with passive stretching and active contractionof the affected muscle. The athlete may also com-plain of local tenderness, pain, and swelling overthe injury site, depending on severity. Decreasedrange of motion, strength, or a palpable defect inthe muscle may also be noted.

Back Pain, while a common complaint inadults, is rare in youth. Presence of back pain mayindicate serious underlying injury, and should becarefully evaluated by a physician.

Overuse injuries of the bones, muscles, and jointsare the most common injuries seen in developmen-tally immature athletes. Overuse injuries appeargradually and may not result in extreme pain,swelling, or dysfunction. As a result, some youngathletes will fail to report these injuries for fearthey will not be allowed to play. Youth footballcoaches should be aware of the changes in bone,cartilage, ligament, and tendon that occur duringgrowth, and the unique susceptibility of thesestructures to injury in young athletes. Early recogni-tion is the key to successful treatment and the pre-vention of life-long musculo-skeletal problems. S

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The Initial Treatment of the CrampingYouth Football Player on the FieldIncludes:

■ Gently stretch and massage the cramping mus-cle, holding it in stretched position until thecramp stops, approximately 15-30 seconds (seeexamples on page 63).

■ If caused by overheating or dehydration, try tocool the athlete and provide water or a sportsdrink in order to replenish fluids, glucose, andelectrolytes. DO NOT USE SALT TABLETS.

■ If the athlete has generalized severe cramping(in nonexercising muscle groups) or has local-ized cramping accompanied by confusion, lossof consciousness, or other central nervous sys-tem disorders, the condition must be treated asa medical emergency. Call EMS and transportthe athlete to the hospital.

Prevention of Exercise-AssociatedMuscle Cramps:Youth football coaches should advise the player to:

■ Be well conditioned (most cramps occur early inthe season).

■ Regularly stretch muscles prone to cramping.The best stretch technique is as follows:a. Do a 10-15 minute cardiovascular warm-up

prior to stretching.b. Slowly move the body part into the stretch

position. Only go until you feel a stretch…not a sharp pain.

c. Hold the stretch without bouncing for 10-15seconds.

d. Repeat 3 times.■ Maintain adequate nutrition—eat plenty of

carbohydrates in order to keep your musclesenergized.

Muscle cramps in youth football players can be prevented, but when crampsdo occur, several stretches can be used to treat them.

BY MARY KIRKLAND, M.S., ATC/L, CSCS KENNEDY SPACE CENTER

PREVENTION AND TREATMENT OF MUSCLE CRAMPS


Muscle cramps generally occur in three different musclegroups:

■ Quadriceps (front of the thigh)

■ Hamstrings (back of the thigh)

■ Gastrocnemius (calves)

Common causes of muscle cramps include:

■ Muscle fatigue/overexertion

■ Dehydration/electrolyte imbalance

■ Inflexibility

■ High-intensity training

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GO ONLINE AT WWW.NFLHS.COM/HEALTHMORE READINGMuscle cramp http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=270&topcategory=SportsSkeletal Muscle Cramps During Exercise http://www.physsportsmed.com/issues/1999/11_99/schwellnus.htmMedline Plus Health Information—Muscle Cramps http://www.nlm.nih.gov/medlineplus/ency/article/003193.htmPain, cramps and charley horses http://www.mayoclinic.com/invoke.cfm?id=SC00004NATA Position Statement: Fluid Replacement for Athletes http://www.nata.org/downloads/jat/jt0200/jt020000212p.pdfGatorade Fluid Pyramid http://www.gatorade.com/products_perform/thirst_quench/fluid_pyramid.html

■ Stay hydrated—drink plenty of water or a sportsdrink before, during, and after your practice orcompetition (see fluid pyramid below).

■ Reduce exercise intensity and duration, if necessary.

Fluid pyramid:

General Activity/Less Active8-10 cups of fluid per day 64-80 oz.)

General Activity/More ActiveAt least 10-12 cups of fluid per day (80-96 oz.)

Before, During, and After Exercise(minimum amounts)

Passive stretching results in almost immediate relief of the cramp. Recommended Stretches to Treat Cramping:

QuadricepsCramp Stand supportedagainst a wall oranother player.Pull foot to but-tocks. Hold for 10-20seconds or until cramp

subsides.

HamstringCramp Sit with legstogether, feetflexed, handson ankles.Bring chin to knees. Hold for10-20 seconds or until crampsubsides. (This position may alsobe used to reduce calf crampssimply by pulling the foot/toesback toward the body.)

Calf Cramp Kneel on left leg;place right legforward at a rightangle. Lungeforward,keeping theback straight. Stretch should befelt in right calf.Hold for 10-20 seconds oruntil cramp subsides.

Before: 2 cups of fluid (16 oz).

During: 1⁄2-1 cup of fluid (4-8 oz.)every 15-20 mins.

After:Fluid equivlent to bodyweight lost

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NOTES

Documents

Play Safe Strength and Conditioning: Presented by the NFL Youth Football Health and Safety Series