NSCA VOLUME 3

COACH ISSUE 23
MAY | 2016
AUGUST | 2016
 NSCA
ABOUT THIS PUBLICATION
The NSCA Coach publishes basic
educational information for Associate
and Professional Members of the VOLUME 3

COACH
NSCA specifically focusing on novice
strength and conditioning coaches. As
ISSUE 3
a quarterly publication, this journal’s AUGUST | 2016
mission is to publish peer-reviewed
articles that provide basic, practical
information that is research-based and
applicable to a wide variety of athlete
and training needs.

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Meredith Griffin, MS, CSCS
Eddie Jo, PHD, CSCS, NSCA-CPT
Pat Mahady, MS, CSCS
Ed McNeely, MS
Ryan Puck, MS, CSCS, USAW
Evan Schick, PHD, CSCS
Collis Spann, MS, IKFF CKT L2, USAW
Aaron Suma, MA, CSCS,*D, USAW

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2 NSCA COACH 3.3 | NSCA.COM

 TABLE OF CONTENTS

04 THORACIC MOBILITY
GREG SPATZ, PT, DPT, PRC, CSCS, AND NATE SHAW, ATC, PRT, RSCC

08 WHAT COACHES NEED TO KNOW ABOUT THE NSCA POSITION STATEMENT

ON LONG-TERM ATHLETIC DEVELOPMENT
RICK HOWARD, MED, CSCS,*D, USAW

12 BIOFEEDBACK FOR STRENGTH AND CONDITIONING PERFORMANCE

GABRIELLE SMITH, MA

16 BUILDING BETTER ATHLETES THROUGH INCREASED SELF-CONFIDENCE

ANDY GILLHAM, PHD, CC-AASP, CSCS

20 ANALYSIS OF “FAD DIETS” AND ALTERNATIVES

FOR OPTIMAL ATHLETIC PERFORMANCE
AMANDA POPPLETON, MFN, RD, LDN

24 AN INTEGRATED APPROACH TO BECOMING AN EFFECTIVE COLLEGIATE STRENGTH

AND CONDITIONING INTERN—FOR THE EXERCISE SCIENCE STUDENT
SETH FURMAN, CSCS, USAW, AND TIM PIPER, MS, CSCS,*D, USAW

30 FUELING WITH A PURPOSE—PREVENTION AND TREATMENT OF

RELATIVE EATING DISORDER IN MALE AND FEMALE ATHLETES
KELSEE GOMES, MS, RD, CSSD, LDN, CLT

34 AN OVERVIEW OF THE IMPORTANCE OF WARM-UPS FOR BASEBALL PITCHERS

ZACHARY KAPALKA, CSCS, GUILLERMO MARTINEZ JR., JESUS MARTINEZ, AND
JUAN GONZALEZ, PHD, CSCS

NSCA COACH 3.3 | NSCA.COM 3

THORACIC MOBILITY

GREG SPATZ, PT, DPT, PRC, CSCS, AND NATE SHAW, ATC, PRT, RSCC

W
hether you are throwing a ball, swinging a club, or
evading a grappling opponent on the mat, impeded FIGURE 1. FIGURE 2.
INHALATION/EXTENTION EXHALATION/FLEXION
trunk rotation and thoracic and pelvic dissociation—
separation in opposite directions—may biomechanically be a
contributing factor of performance deficits and injury. The loss
of required thoracic spine ranges of motion for sport movements
can be problematic for the elite athlete, as well as the weekend
warrior. No matter what level of competition, athletes are required
to access the transverse plane to produce power and excel in
most sport or physical activities. Limitations in mobility can occur
for different reasons including bony impingement, soft tissue
hypertonicity or adaptive shortening, motor control deficits, a
reduced tolerance for physiological stress (fitness), or even pain
and the fear of pain. In this article, the first three listed will be
the focus because restrictions in thoracic mobility may require
compensatory extremity movement beyond physiologically
acceptable ranges, which can lead to injury.

The purpose of this article is to explore biomechanical causes

for restriction as well as provide easily applicable techniques to
restore mobility. Strategies for restoring thoracic mobility in the
transverse (rotational) plane should first consider the sagittal and
frontal planes where flexion/extension and abduction/adduction
occur, respectively. If the spine is restricted to a chronic pattern of
extension with the ribs in external rotation (Figure 1), the vertebral
architecture does not allow for transverse plane movement. The
architecture of the posterior elements of the spine make contact
as the spine is extended, thus suggesting limitations in subsequent Images used and modified with permission from Postural Restoration Institute®
© 2015 www.posturalrestoration.com

4 NSCA COACH 3.3 | NSCA.COM

 NSCA COACH 3.3

frontal and/or transverse plane movements (1,4,5). Thus, it MODIFIED ALL FOUR BELLY LIFT BEAR (FIGURES 3 – 4)
is important to ensure thoracic rotation does not occur with 1. Place the hands below the shoulders and the knees below
excessive concomitant extension. By promoting an exhalation bias the hips
(Figure 2), the athlete can better access the frontal and transverse 2. Reach the back towards the ceiling, but do not allow the
plane ranges of motion. For lack of a better term, this can be pectoral muscles to get engaged
called a “neutral spine” position. A “neutral spine” position can be
considered a transition zone where the spine is neither extended 3. Keep the shoulders away from the ears when leaning forward
nor flexed with a normal curvature to the lumbar and thoracic 4. Raise the knees two inches from the floor while keeping in
spines—mid-range lordosis and kyphosis, respectively. this position
5. Maintain this position for 3 – 5 breaths
This is not meant to imply that extension is deleterious to sports
performance. In fact, extensor strength is needed to perform 6. Repeat two more times
most strength and power movements. However, appreciation of
vertebral column and rib cage anatomy as well as biomechanics
suggests that hyperextension is not favorable to thoracic mobility FIGURE 3. MODIFIED ALL FOUR BELLY LIFT BEAR – START
(1,4,5). For example, the posterior articular facets when first
predisposed to spinal extension are in greater contact with each
other and may contribute to limiting spinal mobility for rotation
and sidebending. Therefore, it is important to restore sagittal
plane mechanics by flexing the spine out of hyperextension—
towards a “neutral spine”—to access the proper joint positions and
in turn, joint actions, in the frontal and transverse planes. Faulty
joint position leads to faulty joint action.

The concept of a “neutral spine” should first be cultivated under

low duress to establish motor control before incorporating
substantial load or speed. Deliberate breathing that emphasizes
exhalation can help to favorably position the spine and rib
cage reflexively by promoting rib retraction, depression, and
internal rotation (2,3,4). These movements flex the spine out of
extension and more toward “neutral” in individuals who gravitate
towards hyperextension (Figure 2). Additionally, it is important
for athletes to be able to dissociate their pelvis from their rib
cage in order to create torque for power output. The dissociation
required for rotational power is built into the exercises below in FIGURE 4. MODIFIED ALL FOUR BELLY LIFT BEAR – FINISH
order to help train for the positional demands needed for sport
performance. In the following exercises, breathing is the driver
to improving mobility by changing the position of the rib cage.
Purposeful muscle activation is needed to make these areas of
the thorax more receptive to airflow and to allow the breath
cycle to influence motor control away from hyperextension.
Beyond utilizing these techniques to improve mobility, the athlete
must train these new ranges and display strength and power
capabilities. The following techniques originated and have been
modified with permission by the Postural Restoration Institute® ©
2016 www.posturalrestoration.com.

NSCA COACH 3.3 | NSCA.COM 5

THORACIC MOBILITY
90 – 90 SUPPORTED ALTERNATING CROSSOVER WITH
INTERNAL OBLIQUE AND TRANSVERSUS ABDOMINIS (FIGURE 5)
1. Pull the heels down to reach the knees towards the ceiling
2. Feel the hamstrings as the low back lowers toward the ground
3. Lift the right foot up while straightening the right knee
4. Reach the left hand towards the ceiling
5. Maintain this position while blowing up a balloon, pausing for
3 – 5 s during each exhale
6. Switch sides and repeat two more times
FIGURE 5. 90 – 90 SUPPORTED ALTERNATING CROSSOVER
WITH INTERNAL OBLIQUE AND TRANSVERSUS ABDOMINIS
FIGURE 6. SIDE LYING TRUNK LIFT WITH HIP SHIFT
6 NSCA COACH 3.3 | NSCA.COM
SIDE LYING TRUNK LIFT WITH HIP SHIFT (FIGURE 6)
1. Lie on the side with the knees and hips bent at 90 degrees
2. Drive the elbow and forearm into the floor to round out the
upper back
3. Push the knees into the floor to lift the hips in the air and round
the lower back
4. Shift the top knee in front of the bottom knee
5. Reach the free hand to the ceiling and turn the head to watch it
6. Hold this position for 3 – 5 breaths
7. Switch sides and repeat two more times
FIGURE 7. WALL-SUPPORTED HIP SHIFT WITH REACH

WALL-SUPPORTED HIP SHIFT WITH REACH (FIGURE 7)
1. Stand about 7 – 10 in. from a wall while holding a 4 – 6 in. ball
between the knees
2. Reach the tailbone to the floor with a slight knee bend to
press the lower back inon the wall
3. Only allow a little bit of pressure from the back to press into
the wall
4. Shift one knee forward and reach toward the floor with the
opposite hand while rounding the back
5. Hold this position for 3 – 5 breaths
6. Switch sides and repeat twice more
For each exercise, a general guideline to follow is about three
sets of 3 – 5 breaths in each position. Breaths should focus on a
forceful and elongated exhalation phase with a gentle subsequent
inhalation—in through the nose and out through the mouth. Time-
wise, a 2-s inhale followed by a 4 – 6-s exhale with a 4 – 6-s pause
before the next inhalation is considered an appropriate breath.
Clinical experience suggests performing these exercises twice
per day in order to be sufficient enough to progress the exercises
within 2 – 4 weeks, based on objective changes. Performing a
mixture of these exercises before and after a performance training
session as part of the movement preparation and dynamic warm-
up is considered an appropriate strategy.
Though individuals respond differently to the interventions listed
above, immediate objective changes in mobility typically occur.
However, these changes should not be expected to last long-
term without dedicated execution of these exercises on a regular
basis and/or further progression to more advanced activities.
The exercises listed are some lower-level options while over the
subsequent weeks and months they would be replaced with higher
level exercises that progress in intensity, coordination, and motor
control demands as needed, which is much more individualized
and beyond the scope of this article.
Coaches should consider the biomechanical concepts within
this article to be an important piece of the performance training
puzzle. Reducing excessive spinal extension patterning during
training should be the goal to maintain optimal spinal mechanics
for athletic endeavors. For example, hip hinging, squatting,
pressing, and pulling movements in the gym should occur with
a “neutral spine” position without hyperextension—under load—
at all ranges of extremity movement. The focus should be on
proximal stability to train the appendages for loaded mobility.
Proper technique under load is key to making any changes in
restriction last. Correcting a restriction will be fleeting in nature if
the aforementioned biomechanics aren’t carried over into training.
NSCA COACH 3.3 | NSCA.COM 7
NSCA COACH 3.3
REFERENCES
1. Inufusa, A, An, HS, Lim, TH, et al. Anatomic changes of the
spinal canal and intervertebral foramen associated with flexion-
extension movement. Spine 21: 2412-2420, 1996.
2. Key, J. “The core:” Understanding it, and retraining its
dysfunction. Journal of Bodywork and Movement Therapies 17.4:
541-559, 2013.
3. Lee, D. Biomechanics of the thorax: A clinical model of in vivo
function. Journal of Manual and Manipulative Therapy 1(1): 13-21,
1993.
4. Neumann, DA. Kinesiology of the Musculoskeletal System:
Foundations for Rehabilitation. St. Louis, MO: Mosby/Elsevier;
2010.
5. Sizer, PS Jr., Brismee, JM, and Cook, C. Coupling behavior of
the thoracic spine: A systematic review of the literature. Journal of
Manipulative Physiological Therapeutics 30: 390-399, 2007.
ABOUT THE AUTHORS
Greg Spatz is a performance-based physical therapist and
strength and conditioning coach who recognizes the continuum of
rehabilitation to sports performance. He is Co-Founder and Owner
of Resilient Performance Physical Therapy in New York, NY. Prior
to working as a Strength and Conditioning Coach in the Arizona
Diamondbacks Major League Baseball (MLB) organization, Spatz
received his Bachelor of Science in Health and Exercise Science
from the College of New Jersey where he was a member of the
baseball team. He earned his Doctor of Physical Therapy degree
from Columbia University and is Postural Restoration Certified.
Nate Shaw has been the Major League Strength and Conditioning
Coordinator for the Arizona Diamondbacks Major League Baseball
(MLB) organization since 2006. The Diamondback’s strength
and conditioning philosophy could be described in many ways.
Key concepts include: functional movements, joint centration,
diaphragmatic breathing, intra-abdominal pressure, thoracic
rotation, strength, durability, etc. Ultimately, the program is about
fostering and creating movement efficiency in an effort to minimize
wear and maximize recovery throughout the marathon 162-game
season. Simple concepts and simple tools work the best. Combining
simple concepts, smart training, and the game of baseball is a very
intricate process. We try to use tools that make sense and enable us
to achieve good results in any location. These exercises work really
well at home or on the road.
WHAT COACHES NEED TO KNOW ABOUT THE NSCA POSITION STATEMENT
ON LONG-TERM ATHLETIC DEVELOPMENT
RICK HOWARD, MED, CSCS,*D

WHAT IS A POSITION STATEMENT? THE 10 PILLARS OF LONG-TERM ATHLETIC

A
position statement is a concise document on a particular
topic in the field that helps in 1) understanding the key
concepts of the topic and 2) sharing and promoting the
scientifically-based, peer-reviewed information in the position
statement with people who work within the field. A position
statement typically lets others know where an organization stands
on a specific topic or issue. Many position statements include
the explanation or justification for the point of view, along with a
recommended course of action. The recently published National
Strength and Conditioning Association (NSCA) Position Statement
on Long-Term Athletic Development helps coaches understand
the key principles of long-term athletic development, as well as
key recommendations for coaches to promote the 10 pillars for
successful long-term athletic development (1).
DEVELOPMENT
The 10 pillars of long-term athletic development summarize the
key recommendations within the position statement (1). The 10
pillars provide coaches with workable strategies to promote long-
term athletic development for all youth by: 1) fostering a more
unified and holistic approach to long-term athletic development,
2) promoting the benefits of a lifetime of healthy physical
activity, and 3) preventing and minimizing injuries from sports
participation for all boys and girls (1). For coaches to effectively
promote long-term athletic development, the following 10
recommendations were made:

10 PILLARS FOR SUCCESSFUL

LONG-TERM ATHLETIC DEVELOPMENT
Long-term athletic development pathways should
accommodate for the highly individualized and non-linear
nature of the growth and development of youth.
Youth of all ages, abilities, and aspirations should engage
in long-term athletic development programs that promote
both physical fitness and psychosocial wellbeing.
All youth should be encouraged to enhance physical
fitness from early childhood, with a primary focus on
motor skill and muscular strength development.
Long-term athletic development pathways should
encourage an early sampling approach for youth that
promotes and enhances a broad range of motor skills.
RECOMMENDATION FOR COACHES
Apply sound understanding of pediatric exercise science to:
• prescribe training programs commensurate with the needs and
abilities of the individual,
• distinguish between training-induced and growth-related
adaptations (positive or negative) in performance, and
• understand the manner in which growth, maturation, and
training interact.
• Appreciate the potential impact that other lifestyle factors
(nutrition, rest and recovery, psychosocial health, and external
pressures) can have on physical fitness and physical activity.
• Be aware of the condition of each youth and prescribe exercise
intervention for muscle strength, motor skills, and athleticism.
• Promote participation pathways for all youth to be able to
transition between developmental pathways.
• Encourage an early start to free play and deliberate play (birth to
5 – 6 years of age) and developmentally appropriate strength and
conditioning (starting at 6 – 7 years of age).
• View coordination and muscle strength as synergistic components
of motor skill performance.
• Prioritize neuromuscular training as part of the multidimensional
strength and conditioning program.
• Promote sampling (an approach that encourages youth to be
introduced to a variety of sports and activities and to participate
in a number of positions within a given sport).
• Focus on the quality of practice rather than the quantity
of practice.
• Refrain from early specialization (year-round intensive training
within a single sport or physical activity at the exclusion of other
sports and activities).

8 NSCA COACH 3.3 | NSCA.COM


10 PILLARS FOR SUCCESSFUL
LONG-TERM ATHLETIC DEVELOPMENT
Health and wellbeing of the child should always be the
central tenet of long-term athletic development.
Youth should participate in physical conditioning
that helps reduce the risk of injury to ensure their on-
going participation in long-term athletic development
programs.
Long-term athletic development programs should provide
all youth with a range of training modes to enhance both
health- and skill-relates components of fitness.
Practitioners should use relevant monitoring and
assessment tools as part of a long-term athletic
development strategy.
NSCA COACH 3.3 | NSCA.COM 9
NSCA.com
RECOMMENDATION FOR COACHES
• Create a pleasurable and fulfilling culture of positive experiences in
sport and physical activity that promote wellbeing by emphasizing:
»» a growth mindset,
»» self-determined motivation,
»» perceived competence,
»» confidence, and
»» resilience.
• Focus on the long-term view of developing athleticism that
includes chronic and sustainable adaptations.
• Do not use physical activity as a punishment.
• Provide a well-rounded strength and conditioning program that
includes strength training, motor skill and balance training, speed
and agility training, and appropriate rest.
• Be sure that the strength and conditioning program is
developmentally appropriate and suitably prepares youth for the
demands of sport and physical activity.
• Address “underuse” concerns by providing a long-term program
for athleticism for non-athletic youth.
• Recognize that both children and adolescents can make worthwhile
improvements in all components of fitness irrespective of their
stage
of development.
• Collect quarterly measures of stature, limb length, and body mass
to monitor growth and maturation.
• Measure both the product (e.g., jump distance) and process
(e.g., how technically proficient the jumps are performed) when
assessing physical capacities in youth.
• Assess psychosocial wellbeing in youth with a validated instrument
for children and youth.
WHAT COACHES NEED TO KNOW ABOUT THE NSCA POSITION STATEMENT
ON LONG-TERM ATHLETIC DEVELOPMENT
10 PILLARS FOR SUCCESSFUL
LONG-TERM ATHLETIC DEVELOPMENT
Practitioners working with youth should systematically
progress and individualize training programs for
successful long-term athletic development.
Qualified professionals and sound pedagogical
approaches are fundamental to the success of long-term
athletic development programs.
THE LONG-TERM VIEW
Coaches at all levels need to take the long-term view of
athleticism. The ultimate goal should be a lifetime of healthy and
enjoyable engagement in sports and physical activity, so long-
term athletic development plays a key role for athletes of all ages.
It is incumbent on all youth coaches to provide youth with the very
best opportunities to succeed and develop to the best of their
potential. The 10 pillars of long-term athletic development and
recommendations provide coaches with the information they need
to help all youth reach their potential.
10 NSCA COACH 3.3 | NSCA.COM
RECOMMENDATION FOR COACHES
• Adopt a progressive, individualized, and integrated approach to the
programming of strength and conditioning activities.
• Youth training programs should be dictated by the needs of the
individual, his or her technical competency, and the needs of the
relevant sports or activities.
• Periodization represents the theoretical framework and involves
sequential blocks of training to maximize the overall training
response and considers:
»» accommodation of influential factors, such as time and facilities
available for training,
»» pressures of academic work,
»» need for socializing with family and friends,
»» rest and recovery within and between sessions, and as
mandatory blocks within the periodization model,
»» scheduling of training and competitions, and
»» influence of growth and maturation for each youth.
Coaches need a fundamental understanding of:
• pediatric exercise science,
• training principles for youth,
• pedagogy,
• developmental appropriateness,
• coaching skills,
• cueing,
• providing a motivational climate for youth, and
• cultivating an environment that promotes intrinsic motivation and
enjoyment.
REFERENCES
1. Lloyd, R, Cronin, J, Faigenbaum, A, Haff, G, Howard, R,
Kraemer, WJ, et al. National Strength and Conditioning Association
position statement on long-term athletic development. Official
position stand of the National Strength and Conditioning
Association. The Journal of Strength and Conditioning Research
30(6): 1491-1509, 2016.
ABOUT THE AUTHOR
Rick Howard helped start the National Strength and Conditioning
Association (NSCA) Youth Special Interest Group (SIG) and served
this year as Immediate Past Chair. In addition, Howard serves on
the NSCA Membership Committee and is the NSCA State/Provincial
Program Regional Coordinator for the Mid-Atlantic Region. Howard
is involved in many pursuits that advance knowledge, skills, and
coaching education to help all children enjoy lifelong physical
activity and sports participation.
 COACH
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BIOFEEDBACK FOR STRENGTH AND CONDITIONING PERFORMANCE
GABRIELLE SMITH, MA
B
iofeedback is a tool that not everyone knows about, yet
many coaches and athletes could benefit from using it.
The practice of biofeedback is based on the idea that the
brain and body are tightly woven and constantly affecting the
other. This article will describe the psychophysiological principle,
introduce biofeedback, and provide descriptions of two biofeedback
modalities that may be useful for strength and conditioning
professionals to improve performance. Lastly, suggestions for using
biofeedback tools across coaching contexts are provided.
THE PSYCHOPHYSIOLOGICAL PRINCIPLE
According to the psychophysiological principle, “every change in
the physiological state is accompanied by an appropriate change
in the mental-emotional state, conscious or unconscious; and
conversely, every change in the mental-emotional state, conscious
or unconscious, is accompanied by an appropriate change in
the physiological state,” (2). In other words, a human is a single
system. It is not a matter of the brain being one system and
everything from the neck down being another separate system.
Contrary to popular belief, neither the brain nor the rest of the
body is in command; one does not control the other, but rather,
they are completely interdependent.
Because of this interdependency, an issue in one’s physiology
will also present itself in that person’s psychology. Likewise,
an issue in one’s psychology will also present itself in their
physiology. Biofeedback is a useful tool for addressing the entire
psychophysiological system in order to improve both mental and
physical performance.
12 NSCA COACH 3.3 | NSCA.COM
INTRODUCTION TO BIOFEEDBACK
Biofeedback was designed with two goals in mind. The first goal
of biofeedback is to train the athlete to develop self-awareness of
certain psychophysiological states. Athletes are trained to notice
things such as tense muscles, shallow breathing patterns, and
distracted thoughts. The second goal of biofeedback is to train the
athlete to develop self-regulation of those psychophysiological
states. For example, athletes can be trained to relax tense muscles,
regulate their breathing patterns, and improve their focus.
Self-awareness and self-regulation can be trained by using
biofeedback instruments to measure psychophysiological activity
such as brainwaves, heart function, breathing, muscle activity, and
skin temperature (1). That information can then be presented to
the athlete so they receive feedback about what is happening in
their psychophysiology. Receiving this feedback allows the athlete
to make changes that improve their health and performance (1).
After sufficient biofeedback training, the goal is to continue these
beneficial habits without the use of a biofeedback instrument.
Biofeedback has been shown to be effective in treating a number
of disorders including attention deficit hyperactivity disorder
(ADHD), hypertension, headaches, anxiety, chronic pain, epilepsy,
and digestive issues (7). In addition to treating disorders, it can
also be used in healthy populations to improve focus, quiet the
mind, improve sleep, regulate heart rate, recover quicker, enhance
imagery, and improve reaction time.

BIOFEEDBACK APPLICATIONS FOR STRENGTH AND
CONDITIONING POPULATIONS
Although there are several biofeedback modalities that can be used,
this article will focus on the following two applications: respiratory
biofeedback and heart rate variability (HRV) biofeedback.
RESPIRATORY BIOFEEDBACK
Because breathing is an innate process, its importance can
often be taken for granted. However, dysfunctional breathing
patterns contribute to many different medical and psychological
issues (1). The most common dysfunctional breathing pattern is
overbreathing, which happens when an individual exhales so much
CO2 that blood CO2 declines, blood pH (alkalinity) increases, and
hemoglobin releases insufficient oxygen to tissues and less nitric
oxide (NO) to blood vessels; the resulting vasoconstriction greatly
diminishes glucose delivery to the tissues (1,3). Overbreathing
may contribute to asthma, panic, phobia, and pain disorders like
chronic low-back pain (1). In addition to reducing oxygen delivery
to muscle tissues, moderate overbreathing can reduce oxygen
delivery to the brain by 30 – 40%, while severe overbreathing
can reduce it by 60% (1). Reduced oxygen delivery to the brain
can cause several mental performance issues or weaknesses,
such as poor decision making, fatigue, diminished memory, and
performance anxiety.
Respiratory biofeedback addresses overbreathing and the
resulting lack of oxygen delivery to the brain by first teaching
proper breathing mechanics. Athletes are taught to breathe
effortlessly by focusing on their abdomen, expanding their
abdominal area, widening their lower ribs and back during
inhalation, and exhaling slowly and smoothly (1). After an
evaluation, a biofeedback clinician might decide to measure an
athlete’s accessory muscle activity, blood oxygen saturation,
cardiovascular activity, inhalation volume, or end-tidal CO2 in
order to provide them with the most appropriate feedback (1).
Once the athlete learns to properly regulate their breathing
patterns on a regular basis, any performance issues or weaknesses
that were caused by overbreathing should eventually subside.
HRV BIOFEEDBACK
HRV is a measure of the change in time intervals between
heart beats. HRV is used to measure the interaction between
the sympathetic nervous system, which regulates the “fight or
flight” response, and the parasympathetic nervous system, which
regulates the “rest and digest” response. High HRV “represents
a flexible [autonomic nervous system] that is responsive to both
internal and external stimuli and is associated with fast reactions
and adaptability,” (4). High HRV indicates an optimal interplay
between the sympathetic and parasympathetic nervous systems,
which can result in healthy, appropriate, and desirable reactions
to stress (4). Low HRV is associated with cardiovascular problems,
as well as mood and anxiety disorders such as generalized anxiety
disorder, panic disorder, and posttraumatic stress disorder (5,6).
NSCA COACH 3.3 | NSCA.COM 13
NSCA COACH 3.3
In HRV biofeedback, clinicians can simultaneously measure
blood volume pulse, blood volume amplitude, heart rate, and
respiration (1). Athletes can be provided with feedback about
the synchronization of their heart rate and respiration activity.
This synchronization, also known as respiratory sinus arrhythmia,
increases HRV. In healthy individuals, heart rate should increase
during inspiration and decrease during exhalation. Once
the athlete learns to increase their HRV, any performance
issues or weaknesses that were caused by low HRV should
eventually subside.
BIOFEEDBACK TOOLS ACROSS COACHING
CONTEXTS
If seeing a biofeedback clinician is not feasible for an athlete,
there are a number of other options for correcting dysfunctional
breathing patterns and increasing HRV. These options will not
provide the athlete with as much useful information and guidance
as a biofeedback clinician; however, they can still be beneficial
for improving psychophysiological performance in strength and
conditioning settings.
For at-home respiratory biofeedback, one option is to use an app
called “Breath Pacer,” which can be set to a comfortable breathing
pace (usually about six breaths per minute). To use the app, the
athlete should lie on their back and place the right hand on the
stomach and the left hand on the chest. Next, the athlete should
focus on their abdomen, expand their abdominal area widen their
lower ribs and move back during inhalation, and exhale slowly and
smoothly. The athlete’s right hand should rise when the stomach
expands and the left hand should hardly move because breathing
through the chest can contribute to overbreathing. This method
can be performed right before bed to help the athlete wind down
before falling asleep, or after or between workouts in order to get
the body into a more restful state.
Some options for at-home HRV biofeedback include the app
called “Stress Doctor” and “Elite HRV.” The Stress Doctor uses
the camera light and lens to measure heart rate, and rewards the
athlete with points when their HRV meets their standards. Elite
HRV uses a Bluetooth heart rate monitor to gather more in-depth
information about the athlete’s heart rate variability.
CONCLUSION
Respiratory biofeedback and HRV biofeedback are just two
of many biofeedback tools that can be used to improve
psychophysiological health and performance. Many other
biofeedback modalities such as neurofeedback, surface
electromyography biofeedback, and electrodermal response
biofeedback are useful in improving the performance of those
inside and outside of strength and conditioning settings. No
matter what the available resources are, there is always a way to
use biofeedback in order to improve performance in strength and
conditioning settings.
BIOFEEDBACK FOR STRENGTH AND CONDITIONING PERFORMANCE

REFERENCES ABOUT THE AUTHOR

1. Biofeedback Certification International Alliance. The Gabrielle Smith recently earned a Master of Arts degree in
Biofeedback Certification International Alliance – Professional Sport and Performance Psychology from the University of
Standards and Ethical Principles of Biofeedback. Accessed July Denver. During her time at the University of Denver, Smith
2016 from http://www.bcia.org/i4a/pages/index.cfm?pageid=3426. served as an extern in the United States Olympic Committee’s
Sport Performance Division. She provided biofeedback and
2. Green, EE, Green, AM, and Walters, ED. Voluntary control
neurofeedback training services to athletes in the Psychophysiology
of internal states: Psychological and physiological. Journal of
Lab at the Olympic Training Center located in Colorado Springs,
Transpersonal Psychology 2(1): 1-26, 1970.
CO. She also served as a Sport and Performance Psychology
3. Khazan, IZ. The Clinical Handbook of Biofeedback: A Step-by- Consultant at the Center for Performance Excellence, where
Step Guide for Training and Practice with Mindfulness. Chichester, she provided services to middle and high school athletes and
West Sussex, UK: John Wiley and Sons, Ltd.; 2013. coaches. She currently serves as a Neurotherapist at Evergreen
4. Lagos, L, Vaschillo, E, Vaschillo, B, Lehrer, P, Bates, M, and Neurotherapy and Peak Performance and as a Mental Skills
Pandina, R. Heart rate variability biofeedback as a strategy for Trainer and Club Coach for Colorado Premier Basketball Club.
dealing with competitive anxiety: A case study. Biofeedback 36(3): Prior to attending the University of Denver, Smith graduated from
109-115, 2008. Vanderbilt University in Nashville, TN with a Bachelor of Science
degree in Cognitive Studies.
5. Paul, M, and Greg, K. The effect of heart rate variability
biofeedback on performance psychology of basketball players.
Applied Psychophysiology and Biofeedback 37(2): 131-144, 2012.
6. Wells, R, Outhred, T, Heathers, JA, Quintana, DS, and Kemp,
AH. Matter over mind: A randomized-controlled trial of single-
session biofeedback training on performance anxiety and heart
rate variability in musicians. PLOS ONE 7(10): 1-11, 2012.
7. Yucha, CB, and Montgomery, D. Evidence-Based Practice in
Biofeedback and Neurofeedback (2nd ed.). Wheat Ridge, CO:
Association for Applied Psychophysiology and Biofeedback; 2008.

14 NSCA COACH 3.3 | NSCA.COM

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BUILDING BETTER ATHLETES THROUGH INCREASED SELF-CONFIDENCE
ANDY GILLHAM, PHD, CC-AASP, CSCS
DETERMINING SELF-CONFIDENCE
L
ook at the triangle in Figure 1. Each number represents a
different lift. The “1” could be a barbell back squat, the
“2” a barbell front squat, and the “3” a barbell jump squat.
The triangle borders represent the limit of an athlete’s skill level.
The closer the number is to the center of the triangle, the more
confidence the athlete has to properly execute the lift. As athletes
increase their capacity to execute more lifts, their triangle grows
to include more numbers and previously learned ones move closer
to the center. With the basic premise of all training programs
being the need to provide some level of unique stimuli to prompt
training adaptations, the triangle and number analogy serves as
a visual to reinforce athlete performance goals and subsequent
improvements. Each athlete’s triangle will look a bit different,
especially across contexts and competitive levels, but using this
type of visual can aid coaching in a number of ways.
FIGURE 1. TRIANGLE­­­—VISUAL APPROACH FOR DETERMINING
SELF-CONFIDENCE
Planning and designing training programs for a new group of
athletes (e.g., a new recruiting class or a new coaching job)
can be problematic without a base level of understanding of
the athletes’ current skill levels. Providing a numbered list of
exercises and having the athletes fill in their own triangle with
the numbers of the exercises placed within, or outside, the
triangle borders is a way for the coaching staff to get substantive
information quickly. If there are interns or new staff at the facility,
the same task can help the senior staff identify what tasks
are suitable for which individuals. These same visual triangles
completed by athletes can be used in discussions between
strength and conditioning staff and sport coach staff as a way to
quickly describe the skill level of the athletes. Moving beyond the
16 NSCA COACH 3.3 | NSCA.COM
initial data collection stage, this visual approach can be added
to a post-season testing protocol leading to multiple benefits.
One benefit is that the strength and conditioning staff receives
quick feedback from the athletes about how much they have
progressed. That feedback can be used to make adjustments for
the following season, document the work accomplished by the
strength and conditioning staff during the season, and serve as a
take-away for the athletes about their improvements.
Self-confidence is consistently viewed as one of the most
important mental skills (9). Having a take-away reminder of
growth, improvement, and progress is crucial to an athlete’s
self-confidence. Moreover, self-confidence and anxiety are
inversely related meaning that overly anxious athletes can
be helped by improving self-confidence, not just by reducing
anxiety (3). Recent research has shown that athletes report
predominantly positive thoughts and feelings when they achieve
peak performances (1). This is similar to long-standing research
on athletes experiencing flow that shows a total absorption on
the task, thus limiting time for negative, distracting, or critical
thoughts that prompt feelings of anxiousness (8).
BUILDING ATHLETE SELF-CONFIDENCE
A common question amongst strength and conditioning coaches
is how to improve athlete self-confidence and self-efficacy. The
distinguishing facet between self-confidence and self-efficacy is
one of scale. Self-confidence is typically viewed on a larger scale
and inclusive of multiple tasks or areas of life (i.e., confident in
the training facility). Self-efficacy is viewed more narrowly on one
single task at a time (i.e., ability to execute a particular lift). The
distinction between the two constructs is tangential to finding
ways the strength and conditioning staff can better assist athletes.
There are a variety of models or theoretical frameworks that could
be used to aid the development of athlete self-confidence. One
approach is to consider sources of sport confidence and attempt
to address as many areas as possible (12). Another approach
would be to divide an athlete’s sport confidence into physical,
mental, and resilience-based components (10). There is also a
specific model of self-efficacy that extends well beyond sport that
is frequently used in sport research (2,11). It is this last option that
will be used for this article as the framework of how strength and
conditioning professionals can systematically build athletes that
are not just physically stronger, but mentally stronger as well (2).
The model suggests there are four primary means through which
self-efficacy can be improved (2):
1. Mastery experiences: accomplishing tasks that provide
direct evidence of completion.
2. Vicarious experiences: observational learning and
social modeling.
3. Verbal persuasion: input from self or others.
4. Physiological and affective states: a general sense of
how an athlete feels mentally and physically.

These four sources are presented in descending order from most
to least influential. This particular framework is easily identifiable
when considering specific athletes in specific situations. The
athlete that shows up to train feeling run-down from school and
sport practices will not likely show much self-confidence. Athletes
that adopt negative self-talk or have others cut them down rarely
perform well. Additionally, attempting to complete a task that
they have never performed previously, and perhaps have never
seen, is daunting to most athletes and coaches alike. The benefits
to strength and conditioning coaches adopting these four means
to enhance self-efficacy is that each of those identified sources
are areas the staff already addresses, even if it is not done for the
expressed purpose of increasing athlete self-confidence.
SPECIFIC COMPONENTS FOR BUILDING SELF-
CONFIDENCE
MASTERY EXPERIENCES
Goal setting may well be the most straight-forward approach to
generating mastery experiences for athletes. A properly designed
systematic goal setting program yields multiple opportunities for
athletes to accomplish a specific task every day (5). Even better is
that those successes are recorded and logged as part of the goal
setting process so at any point an athlete can look up their goal
attainment showing progress across a variety of tasks. It is difficult
for athletes to examine their own goal sheets, see that they have
been successful at accomplishing 85% of their goals over the
past season, and then report feelings of low self-confidence. That
becomes a double benefit for any athlete that experiences feelings
of anxiety related to performance improvement because of the
inverse relationship between anxiety and self-confidence.
VICARIOUS EXPERIENCES
Vicarious experiences can be more challenging to engineer. From a
mental training standpoint, imagery is often utilized to target this
source of efficacy belief. While powerful, building imagery into the
work the strength and conditioning staff already does is likely to
be a bit cumbersome. Research has shown potential with the use
of imagery during training, which makes it worthy of consideration
and further exploration into its utility (4). Apart from imagery,
there are still myriad ways to develop athlete self-confidence
through vicarious experience. Using videos to teach lifts is an
excellent way to incorporate some observational learning. It is
important to use videos of similarly trained athletes. The purpose
of the video is to prompt a “Hey, I can do that” thought in the
mind of the athletes. If the athletes view the lifter in the video,
or in person, as significantly more advanced, the thoughts can
quickly turn to more of amazement rather than positive social
comparison for the athlete’s benefit. In a collegiate setting, giving
upper-class athletes the task of creating videos that demonstrate
lifts for the under-class athletes is a viable option that may add to
athlete motivation by improving teammate relatedness.
The use of cue words, pictures, and slogans also fall into this
category. For these cues to work, words and images must have a
NSCA COACH 3.3 | NSCA.COM 17
NSCA.com
purpose that is clearly explained to the athletes. A power rack with
the word “Power” on the wall facing the lifter is seen frequently in
facilities. An improvement is to display “Explosion Coming” near
the weight rack where athletes get the plates to be used in the
power rack. The strength and conditioning staff will have already
primed the athletes that the power-based lifts are to be performed
explosively; therefore, placing the cue word by the rack allows the
athletes to mentally prepare for the movements. Athletes spend a
lot of time looking up while training and while at rest in the facility,
so think about the option of placing cue words or pictures on the
ceiling. As a staff, make sure to explain the message behind cue
words and pictures. Do not assume it is obvious to athletes and do
not let the message, cue words, or pictures become stale—change
them up, move them around, or adjust throughout the season.
VERBAL PERSUASION
The verbal persuasion component is viewed as less impactful
than both mastery experiences and vicarious experiences (11).
Nonetheless, there are some noteworthy pieces that can help
build athlete self-confidence as well as limit the debilitating
effects of negatively worded verbal persuasion. The strength
and conditioning staff needs to listen to what the athletes are
saying as it relates to training. Athletes who are overly negative,
or overly positive, likely indicate some concern and this pendulum
can quickly swing from one extreme to the other. Perhaps the
most challenging part here is that these sorts of verbal messages
can spread through a team and facility rapidly. For example, one
coach leads a workout that is received poorly by the athletes. The
athletes begin to discuss the workout and soon a downward spiral
takes shape where the athletes refuse to put forth effort when
training with that specific coach. The negative spiral may not be
coach-related at all. It could be a specific exercise, time of day,
location, or context conflict (e.g., multiple teams at once or mixed
genders training at the same time). The overall point is for the
strength and conditioning staff to be mindful of what the athletes
are saying. If a group of athletes begins to be overly negative
towards a coach, a training component, or other athletes, it can
become difficult to put forth high energy in training. The message
is not to coddle the athletes or “give in” to their complaints; the
message is to be aware of what the athletes are saying and reflect
on whether adjustments are necessary to put the athletes in the
best position for success.
PHYSIOLOGICAL AND AFFECTIVE STATES
The final component is the most general. The simple summation
of physiological and affective states is that it is difficult to be self-
confident when tired, feeling ill, overly distracted, or otherwise
not ready to train. High-level strength and conditioning coaches
report an understanding that athletes need to know the staff
cares about them (6,7). That notion includes reminding the
athletes about how important sleep and proper nutrition are to
training and competition. Strength and conditioning coaches
often have more information on how the athletes are feeling than
the sport coaches, athletic training staff, or other campus-wide
BUILDING BETTER ATHLETES THROUGH INCREASED SELF-CONFIDENCE

support personnel. Reminding athletes about how to take care of
themselves can be especially critical for younger athletes, those
with less local social support, and those living away from home
for the first time. A simple question or reminder by a strength and
conditioning coach can go a long way in the mind of an athlete,
such as, “how are you feeling today?”
CONCLUDING REMARKS
Moving from the bottom up the four levels of sources of self-
efficacy shows a glimpse of how they work together. An athlete
who feels burnt out is more likely to complain about the intensity
of a workout. In that state, the work the strength and conditioning
staff put into engineering the environment and utilizing goal
setting to foster improved self-confidence may not matter.
Recalling the triangle and numbers analogy, this approach is not
about propping athletes up with false flattery or making things
easy. On the contrary, the objective presented here is to foster
an environment where athletes can put in work during training
and be rewarded with performance increases. Athletes who are
more confident in training will put forth greater effort (2). With
that greater effort, improved performance will follow. Getting a
whole team to train harder and see progress will lead to better
performances on the court, in the pool, and on the field.
REFERENCES
1. Anderson, R, Hanrahan, S, and Mallett, CJ. Investigating
the optimal psychological state for peak performance in
Australian elite athletes. Journal of Applied Sport Psychology 26:
318-333, 2014.
2. Bandura, A. Self-efficacy: The exercise of control. New York:
Freeman, 1997.
3. Craft, L, Magyar, M, Becker, B, and Feltz, D. The relationship
between the Competitive State Anxiety Inventory-2 and sport
performance: A meta-analysis. Journal of Sport and Exercise
Psychology 25: 44-65, 2003.
9. Koehn, S, Pearce, A, and Morris, T. The integrated model of
sport confidence: A canonical correlation and mediational analysis.
Journal of Sport and Exercise Psychology 35: 644-654, 2013.
10. Vealey, R. Understanding and enhancing self-confidence in
athletes. In: Singer, RN, Hauesenblas, HA, and Janelle, CM (Eds.),
Handbook of Sport Psychology. (2nd ed.) New York: Wiley; 550-
565, 2001.
11. Vealey, R, and Chase, M. Self-confidence in sport. In: Horn,
TS (Ed.), Advances in Sport Psychology. (3rd ed.) Champaign, IL:
Human Kinetics; 65-97, 2008.
12. Vealey, R, Hayashi, S, Garner-Holman, M, and Giacobbi, P.
Sources of sport-confidence: Conceptualization and instrument
development. Journal of Sport and Exercise Psychology 20(1): 54-
80, 1998.
ABOUT THIS AUTHOR
Andy Gillham owns and operates Ludus Consulting, LLC, which
focuses on performance enhancement for athletes, coaches, and
business executives. Of specific note is his work with coaches and
athletic administrators on improving systematic coach evaluation
and providing targeted coach development opportunities. Gillham
is a Certified Strength and Conditioning Specialist® (CSCS®) through
the National Strength and Conditioning Association (NSCA) and
a Certified Consultant through the Association for Applied Sport
Psychology (CC-AASP). He serves as a sport psychology consultant
for collegiate teams and coaches as well as individual athletes
competing at high school and college levels in the United States
and Canada. Gillham is an Editorial Board member for two peer-
reviewed journals, the International Journal of Sports Sciences and
Coaching and the International Sport Coaching Journal. Gillham
earned both his Bachelor of Science degree in Fitness and Master
of Science degree in Human Performance from the University of
Wisconsin-LaCrosse. He received his PhD in Education with a Major
of Sport and Exercise Psychology from the University of Idaho.

4. Giacobbi, PR, Hausenblas, HA, Fallon, EA, and Hall, C. Even

more about exercise imagery: A grounded theory of exercise
imagery. Journal of Applied Sport Psychology 15: 160-175, 2003.
5. Gillham, A. The application of systematic goal setting for
strength and conditioning coaches. NSCA Coach 3(2): 4-7, 2016.
6. Gillham, A, Doscher, M, Schofield, G, Dalrymple, D, and Bird,
S. Strength and conditioning roundtable: Working with novice
coaches. International Journal of Sports Science and Coaching 10:
985-1000, 2015.
7. Gillham, A, Schofield, G, Doscher, M, Dalrymple, D, and
Kenn, J. Developing and implementing a coaching philosophy:
Guidance from award-winning strength and conditioning coaches.
International Sport Coaching Journal 3: 54-64, 2016.
8. Koehn, S, Morris, T, and Watt, A. Correlates of dispositional
and state flow in tennis competition. Journal of Applied Sport
Psychology 25: 354-369, 2013.

18 NSCA COACH 3.3 | NSCA.COM

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ANALYSIS OF “FAD DIETS” AND ALTERNATIVES FOR OPTIMAL ATHLETIC PERFORMANCE
AMANDA POPPLETON, MFN, RD, LDN
A
“fad diet” can be considered a diet that often eliminates at
least one essential food group, may recommend a type of
food or food group in excess, and is intended to produce
results more quickly than a traditional dietary program. People
tend to flock toward fad diets because they provide “rules” that
seem easy to follow and they provide structure to a person’s
unstructured daily nutrition pattern. These diets often show
results, but the results may be too large and too fast based on the
extreme nature and the lifestyle change that is being promoted.
However, in order to have a healthy and lasting nutritional
program, the “rules” should not be restrictive and the “results”
should come slowly and gradually (9). This article will discuss
the negatives of fad diets, discuss potential pitfalls, and provide
realistic dietary guidelines.
Not all diets are appropriate for every population and this is
especially true of an athlete who is expected to train and perform
at a high level. The performance aspect is the reason “magazine
cover diets” and the hottest trends in weight loss do not generally
apply to athletes. Models, actresses, and the general population
do not have higher nutritional needs like athletes, and do not
have to worry about performance as a factor. Therefore, athletes
should not follow the nutrition trends of celebrities or the general
population. The higher needs and greater demands on an athlete’s
body include:
• Protein intake
• Fluids and electrolytes
• Carbohydrates (amount dependent on training period)
20 NSCA COACH 3.3 | NSCA.COM
• Caloric needs due to training period and higher amount of
lean mass
• Frequent fueling before training and post-workout recovery
nutrition
»» Importance on timing for replenishing and repair muscles
for optimal energy and performance (6,8).
The following sections will address and discuss some of the
negative aspects associated with fad diets, provide a breakdown
of some common diets (Table 1), list a few performance pitfalls
that often accompany fad diets, and finally provide realistic dietary
rules for optimal energy including an example meal plan (Table 2).
NEGATIVES OF FAD DIETS
• Fad diets may eliminate one or more essential food groups or
nutrients. Common food groups eliminated include grains and
dairy.
»» Grains: Source of carbohydrates, especially complex
carbohydrates for slow and sustained release of energy.
Great sources of vitamin B, fiber, iron, magnesium, and
selenium (6,8).
»» Dairy: All dairy foods provide benefits to most people,
especially athletes. Dairy products provide calcium, vitamin
D, and protein, all of which support strong bones (6,8).
»» Red meat: Red meats provide protein, vitamin B, iron, zinc,
amino acids, and is a natural source of creatine (6,8).

• Rate of weight loss is too rapid. This could be from:
»» Loss of water weight: For every gram of glycogen stored,
three grams of water are retained. If depletion of glycogen
stores occur due to a restricted calorie and carbohydrate
intake, a loss of glycogen and water can create the
appearance of a fast “weight loss.” This “weight” is also
quickly regained once dietary patterns normalize (6).
»» Restriction of nutrients: If the body is being provided
minimal fuel overall, or even minimal carbohydrates, most of
the weight loss will be due to muscle loss. In this scenario,
performance may suffer and injury risk may increase. When
reverting back to allowing more nutrients in their diet, there
is also a risk for weight regain in the form of fat (6,8).
• Dietary pattern is not sustainable and/or extreme in nature.
»» An overconsumption of one type of food to replace others:
This may lead to deficiencies of some nutrients and
excessive intake of others, depending on what food(s) is
being discouraged from consumption.
»» Periods of fasting: The body will adapt to function on the
minimal and inconsistent fuel being provided, which may
cause the body to slow its resting metabolism. When the
fast is stopped or calorie intake increases slightly, the
person is at risk for weight regain.
»» Restriction of nutrients: The body will eventually feel
deprived and crave more fuel, which may lead to
overconsumption or binge eating, thereby resulting
in regaining weight (6). Weight regain is due to both
overconsumption and a decrease in resting metabolism.
POTENTIAL PERFORMANCE PITFALLS (2,6):
• Inadequate vitamin and mineral intake:
»» Iron: Low iron status is typically seen with insufficient
fueling and impairs oxygen delivery to the muscle, causing
fatigue and performance issues.
»» Calcium: Intake of this primary bone maintenance nutrient
may be inadequate if dairy is removed. Other foods provide
calcium (e.g., dark and leafy greens, broccoli, legumes,
and salmon), but dairy foods contain the highest amount.
Low calcium intake may lead to an increased risk of stress
fractures if bone cell turnover is not optimal.
»» Sodium: Sodium intake may be insufficient, which increases
risk of cramping due to a decrease in water retention and
poor sodium replenishment. An inadequate balance of
sodium and potassium may also cause impaired muscle
function.
• Low carbohydrate consumption:
»» Poor energy levels during activity.
»» Increased risk of cramping due to inability to retain water,
and insufficient calorie intake.
»» Depletion of glycogen stores over time, leading to
worsening fatigue and increased risk of injury.
NSCA COACH 3.3 | NSCA.COM 21
NSCA COACH 3.3
»» Poor focus, mood, and cognition related to the brain not
being properly fueled.
• The brain and central nervous system relies solely on
carbohydrates for fuel, and requires about 150 g of
carbohydrates, making this an absolute minimum amount
for a non-athlete to consume daily. An athlete needing
to fuel for their brain, activities of daily living, and
training are going to require much more than 150 g of
carbohydrates (2).
• Fasting periods:
»» Poor focus, mood, and cognition.
»» Lean tissue breakdown can occur during periods of fasting.
»» Training with low energy levels during fasting periods.
»» Depletion of glycogen stores over time if the muscles do
not receive adequate recovery nutrition.
»» Inadequate calories during shorter feeding windows, which
may lead to weight and/or lean tissue loss.
»» Body adapts to burn fewer calories by slowing resting
metabolism and storing fat, which sets the body up for
failure in losing weight or maintaining weight loss.
REALISTIC RULES
One of the aspects of fad diets that make them “easy” and
appealing is the “rules” or guidelines that they provide. Below are
basic guidelines for anyone, but especially athletes, to follow to
help them fuel for optimal energy:
• Eat breakfast within one hour of waking up: This gets the
metabolism started and helps to ensure that the body does
not start the day with an energy deficit. If athletes have
morning practice or workouts and do not want to or cannot
eat a full meal, then a snack that has carbohydrates and
protein will suffice until they get a full recovery breakfast.
• Fuel frequently (every 3 – 4 hours): This ensures the muscles
have energy to use, spares some glycogen stores, prevents
muscle from being broken down for energy, and minimizes
unwanted fat storage. If the dietary pattern promotes
inconsistent fueling, the body will think it needs to store body
fat for periods of famine.
• Recover, with carbohydrates and protein, within 30 – 60
minutes of completing a workout: Proper recovery will
prevent injury and fatigue over the course of a season
and help keep energy levels high during performance.
Carbohydrates replenish energy stores and protein repairs the
muscle damage done during the athletic event (8).
• Aim for half an ounce of fluid per pound of bodyweight (1):
Adequate hydration practices will help performance overall,
but can also help prevent overconsumption at meals or in
between meals (1). Sometimes the body can mistake thirst
for hunger (1).
• Balance performance plate: Have the following
three components:
ANALYSIS OF “FAD DIETS” AND ALTERNATIVES FOR OPTIMAL ATHLETIC PERFORMANCE
»» Color (e.g., fruit and non-starchy vegetables).
»» Lean proteins (e.g., lean beef or pork, fish, chicken, turkey,
and low-fat dairy products).
»» Complex carbohydrates (e.g., whole wheat bread, bagels,
pasta, rice, oatmeal, potatoes, and beans).
All three components should be present, but portion sizes should
vary with any nutrition goals or training load for that particular
sport, season, and individual. For examples, higher intensity
training requires more carbohydrates (6,8). As another example,
if an individual is attempting to lose weight or in a period of low-
intensity training, having more vegetables instead of fruit may
be beneficial for addressing the “color” aspect while reducing
caloric intake.
REFERENCES
1. American College of Sports Medicine, Sawka, MN, Burke,
LM, Eichner, ER, Maughan, RJ, Montain, SJ, and Stachenfeld, NS.
American College of Sports Medicine position stand: Exercise and
fluid replacement. Medicine and Science in Sports and Exercise
39(2): 377-390, 2007.
2. Bier, DM, Brosnan, JT, Flatt, JP, Hanson, RW, Heird, W,
Hellerstein, MK, et al. Report of the IDECG Working Group on
lower and upper limits of carbohydrate and fat intake. European
Journal of Clinical Nutrition 53(suppl): S177-178, 1995.
3. Canadian Medical Association. Intermittent fasting: The next
big weight loss fad. Canadian Medical Association Journal 185(8):
E321-E322, 2013.
4. Escott-Stump, S. Nutrition and Diagnosis-Related Care (7th
ed.) Philadelphia, PA: Lippincott, Williams, and Wilkins; 2012.
TABLE 1. BREAKDOWN OF COMMON DIETS
PALEO DIET (7)
Mimics foods eaten by
Premise
“hunter-gather” ancestors.
Those with Celiac disease must avoid
Low carbohydrates: non-starchy
fruits and vegetables making
up 35 – 45% of daily calories.
Principles Higher protein and potassium
Rice products do not contain gluten.
intake, and lower sodium intake.
Moderate to higher fat intake
(mostly Omega-3 and Omega-6).
of gluten in those that are diagnosed.
3 eggs, 2 tbsp of olive oil, parsley,
1 grapefruit, and herbal tea.
Example Breakfast 560 calories and 30 g
of carbohydrates.
21 g of protein and 40 g of fat.
22 NSCA COACH 3.3 | NSCA.COM
5. Maughan, RJ. Fasting and sport: An introduction. British
Journal of Sports Medicine 44(7): 473-474, 2010.
6. McArdle, WD, Katch, FI, and Katch VL. Sports and Exercise
Nutrition (3rd ed.) Philadelphia, PA: Lippincott, Williams, and
Wilkins; 2009.
7. Pitt, CE. Cutting through the Paleo hype: The evidence for the
Paleolithic diet. Australian Family Physician 45(1-2): 2016.
8. Position of Dietitians of Canada, the Academy of Nutrition
and Dietetics, and the American College of Sports Medicine.
Nutrition and Athletic Performance: 501-528, 2016.
9. Saltzman, E, Thomason, P, and Roberts, SB. Fad diets: A
review for the primary care provider. Nutrition in Clinical Care 4(5):
235-242, 2001.
ABOUT THE AUTHOR
Amanda Poppleton joined the North Carolina State University
Athletics Department staff in July of 2014. Her current title is the
Assistant Director of Sports Nutrition, where she oversees the
nutritional needs of the men’s basketball, baseball, softball, men’s
soccer, women’s soccer, swimming/diving, cross country, track,
volleyball, gymnastics, and rifle teams. She focuses the most on the
men’s basketball team, as she manages their day-to-day nutrition,
including at home and on the road. Additionally, she has also held
the Sports Nutrition Assistant position at both the University of
Georgia and the University of Florida. Poppleton received her
Bachelor of Science degree from the University of Tennessee in
Knoxville, TN. She earned her Master’s degree in Food and Nutrition
from Bowling Green State University. Poppleton was one of 12
nominated invitees to the first annual Collegiate and Professional
Sports Dietitians Association (CPSDA) Advanced Practice
Workshop for upcoming Sports Registered Dietitians (RD) in 2014.
GLUTEN FREE DIET (4) INTERMITTENT FASTING (3,5)
Periodic fasting aiming to curve
Medical nutrition diet used to treat
hunger which ultimately restricts
Celiac disease. This should only be
calories from the shortened
used if a gluten allergy is present.
feeding window.
gluten-containing foods such as: Includes different variations
bread, pasta, cereals, soups, sauces, of fasting. Drawing out the
baked goods, malt, etc. overnight fast for a specified
period of time (e.g., 16 – 36
hours) and narrowing the
This is to protect the small intestine
feeding window to 4 – 12 hours.
from the damaging autoimmune
response that occurs with ingestion
2 cups of Rice Chex cereal,
1 cup of 1% milk, 1 banana,
Most fasts occur during
and 1 oz of walnuts.
breakfast time as they
645 calories and 99 g
continue to fast from sleep.
of carbohydrates.
18 g of protein and 19 g of fat.
 NSCA COACH 3.3

TABLE 1. BREAKDOWN OF COMMON DIETS (CONTINUED)

PALEO DIET (7)
Promotes healthy fats,
Able to alleviate symptoms of those
increases cognitive function,
with Celiac disease. This should only
and decreases inflammation.
Promotes fruit and vegetable
Potential Benefits consumption including an increase
for the Athlete in overall nutrient quality
(e.g., vitamins, minerals,
antioxidants, and phytochemicals).
May decrease in bodyweight
and/or body fat percentage.
Favors low carbohydrate
consumption from grains.
Favors low sodium consumption.
Restricts many fruits and
Potential Pitfalls for
vegetables, contributing to a
the Athlete
lower carbohydrate intake.
Very restrictive and expensive
for college athletes with
limited money and time.
GLUTEN FREE DIET (4) INTERMITTENT FASTING (3,5)
be used if a medical diagnosis of
Celiac disease is confirmed.
May decrease body weight
May decrease in bodyweight
and/or body fat percentage.
and/or body fat percentage.
Elimination of many refined
grains, and flour-based sweets
(e.g., cookies, cakes, etc.).
Would require athlete to train
while fasting such as a Muslim
May be hard to meet athlete during Ramadan.
carbohydrate needs through
limited gluten-free food choices. Inability for proper muscle
recovery during fasting periods.
Possible nutrient deficiencies if not
Could potentially be dangerous
replacing nutrients found in whole
grain or gluten-containing foods. if athletes have morning practice
and thus an increased risk of
syncope (fainting).

TABLE 2. EXAMPLE MEAL PLAN DAY (ABOUT 3,000 CALORIES, 432 G OF CARBOHYDRATES, AND 166 G OF PROTEIN)
MEAL (TIME) FUEL NUTRIENT BREAKDOWN
1 cup of oatmeal
2 tbsp of brown sugar
¾ cups of blueberries 750 calories, 86 g of carbohydrates,
Breakfast (7:30 am)
3 scrambled eggs and 35 g of protein

1 slice of wheat bread

1 tbsp of peanut butter
1 low-fat Greek yogurt 210 calories, 30 g of carbohydrates,
Snack (10:30 am)
¼ cup of granola and 17 g of protein

6” turkey/ham and cheese sub with lettuce,

tomato, and light mayo 635 calories, 96 g of carbohydrates,
Lunch (1:30 pm)
1 apple and 36 g of protein
1 oz of Sun Chips
350 calories, 65 g of carbohydrates,
Pre-Practice Fuel (3:30 pm) Peanut butter and jelly sandwich
and 13 g of protein
280 calories, 45 g of carbohydrates,
Post-Practice Recovery (5:30 pm) Recovery shake
and 20 g of protein
4 oz of pork tenderloin
¾ cup of brown rice 530 calories, 75 g of carbohydrates,
Dinner (7:00 pm)
1 cup of steamed broccoli and 36 g of protein

1 dinner roll
1 banana 300 calories, 35 g of carbohydrates,
Snack (10:00 pm)
2 tbsp of peanut butter 9 g of protein

NSCA COACH 3.3 | NSCA.COM 23

AN INTEGRATED APPROACH TO BECOMING AN EFFECTIVE COLLEGIATE STRENGTH AND
CONDITIONING INTERN—FOR THE EXERCISE SCIENCE STUDENT
SETH FURMAN, CSCS, USAW, AND TIM PIPER, MS, CSCS,*D, USAW
G
aining practical experience is critical for the professional
development of the exercise science student looking to
become a collegiate strength and conditioning coach. For
the student interested in working with athletes at the collegiate
level, internships can be obtained in athletic departments at
the Division I, Division II, Division III, National Association of
Intercollegiate Athletics (NAIA), and community college levels.
Exercise science students do not typically receive practical
coaching and pedagogical knowledge through their educational
programs (4). Students are expected to obtain experience through
job training or an athletic position in the first few years in the
field (10). These typical methods seem to be an inefficient way to
learn and could serve as an impediment to the student’s long-
term success and longevity (7). Chiu suggests that academic
degrees and relevant certifications are not sufficient enough to
attain competency within the strength and conditioning field:
degrees only aid in learning the minimal level of expertise to begin
as a practitioner and many exercise science programs require an
internship prior to graduation (1). An internship is a good way
for the exercise science student to start getting some valuable
experience in the field of strength and conditioning. The purpose
of this article is to present an integrated approach to becoming an
effective intern in the collegiate setting.
PRACTICE PROFESSIONALISM
Professionalism is a critical characteristic in the field of strength
and conditioning. Professionalism can be defined as “the conduct,
aims, or qualities that characterize or mark a profession or
24 NSCA COACH 3.3 | NSCA.COM
a professional person,” (5). Even though an intern is not a
permanent employee, they are still expected to portray themselves
as representatives of the internship site. It is important to preserve
or improve the image of the institution by acting in a professional
manner. Positive body language, maintaining a clean appearance,
and having great interpersonal skills are all aspects of a strength
and conditioning professional.
It is critical that the intern exhibit professionalism towards the
athletes. The full-time coaches and athletes are the reason an
internship is possible and decisions need to be made based
on their best interest. Inappropriate behavior (e.g., unwanted
touching, foul language, etc.) with the athletes could result in
possible termination. Even though the athletes may be very
similar in age to the intern, both the athlete and intern need to
understand that there are professional boundaries that should not
be crossed (e.g., no sexual relationships). Staff expectations of the
intern-athlete relationship should be established on the first day
of the internship. If it is unclear how to interact with the athletes,
then the intern should ask the supervisor for guidance. The intern-
athlete relationship may vary from place to place, but the intern
should know what is expected of him or her professionally.
BUILD TRUST
Strength and conditioning coaching can be very taxing on the
mind and body. The hours may be long and the daily tasks of the
intern may seem overwhelming and stressful, but it is important
for them to continuously show their supervisor that they can be

trusted to carry out the daily duties consistently and efficiently.
Performing the “basics” (e.g., cleaning, maintenance, and daily
set-up) with precise detail will allow the supervisors to trust the
intern’s abilities to accomplish the required tasks in the everyday
operation of a facility. Consequently, with more trust comes
more responsibility, allowing the intern to show the supervisor
their full capabilities. For example, the strength and conditioning
coach could give the intern a chance to demonstrate an exercise
or coach various parts of an exercise. The supervising strength
and conditioning coach could gradually give the intern more
responsibility such as the intern leading full warm-ups with teams,
coaching injured athletes or make-up sessions, or even leading the
entire team through a workout. Whatever the responsibility is, it
is important that the intern be prepared for whatever is given to
them and that they make the most of the opportunity.
INTERACT WITH THE COMMUNITY
Being in a new environment may make the intern feel
uncomfortable. Embracing the professional community will help
the intern deal with stressors that are associated with being
exposed to something unfamiliar. If the intern can embrace the
internship site as a community of practice (COP), it could lead to
a more effective development of skills, knowledge, and abilities.
COPs are defined as “groups of people who share concern, a
set of problems, or a passion about a topic, and who deepen
their knowledge and expertise in this area by interaction on an
ongoing basis,” (12). Participating in a high-functioning COP
(consisting of the head coach, assistant coaches, other staff, and
peer interns) leads to the development of knowledge based on
the behaviors, meanings, and beliefs shared by others. Members
of the COP may gain a sense of belonging and accountability to
the community while simultaneously developing their skills (8).
By developing and embracing the relationships within the COP,
interns will be provided resources to utilize when questions or
problems arise in the future.
Mentorship can serve as a critical educational relationship for the
future strength and conditioning coach (1). Beginner coaches often
watch and listen to more expert coaches who are perceived as
successful to gain insight on coaching athletes (4). By observing
and interacting with the strength and conditioning staff, the
intern will have more experienced practitioners to question
when needed. If the intern does not already have a mentor, it is
suggested that the intern attempt to become a mentee to one
of the admired strength and conditioning coaches on staff. If the
strength and conditioning coaches are not available to mentor,
then the intern should have a professional relationship with
someone else in the strength and conditioning field.
PRACTICING PRACTICAL KNOWLEDGE
The average exercise science student has spent countless hours
in the classroom learning science and studying for national
certifications. However, there is not always a large emphasis
placed on “real life” coaching experience. If an intern cannot
deliver the intended message to the athletes in an effective way, it
may have little to no value. Plisk stated that “teaching is arguably
NSCA COACH 3.3 | NSCA.COM 25
NSCA COACH 3.3
the most important aspect to the strength and conditioning
practitioner’s job,” (10). Previous research from the perspective
of actual strength and conditioning coaches working in the field
shows that although the science of exercise is important, coaching
ability serves as a more valuable function in the workplace (7).
As a result of their work in situated learning, Lave and Wenger
concluded that learning requires both knowledge and experience;
going over coaching cues, demonstrating exercises to teams, and
creating hypothetical situations are a few examples of how the
intern can continue to get practice (6). The exposure of getting in
front of athletes and coaches will prepare the intern for critical job
functions of an actual strength and conditioning coach.
REVIEWING PERFORMANCE
Another way to continue to develop as a strength and
conditioning intern is to constantly reflect on performance. It is
highly likely that the supervisor is going to provide constructive
criticism to the intern. It is what the intern chooses to do with
the criticism that will be one of the determining factors of his or
her success. Internships may require performance reviews (e.g.,
weekly, monthly, etc.) from the supervisor. This feedback can
provide interns with crucial information needed for improvement.
It can give the intern a deeper understanding of what they need
to improve on and the coaching functions needed to succeed. The
intern should take full advantage of this face-to-face interaction
with his or her supervisor, especially if the supervisor has a very
busy schedule.
If performance reviews are not a regular practice, an example
of a grading rubric is provided in Table 1. Peer review and
self-analysis tools can also be very beneficial for the strength
and conditioning intern. Gilbert and Trudel demonstrated how
self- and peer-mediated reflection can be used to develop
effectiveness in coaching (3). If the intern is accompanied
by other peers or interns, they could grade each other and
themselves on daily performances. This can be done by
observing each other while working with their designated team
or athlete. At the end of the day, the interns could then compare
notes and give instructional feedback. For an example of a self-
analysis questionnaire, see Table 2.
It is important that the intern has the ability to communicate
effectively to the athletes if they get a chance to work directly
with them. To gain experience with effective communication, the
intern can ask mentors or experienced strength and conditioning
coaches to create a “teach back” environment. This is where the
strength and conditioning coach acts as if they are an athlete and
the intern has to take them through the components of a team
session. This is the perfect opportunity for the intern to practice
setting up the session efficiently and to confidently lead a group
through various exercises. These types of deliberate practices may
help the intern improve his or her skills and to develop a coaching
philosophy (1). This teaching exercise is a great way to practice all
aspects of coaching and getting used to being in high-pressure
situations. This will give the intern the most practical experience
outside of leading an actual team.
AN INTEGRATED APPROACH TO BECOMING AN EFFECTIVE COLLEGIATE STRENGTH AND
CONDITIONING INTERN—FOR THE EXERCISE SCIENCE STUDENT

CONCLUSION ABOUT THE AUTHORS

As the popularity of sport continues to grow, more opportunities Seth Furman is currently a Master’s student at Western Illinois
may be available to the collegiate strength and conditioning University, studying Kinesiology with an emphasis in Strength and
coach (1). It is critical for the intern to continue to build on the Conditioning. He has served as an intern at the high school level
competencies and practical experiences they have had during and completed an internship with the University of California,
their educational career. Therefore, it is important for the intern Los Angeles athletic performance staff. He is currently a Teaching
to continue to practice coaching, keep up with the most recent Assistant for the Department of Kinesiology.
literature, and keep a close relationship with a mentor to help
foster their professional development. Tim Piper is an Assistant Professor and Educational Recognition
Program Director in the Kinesiology Department at Western
REFERENCES Illinois University.
1. Chiu, LZF. Chaos revisited: From the brickyard into the weight
room. Strength and Conditioning Journal 32(2): 83-89, 2010.
2. Gearity, B, Hudson, G, and Murray, M. Using project-
based learning to promote college student understanding of
strength and conditioning coaching. The Journal of Strength and
Conditioning Research 36(1): 70-81, 2014.
3. Gilbert, W, and Trudel, P. Learning to coach through
experience: Reflection in model youth sport coaches. Journal of
Teaching Physical Education 21: 16-34, 2001.
4. Grant, MA, and Sorgo, D. Developing expertise in strength and
conditioning. Strength and Conditioning Journal 36(1): 9-15, 2014.
5. Professionalism. Merriam-Webster Online. Merriam-Webster.
Retrieved July 22, 2015, from http://www.merriamwebster.com/
dictionary/professionalism.
6. Lave, J, and Wegner, E. Situated Learning: Legitimate
Peripheral Participation. Cambridge University Press; 1991.
7. Massey, D, and Vincent, J. A job analysis of major college
female strength and conditioning coaches. The Journal of Strength
and Conditioning Research 27(7): 2000-2012, 2013.
8. Massey, D, and Vincent, J. A call to improve educational
programs in strength and conditioning. The Journal of Strength
and Conditioning Research 36(1): 23-27, 2014.
9. Murray, MA, Zakrajsek, RA, and Gearity, BT. Developing
effective internships in strength and conditioning: A community
of practice approach. The Journal of Strength and Conditioning
Research 36(1): 35-40, 2014.
10. Plisk, S. Principle-based teaching practices. Strength and
Conditioning Journal 25: 57-64, 2003.
11. Stone, M, Sands, W, and Stone, M. The downfall of sports
science in the United States. Strength and Conditioning Journal
26(2): 72-75, 2004.
12. Wegner, E, McDermott, R, and Snyder, WM. Cultivating
Communities of Practice. Boston, MA: Harvard Business School
Press; 2002.

26 NSCA COACH 3.3 | NSCA.COM

 NSCA COACH 3.3

TABLE 1. EXAMPLE OF INTERN PERFORMANCE REVIEW TEMPLATE

1. Punctuality: Interns are always early for their sessions.
Comments:
 

2. Interaction with Athletes: Interns have a good rapport with the athletes and understand boundaries within the “coach-
athlete” relationship.
Comments:

 
3. Interaction with Staff: Interns communicate with all members of the staff, this includes coaches and other interns, and they
respect the boundaries of others on staff.
Comments:

 
4. Initiative: Interns desire more responsibilities and are consistently seeking ways to educate themselves.
Comments:

 
5. Pre-Set Up/Post-Breakdown: Interns set up and breakdown in a timely manner, are efficient, and have a high attention
to detail.
Comments:

6. Coaching Skills: Interns are technically proficient and well-versed in all exercise techniques so that they may effectively
teach and demonstrate for their athletes.
Comments:

7. Professionalism: Interns have a professional appearance. Their language is appropriate in the presence of athletes and their
body language is positive.
Comments:

8. Energy: Interns have contagious energy. They are able to motivate athletes and own the coaching floor. They are never
quiet or tired looking.
Comments:

 Interns can be graded on a traditional letter scale (A – F) or number scale (1 – 5)

*Adapted and modified from the University of California, Los Angeles Athletic Performance staff

NSCA COACH 3.3 | NSCA.COM 27

AN INTEGRATED APPROACH TO BECOMING AN EFFECTIVE COLLEGIATE STRENGTH AND
CONDITIONING INTERN—FOR THE EXERCISE SCIENCE STUDENT

TABLE 2. AN EXAMPLE OF AN INTERN SELF-ANALYSIS QUESTIONNAIRE

Intern’s Name:

Circle the number that best represents your performance 1 = not effective; 5 = most effective

PRE-SESSION

I ensured that I understood the technical expectations of the exercises

NA 1 2 3 4 5
to be performed during the session

I ensured that I understood the set up for the session NA 1 2 3 4 5

I ensured that I understood the expectations for the intensity for the session NA 1 2 3 4 5

I ensured that I understood what my exact role would be throughout the session NA 1 2 3 4 5

My set up ensured for an efficient and well-organized session NA 1 2 3 4 5

DURING SESSION

My posture and positioning demonstrated professionalism throughout the session NA 1 2 3 4 5

My voice and message were easily understood NA 1 2 3 4 5

I ensured the athletes understood the technical expectations for each exercise NA 1 2 3 4 5

I gave positive and constructive feedback to each athlete during the session NA 1 2 3 4 5

I helped control the tempo and intensity throughout the session NA 1 2 3 4 5

POST-SESSION

I ensured the weight room was returned to standard set up NA 1 2 3 4 5

I sought feedback on my performance from the full-time coach NA 1 2 3 4 5

I sought clarity on any techniques that were unclear NA 1 2 3 4 5

*Adapted and modified from the University of California, Los Angeles Athletic Performance staff

28 NSCA COACH 3.3 | NSCA.COM

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FUELING WITH A PURPOSE—PREVENTION AND TREATMENT OF RELATIVE EATING DISORDER IN
MALE AND FEMALE ATHLETES
KELSEE GOMES, MS, RD, CSSD, LDN, CLT
O
ne of the main job responsibilities of a sports dietitian
is to promote food as a tool to help athletes excel at the
highest level. Sports dietitians may say things like “fuel
to be strong,” “fuel your body,” or “food is fuel.” Sports dietitians
promote fueling performance when promoting nutrition education
to their athletes. Many successful athletes are motivated by a
desire to excel and have a natural competitive nature, often
possessing driven and perfectionistic personalities (10). It is not
uncommon for athletes to begin to take workouts and dietary
practices to unhealthy extremes in order to achieve success.
Moreover, individuals with disordered eating usually are affected
beyond just dieting, weight preoccupation, and other food
issues, as it can affect many aspects of their lives (9,10). As the
prevalence of disordered eating in sport continues to increase,
sports dietitians and all medical personnel must learn to identify
it properly and follow evidence-based practice, including sound
judgment, when treating athletes with these issues (10).
As a part of the original position stand on the Female Athlete
Triad, the American College of Sports Medicine (ACSM), defined
disordered eating as “a wide spectrum of harmful and often
ineffective eating behaviors used in attempts to lose weight or
achieve a lean appearance. The spectrum of behaviors ranges in
severity from restricting food intake, to binging and purging, to
the DSM-IV defined disorders of anorexia nervosa and bulimia
30 NSCA COACH 3.3 | NSCA.COM
nervosa” (1). ACSM chose the term disordered eating rather
than eating disorders in part because the menstrual and bone
complications associated with the triad can occur when eating is
disturbed at levels not severe enough to meet diagnostic criteria
for an eating disorder (10).
DISORDERED EATING
Disordered eating occurs when attitudes toward food, body weight,
and size lead to eating and exercise habits that could potentially be
dangerous to one’s health and well-being. Numerous environmental
factors contribute to unhealthy dietary practices. The increased use
of social media platforms like Pinterest and Instagram provide a
unique challenge for health professionals as they are a seemingly
constant source of outside pressure, which can encourage athletes
to set unrealistic goals. Peers and self-perception may also
influence body dissatisfaction, dietary restraint, and disordered
eating. Rates of eating disorders are higher among elite athletes
compared to non-athletes (6). This may be due to how athletes
are sometimes subjected to excessive criticism and might feel that
they are seldom praised, leading them to perceive themselves as
not good enough or unworthy. External pressure from coaches or
others close to them may lead to self-critical thoughts, disordered
eating, disordered exercise patterns, body dissatisfaction, and
eating disorders. In a recent update of the ACSM position stand on
the Female Athlete Triad, the term disordered eating was replaced
with energy availability (2).

EATING DISORDER
An eating disorder manifests in an effort to cope, communicate,
or even solve other problems that are often outside of one’s
control (10). Many times athletes feel a “drive for thinness” as
a way to get faster or increase performance if one’s needs are
not being met (e.g., not in the starting lineup, not making the
travel team, pressure from parents or coaches, etc.). In response,
adaptive measures can be taken to make the individual feel
secure. For some individuals, food, weight loss, and eating rituals
can serve this purpose, especially if they start receiving praise or
compliments from others about their changing habits and body
(10). As competitive athletes, they know that their bodies are their
tool for success and many are influenced by what is considered
the ideal body type for their sport.
When a physically active athlete ingests insufficient calories
to fuel their sport to achieve this “ideal body type, this can be
potentially life threatening with multiple risk factors as noted
below (4,6,7,8,9,10). By restricting calories, there are long-term
risks that athletes may experience, both with their body as well as
their performance.
POTENTIAL LONG-TERM RISKS OF CALORIE
RESTRICTION
• Decrease in speed
• Decrease in endurance and coordination
• Increased risk of injury due to weak bones (stress fractures or
repeated bone injuries)
• Menstrual (i.e., period) irregularities/dysfunction
• Chronic muscle soreness
• Changes in energy and mood
• Fatigue
Only a physician can diagnose an eating disorder; however,
everyone on the medical staff should be aware of how to identify a
potential eating disorder in an athlete. The diagnosis of an eating
disorder requires that the individuals meet criteria currently listed
in the Diagnostic and Statistical Manual of Mental Disorders (10).
Identification is extremely important in helping to lead to recovery
from an eating disorder. Noted below are common physical
signs and symptoms (3,4,5,9,10). Knowing how to identify these
symptoms is important to be able to connect an athlete with the
appropriate professionals for treatment.
NSCA COACH 3.3 | NSCA.COM 31
NSCA COACH 3.3
COMMON CONSEQUENCES AND SIGNS OF AN
EATING DISORDER/DISORDERED EATING
• Loss of muscle
• Decrease in testosterone levels in men
• Fatigue
• Poor performance
• Irritability
• Inability to gain muscle or strength
• Dehydration
• Electrolyte imbalance
• Low blood sugar
• Training more than recommended by coach or athletic trainer
• Overuse injuries or stress fractures
• Low energy availability
• High level of anxiety when unable to practice or train
• Negative comments about weight or being “fat”
• Avoidance of social situations, especially those involving food
• Preoccupation with diet, food, or body
RELATIVE ENERGY DEFICIENCY IN SPORT (RED-S)
The International Olympic Committee (IOC) recently broadened
and redefined its previous consensus statement on the Female
Athlete Triad, and has proposed the term Relative Energy
Deficiency in Sport (RED-S) (9). RED-S is defined as a syndrome
of “impaired physiological functioning including, but not limited
to, metabolic rate, menstrual function, bone health, immunity,
protein synthesis, and cardiovascular health caused by relative
energy deficiency,” (9). The IOC argued that the current concept
of the Female Athlete Triad may not address consequences of
low energy availability for male athletes, non-Caucasian athletes,
and disabled athletes (9). The RED-S statement requires further
research and validation, so it is not yet fully accepted by all
members of the research and medical community.
The cause of RED-S is a scenario termed low energy availability
(EA) where an individual’s dietary energy intake is not sufficient
to support the energy expenditure required for health, function,
and daily living (9). Energy availability (EA) is defined as dietary
energy intake (EI) minus exercise energy expenditure (EE) or
the energy left available after the energy cost of exercise has
been spent (9,10). The potential health consequences of RED-S
are depicted below in Figure 1 (the RED-S conceptual model)
(9). Psychological problems can be both the result and cause of
RED-S (9). The prevalence of low EA is unknown, however, health
and nutrition professionals can address low EA by working with
athletes to increase calorie intake and decrease activity.
FUELING WITH A PURPOSE—PREVENTION AND TREATMENT OF RELATIVE EATING DISORDER
IN MALE AND FEMALE ATHLETES
FIGURE 1. POTENTIAL HEALTH CONSEQUENCES OF RED-S (9)
Student-athletes are typically very busy and it is a sports
dietitian’s job to have a plan to help athletes meet their daily
energy needs. Between walking to class, participating at sport
practice, and studying at night, athletes may have limited time to
properly fuel their bodies. By having a nutrition plan for the day
and making adjustments to nutrient timing, the athlete may be
able to maintain an energy balance (~45 kcal/kg/fat-free mass)
that is positive for both health and performance (8).
Intentionally or not, athletes often negatively alter their EA. EA
can be diminished due to increased training, over-exercising, or
under-fueling compared to one’s energy needs. Weight loss is
one sign that the body is in an energy deficit. Another common
sign among female athletes is a lack of menstruation. Once
calories are syphoned from supporting the menstrual cycle,
another extremely important organ is also affected—bone. Low
EA directly impairs bone health and development by affecting
hormones that build and restore bone (3,6,8,10). Low EA also
indirectly impairs bone health and strength through disruption
of both estrogen levels and the female menstrual cycle (10,11).
Adolescence and young adulthood are periods of rapid bone
mass with about 90% of peak bone mass achieved by the age of
18 (6). Therefore, athletes should aim to build and protect their
bones during their college years to prevent chronic injuries and
protect long-term health post-college.
RECOMMENDATIONS FOR FOSTERING HEALTHY
EATING HABITS AMONG ATHLETES
Sports dietitians aim to never focus on bodyweight or body
fat percentages, but rather focus more on fitness levels and
performance. A large part of nutrition education sessions include
helping athletes strive for balance between exercise and eating.
One common strategy to achieve this is by reconnecting athletes
to their hunger and fullness. Athletes should be reminded that
32 NSCA COACH 3.3 | NSCA.COM
celebrities and models are not high-performing athletes, as well
as educated on how images of celebrities are often altered with
airbrushing. Each athlete’s body is unique to him or her, and there
is no need to compare themselves to anyone else. If an athletic
department staff does not have a sports dietitian at their disposal,
they can use the Academy of Nutrition and Dietetics website to
find one in their area. The “Find a Dietitian” tool (http://www.
eatright.org/find-an-expert) can be a useful way to search for
a dietitian who specializes in eating disorders, or even eating
disorders in athletes.
The following are three simple steps to take when concerned
about an athlete with disordered eating or an eating disorders:
1. Identification: If a teammate or someone witnesses an athlete
displaying signs or symptoms of an eating disorder, then he or
she should inform an athletic trainer or medical staff member
about the observed behaviors.
2. Referral: Appropriate intervention involves an expression
of concern for the student-athlete. The first step is to
discuss these concerns with the appropriate medical
practitioner. From here, the medical professional(s) should
determine appropriate referrals to the designated physician,
psychologist, registered dietitian, or other providers.
3. Treatment and Intervention: An individualized treatment plan
should be determined based on initial assessments from the
treatment providers.
The following are possible strategies for improving EA (4,9,10):
• Build trust with the athlete by showing concern and ensuring
confidentiality.
• Ensure that the information given to the coach is only what
he or she needs to know (it is important to be aware of the
department’s policy on sharing any information with coaches;

often, only the medical staff has clearance for discussing an
athlete’s health).
• Make sure the athlete is connected with a physician, dietitian,
and/or mental health provider, if necessary.
• Ensure a team approach and regular communication.
• Nutrition education and counseling by a registered dietitian
should be provided in order to focus on “fueling with a
purpose” and developing mindful eating strategies.
»» The sports dietitian should determine the need for vitamin
D, calcium or an omega 3 supplement based on lab results
and/or dietary intake assessment or per medical doctor.
»» A bone mineral density measurement, such as dual-
energy X-ray absorptiometry (DXA), may be beneficial
for evaluating bone status (discuss with sports medicine
provider).
»» Set a realistic timeline for any weight loss or body
composition changes recommended by the sports dietitian
and avoid quick fixes.
• The sports dietitian will help the athlete set goals that are
realistic, performance-oriented, and health-minded.
»» Ensure the athlete is following the plan he or she created
with the dietitian. It should include a daily fueling plan,
providing meals and snacks every 3 – 4 hours to help the
athlete maintain energy levels and perform at their best.
• Communicate the plan with the entire medical team
working with the athlete.
• Sports psychologists should address barriers, challenges, and
psychological issues in achieving adequate calorie intake.
»» Treatment should involve helping individuals get in touch
with their unconscious, unresolved needs and helping to
provide what the individual was missing in the past.
CONCLUSION
Coaches, strength coaches, and athletic trainers should take the
time to educate themselves on the dangers and signs to look for
in an athlete who may be suffering from an eating disorder. With
the increasing numbers of eating disorders among athletes, it is
important to be able to recognize when healthy eating routines
turn into obsessive thoughts and practices. Early recognition and
treatment is critical to prevent life threatening complications.
Connect your athletes with a registered sports dietitian as soon as
they display risk factors for disordered eating.
REFERENCES
1. American College of Sports Medicine (ACSM). Position stand:
The female athlete triad. Medicine and Science in Sports and
Exercise 29: i-ix, 1997.
2. American College of Sports Medicine (ACSM). Position stand:
The female athlete triad. Medicine and Science in Sports and
Exercise 39: 1867-1882, 2007.
NSCA COACH 3.3 | NSCA.COM 33
NSCA COACH 3.3
3. Da Costa, NF, Schtscherbyna, A, Soares, EA, and Ribeiro, BG.
Disordered eating among adolescent female swimmers: Dietary,
biochemical, and body composition factors. Nutrition 29(1): 172-
177, 2013.
4. De Souza, MJ, Nattiv, A, Joy, E, Misra, M, Williams, N,
Mallinson, RJ, et al. 2014 Female Athlete Triad Coalition Consensus
Statement on Treatment and Return to Play of the Female Athlete
Triad. British Journal of Sports Medicine 48: 289, 2014.
5. Deutz, R, Benardot, D, Martin, D, and Cody, M. Relationship
between energy deficits and body composition in elite female
gymnasts and runners. Medicine and Science in Sports and Science
32(3): 660-668, 2000.
6. Lambrinoudaki, I, and Papadimitriou, D. Pathophysiology of
bone loss in the female athlete. Annals of the New York Academy
of Science 1205: 45-50, 2010.
7. Loucks, AB. Energy availability, not body fatness, regulates
reproductive function in women. Exercise and Sport Sciences
Reviews 31: 144-148, 2003.
8. Manore, MM, Kam, LC, and Loucks, AB. The female athlete
triad: Components, nutrition issues, and health consequences.
Journal of Sports Sciences 25(S1): S61-S71, 2007.
9. Mountjoy, M, Sundgot-Borgen, J, Burke, L, Carter, S,
Constantini, N, Lebrun, C, et al. The IOC consensus statement:
Beyond the female athlete triad—Relative energy deficiency in
sport (RED-S). British Journal of Sports Medicine 48: 491-497,
2014.
10. Thompson, R, and Sherman, R. Eating Disorders in Sport. New
York, NY: Taylor & Francis Group, LLC; 2010.
11. Vanheese, JL, Rodgers, CD, Mahoney, CE, and De Souza, MJ.
Ovarian suppression impairs sport performance in junior elite
female swimmers. Medicine and Science in Sports Exercise 46(1):
156-166, 2014.
ABOUT THE AUTHOR
Kelsee Gomes joined the University of North Carolina (UNC) Sports
Medicine staff in February 2015 as the Director of Sports Nutrition.
She works closely with UNC’s varsity athletic teams, providing
sports nutrition education, nutrition counseling, and meal planning
assistance. Gomes received her Bachelor’s degree in Heath
Education and a Minor in Chemistry from North Carolina University
at Wilmington, and her Master’s degree in Sports Nutrition from
Florida State University.Gomes is credentialed as a Registered
Dietitian (RD), a Certified Specialist in Sports Dietetics (CSSD), a
certified LEAP Therapist (CLT) specializing in food sensitives, and
is also certified in adult weight management by the Academy of
Nutrition and Dietetics. Prior to coming to UNC, she served as the
Coordinator of Sports Nutrition at the University of Florida from
2012 –2015. She received the 2014 Recognized Young Dietitian
of the Year award from the Florida Academy of Nutrition and
Dietetics (FAND).
AN OVERVIEW OF THE IMPORTANCE OF WARM-UPS FOR BASEBALL PITCHERS
ZACHARY KAPALKA, CSCS, GUILLERMO MARTINEZ JR., JESUS MARTINEZ, AND JUAN GONZALEZ, PHD, CSCS
INTRODUCTION
A
warm-up routine is a common activity performed
prior to any strenuous physical activity. Warming up is
an important component to maximizing readiness in
sports, particularly those that require explosive movements
(3,5,9,11,14,15,17,26,27,38). Primary goals of warm-ups include:
increasing core body temperature, decreasing fluid viscosity
within the joints, and increasing joint and muscle mobility
(4,12,14,16,22,31). Proper warm-ups not only aid in preventing
injury, but can also stimulate the activity of the central nervous
system (CNS) by speeding up motor unit reactions, which elicits
faster nerve impulses (5,14,29,32). Currently, there are various
approaches to warm-ups for the sport of baseball, which focus on
maximizing performance while minimizing the risk of injury at the
high school, college, and professional levels (7,8,14,15,19,25,26).
The aim of this article is to provide an overview of the relationship
between a pitcher’s pitching movement, injury rates for pitchers,
and contemporary warm-up procedures.
THE THROWING MOTION
The pitching motion in baseball is a full body movement which
requires the use and coordination of the upper extremities, trunk,
and lower extremities by utilizing rotational and linear movements
(30,38,40). During the phases of pitching, the lower body, core,
and upper body all work together in one smooth movement to
create a substantial amount of force in a brief timeframe of only
a few seconds (33). Each pitch begins in the lower extremities
(e.g., ankles, knees, thighs, and hips). This sequence generates
34 NSCA COACH 3.3 | NSCA.COM
energy which is transferred to the trunk and upper extremities
(e.g., shoulder, elbow, and wrist). This interaction is what produces
maximal ball velocity and effective command (34). The following
joints along the kinetic chain are all part of the pitching sequence:
the elbow joint, shoulder joint, trunk musculature, and hip joint—
the primary joint initiating spinal rotation (10,13,15,31,33,35). Above
all, an accelerated array of pelvic rotation is followed by torso
rotation, then upper torso angular velocity, then glenohumeral
(i.e., shoulder) rotation at ball release (31). Effectively coordinating
the pitching motion requires a precisely timed kinetic chain of
events that progresses from the actions of the lower extremities
and trunk to the upper extremities (35). Uniting the upper and
lower extremities into one smooth movement, and enhancing
performance during pitching calls for a specific approach to
warming up to ensure that the extremities are sufficiently
prepared for the load. Because of this, a full-body warm-up
routine is most sensible.
INJURY RATES
Due to the torque and stress placed on the pitcher’s body during
the action of pitching, it is not surprising that pitchers are subject
to injuries, particularly in the shoulder and elbow. In a study of
injuries to high school baseball and softball players across 10
different positions, pitchers represented 48.4% of players on the
disabled list (19). Pitchers were also found to be twice as likely
to be injured compared to position players (18). Oullette et al.
estimates that about 57% of all baseball pitchers suffer some sort
of shoulder injury during the playing season (26). In an analysis

of injuries to both baseball and softball players, it was found
that the most common body region to sustain injuries was in the
upper extremities—about 58% of total injuries reported due to
both overuse and improper conditioning (8,19). Dick et al. also
found that 23.4% of injuries during practice and 16.0% of injuries
during games, were to the shoulder (8). Elbow injuries represented
10.8% and 9.3%, respectively. Finally, according to McFarland and
Wasik’s study, out of 972 reported cases of injury associated with
throwing, pitching represented 70.9% of those injuries (25). The
data presented serves to highlight the susceptibility of pitchers to
injury. Several studies have shown that with a warm-up routine in
place, the odds of injury in sports decrease appreciably (10,16).
Table 3 includes several different exercises that may be used as
preventive measures to reduce the risk of injuries by strengthening
the rotator cuff, shoulder girdle, and muscles involved in elbow
extension and flexion to accommodate the stress placed on those
muscles from pitching.
WARM-UPS
Warm-ups may be categorized into two different sections—
active and passive (4). Active warm-ups involve exercises to
raise the body temperature; whereas, passive warm-ups rely on
external means such as a thermal blanket or a heater (3). Active
warm-ups can be further broken down into different categories:
stretching, dynamic, specific, and functional (32). Stretching is
an extensive subject and will be addressed later. Dynamic and
sport-specific warm-ups differ in that dynamic warm-ups do
not replicate any sport-specific movements, while sport-specific
warm-ups replicate movements found in a given sport (27,29,32).
Dynamic warm-ups prepare the body for athletic movement
by increasing body temperature, enhancing neuromuscular
recruitment, and increasing elasticity. Figures 1, 2, 22, 23, and
24 demonstrate jogging and skipping as dynamic warm-up
examples (17,20,22,23,32). Sport-specific warm-ups are focused
on prepping the joints and the muscles for the loads placed on
them during athletic movement (32). Figures 3, 4, 5, 10, 11, 20, and
21 are examples of sport-specific warm-ups for baseball pitchers,
which include high knees, arm rotations, and lunges with torso
twists (9,10). Functional warm-ups incorporate equipment such
as medicine balls, Swiss balls, and resistance bands. This type
of warm-up focuses primarily on the individual’s balance and
coordination by targeting the stabilizing muscles, while utilizing
the mentioned equipment (32). Figures 44, 45, 46, and 47
demonstrate functional warm-ups for baseball by demonstrating
external rotation and elevated external rotation using resistance
bands. Also, other examples of functional warm-ups for baseball
can include woodchoppers and abdominal twists using medicine
balls (32).
TYPES OF STRETCHING
There are six different methods of stretching muscles: static,
dynamic, ballistic, proprioceptive neuromuscular facilitation
(PNF), active isolated stretching, and myofascial release
(1,2,13,21,22,24,28). These various methods of stretching have
strengths and weaknesses depending on the goal. A static stretch
NSCA COACH 3.3 | NSCA.COM 35
NSCA COACH 3.3
poses a low risk of injury to muscles and tendons, but it has been
shown to reduce performance in explosive activities (1,3,13,15).
Dynamic stretching is one of the most commonly used methods of
stretching and can be easy to administer (9,36,37). These stretches
use sport-specific movements that duplicate the sports activity
that the individual will perform in a game. Dynamic stretches allow
individuals to prepare for the upcoming activity more closely;
however, they have been shown to be inferior to static and PNF
stretches at enhancing static range of motion (ROM) (1).
Ballistic stretches utilize active and bouncing motions; however,
because of these motions, the risk of injury is higher compared
to the other stretching methods (1). This manner of stretching
is unlikely to decrease performance and permits specificity
in training and warm-up, as the movements have powerful,
sequential, ballistic, and rotational movement dynamics similar to
actions performed in the sport (6,31,33,34). However, Rhea and
Bunker warrant caution in order to avoid placing excessive strain
on rotator cuff musculature when applying ballistic stretching to
the upper extremities (33).
PNF stretching is more commonly used in a rehabilitative
setting, and has shown positive effects on increasing ROM
when performed long-term. The downside of this technique is
that it is much more difficult to administer, because it is a
particular procedure that requires advanced skills on the side
of clinicians (1,6,9,33,39).
TYPICAL MAJOR LEAGUE BASEBALL WARM-UP
According to Ebben et al., 21 out of 30 Major League Baseball
strength and conditioning coaches who responded to a survey
have employed some type of flexibility training, including static
stretching (9). Seventeen out of 21 strength coaches incorporated
dynamic flexibility as part of their warm-up routine, 15 out of
21 reported using PNF stretches in a training and rehabilitative
setting, and only 4 out of 21 strength coaches reported using
ballistic stretching as part of their warm-up. A common theme
obtained from those surveys was that the focus was more on
injury prevention rather than maintenance of strength. A typical
baseball warm-up should be implemented 30 – 40 minutes prior
to competition and may include a progressive run, lunges with
rotation and reach variations, explosive skips, shuffles, sprints, and
stretching (5,6,9,10,14).
In addition, Rhea and Bunker stated that the squat and lunge
were the most frequently prescribed exercises for baseball-
specific conditioning (32). Outlined below in Tables 1, 2, and 3
is a proposed functional warm-up routine for baseball pitchers
that incorporates many research studies on warm-up and injury
prevention. Each exercise in Tables 1, 2, and 3 has been selected to
maximize the performance of pitchers while mitigating the risk of
injuries to susceptible muscles involved in pitching.
AN OVERVIEW OF THE IMPORTANCE OF WARM-UPS FOR BASEBALL PITCHERS

TABLE 1. FUNCTIONAL DYNAMIC WARM-UP FOR THE BASEBALL PITCHER

SETS /
EXERCISES FIGURES(S) MUSCLES USED
REPETITIONS

Core muscles, gluteus maximus,

Form jog
Skip with arm rotation
Knee hug (walking) with internal rotation
biceps femoris, semitendinosus,
1, 2 semimembranosus, adductor magnus, 2 / 15 yards
adductor brevis, adductor minimus,
pectineus, gracilis, and tibialis anterior
Core muscles, gluteus maximus,
biceps femoris, semitendinosus,
3, 4, 5 semimembranosus, adductor magnus, 1 / 15 yards
adductor brevis, adductor minimus,
pectineus, gracilis, and tibialis anterior
Core muscles, iliopsoas major,
6, 7 iliopsoas minor, illiacus, sartorius, 1 / 15 yards
rectus femoris, and gluteus maximus

Hamstrings, iliopsoas, core muscles,

Quad stretch (walking) to Romanian deadlift (RDL) 8, 9 1 / 15 yards
and gluteus maximus

Forward lunge (walking) with external rotation 10, 11 Iliopsoas and erector spinae complex 1 / 15 yards

Backward lunge (walking) with arm reach 12, 13 Iliopsoas and erector spinae complex 1 / 15 yards

Pectineus, adductor magnus,

Lateral lunge to shuffle step 14, 15, 16 adductor longus, adductor brevis, 1 / 15 yards
adductor minimus, and gracilis
Core muscles, iliopsoas major, iliopsoas
minor, illiacus, sartorius, rectus femoris,
Carioca 17, 18, 19 2 / 15 yards
pectineus, adductor magnus, adductor
longus, adductor brevis, and gracilis
Core muscles, gluteus maximus,
biceps femoris, semitendinosus,
semimembranosus, adductor
High knees 20, 21 1 / 15 yards
magnus, adductor brevis, adductor
minimus, pectineus, gracilis,
tibialis anterior, and iliopsoas
Core muscles, gluteus maximus,
biceps femoris, semitendinosus,
semimembranosus, adductor
Skip for height 22, 23, 24 1 / 15 yards
magnus, adductor brevis, adductor
minimus, pectineus, gracilis,
tibialis anterior, and iliopsoas
Pectineus, adductor pectineus,
Lateral shuffle 25, 26, 27 adductor longus, adductor brevis, adductor 1 / 15 yards
minimus, gracilis, and iliopsoas

36 NSCA COACH 3.3 | NSCA.COM

 NSCA COACH 3.3

TABLE 2. FUNCTIONAL STATIC STRETCHES FOR THE BASEBALL PITCHER

SETS /
EXERCISES FIGURES(S) MUSCLES USED
REPETITIONS

Pectineus, adductor magnus,

Sumo squat stretch 28 adductor longus, adductor brevis, 2 / 15 s
adductor minimus, and gracilis

Hamstrings, abductors, adductors,

Straddle (middle, right, left, and reach) 29, 30, 31, 32 1 / 15 s
glutes, and erector spinae complex

Pectineus, adductor magnus,

Butterfly stretch 33 adductor longus, adductor brevis, 2 / 15 s
adductor minimus, gracilis, and sartorius

Hamstrings, abductors, adductors, glutes,

Figure 4 with rock back 34, 35 4 / 15 s
iliopsoas major, and erector spinae complex

Erector spinae complex, deltoid,

Back/rotator stretch 36, 37 2 / 15 s
infraspinatus, teres major, and teres minor

Lat stretch 38, 39 Latissimus dorsi 2 / 15 s

Forearm stretch 40 Brachioradialis, flexors, and extensors 2 / 15 s

Gluteus maximus, biceps femoris,

semitendinosus, semimembranosus,
Calf stretch to hamstring stretch 41, 42, 43 adductor magnus, adductor brevis, 2 / 15 s
adductor minimus, pectineus, gracilis,
tibialis anterior, soleus, and gastrocnemius

TABLE 3. PREHABILITATION FOR THE PECTORAL AND SHOULDER GIRDLE FOR THE BASEBALL PITCHER

SETS /
EXERCISES FIGURES(S) MUSCLES USED
REPETITIONS

Subscapularis, supraspinatus deltoids,

External rotation 44, 45 2 – 3 / 15
infraspinatus, and teres minor

Subscapularis, supraspinatus deltoids,

Elevated external rotation 46, 47 2 – 3 / 15
infraspinatus, and teres minor

Latissimus dorsi, posterior deltoid, rhomboids,

Standing single-arm row 48, 49 2 – 3 / 15
middle trapezius, and biceps brachii

Triceps brachii, aconeus, biceps brachii,

Elbow extension/flexion 50, 51 2 – 3 / 15
and brachioradialis

Posterior deltoid, rhomboids,

Chest fly 52, 53 2 – 3 / 15
middle trapezius, and pectoralis major

NSCA COACH 3.3 | NSCA.COM 37

AN OVERVIEW OF THE IMPORTANCE OF WARM-UPS FOR BASEBALL PITCHERS
DYNAMIC WARM-UP
Table 1 consists of dynamic warm-up exercises that may be utilized
by the pitcher to prepare for games. Table 3 also includes injury
prevention exercises for the upper body, but they can also be
performed as dynamic warm-ups.
DYNAMIC WARM-UP FOR THE WHOLE BODY (FIGURES 1 – 5)
The pitcher may elect to begin with jogging and skipping with arm
rotations since both exercises are simple to perform. It also serves
to begin the process of increasing the body temperature so that
the body responds better to additional warm-up exercises.
DYNAMIC WARM-UP FOR THE LOWER BODY (FIGURES 6 – 27)
Some of the major muscles involved in the lower body during
pitching are the iliopsoas major, iliopsoas minor, iliacus, sartorius,
rectus femoris, and gluteus maximus. The muscles listed above are
all targeted during the dynamic warm-up focusing on the lower
body due to the pitching movement beginning in the lower body
(30,38,40). Specifically, the hip muscles are targeted because
pitching mechanics begin from movement at the hips (30).
FUNCTIONAL STATIC STRETCHES
Table 2 features static stretches which may be favored by some
pitchers or strength and conditioning coaches. The stretches were
selected according to their applicability for pitchers, as well as the
muscles involved in pitching.
UPPER BODY STATIC STRETCHES (FIGURES 36 – 40)
Stretching out the rotator cuff, latissimi dorsi, and forearm can
be useful in increasing the ROM of the upper body. Specifically,
the erector spinae, deltoid, part of the rotor cuff, latissimus dorsi,
and the forearms flexors and extensors, which are important for
pitchers. But those can also be used as part of a warm-up routine
to aid the pitcher.
LOWER BODY STATIC STRETCHES (FIGURES 28 – 35, AND
41 – 43)
Figures 28 and 33 both use the sumo squat and butterfly stretches
to target several of the accessory muscles in the legs including the
pectineus, gracilis, and adductor group of muscles. The straddle
and the figure 4 with rock back stretches (as seen in Figures 29 –
32, and 34 – 35) allow the hamstrings to be stretched, potentially
avoiding hamstring injuries (5,8,32).
PREHABILITATION FOR THE PECTORAL AND
SHOULDER GIRDLE
Table 3 contains a list of injury preventive exercises for the
pectoral and shoulder girdle, rotator cuff, and elbow. The exercises
also can be performed as a dynamic warm-up for the upper
body for pitchers if so desired. All exercises are performed with
resistance bands. The level of resistance should provide a mild
challenge while performing the exercises to strengthen the
pectoral and shoulder girdle, rotator cuff, and elbow.
ROTATOR CUFF (FIGURES 44 – 47)
The rotator cuff is a group of muscles that includes the teres
38 NSCA COACH 3.3 | NSCA.COM
minor, infraspinatus, supraspinatus, and subscapularis. External
rotation and elevated external rotations are both recommended
because injuries to the rotator cuff are fairly common in pitchers
(8). The supraspinatus is of special concern because it is the
primary muscle responsible for decelerating the arm’s internal
rotation after the ball is released (18).
ELBOW (FIGURES 50 – 51)
Elbow extension and flexion exercises can be beneficial to help
prepare the elbow for the torque of pitching (13,35). Additionally,
during the acceleration and deceleration phase of the pitching
movement, the elbow is especially vulnerable due to the internal
angular velocity reaching up to 2,500 degrees per second (35).
SHOULDER GIRDLE (FIGURES 48 – 49, AND 52 – 53)
Chest fly and standing single-arm row are included in the program
because of the role that the shoulder girdle plays in pitching
(10,31). Additionally, both exercises were selected because some of
the movements carry over to pitching, such as the row mimicking
the action of the pitcher rearing their arm backward, and the chest
fly replicating the throwing movement.
CONCLUSION
With the crucial role that pitchers play for their baseball teams,
different approaches of warming up have been developed in
order to maximize the pitcher’s performance, while minimizing
negative factors that may interfere with their performance. There
are many different approaches of warming up currently used by
baseball strength and conditioning coaches, including several
different types of stretches. Pitchers of any level can benefit from
performing proper warm-up routines in that they can help in
maximizing performance while minimizing the risk for injury.
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21. Lust, KR, Sandrey, MA, Bulger, SM, and Wilder, N. The
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40 NSCA COACH 3.3 | NSCA.COM
ABOUT THE AUTHORS
Zach Kapalka is a current University of Texas at Rio Grande Valley
Graduate Student, pursuing a Master’s degree in Kinesiology. He
received his Bachelor’s degree of Exercise Science from University
of Texas at Arlington. He engages in strength and conditioning
work with a wide variety of populations, from the athletic to the
sedentary populations.
Guillermo Martinez Jr. is a Graduate Assistant Coach at Texas A&M
University – Corpus Christi, where he coaches track and field,
specifically hurdles and sprints. He graduated from the University
of Texas Rio Grande Valley with a Bachelor’s degree in Criminal
Justice with a Minor in Kinesiology. Currently, he is enrolled in
graduate school at Texas A&M University – Corpus Christi, pursuing
a Master’s degree in Kinesiology – Exercise Science. After his
anticipated graduation date of December 2016, he plans to pursue
a career in coaching track and field at the collegiate level.
Jesus Martinez is currently a Kinesiology Graduate Student at the
University of Texas Rio Grande Valley. He is a Wellness Exercise
Fitness Nutrition Association (WEFNA) Certified Personal Trainer
and currently working to obtain his Certified Strength and
Conditioning Specialist® (CSCS®) certification. He has been a pitcher
in Division I baseball with multiple standing professional contract
offers from the Mexican Baseball League.
Juan Gonzalez is a former National Collegiate Athletic Association
(NCAA) Women’s Cross Country Coach and Assistant Professor
in the Department of Health and Human Performance at the
University of Texas Rio Grande Valley. He authored the book “The
Athlete Whisperer: What it Takes to Make her Great.” Gonzalez
specializes in training female athletes.
 NSCA COACH 3.3

FIGURE 1. FORM JOG FIGURE 2. FORM JOG

FIGURE 3. SKIP WITH ARM ROTATION FIGURE 4. SKIP WITH ARM ROTATION

FIGURE 5. SKIP WITH ARM ROTATION FIGURE 6. KNEE HUG (WALKING) WITH INTERNAL ROTATION

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AN OVERVIEW OF THE IMPORTANCE OF WARM-UPS FOR BASEBALL PITCHERS

FIGURE 7. KNEE HUG (WALKING) WITH INTERNAL ROTATION FIGURE 8. QUAD STRETCH (WALKING) TO RDL

FIGURE 10. FORWARD LUNGE (WALKING) WITH

FIGURE 9. QUAD STRETCH (WALKING) TO RDL EXTERNAL ROTATION

FIGURE 11. FORWARD LUNGE (WALKING) WITH

EXTERNAL ROTATION FIGURE 12. BACKWARD LUNGE (WALKING) WITH ARM REACH

42 NSCA COACH 3.3 | NSCA.COM

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FIGURE 13. BACKWARD LUNGE (WALKING) WITH ARM REACH FIGURE 14. LATERAL LUNGE TO SHUFFLE STEP

FIGURE 15. LATERAL LUNGE TO SHUFFLE STEP FIGURE 16. LATERAL LUNGE TO SHUFFLE STEP

FIGURE 17. CARIOCA FIGURE 18. CARIOCA

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AN OVERVIEW OF THE IMPORTANCE OF WARM-UPS FOR BASEBALL PITCHERS

FIGURE 19. CARIOCA FIGURE 20. HIGH KNEES

FIGURE 21. HIGH KNEES FIGURE 22. SKIP FOR HEIGHT

FIGURE 23. SKIP FOR HEIGHT FIGURE 24. SKIP FOR HEIGHT

44 NSCA COACH 3.3 | NSCA.COM

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FIGURE 25. LATERAL SHUFFLE FIGURE 26. LATERAL SHUFFLE

FIGURE 27. LATERAL SHUFFLE FIGURE 28. SUMO SQUAT STRETCH

FIGURE 29. STRADDLE – MIDDLE FIGURE 30. STRADDLE – RIGHT

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AN OVERVIEW OF THE IMPORTANCE OF WARM-UPS FOR BASEBALL PITCHERS

FIGURE 31. STRADDLE – LEFT FIGURE 32. STRADDLE – REACH

FIGURE 33. BUTTERFLY STRETCH FIGURE 34. FIGURE 4 WITH ROCK BACK

FIGURE 35. FIGURE 4 WITH ROCK BACK FIGURE 36. BACK/ROTATOR STRETCH

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FIGURE 37. BACK/ROTATOR STRETCH FIGURE 38. LAT STRETCH

FIGURE 39. LAT STRETCH FIGURE 40. FOREARM STRETCH

FIGURE 41. CALF STRETCH TO HAMSTRING STRETCH FIGURE 42. CALF STRETCH TO HAMSTRING STRETCH

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AN OVERVIEW OF THE IMPORTANCE OF WARM-UPS FOR BASEBALL PITCHERS

FIGURE 43. CALF STRETCH TO HAMSTRING STRETCH FIGURE 44. EXTERNAL ROTATION

FIGURE 45. EXTERNAL ROTATION FIGURE 46. ELEVATED EXTERNAL ROTATION

FIGURE 47. ELEVATED EXTERNAL ROTATION FIGURE 48. STANDING SINGLE-ARM ROW

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FIGURE 49. STANDING SINGLE-ARM ROW FIGURE 50. ELBOW EXTENSION/FLEXION

FIGURE 51. ELBOW FLEXION/FLEXION FIGURE 52. CHEST FLY

FIGURE 53. CHEST FLY

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