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Revistinha em Inglês NSCA - Coach - 3.3
Revistinha em Inglês NSCA - Coach - 3.3
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.
ISSN 2376-0982
04 THORACIC MOBILITY
GREG SPATZ, PT, DPT, PRC, CSCS, AND NATE SHAW, ATC, PRT, RSCC
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.
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.
90 – 90 SUPPORTED ALTERNATING CROSSOVER WITH SIDE LYING TRUNK LIFT WITH HIP SHIFT (FIGURE 6)
INTERNAL OBLIQUE AND TRANSVERSUS ABDOMINIS (FIGURE 5) 1. Lie on the side with the knees and hips bent at 90 degrees
1. Pull the heels down to reach the knees towards the ceiling
2. Drive the elbow and forearm into the floor to round out the
2. Feel the hamstrings as the low back lowers toward the ground upper back
3. Lift the right foot up while straightening the right knee 3. Push the knees into the floor to lift the hips in the air and round
4. Reach the left hand towards the ceiling the lower back
5. Maintain this position while blowing up a balloon, pausing for 4. Shift the top knee in front of the bottom knee
3 – 5 s during each exhale 5. Reach the free hand to the ceiling and turn the head to watch it
6. Switch sides and repeat two more times 6. Hold this position for 3 – 5 breaths
7. Switch sides and repeat two more times
4. Shift one knee forward and reach toward the floor with the 3. Lee, D. Biomechanics of the thorax: A clinical model of in vivo
opposite hand while rounding the back function. Journal of Manual and Manipulative Therapy 1(1): 13-21,
1993.
5. Hold this position for 3 – 5 breaths
4. Neumann, DA. Kinesiology of the Musculoskeletal System:
6. Switch sides and repeat twice more
Foundations for Rehabilitation. St. Louis, MO: Mosby/Elsevier;
2010.
For each exercise, a general guideline to follow is about three
5. Sizer, PS Jr., Brismee, JM, and Cook, C. Coupling behavior of
sets of 3 – 5 breaths in each position. Breaths should focus on a
the thoracic spine: A systematic review of the literature. Journal of
forceful and elongated exhalation phase with a gentle subsequent
Manipulative Physiological Therapeutics 30: 390-399, 2007.
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 ABOUT THE AUTHORS
per day in order to be sufficient enough to progress the exercises Greg Spatz is a performance-based physical therapist and
within 2 – 4 weeks, based on objective changes. Performing a strength and conditioning coach who recognizes the continuum of
mixture of these exercises before and after a performance training rehabilitation to sports performance. He is Co-Founder and Owner
session as part of the movement preparation and dynamic warm- of Resilient Performance Physical Therapy in New York, NY. Prior
up is considered an appropriate strategy. to working as a Strength and Conditioning Coach in the Arizona
Diamondbacks Major League Baseball (MLB) organization, Spatz
Though individuals respond differently to the interventions listed received his Bachelor of Science in Health and Exercise Science
above, immediate objective changes in mobility typically occur. from the College of New Jersey where he was a member of the
However, these changes should not be expected to last long- baseball team. He earned his Doctor of Physical Therapy degree
term without dedicated execution of these exercises on a regular from Columbia University and is Postural Restoration Certified.
basis and/or further progression to more advanced activities.
The exercises listed are some lower-level options while over the Nate Shaw has been the Major League Strength and Conditioning
subsequent weeks and months they would be replaced with higher Coordinator for the Arizona Diamondbacks Major League Baseball
level exercises that progress in intensity, coordination, and motor (MLB) organization since 2006. The Diamondback’s strength
control demands as needed, which is much more individualized and conditioning philosophy could be described in many ways.
and beyond the scope of this article. Key concepts include: functional movements, joint centration,
diaphragmatic breathing, intra-abdominal pressure, thoracic
Coaches should consider the biomechanical concepts within rotation, strength, durability, etc. Ultimately, the program is about
this article to be an important piece of the performance training fostering and creating movement efficiency in an effort to minimize
puzzle. Reducing excessive spinal extension patterning during wear and maximize recovery throughout the marathon 162-game
training should be the goal to maintain optimal spinal mechanics season. Simple concepts and simple tools work the best. Combining
for athletic endeavors. For example, hip hinging, squatting, simple concepts, smart training, and the game of baseball is a very
pressing, and pulling movements in the gym should occur with intricate process. We try to use tools that make sense and enable us
a “neutral spine” position without hyperextension—under load— to achieve good results in any location. These exercises work really
at all ranges of extremity movement. The focus should be on well at home or on the road.
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.
A
position statement is a concise document on a particular DEVELOPMENT
topic in the field that helps in 1) understanding the key The 10 pillars of long-term athletic development summarize the
concepts of the topic and 2) sharing and promoting the key recommendations within the position statement (1). The 10
scientifically-based, peer-reviewed information in the position pillars provide coaches with workable strategies to promote long-
statement with people who work within the field. A position term athletic development for all youth by: 1) fostering a more
statement typically lets others know where an organization stands unified and holistic approach to long-term athletic development,
on a specific topic or issue. Many position statements include 2) promoting the benefits of a lifetime of healthy physical
the explanation or justification for the point of view, along with a activity, and 3) preventing and minimizing injuries from sports
recommended course of action. The recently published National participation for all boys and girls (1). For coaches to effectively
Strength and Conditioning Association (NSCA) Position Statement promote long-term athletic development, the following 10
on Long-Term Athletic Development helps coaches understand recommendations were made:
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).
Health and wellbeing of the child should always be the »» perceived competence,
central tenet of long-term athletic development. »» 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.
Youth should participate in physical conditioning
that helps reduce the risk of injury to ensure their on- • Be sure that the strength and conditioning program is
going participation in long-term athletic development developmentally appropriate and suitably prepares youth for the
programs. 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
Long-term athletic development programs should provide
improvements in all components of fitness irrespective of their
all youth with a range of training modes to enhance both
stage
health- and skill-relates components of fitness.
of development.
• Collect quarterly measures of stature, limb length, and body mass
to monitor growth and maturation.
Practitioners should use relevant monitoring and • Measure both the product (e.g., jump distance) and process
assessment tools as part of a long-term athletic (e.g., how technically proficient the jumps are performed) when
development strategy. assessing physical capacities in youth.
• Assess psychosocial wellbeing in youth with a validated instrument
for children and youth.
exercise. Its uniquely patented design enables hundreds of exercises that can be scaled to meet the
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coaches, TRX is the perfect tool to get athletes moving better, feeling better and performing better.
For optimal results, learn how to integrate the Foundational Movement Standards
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B
iofeedback is a tool that not everyone knows about, yet INTRODUCTION TO BIOFEEDBACK
many coaches and athletes could benefit from using it. Biofeedback was designed with two goals in mind. The first goal
The practice of biofeedback is based on the idea that the of biofeedback is to train the athlete to develop self-awareness of
brain and body are tightly woven and constantly affecting the certain psychophysiological states. Athletes are trained to notice
other. This article will describe the psychophysiological principle, things such as tense muscles, shallow breathing patterns, and
introduce biofeedback, and provide descriptions of two biofeedback distracted thoughts. The second goal of biofeedback is to train the
modalities that may be useful for strength and conditioning athlete to develop self-regulation of those psychophysiological
professionals to improve performance. Lastly, suggestions for using states. For example, athletes can be trained to relax tense muscles,
biofeedback tools across coaching contexts are provided. regulate their breathing patterns, and improve their focus.
BIOFEEDBACK APPLICATIONS FOR STRENGTH AND In HRV biofeedback, clinicians can simultaneously measure
CONDITIONING POPULATIONS blood volume pulse, blood volume amplitude, heart rate, and
Although there are several biofeedback modalities that can be used, respiration (1). Athletes can be provided with feedback about
this article will focus on the following two applications: respiratory the synchronization of their heart rate and respiration activity.
biofeedback and heart rate variability (HRV) biofeedback. This synchronization, also known as respiratory sinus arrhythmia,
increases HRV. In healthy individuals, heart rate should increase
RESPIRATORY BIOFEEDBACK during inspiration and decrease during exhalation. Once
Because breathing is an innate process, its importance can the athlete learns to increase their HRV, any performance
often be taken for granted. However, dysfunctional breathing issues or weaknesses that were caused by low HRV should
patterns contribute to many different medical and psychological eventually subside.
issues (1). The most common dysfunctional breathing pattern is
overbreathing, which happens when an individual exhales so much BIOFEEDBACK TOOLS ACROSS COACHING
CO2 that blood CO2 declines, blood pH (alkalinity) increases, and CONTEXTS
hemoglobin releases insufficient oxygen to tissues and less nitric If seeing a biofeedback clinician is not feasible for an athlete,
oxide (NO) to blood vessels; the resulting vasoconstriction greatly there are a number of other options for correcting dysfunctional
diminishes glucose delivery to the tissues (1,3). Overbreathing breathing patterns and increasing HRV. These options will not
may contribute to asthma, panic, phobia, and pain disorders like provide the athlete with as much useful information and guidance
chronic low-back pain (1). In addition to reducing oxygen delivery as a biofeedback clinician; however, they can still be beneficial
to muscle tissues, moderate overbreathing can reduce oxygen for improving psychophysiological performance in strength and
delivery to the brain by 30 – 40%, while severe overbreathing conditioning settings.
can reduce it by 60% (1). Reduced oxygen delivery to the brain
can cause several mental performance issues or weaknesses, For at-home respiratory biofeedback, one option is to use an app
such as poor decision making, fatigue, diminished memory, and called “Breath Pacer,” which can be set to a comfortable breathing
performance anxiety. 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
Respiratory biofeedback addresses overbreathing and the stomach and the left hand on the chest. Next, the athlete should
resulting lack of oxygen delivery to the brain by first teaching focus on their abdomen, expand their abdominal area widen their
proper breathing mechanics. Athletes are taught to breathe lower ribs and move back during inhalation, and exhale slowly and
effortlessly by focusing on their abdomen, expanding their smoothly. The athlete’s right hand should rise when the stomach
abdominal area, widening their lower ribs and back during expands and the left hand should hardly move because breathing
inhalation, and exhaling slowly and smoothly (1). After an through the chest can contribute to overbreathing. This method
evaluation, a biofeedback clinician might decide to measure an can be performed right before bed to help the athlete wind down
athlete’s accessory muscle activity, blood oxygen saturation, before falling asleep, or after or between workouts in order to get
cardiovascular activity, inhalation volume, or end-tidal CO2 in the body into a more restful state.
order to provide them with the most appropriate feedback (1).
Once the athlete learns to properly regulate their breathing Some options for at-home HRV biofeedback include the app
patterns on a regular basis, any performance issues or weaknesses called “Stress Doctor” and “Elite HRV.” The Stress Doctor uses
that were caused by overbreathing should eventually subside. the camera light and lens to measure heart rate, and rewards the
athlete with points when their HRV meets their standards. Elite
HRV BIOFEEDBACK HRV uses a Bluetooth heart rate monitor to gather more in-depth
HRV is a measure of the change in time intervals between information about the athlete’s heart rate variability.
heart beats. HRV is used to measure the interaction between
the sympathetic nervous system, which regulates the “fight or CONCLUSION
flight” response, and the parasympathetic nervous system, which Respiratory biofeedback and HRV biofeedback are just two
regulates the “rest and digest” response. High HRV “represents of many biofeedback tools that can be used to improve
a flexible [autonomic nervous system] that is responsive to both psychophysiological health and performance. Many other
internal and external stimuli and is associated with fast reactions biofeedback modalities such as neurofeedback, surface
and adaptability,” (4). High HRV indicates an optimal interplay electromyography biofeedback, and electrodermal response
between the sympathetic and parasympathetic nervous systems, biofeedback are useful in improving the performance of those
which can result in healthy, appropriate, and desirable reactions inside and outside of strength and conditioning settings. No
to stress (4). Low HRV is associated with cardiovascular problems, matter what the available resources are, there is always a way to
as well as mood and anxiety disorders such as generalized anxiety use biofeedback in order to improve performance in strength and
disorder, panic disorder, and posttraumatic stress disorder (5,6). conditioning settings.
800-556-7464 • PERFORMBETTER.com
BUILDING BETTER ATHLETES THROUGH INCREASED SELF-CONFIDENCE
DETERMINING SELF-CONFIDENCE initial data collection stage, this visual approach can be added
L
ook at the triangle in Figure 1. Each number represents a to a post-season testing protocol leading to multiple benefits.
different lift. The “1” could be a barbell back squat, the One benefit is that the strength and conditioning staff receives
“2” a barbell front squat, and the “3” a barbell jump squat. quick feedback from the athletes about how much they have
The triangle borders represent the limit of an athlete’s skill level. progressed. That feedback can be used to make adjustments for
The closer the number is to the center of the triangle, the more the following season, document the work accomplished by the
confidence the athlete has to properly execute the lift. As athletes strength and conditioning staff during the season, and serve as a
increase their capacity to execute more lifts, their triangle grows take-away for the athletes about their improvements.
to include more numbers and previously learned ones move closer
to the center. With the basic premise of all training programs Self-confidence is consistently viewed as one of the most
being the need to provide some level of unique stimuli to prompt important mental skills (9). Having a take-away reminder of
training adaptations, the triangle and number analogy serves as growth, improvement, and progress is crucial to an athlete’s
a visual to reinforce athlete performance goals and subsequent self-confidence. Moreover, self-confidence and anxiety are
improvements. Each athlete’s triangle will look a bit different, inversely related meaning that overly anxious athletes can
especially across contexts and competitive levels, but using this be helped by improving self-confidence, not just by reducing
type of visual can aid coaching in a number of ways. anxiety (3). Recent research has shown that athletes report
predominantly positive thoughts and feelings when they achieve
FIGURE 1. TRIANGLE—VISUAL APPROACH FOR DETERMINING peak performances (1). This is similar to long-standing research
SELF-CONFIDENCE 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).
These four sources are presented in descending order from most purpose that is clearly explained to the athletes. A power rack with
to least influential. This particular framework is easily identifiable the word “Power” on the wall facing the lifter is seen frequently in
when considering specific athletes in specific situations. The facilities. An improvement is to display “Explosion Coming” near
athlete that shows up to train feeling run-down from school and the weight rack where athletes get the plates to be used in the
sport practices will not likely show much self-confidence. Athletes power rack. The strength and conditioning staff will have already
that adopt negative self-talk or have others cut them down rarely primed the athletes that the power-based lifts are to be performed
perform well. Additionally, attempting to complete a task that explosively; therefore, placing the cue word by the rack allows the
they have never performed previously, and perhaps have never athletes to mentally prepare for the movements. Athletes spend a
seen, is daunting to most athletes and coaches alike. The benefits lot of time looking up while training and while at rest in the facility,
to strength and conditioning coaches adopting these four means so think about the option of placing cue words or pictures on the
to enhance self-efficacy is that each of those identified sources ceiling. As a staff, make sure to explain the message behind cue
are areas the staff already addresses, even if it is not done for the words and pictures. Do not assume it is obvious to athletes and do
expressed purpose of increasing athlete self-confidence. not let the message, cue words, or pictures become stale—change
them up, move them around, or adjust throughout the season.
SPECIFIC COMPONENTS FOR BUILDING SELF-
CONFIDENCE VERBAL PERSUASION
MASTERY EXPERIENCES The verbal persuasion component is viewed as less impactful
Goal setting may well be the most straight-forward approach to than both mastery experiences and vicarious experiences (11).
generating mastery experiences for athletes. A properly designed Nonetheless, there are some noteworthy pieces that can help
systematic goal setting program yields multiple opportunities for build athlete self-confidence as well as limit the debilitating
athletes to accomplish a specific task every day (5). Even better is effects of negatively worded verbal persuasion. The strength
that those successes are recorded and logged as part of the goal and conditioning staff needs to listen to what the athletes are
setting process so at any point an athlete can look up their goal saying as it relates to training. Athletes who are overly negative,
attainment showing progress across a variety of tasks. It is difficult or overly positive, likely indicate some concern and this pendulum
for athletes to examine their own goal sheets, see that they have can quickly swing from one extreme to the other. Perhaps the
been successful at accomplishing 85% of their goals over the most challenging part here is that these sorts of verbal messages
past season, and then report feelings of low self-confidence. That can spread through a team and facility rapidly. For example, one
becomes a double benefit for any athlete that experiences feelings coach leads a workout that is received poorly by the athletes. The
of anxiety related to performance improvement because of the athletes begin to discuss the workout and soon a downward spiral
inverse relationship between anxiety and self-confidence. takes shape where the athletes refuse to put forth effort when
training with that specific coach. The negative spiral may not be
VICARIOUS EXPERIENCES coach-related at all. It could be a specific exercise, time of day,
Vicarious experiences can be more challenging to engineer. From a location, or context conflict (e.g., multiple teams at once or mixed
mental training standpoint, imagery is often utilized to target this genders training at the same time). The overall point is for the
source of efficacy belief. While powerful, building imagery into the strength and conditioning staff to be mindful of what the athletes
work the strength and conditioning staff already does is likely to are saying. If a group of athletes begins to be overly negative
be a bit cumbersome. Research has shown potential with the use towards a coach, a training component, or other athletes, it can
of imagery during training, which makes it worthy of consideration become difficult to put forth high energy in training. The message
and further exploration into its utility (4). Apart from imagery, is not to coddle the athletes or “give in” to their complaints; the
there are still myriad ways to develop athlete self-confidence message is to be aware of what the athletes are saying and reflect
through vicarious experience. Using videos to teach lifts is an on whether adjustments are necessary to put the athletes in the
excellent way to incorporate some observational learning. It is best position for success.
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 PHYSIOLOGICAL AND AFFECTIVE STATES
mind of the athletes. If the athletes view the lifter in the video, The final component is the most general. The simple summation
or in person, as significantly more advanced, the thoughts can of physiological and affective states is that it is difficult to be self-
quickly turn to more of amazement rather than positive social confident when tired, feeling ill, overly distracted, or otherwise
comparison for the athlete’s benefit. In a collegiate setting, giving not ready to train. High-level strength and conditioning coaches
upper-class athletes the task of creating videos that demonstrate report an understanding that athletes need to know the staff
lifts for the under-class athletes is a viable option that may add to cares about them (6,7). That notion includes reminding the
athlete motivation by improving teammate relatedness. athletes about how important sleep and proper nutrition are to
training and competition. Strength and conditioning coaches
The use of cue words, pictures, and slogans also fall into this often have more information on how the athletes are feeling than
category. For these cues to work, words and images must have a the sport coaches, athletic training staff, or other campus-wide
support personnel. Reminding athletes about how to take care of 9. Koehn, S, Pearce, A, and Morris, T. The integrated model of
themselves can be especially critical for younger athletes, those sport confidence: A canonical correlation and mediational analysis.
with less local social support, and those living away from home Journal of Sport and Exercise Psychology 35: 644-654, 2013.
for the first time. A simple question or reminder by a strength and 10. Vealey, R. Understanding and enhancing self-confidence in
conditioning coach can go a long way in the mind of an athlete, athletes. In: Singer, RN, Hauesenblas, HA, and Janelle, CM (Eds.),
such as, “how are you feeling today?” Handbook of Sport Psychology. (2nd ed.) New York: Wiley; 550-
565, 2001.
CONCLUDING REMARKS
Moving from the bottom up the four levels of sources of self- 11. Vealey, R, and Chase, M. Self-confidence in sport. In: Horn,
efficacy shows a glimpse of how they work together. An athlete TS (Ed.), Advances in Sport Psychology. (3rd ed.) Champaign, IL:
who feels burnt out is more likely to complain about the intensity Human Kinetics; 65-97, 2008.
of a workout. In that state, the work the strength and conditioning 12. Vealey, R, Hayashi, S, Garner-Holman, M, and Giacobbi, P.
staff put into engineering the environment and utilizing goal Sources of sport-confidence: Conceptualization and instrument
setting to foster improved self-confidence may not matter. development. Journal of Sport and Exercise Psychology 20(1): 54-
Recalling the triangle and numbers analogy, this approach is not 80, 1998.
about propping athletes up with false flattery or making things
easy. On the contrary, the objective presented here is to foster
ABOUT THIS AUTHOR
an environment where athletes can put in work during training
Andy Gillham owns and operates Ludus Consulting, LLC, which
and be rewarded with performance increases. Athletes who are
focuses on performance enhancement for athletes, coaches, and
more confident in training will put forth greater effort (2). With
business executives. Of specific note is his work with coaches and
that greater effort, improved performance will follow. Getting a
athletic administrators on improving systematic coach evaluation
whole team to train harder and see progress will lead to better
and providing targeted coach development opportunities. Gillham
performances on the court, in the pool, and on the field.
is a Certified Strength and Conditioning Specialist® (CSCS®) through
the National Strength and Conditioning Association (NSCA) and
REFERENCES
a Certified Consultant through the Association for Applied Sport
1. Anderson, R, Hanrahan, S, and Mallett, CJ. Investigating
Psychology (CC-AASP). He serves as a sport psychology consultant
the optimal psychological state for peak performance in
for collegiate teams and coaches as well as individual athletes
Australian elite athletes. Journal of Applied Sport Psychology 26:
competing at high school and college levels in the United States
318-333, 2014.
and Canada. Gillham is an Editorial Board member for two peer-
2. Bandura, A. Self-efficacy: The exercise of control. New York: reviewed journals, the International Journal of Sports Sciences and
Freeman, 1997. Coaching and the International Sport Coaching Journal. Gillham
3. Craft, L, Magyar, M, Becker, B, and Feltz, D. The relationship earned both his Bachelor of Science degree in Fitness and Master
between the Competitive State Anxiety Inventory-2 and sport of Science degree in Human Performance from the University of
performance: A meta-analysis. Journal of Sport and Exercise Wisconsin-LaCrosse. He received his PhD in Education with a Major
Psychology 25: 44-65, 2003. of Sport and Exercise Psychology from the University of Idaho.
Nationwide Insurance has made a financial contribution to this organization in return for the opportunity to market products and services to its members or customers.
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Insurance Company. © 2016 Nationwide AFR-0162AO.1 (04/16)
ANALYSIS OF “FAD DIETS” AND ALTERNATIVES FOR OPTIMAL ATHLETIC PERFORMANCE
A
“fad diet” can be considered a diet that often eliminates at • Caloric needs due to training period and higher amount of
least one essential food group, may recommend a type of lean mass
food or food group in excess, and is intended to produce • Frequent fueling before training and post-workout recovery
results more quickly than a traditional dietary program. People nutrition
tend to flock toward fad diets because they provide “rules” that
seem easy to follow and they provide structure to a person’s »» Importance on timing for replenishing and repair muscles
unstructured daily nutrition pattern. These diets often show for optimal energy and performance (6,8).
results, but the results may be too large and too fast based on the The following sections will address and discuss some of the
extreme nature and the lifestyle change that is being promoted. negative aspects associated with fad diets, provide a breakdown
However, in order to have a healthy and lasting nutritional of some common diets (Table 1), list a few performance pitfalls
program, the “rules” should not be restrictive and the “results” that often accompany fad diets, and finally provide realistic dietary
should come slowly and gradually (9). This article will discuss rules for optimal energy including an example meal plan (Table 2).
the negatives of fad diets, discuss potential pitfalls, and provide
realistic dietary guidelines. NEGATIVES OF FAD DIETS
• Fad diets may eliminate one or more essential food groups or
Not all diets are appropriate for every population and this is nutrients. Common food groups eliminated include grains and
especially true of an athlete who is expected to train and perform dairy.
at a high level. The performance aspect is the reason “magazine
»» Grains: Source of carbohydrates, especially complex
cover diets” and the hottest trends in weight loss do not generally
carbohydrates for slow and sustained release of energy.
apply to athletes. Models, actresses, and the general population
Great sources of vitamin B, fiber, iron, magnesium, and
do not have higher nutritional needs like athletes, and do not
selenium (6,8).
have to worry about performance as a factor. Therefore, athletes
should not follow the nutrition trends of celebrities or the general »» Dairy: All dairy foods provide benefits to most people,
population. The higher needs and greater demands on an athlete’s especially athletes. Dairy products provide calcium, vitamin
body include: D, and protein, all of which support strong bones (6,8).
• Protein intake »» Red meat: Red meats provide protein, vitamin B, iron, zinc,
• Fluids and electrolytes amino acids, and is a natural source of creatine (6,8).
• Carbohydrates (amount dependent on training period)
• Rate of weight loss is too rapid. This could be from: »» Poor focus, mood, and cognition related to the brain not
being properly fueled.
»» Loss of water weight: For every gram of glycogen stored,
three grams of water are retained. If depletion of glycogen • The brain and central nervous system relies solely on
stores occur due to a restricted calorie and carbohydrate carbohydrates for fuel, and requires about 150 g of
intake, a loss of glycogen and water can create the carbohydrates, making this an absolute minimum amount
appearance of a fast “weight loss.” This “weight” is also for a non-athlete to consume daily. An athlete needing
quickly regained once dietary patterns normalize (6). to fuel for their brain, activities of daily living, and
training are going to require much more than 150 g of
»» Restriction of nutrients: If the body is being provided
carbohydrates (2).
minimal fuel overall, or even minimal carbohydrates, most of
the weight loss will be due to muscle loss. In this scenario, • Fasting periods:
performance may suffer and injury risk may increase. When »» Poor focus, mood, and cognition.
reverting back to allowing more nutrients in their diet, there
is also a risk for weight regain in the form of fat (6,8). »» Lean tissue breakdown can occur during periods of fasting.
• Dietary pattern is not sustainable and/or extreme in nature. »» Training with low energy levels during fasting periods.
»» An overconsumption of one type of food to replace others: »» Depletion of glycogen stores over time if the muscles do
This may lead to deficiencies of some nutrients and not receive adequate recovery nutrition.
excessive intake of others, depending on what food(s) is »» Inadequate calories during shorter feeding windows, which
being discouraged from consumption. may lead to weight and/or lean tissue loss.
»» Periods of fasting: The body will adapt to function on the »» Body adapts to burn fewer calories by slowing resting
minimal and inconsistent fuel being provided, which may metabolism and storing fat, which sets the body up for
cause the body to slow its resting metabolism. When the failure in losing weight or maintaining weight loss.
fast is stopped or calorie intake increases slightly, the
person is at risk for weight regain.
REALISTIC RULES
»» Restriction of nutrients: The body will eventually feel One of the aspects of fad diets that make them “easy” and
deprived and crave more fuel, which may lead to appealing is the “rules” or guidelines that they provide. Below are
overconsumption or binge eating, thereby resulting basic guidelines for anyone, but especially athletes, to follow to
in regaining weight (6). Weight regain is due to both help them fuel for optimal energy:
overconsumption and a decrease in resting metabolism. • Eat breakfast within one hour of waking up: This gets the
metabolism started and helps to ensure that the body does
POTENTIAL PERFORMANCE PITFALLS (2,6): not start the day with an energy deficit. If athletes have
• Inadequate vitamin and mineral intake: morning practice or workouts and do not want to or cannot
eat a full meal, then a snack that has carbohydrates and
»» Iron: Low iron status is typically seen with insufficient protein will suffice until they get a full recovery breakfast.
fueling and impairs oxygen delivery to the muscle, causing
fatigue and performance issues. • Fuel frequently (every 3 – 4 hours): This ensures the muscles
have energy to use, spares some glycogen stores, prevents
»» Calcium: Intake of this primary bone maintenance nutrient muscle from being broken down for energy, and minimizes
may be inadequate if dairy is removed. Other foods provide unwanted fat storage. If the dietary pattern promotes
calcium (e.g., dark and leafy greens, broccoli, legumes, inconsistent fueling, the body will think it needs to store body
and salmon), but dairy foods contain the highest amount. fat for periods of famine.
Low calcium intake may lead to an increased risk of stress
fractures if bone cell turnover is not optimal. • Recover, with carbohydrates and protein, within 30 – 60
minutes of completing a workout: Proper recovery will
»» Sodium: Sodium intake may be insufficient, which increases prevent injury and fatigue over the course of a season
risk of cramping due to a decrease in water retention and and help keep energy levels high during performance.
poor sodium replenishment. An inadequate balance of Carbohydrates replenish energy stores and protein repairs the
sodium and potassium may also cause impaired muscle muscle damage done during the athletic event (8).
function.
• Aim for half an ounce of fluid per pound of bodyweight (1):
• Low carbohydrate consumption: Adequate hydration practices will help performance overall,
»» Poor energy levels during activity. but can also help prevent overconsumption at meals or in
between meals (1). Sometimes the body can mistake thirst
»» Increased risk of cramping due to inability to retain water,
for hunger (1).
and insufficient calorie intake.
• Balance performance plate: Have the following
»» Depletion of glycogen stores over time, leading to
three components:
worsening fatigue and increased risk of injury.
»» Color (e.g., fruit and non-starchy vegetables). 5. Maughan, RJ. Fasting and sport: An introduction. British
Journal of Sports Medicine 44(7): 473-474, 2010.
»» Lean proteins (e.g., lean beef or pork, fish, chicken, turkey,
and low-fat dairy products). 6. McArdle, WD, Katch, FI, and Katch VL. Sports and Exercise
Nutrition (3rd ed.) Philadelphia, PA: Lippincott, Williams, and
»» Complex carbohydrates (e.g., whole wheat bread, bagels,
Wilkins; 2009.
pasta, rice, oatmeal, potatoes, and beans).
7. Pitt, CE. Cutting through the Paleo hype: The evidence for the
All three components should be present, but portion sizes should
Paleolithic diet. Australian Family Physician 45(1-2): 2016.
vary with any nutrition goals or training load for that particular
sport, season, and individual. For examples, higher intensity 8. Position of Dietitians of Canada, the Academy of Nutrition
training requires more carbohydrates (6,8). As another example, and Dietetics, and the American College of Sports Medicine.
if an individual is attempting to lose weight or in a period of low- Nutrition and Athletic Performance: 501-528, 2016.
intensity training, having more vegetables instead of fruit may 9. Saltzman, E, Thomason, P, and Roberts, SB. Fad diets: A
be beneficial for addressing the “color” aspect while reducing review for the primary care provider. Nutrition in Clinical Care 4(5):
caloric intake. 235-242, 2001.
REFERENCES
1. American College of Sports Medicine, Sawka, MN, Burke, ABOUT THE AUTHOR
LM, Eichner, ER, Maughan, RJ, Montain, SJ, and Stachenfeld, NS. Amanda Poppleton joined the North Carolina State University
American College of Sports Medicine position stand: Exercise and Athletics Department staff in July of 2014. Her current title is the
fluid replacement. Medicine and Science in Sports and Exercise Assistant Director of Sports Nutrition, where she oversees the
39(2): 377-390, 2007. nutritional needs of the men’s basketball, baseball, softball, men’s
soccer, women’s soccer, swimming/diving, cross country, track,
2. Bier, DM, Brosnan, JT, Flatt, JP, Hanson, RW, Heird, W, volleyball, gymnastics, and rifle teams. She focuses the most on the
Hellerstein, MK, et al. Report of the IDECG Working Group on men’s basketball team, as she manages their day-to-day nutrition,
lower and upper limits of carbohydrate and fat intake. European including at home and on the road. Additionally, she has also held
Journal of Clinical Nutrition 53(suppl): S177-178, 1995. the Sports Nutrition Assistant position at both the University of
3. Canadian Medical Association. Intermittent fasting: The next Georgia and the University of Florida. Poppleton received her
big weight loss fad. Canadian Medical Association Journal 185(8): Bachelor of Science degree from the University of Tennessee in
E321-E322, 2013. Knoxville, TN. She earned her Master’s degree in Food and Nutrition
from Bowling Green State University. Poppleton was one of 12
4. Escott-Stump, S. Nutrition and Diagnosis-Related Care (7th
ed.) Philadelphia, PA: Lippincott, Williams, and Wilkins; 2012. nominated invitees to the first annual Collegiate and Professional
Sports Dietitians Association (CPSDA) Advanced Practice
Workshop for upcoming Sports Registered Dietitians (RD) in 2014.
TABLE 1. BREAKDOWN OF COMMON DIETS
PALEO DIET (7) GLUTEN FREE DIET (4) INTERMITTENT FASTING (3,5)
Periodic fasting aiming to curve
Medical nutrition diet used to treat
Mimics foods eaten by hunger which ultimately restricts
Premise Celiac disease. This should only be
“hunter-gather” ancestors. calories from the shortened
used if a gluten allergy is present.
feeding window.
Those with Celiac disease must avoid
Low carbohydrates: non-starchy gluten-containing foods such as: Includes different variations
fruits and vegetables making bread, pasta, cereals, soups, sauces, of fasting. Drawing out the
up 35 – 45% of daily calories. baked goods, malt, etc. overnight fast for a specified
Principles Higher protein and potassium period of time (e.g., 16 – 36
Rice products do not contain gluten.
intake, and lower sodium intake. hours) and narrowing the
This is to protect the small intestine
feeding window to 4 – 12 hours.
Moderate to higher fat intake from the damaging autoimmune
(mostly Omega-3 and Omega-6). response that occurs with ingestion
of gluten in those that are diagnosed.
2 cups of Rice Chex cereal,
3 eggs, 2 tbsp of olive oil, parsley,
1 cup of 1% milk, 1 banana,
1 grapefruit, and herbal tea. Most fasts occur during
and 1 oz of walnuts.
Example Breakfast 560 calories and 30 g breakfast time as they
645 calories and 99 g
of carbohydrates. continue to fast from sleep.
of carbohydrates.
21 g of protein and 40 g of fat.
18 g of protein and 19 g of fat.
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 dinner roll
1 banana 300 calories, 35 g of carbohydrates,
Snack (10:00 pm)
2 tbsp of peanut butter 9 g of protein
G
aining practical experience is critical for the professional a professional person,” (5). Even though an intern is not a
development of the exercise science student looking to permanent employee, they are still expected to portray themselves
become a collegiate strength and conditioning coach. For as representatives of the internship site. It is important to preserve
the student interested in working with athletes at the collegiate or improve the image of the institution by acting in a professional
level, internships can be obtained in athletic departments at manner. Positive body language, maintaining a clean appearance,
the Division I, Division II, Division III, National Association of and having great interpersonal skills are all aspects of a strength
Intercollegiate Athletics (NAIA), and community college levels. and conditioning professional.
Exercise science students do not typically receive practical
coaching and pedagogical knowledge through their educational It is critical that the intern exhibit professionalism towards the
programs (4). Students are expected to obtain experience through athletes. The full-time coaches and athletes are the reason an
job training or an athletic position in the first few years in the internship is possible and decisions need to be made based
field (10). These typical methods seem to be an inefficient way to on their best interest. Inappropriate behavior (e.g., unwanted
learn and could serve as an impediment to the student’s long- touching, foul language, etc.) with the athletes could result in
term success and longevity (7). Chiu suggests that academic possible termination. Even though the athletes may be very
degrees and relevant certifications are not sufficient enough to similar in age to the intern, both the athlete and intern need to
attain competency within the strength and conditioning field: understand that there are professional boundaries that should not
degrees only aid in learning the minimal level of expertise to begin be crossed (e.g., no sexual relationships). Staff expectations of the
as a practitioner and many exercise science programs require an intern-athlete relationship should be established on the first day
internship prior to graduation (1). An internship is a good way of the internship. If it is unclear how to interact with the athletes,
for the exercise science student to start getting some valuable then the intern should ask the supervisor for guidance. The intern-
experience in the field of strength and conditioning. The purpose athlete relationship may vary from place to place, but the intern
of this article is to present an integrated approach to becoming an should know what is expected of him or her professionally.
effective intern in the collegiate setting.
BUILD TRUST
PRACTICE PROFESSIONALISM Strength and conditioning coaching can be very taxing on the
Professionalism is a critical characteristic in the field of strength mind and body. The hours may be long and the daily tasks of the
and conditioning. Professionalism can be defined as “the conduct, intern may seem overwhelming and stressful, but it is important
aims, or qualities that characterize or mark a profession or for them to continuously show their supervisor that they can be
trusted to carry out the daily duties consistently and efficiently. the most important aspect to the strength and conditioning
Performing the “basics” (e.g., cleaning, maintenance, and daily practitioner’s job,” (10). Previous research from the perspective
set-up) with precise detail will allow the supervisors to trust the of actual strength and conditioning coaches working in the field
intern’s abilities to accomplish the required tasks in the everyday shows that although the science of exercise is important, coaching
operation of a facility. Consequently, with more trust comes ability serves as a more valuable function in the workplace (7).
more responsibility, allowing the intern to show the supervisor As a result of their work in situated learning, Lave and Wenger
their full capabilities. For example, the strength and conditioning concluded that learning requires both knowledge and experience;
coach could give the intern a chance to demonstrate an exercise going over coaching cues, demonstrating exercises to teams, and
or coach various parts of an exercise. The supervising strength creating hypothetical situations are a few examples of how the
and conditioning coach could gradually give the intern more intern can continue to get practice (6). The exposure of getting in
responsibility such as the intern leading full warm-ups with teams, front of athletes and coaches will prepare the intern for critical job
coaching injured athletes or make-up sessions, or even leading the functions of an actual strength and conditioning coach.
entire team through a workout. Whatever the responsibility is, it
is important that the intern be prepared for whatever is given to REVIEWING PERFORMANCE
them and that they make the most of the opportunity. Another way to continue to develop as a strength and
conditioning intern is to constantly reflect on performance. It is
INTERACT WITH THE COMMUNITY highly likely that the supervisor is going to provide constructive
Being in a new environment may make the intern feel criticism to the intern. It is what the intern chooses to do with
uncomfortable. Embracing the professional community will help the criticism that will be one of the determining factors of his or
the intern deal with stressors that are associated with being her success. Internships may require performance reviews (e.g.,
exposed to something unfamiliar. If the intern can embrace the weekly, monthly, etc.) from the supervisor. This feedback can
internship site as a community of practice (COP), it could lead to provide interns with crucial information needed for improvement.
a more effective development of skills, knowledge, and abilities. It can give the intern a deeper understanding of what they need
COPs are defined as “groups of people who share concern, a to improve on and the coaching functions needed to succeed. The
set of problems, or a passion about a topic, and who deepen intern should take full advantage of this face-to-face interaction
their knowledge and expertise in this area by interaction on an with his or her supervisor, especially if the supervisor has a very
ongoing basis,” (12). Participating in a high-functioning COP busy schedule.
(consisting of the head coach, assistant coaches, other staff, and
peer interns) leads to the development of knowledge based on If performance reviews are not a regular practice, an example
the behaviors, meanings, and beliefs shared by others. Members of a grading rubric is provided in Table 1. Peer review and
of the COP may gain a sense of belonging and accountability to self-analysis tools can also be very beneficial for the strength
the community while simultaneously developing their skills (8). and conditioning intern. Gilbert and Trudel demonstrated how
By developing and embracing the relationships within the COP, self- and peer-mediated reflection can be used to develop
interns will be provided resources to utilize when questions or effectiveness in coaching (3). If the intern is accompanied
problems arise in the future. by other peers or interns, they could grade each other and
themselves on daily performances. This can be done by
Mentorship can serve as a critical educational relationship for the observing each other while working with their designated team
future strength and conditioning coach (1). Beginner coaches often or athlete. At the end of the day, the interns could then compare
watch and listen to more expert coaches who are perceived as notes and give instructional feedback. For an example of a self-
successful to gain insight on coaching athletes (4). By observing analysis questionnaire, see Table 2.
and interacting with the strength and conditioning staff, the
intern will have more experienced practitioners to question It is important that the intern has the ability to communicate
when needed. If the intern does not already have a mentor, it is effectively to the athletes if they get a chance to work directly
suggested that the intern attempt to become a mentee to one with them. To gain experience with effective communication, the
of the admired strength and conditioning coaches on staff. If the intern can ask mentors or experienced strength and conditioning
strength and conditioning coaches are not available to mentor, coaches to create a “teach back” environment. This is where the
then the intern should have a professional relationship with strength and conditioning coach acts as if they are an athlete and
someone else in the strength and conditioning field. the intern has to take them through the components of a team
session. This is the perfect opportunity for the intern to practice
PRACTICING PRACTICAL KNOWLEDGE setting up the session efficiently and to confidently lead a group
The average exercise science student has spent countless hours through various exercises. These types of deliberate practices may
in the classroom learning science and studying for national help the intern improve his or her skills and to develop a coaching
certifications. However, there is not always a large emphasis philosophy (1). This teaching exercise is a great way to practice all
placed on “real life” coaching experience. If an intern cannot aspects of coaching and getting used to being in high-pressure
deliver the intended message to the athletes in an effective way, it situations. This will give the intern the most practical experience
may have little to no value. Plisk stated that “teaching is arguably outside of leading an actual team.
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:
Circle the number that best represents your performance 1 = not effective; 5 = most effective
PRE-SESSION
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
DURING SESSION
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
POST-SESSION
*Adapted and modified from the University of California, Los Angeles Athletic Performance staff
O
ne of the main job responsibilities of a sports dietitian nervosa” (1). ACSM chose the term disordered eating rather
is to promote food as a tool to help athletes excel at the than eating disorders in part because the menstrual and bone
highest level. Sports dietitians may say things like “fuel complications associated with the triad can occur when eating is
to be strong,” “fuel your body,” or “food is fuel.” Sports dietitians disturbed at levels not severe enough to meet diagnostic criteria
promote fueling performance when promoting nutrition education for an eating disorder (10).
to their athletes. Many successful athletes are motivated by a
desire to excel and have a natural competitive nature, often DISORDERED EATING
possessing driven and perfectionistic personalities (10). It is not Disordered eating occurs when attitudes toward food, body weight,
uncommon for athletes to begin to take workouts and dietary and size lead to eating and exercise habits that could potentially be
practices to unhealthy extremes in order to achieve success. dangerous to one’s health and well-being. Numerous environmental
Moreover, individuals with disordered eating usually are affected factors contribute to unhealthy dietary practices. The increased use
beyond just dieting, weight preoccupation, and other food of social media platforms like Pinterest and Instagram provide a
issues, as it can affect many aspects of their lives (9,10). As the unique challenge for health professionals as they are a seemingly
prevalence of disordered eating in sport continues to increase, constant source of outside pressure, which can encourage athletes
sports dietitians and all medical personnel must learn to identify to set unrealistic goals. Peers and self-perception may also
it properly and follow evidence-based practice, including sound influence body dissatisfaction, dietary restraint, and disordered
judgment, when treating athletes with these issues (10). eating. Rates of eating disorders are higher among elite athletes
compared to non-athletes (6). This may be due to how athletes
As a part of the original position stand on the Female Athlete are sometimes subjected to excessive criticism and might feel that
Triad, the American College of Sports Medicine (ACSM), defined they are seldom praised, leading them to perceive themselves as
disordered eating as “a wide spectrum of harmful and often not good enough or unworthy. External pressure from coaches or
ineffective eating behaviors used in attempts to lose weight or others close to them may lead to self-critical thoughts, disordered
achieve a lean appearance. The spectrum of behaviors ranges in eating, disordered exercise patterns, body dissatisfaction, and
severity from restricting food intake, to binging and purging, to eating disorders. In a recent update of the ACSM position stand on
the DSM-IV defined disorders of anorexia nervosa and bulimia the Female Athlete Triad, the term disordered eating was replaced
with energy availability (2).
FIGURE 1. POTENTIAL HEALTH CONSEQUENCES OF RED-S (9) celebrities and models are not high-performing athletes, as well
Student-athletes are typically very busy and it is a sports as educated on how images of celebrities are often altered with
dietitian’s job to have a plan to help athletes meet their daily airbrushing. Each athlete’s body is unique to him or her, and there
energy needs. Between walking to class, participating at sport is no need to compare themselves to anyone else. If an athletic
practice, and studying at night, athletes may have limited time to department staff does not have a sports dietitian at their disposal,
properly fuel their bodies. By having a nutrition plan for the day they can use the Academy of Nutrition and Dietetics website to
and making adjustments to nutrient timing, the athlete may be find one in their area. The “Find a Dietitian” tool (http://www.
able to maintain an energy balance (~45 kcal/kg/fat-free mass) eatright.org/find-an-expert) can be a useful way to search for
that is positive for both health and performance (8). a dietitian who specializes in eating disorders, or even eating
disorders in athletes.
Intentionally or not, athletes often negatively alter their EA. EA
can be diminished due to increased training, over-exercising, or The following are three simple steps to take when concerned
under-fueling compared to one’s energy needs. Weight loss is about an athlete with disordered eating or an eating disorders:
one sign that the body is in an energy deficit. Another common 1. Identification: If a teammate or someone witnesses an athlete
sign among female athletes is a lack of menstruation. Once displaying signs or symptoms of an eating disorder, then he or
calories are syphoned from supporting the menstrual cycle, she should inform an athletic trainer or medical staff member
another extremely important organ is also affected—bone. Low about the observed behaviors.
EA directly impairs bone health and development by affecting
hormones that build and restore bone (3,6,8,10). Low EA also 2. Referral: Appropriate intervention involves an expression
indirectly impairs bone health and strength through disruption of concern for the student-athlete. The first step is to
of both estrogen levels and the female menstrual cycle (10,11). discuss these concerns with the appropriate medical
Adolescence and young adulthood are periods of rapid bone practitioner. From here, the medical professional(s) should
mass with about 90% of peak bone mass achieved by the age of determine appropriate referrals to the designated physician,
18 (6). Therefore, athletes should aim to build and protect their psychologist, registered dietitian, or other providers.
bones during their college years to prevent chronic injuries and 3. Treatment and Intervention: An individualized treatment plan
protect long-term health post-college. should be determined based on initial assessments from the
treatment providers.
RECOMMENDATIONS FOR FOSTERING HEALTHY
EATING HABITS AMONG ATHLETES The following are possible strategies for improving EA (4,9,10):
Sports dietitians aim to never focus on bodyweight or body
• Build trust with the athlete by showing concern and ensuring
fat percentages, but rather focus more on fitness levels and
confidentiality.
performance. A large part of nutrition education sessions include
helping athletes strive for balance between exercise and eating. • Ensure that the information given to the coach is only what
One common strategy to achieve this is by reconnecting athletes he or she needs to know (it is important to be aware of the
to their hunger and fullness. Athletes should be reminded that department’s policy on sharing any information with coaches;
often, only the medical staff has clearance for discussing an 3. Da Costa, NF, Schtscherbyna, A, Soares, EA, and Ribeiro, BG.
athlete’s health). Disordered eating among adolescent female swimmers: Dietary,
biochemical, and body composition factors. Nutrition 29(1): 172-
• Make sure the athlete is connected with a physician, dietitian,
177, 2013.
and/or mental health provider, if necessary.
4. De Souza, MJ, Nattiv, A, Joy, E, Misra, M, Williams, N,
• Ensure a team approach and regular communication.
Mallinson, RJ, et al. 2014 Female Athlete Triad Coalition Consensus
• Nutrition education and counseling by a registered dietitian Statement on Treatment and Return to Play of the Female Athlete
should be provided in order to focus on “fueling with a Triad. British Journal of Sports Medicine 48: 289, 2014.
purpose” and developing mindful eating strategies.
5. Deutz, R, Benardot, D, Martin, D, and Cody, M. Relationship
»» The sports dietitian should determine the need for vitamin between energy deficits and body composition in elite female
D, calcium or an omega 3 supplement based on lab results gymnasts and runners. Medicine and Science in Sports and Science
and/or dietary intake assessment or per medical doctor. 32(3): 660-668, 2000.
»» A bone mineral density measurement, such as dual- 6. Lambrinoudaki, I, and Papadimitriou, D. Pathophysiology of
energy X-ray absorptiometry (DXA), may be beneficial bone loss in the female athlete. Annals of the New York Academy
for evaluating bone status (discuss with sports medicine of Science 1205: 45-50, 2010.
provider).
7. Loucks, AB. Energy availability, not body fatness, regulates
»» Set a realistic timeline for any weight loss or body reproductive function in women. Exercise and Sport Sciences
composition changes recommended by the sports dietitian Reviews 31: 144-148, 2003.
and avoid quick fixes.
8. Manore, MM, Kam, LC, and Loucks, AB. The female athlete
• The sports dietitian will help the athlete set goals that are triad: Components, nutrition issues, and health consequences.
realistic, performance-oriented, and health-minded. Journal of Sports Sciences 25(S1): S61-S71, 2007.
»» Ensure the athlete is following the plan he or she created 9. Mountjoy, M, Sundgot-Borgen, J, Burke, L, Carter, S,
with the dietitian. It should include a daily fueling plan, Constantini, N, Lebrun, C, et al. The IOC consensus statement:
providing meals and snacks every 3 – 4 hours to help the Beyond the female athlete triad—Relative energy deficiency in
athlete maintain energy levels and perform at their best. sport (RED-S). British Journal of Sports Medicine 48: 491-497,
• Communicate the plan with the entire medical team 2014.
working with the athlete. 10. Thompson, R, and Sherman, R. Eating Disorders in Sport. New
• Sports psychologists should address barriers, challenges, and York, NY: Taylor & Francis Group, LLC; 2010.
psychological issues in achieving adequate calorie intake. 11. Vanheese, JL, Rodgers, CD, Mahoney, CE, and De Souza, MJ.
»» Treatment should involve helping individuals get in touch Ovarian suppression impairs sport performance in junior elite
with their unconscious, unresolved needs and helping to female swimmers. Medicine and Science in Sports Exercise 46(1):
provide what the individual was missing in the past. 156-166, 2014.
ABOUT THE AUTHOR
CONCLUSION Kelsee Gomes joined the University of North Carolina (UNC) Sports
Coaches, strength coaches, and athletic trainers should take the Medicine staff in February 2015 as the Director of Sports Nutrition.
time to educate themselves on the dangers and signs to look for She works closely with UNC’s varsity athletic teams, providing
in an athlete who may be suffering from an eating disorder. With sports nutrition education, nutrition counseling, and meal planning
the increasing numbers of eating disorders among athletes, it is assistance. Gomes received her Bachelor’s degree in Heath
important to be able to recognize when healthy eating routines Education and a Minor in Chemistry from North Carolina University
turn into obsessive thoughts and practices. Early recognition and at Wilmington, and her Master’s degree in Sports Nutrition from
treatment is critical to prevent life threatening complications. Florida State University.Gomes is credentialed as a Registered
Connect your athletes with a registered sports dietitian as soon as Dietitian (RD), a Certified Specialist in Sports Dietetics (CSSD), a
they display risk factors for disordered eating. certified LEAP Therapist (CLT) specializing in food sensitives, and
is also certified in adult weight management by the Academy of
REFERENCES Nutrition and Dietetics. Prior to coming to UNC, she served as the
1. American College of Sports Medicine (ACSM). Position stand: Coordinator of Sports Nutrition at the University of Florida from
The female athlete triad. Medicine and Science in Sports and 2012 –2015. She received the 2014 Recognized Young Dietitian
Exercise 29: i-ix, 1997. of the Year award from the Florida Academy of Nutrition and
2. American College of Sports Medicine (ACSM). Position stand: Dietetics (FAND).
The female athlete triad. Medicine and Science in Sports and
Exercise 39: 1867-1882, 2007.
ZACHARY KAPALKA, CSCS, GUILLERMO MARTINEZ JR., JESUS MARTINEZ, AND JUAN GONZALEZ, PHD, CSCS
A
warm-up routine is a common activity performed (e.g., shoulder, elbow, and wrist). This interaction is what produces
prior to any strenuous physical activity. Warming up is maximal ball velocity and effective command (34). The following
an important component to maximizing readiness in joints along the kinetic chain are all part of the pitching sequence:
sports, particularly those that require explosive movements the elbow joint, shoulder joint, trunk musculature, and hip joint—
(3,5,9,11,14,15,17,26,27,38). Primary goals of warm-ups include: the primary joint initiating spinal rotation (10,13,15,31,33,35). Above
increasing core body temperature, decreasing fluid viscosity all, an accelerated array of pelvic rotation is followed by torso
within the joints, and increasing joint and muscle mobility rotation, then upper torso angular velocity, then glenohumeral
(4,12,14,16,22,31). Proper warm-ups not only aid in preventing (i.e., shoulder) rotation at ball release (31). Effectively coordinating
injury, but can also stimulate the activity of the central nervous the pitching motion requires a precisely timed kinetic chain of
system (CNS) by speeding up motor unit reactions, which elicits events that progresses from the actions of the lower extremities
faster nerve impulses (5,14,29,32). Currently, there are various and trunk to the upper extremities (35). Uniting the upper and
approaches to warm-ups for the sport of baseball, which focus on lower extremities into one smooth movement, and enhancing
maximizing performance while minimizing the risk of injury at the performance during pitching calls for a specific approach to
high school, college, and professional levels (7,8,14,15,19,25,26). warming up to ensure that the extremities are sufficiently
The aim of this article is to provide an overview of the relationship prepared for the load. Because of this, a full-body warm-up
between a pitcher’s pitching movement, injury rates for pitchers, routine is most sensible.
and contemporary warm-up procedures.
INJURY RATES
THE THROWING MOTION Due to the torque and stress placed on the pitcher’s body during
The pitching motion in baseball is a full body movement which the action of pitching, it is not surprising that pitchers are subject
requires the use and coordination of the upper extremities, trunk, to injuries, particularly in the shoulder and elbow. In a study of
and lower extremities by utilizing rotational and linear movements injuries to high school baseball and softball players across 10
(30,38,40). During the phases of pitching, the lower body, core, different positions, pitchers represented 48.4% of players on the
and upper body all work together in one smooth movement to disabled list (19). Pitchers were also found to be twice as likely
create a substantial amount of force in a brief timeframe of only to be injured compared to position players (18). Oullette et al.
a few seconds (33). Each pitch begins in the lower extremities estimates that about 57% of all baseball pitchers suffer some sort
(e.g., ankles, knees, thighs, and hips). This sequence generates of shoulder injury during the playing season (26). In an analysis
of injuries to both baseball and softball players, it was found poses a low risk of injury to muscles and tendons, but it has been
that the most common body region to sustain injuries was in the shown to reduce performance in explosive activities (1,3,13,15).
upper extremities—about 58% of total injuries reported due to Dynamic stretching is one of the most commonly used methods of
both overuse and improper conditioning (8,19). Dick et al. also stretching and can be easy to administer (9,36,37). These stretches
found that 23.4% of injuries during practice and 16.0% of injuries use sport-specific movements that duplicate the sports activity
during games, were to the shoulder (8). Elbow injuries represented that the individual will perform in a game. Dynamic stretches allow
10.8% and 9.3%, respectively. Finally, according to McFarland and individuals to prepare for the upcoming activity more closely;
Wasik’s study, out of 972 reported cases of injury associated with however, they have been shown to be inferior to static and PNF
throwing, pitching represented 70.9% of those injuries (25). The stretches at enhancing static range of motion (ROM) (1).
data presented serves to highlight the susceptibility of pitchers to
injury. Several studies have shown that with a warm-up routine in Ballistic stretches utilize active and bouncing motions; however,
place, the odds of injury in sports decrease appreciably (10,16). because of these motions, the risk of injury is higher compared
to the other stretching methods (1). This manner of stretching
Table 3 includes several different exercises that may be used as is unlikely to decrease performance and permits specificity
preventive measures to reduce the risk of injuries by strengthening in training and warm-up, as the movements have powerful,
the rotator cuff, shoulder girdle, and muscles involved in elbow sequential, ballistic, and rotational movement dynamics similar to
extension and flexion to accommodate the stress placed on those actions performed in the sport (6,31,33,34). However, Rhea and
muscles from pitching. Bunker warrant caution in order to avoid placing excessive strain
on rotator cuff musculature when applying ballistic stretching to
WARM-UPS the upper extremities (33).
Warm-ups may be categorized into two different sections—
active and passive (4). Active warm-ups involve exercises to PNF stretching is more commonly used in a rehabilitative
raise the body temperature; whereas, passive warm-ups rely on setting, and has shown positive effects on increasing ROM
external means such as a thermal blanket or a heater (3). Active when performed long-term. The downside of this technique is
warm-ups can be further broken down into different categories: that it is much more difficult to administer, because it is a
stretching, dynamic, specific, and functional (32). Stretching is particular procedure that requires advanced skills on the side
an extensive subject and will be addressed later. Dynamic and of clinicians (1,6,9,33,39).
sport-specific warm-ups differ in that dynamic warm-ups do
not replicate any sport-specific movements, while sport-specific TYPICAL MAJOR LEAGUE BASEBALL WARM-UP
warm-ups replicate movements found in a given sport (27,29,32). According to Ebben et al., 21 out of 30 Major League Baseball
Dynamic warm-ups prepare the body for athletic movement strength and conditioning coaches who responded to a survey
by increasing body temperature, enhancing neuromuscular have employed some type of flexibility training, including static
recruitment, and increasing elasticity. Figures 1, 2, 22, 23, and stretching (9). Seventeen out of 21 strength coaches incorporated
24 demonstrate jogging and skipping as dynamic warm-up dynamic flexibility as part of their warm-up routine, 15 out of
examples (17,20,22,23,32). Sport-specific warm-ups are focused 21 reported using PNF stretches in a training and rehabilitative
on prepping the joints and the muscles for the loads placed on setting, and only 4 out of 21 strength coaches reported using
them during athletic movement (32). Figures 3, 4, 5, 10, 11, 20, and ballistic stretching as part of their warm-up. A common theme
21 are examples of sport-specific warm-ups for baseball pitchers, obtained from those surveys was that the focus was more on
which include high knees, arm rotations, and lunges with torso injury prevention rather than maintenance of strength. A typical
twists (9,10). Functional warm-ups incorporate equipment such baseball warm-up should be implemented 30 – 40 minutes prior
as medicine balls, Swiss balls, and resistance bands. This type to competition and may include a progressive run, lunges with
of warm-up focuses primarily on the individual’s balance and rotation and reach variations, explosive skips, shuffles, sprints, and
coordination by targeting the stabilizing muscles, while utilizing stretching (5,6,9,10,14).
the mentioned equipment (32). Figures 44, 45, 46, and 47
demonstrate functional warm-ups for baseball by demonstrating In addition, Rhea and Bunker stated that the squat and lunge
external rotation and elevated external rotation using resistance were the most frequently prescribed exercises for baseball-
bands. Also, other examples of functional warm-ups for baseball specific conditioning (32). Outlined below in Tables 1, 2, and 3
can include woodchoppers and abdominal twists using medicine is a proposed functional warm-up routine for baseball pitchers
balls (32). that incorporates many research studies on warm-up and injury
prevention. Each exercise in Tables 1, 2, and 3 has been selected to
TYPES OF STRETCHING maximize the performance of pitchers while mitigating the risk of
There are six different methods of stretching muscles: static, injuries to susceptible muscles involved in pitching.
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
SETS /
EXERCISES FIGURES(S) MUSCLES USED
REPETITIONS
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
SETS /
EXERCISES FIGURES(S) MUSCLES USED
REPETITIONS
TABLE 3. PREHABILITATION FOR THE PECTORAL AND SHOULDER GIRDLE FOR THE BASEBALL PITCHER
SETS /
EXERCISES FIGURES(S) MUSCLES USED
REPETITIONS
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36. Wallmann, HW, Scott, CD, Perry, C, and Hoover, DT. The acute ABOUT THE AUTHORS
effects of various types of stretching static, dynamic, ballistic, and Zach Kapalka is a current University of Texas at Rio Grande Valley
no stretch of the iliopsoas on 40-yard sprint times in recreational Graduate Student, pursuing a Master’s degree in Kinesiology. He
runner. International Journal of Sports Physical Therapy 7(5): 540- received his Bachelor’s degree of Exercise Science from University
547, 2012. of Texas at Arlington. He engages in strength and conditioning
37. Wong, DP, Chaouachi, A, Lau, PC, and Behm, DG. Short work with a wide variety of populations, from the athletic to the
durations of static stretching do not impair repeated sprints and sedentary populations.
agility. Journal of Sports Science and Medicine 10(2): 408-416, 2011.
Guillermo Martinez Jr. is a Graduate Assistant Coach at Texas A&M
38. Woods, K, Bishop, P, and Jones, E. Warm-up and stretching in
University – Corpus Christi, where he coaches track and field,
the prevention of muscular injury. Sports Medicine 37(12): 1089-
specifically hurdles and sprints. He graduated from the University
1099, 2007.
of Texas Rio Grande Valley with a Bachelor’s degree in Criminal
39. Yuklasir, B., and Kaya, F. Exercise physiology: Investigation Justice with a Minor in Kinesiology. Currently, he is enrolled in
into the long-term effects of static and PNF stretching exercise on graduate school at Texas A&M University – Corpus Christi, pursuing
range of motion and jump performance. Journal of Bodywork and a Master’s degree in Kinesiology – Exercise Science. After his
Movement Therapies 13(1): 73-79, 2009. anticipated graduation date of December 2016, he plans to pursue
40. Yung Chien, C, Fleisig, GS, Simpson, KJ, and Andrews, a career in coaching track and field at the collegiate level.
JR. Biomechanical comparison between elite female and male
baseball pitchers. Journal of Applied Biomechanics 25(1): Jesus Martinez is currently a Kinesiology Graduate Student at the
22-31, 2009. 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.
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
FIGURE 7. KNEE HUG (WALKING) WITH INTERNAL ROTATION FIGURE 8. QUAD STRETCH (WALKING) TO RDL
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 23. SKIP FOR HEIGHT FIGURE 24. SKIP FOR HEIGHT
FIGURE 33. BUTTERFLY STRETCH FIGURE 34. FIGURE 4 WITH ROCK BACK
FIGURE 35. FIGURE 4 WITH ROCK BACK FIGURE 36. BACK/ROTATOR STRETCH
FIGURE 41. CALF STRETCH TO HAMSTRING STRETCH FIGURE 42. CALF STRETCH TO HAMSTRING STRETCH
FIGURE 43. CALF STRETCH TO HAMSTRING STRETCH FIGURE 44. EXTERNAL ROTATION
FIGURE 47. ELEVATED EXTERNAL ROTATION FIGURE 48. STANDING SINGLE-ARM ROW