The musculoskeletal structures of children and adolescents are susceptible to injuries if the workload is more than what

their bodies can tolerate. As they mature, the growth plates of the bones starts to calcify and fuse then completely
hardens between ages 18 to 25. While the bone is still young, these regions of the bone cannot tolerate large amounts
of stress and can fracture easily. Once the plates are injured, it can stunt the growth of a child. It is important that the
adolescent trains within the allowable limits in order to stimulate bone growth without causing injury.

The resistance training program for children and adolescents should be properly planned and taught. It is necessary that
the fitness expert supervise the exercise session and ensure that the child performs the correct technique. Aside from
focusing on proper form, the child should avoid exercises wherein the load is lifted above the head. The child should
start with a light load and perform one to three sets of 10 to 15 repetitions per set. The intensity should be increased
gradually at less than 10% of the previous load. The exercise sessions should be scheduled twice a week with rest days in
between. The program should also include single joint and multi-joint exercises but exclude Olympic lifts. In addition, a
series of stabilization exercises for the lower back and shoulder should be included in the program. Aside from these
safety precautions, the exercise program for adolescents is similar with that of the adults.

A novice lifter should start with a lowload while emphasizing on technique. Resistance training puts an excessive load on
the musculoskeletal structures which can lead to injury If not properly performed. Some fitness trainers advocate the
use of machines over free weights for novice lifters because it is safer and easy to teach. The limitation of using
machines is that movement usually occurs in a single plane and does not imitate the normal human movement that
occurs at different planes. On the other hand, some trainers would emphasize on using free weights like dumbbells and
barbells because it emphasizes on learning the proper technique, balance, and coordination. Learning the technique
takes more time but the exercise is more functional compared to exercises performed using a machine. The
recommended intensity or load for a novice lifter is around 50% to 60% of his One Repetition Maximum (1 RM) for 8 to
12 repetitions. The 1RM is the heaviest load that the individual can lift with just one repetition for that exercise; hence,
the load is usually expressed as a percentage of an individual's 1RM. The 1RM can be assessed through a trial-and-error
method with supervision or it can be estimated using a conversion table. The recommended load for novice lifters is low
compared to the ideal load for a strength program which is around 85% of the 1 RM. The intensity is gradually increased
when the individual can perform more repetitions than what is written in the program. The load is increased gradually at
a rate of 10% after every two weeks. The recommended frequency is 2 to 3 times a week with rest days in between. As
an individual is able to tolerate the workload, the frequency can be increased to 4-6 times a week. Beginners need to
start with a low workload to emphasize Figure 3.6. Exercises using technique and minimizes the occurrence of DOMS or
delayed onset of free weights require technique and assistance. muscle soreness. DOMS is a muscle pain commonly
experienced a day after the first workout. Many people discontinue the exercise program because of this. It is not true
that an exercise has to be hard or difficult to develop the muscles. The old saying "No Pain, No Gain" is no longer
applicable. It is important that the program reduces the risk of muscles soreness by starting it with a light load and
moderate number of repetitions.

Hypertrophy is dependent on several factors such as muscle fiber type, nutrition, hormone level, and type of resistance
program. The muscle is comprised of different types of muscle fibers and each type has a different characteristic. Muscle
fibers are commonly subdivided into fast twitch and slow twitch. These fibers differ significantly in their ability to
generate force as well as resist fatigue. Slow twitch fibers are usually smaller in diameter, have low power output, and
enhanced capability to resist fatigue. On the other hand, fast twitch fibers are bigger in diameter, generate high force
output, e and have lower resistance to fatigue. Fast twitch fibers increase in size as a result of resistance training while
slow twitch muscle fibers tend to remain the same. An individual's ability to bulk up is dependent on which fiber type is
predominant in his/ her body. The distribution and proportion of a fiber type is genetically predetermined.

An important factor that influences hypertrophy is recovery. The muscles should be given ample time to replenish the
stored energy and adequate resources to repair the muscle fibers. Recovery and adaptation is coordinated by the
endocrine system. Proper nutrition and adequate hormonal levels would considerably improve the ability of the muscle
to increase in size. The presence of appropriate hormones causes the muscle fiber to increase the protein content of
each muscle fiber which leads to an increase in muscle fiber size. Furthermore, the diet of an individual should contain
adequate amounts of essential amino acids which are the building blocks for synthesizing protein in the muscle fiber.
Lastly, the type of resistance program is also important in stimulating the muscle fiber to expand There are several forms
of resistance training programs and each one creates a unique adaptation on the individual muscle fiber. Resistance
training programs are commonly classified based on the goal of the individual. The individual can choose from strength,
endurance, hypertrophy, or power program. A strength program emphasizes in increasing the force production
capability of the muscle. An endurance program is characterized by high repetitions because it emphasizes on the ability
of the muscle to resist fatigue. A hypertrophy program emphasizes on increasing muscle size without being concerned
with increasing strength. A power program trains the muscle to increase speed and explosiveness of movement. There
are two schools of thought for developing power. In the first philosophy, power is increased by emphasizing speed of
movement against light resistance. In the second philosophy, power can be increased by focusing on generating forces
against heavy resistance.

The chance of women bulking up is low because their average testosterone level is lower than men. The lower
concentration of testosterone reduces the capacity of the muscle cells to increase in muscle size. Before puberty, the
testosterone levels of males and females are almost similar. At the start of puberty, the testosterone level of males
increases tenfold while the level in females remains the same. Women who artificially increase their testosterone level
will spark the same masculinizing changes observed in men and this includes muscle mass increase. Aside from the
genetic tendencies, testosterone level also increases with resistance training. Studies show that in men, a resistance
training program that incorporates large muscle groups, multi-joint exercise, high work load, and short rest intervals is
able to increase the testosterone level in the blood. Studies among female lifters show a minimal rise in testosterone as
a result of resistance training. The chance of a female lifter to increase her muscle mass is low because testosterone
does not significantly increase after performing resistance exercises.

There is an increased risk for injuries when lifting weights because the stress can be too high than what the individual
can tolerate. Furthermore, accidents can happen when the individual is not focused. It is important for an individual to
get a medical clearance first before lifting weights especially if he/she has been sedentary for a long time. Another way
of reducing injury risk is by following the training program and increasing the workload gradually. Fitness trainers also
recommend wearing the proper attire during workout as well as following the rules and etiquette of the gym. An
adequate warm-up is also recommended before the actual workout to prepare the muscles for a more strenuous
activity. Clavicle Coracoacromial Ligament The lifter should focus on learning the technique before increasing the load
especially for multi-joint exercises (i.e., squat) or Olympic lifts (i.e., snatch). It is advised to perform Rotator sufficient
warm-up before lifting loads close to an individual's Cuff 1RM. When lifting loads close to 1RM, an individual should also
ask for a spotter who will assist in case he/she is unable Humerus to continue the repetition. Lastly, an individual should
inhale during the easy part of the movement and exhale during the "sticking point" or difficult part of the movement.
Exhaling at the sticking point ensures that blood flow in the chest remains normal.

Poor flexibility changes normal movement patterns and posture. Aside from increasing range of motion, flexibility
exercises corrects muscle imbalance and helps improve neuromuscular efficiency. For example, a low back pain is
commonly due to tight hamstrings and trunk muscle imbalance. A stretching exercise program for the hamstring muscles
and other muscles surrounding the hip joint will improve flexibility around the joint and reduce the occurrence of low
back pain. Flexibility is the available range of motion for each joint. It varies from joint to joint and from person to
person. Flexibility can be classified as active which implies that the limb is moved through muscle action or passive when
the limb is moved by an external force. Some joints have limited range of motion (i.e., vertebral joints) while some joints
have the ability to move along different planes (i.e., shoulder joints). Furthermore, the joint structure and the tissues
surrounding the joints determine its range of motion. A thick muscle or fat around the joint structure can limit the range
of motion. On the other hand, some joints are unusually flexible because of inherent tolerance and long muscle-tendon
units. Aside from joint structures, other factors influence the flexibility of the joint. It is common knowledge that
flexibility changes as an individual grows older. The growth spurt experienced during puberty negatively affects flexibility
as the muscles are not able to lengthen at the same rate as bone growth. In addition, the elasticity of connective tissues
deteriorates as the individual grows older and this can contribute to poor flexibility. Another factor that influences
flexibility is gender. Because of the smaller muscle size and hormone, women tend to be more flexible at the hip joint
than men.

There are four types of flexibility training static, programs: dynamic ballistic, and Proprioceptive Neuromuscular
Facilitation (PNF). Static stretching is a slow and sustained muscle- tendon lengthening exercise usually held at the end
of ROM (range of motion) for 30 seconds. Dynamic stretches lengthen the muscle-tendon unit by slowly moving the limb
throughout the entire range of motion but the position is not held or sustained. The exercise is performed repeatedly to
improve the range of motion. Ballistic stretching incorporates rapid movements (i.e., bouncing) to lengthen the Figure
3.10. The PNF stretching method is muscle-tendon unit. The momentum lengthens the commonly used in a clinical
setting. muscle beyond the normal range. The rapid increase in tension over the stretched muscle might lead to muscle
strains. PNF is usually an assisted stretching routine wherein the muscle-tendon unit is made to contract a resistance
followed by a passive lengthening similar to the static stretch. This contraction-and-relaxation routine is repeated three
times with each cycle for 20 to 30 seconds. Static stretches do not help with the warm-up activity because it relaxes the
muscle and helps return the core temperature to resting levels. It is important that an individual feels a mild strain or
tension during the static stretch but should not stretch the muscle beyond mild discomfort to avoid the myotatic stretch
reflex (an automatic contraction of the muscle to prevent injury). It counteracts the stretch and increases the stiffness at
the joint which limits the range of motion. However, after holding the stretch for several seconds the autogenic
inhibition takes effect. The autogenic inhibitionis an automatic relaxation response of the muscle-tendon unit which
opposes the myotatic stretch reflex and allows more movement around the joint. Ballistic and dynamic stretching
exercise is not as effective as static stretching in increasing ROM because it stimulates the myotatic stretch reflex.
However, it uses reciprocal inhibition to lengthen the opposite muscle tendon unit. Muscles usually work in pairs, if one
group of muscles bends the arm (i.e., biceps), another group straightens it (i.e., triceps). When one muscle group
contracts, the muscle group that performs the opposite action automatically relaxes. This automatic relaxation response
is called reciprocal inhibition.