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In December 2019, I had the opportunity to complete the Apprentice Coach Program (ACP) at ALTIS in Phoenix, Arizona. Everyone involved in team sports is interested in speed development in some way. Personally, I work in Rugby Union, in which there are game-defining moments that will require an effective burst of maximal acceleration from a player, or for that athlete to remain composed at max or near-max speed—both abilities that are common to high-level sprinters.

Since I had been following the work ALTIS does for quite a while, I felt that completing the ACP would be a valuable learning experience. Being immersed in an environment that is so open and transparent can only reap positive rewards, and Coach Kevin Tyler reiterated this in his welcome presentation as he expressed gratitude to all attendees for investing their “hard-earned dollars” at ALTIS. In the end, however, I was even more grateful to ALTIS for opening their doors and allowing for this interaction.

In this article, I discuss four key learning points from the four days I spent at ALTIS. There were, of course, many more noteworthy insights and hands-on sessions, but these four central points were particularly applicable for me in my environment. In addition to providing a balance of the art and the science of enhancing performance, the ACP served as a reminder to critically evaluate everything in the context of my own program.

Acceleration – Error Detection and Correction

“S&C coaches often have a PhD understanding of lifting weights, but an elementary school understanding of sprinting.” –Dan Pfaff, ALTIS

Coach Stuart McMillan’s first presentation on acceleration error detection was incredibly thought-provoking, and it was not until the day was over and I reflected on what he said that I took so much from it. When analyzing movements, Coach McMillan looks at:

• Shapes
• Patterns
• Rhythm

For example, in acceleration:

• Shapes: touch-down and toe-off
• Patterns: one gait cycle
• Rhythm: multiple gait cycles

There are more key shapes in top-end sprinting (Coach McMillan identified 3–5 key shapes), but for this section, we will focus on the acceleration phase. According to Bondarchuk’s exercise classification system, sprinting (a specific development exercise) arguably transfers better to team sports than does lifting (general preparatory and specific preparatory). I must also note that it is next to impossible to measure transfer— especially in team sports.

Coach McMillan’s presentation sparked considerable debate and discussion around acceleration mechanics and creating an acceleration model. As McMillan tweeted after his presentation: “all models are wrong … some are useful – George Box.” In this context, all acceleration models are wrong, but some are useful because, as Coach Dan Pfaff declared, “You’ve got to coach to something.” If a coach does not know what they want, they cannot reverse engineer the training process. An acceleration model will give coaches a framework to decide how best to intervene with an athlete in front of them.

If a coach does not know what they want, they cannot reverse engineer the training process, says @Jordy_Cass. Share on X

Reflecting on this presentation and the ensuing discussion stimulated a lot of thought: Performance is a conscious effort, and it is important to equip players with tools to execute most effectively in the environment in which they find themselves. In a chaotic and variable environment (like team sports are played in), players must have a variety of tools to choose from. A couple of my other impressions resulting from the afternoon’s talk are:

• • The question becomes, do we want players accelerating to maximal speed or optimal speed (where they can still execute the sport-specific skills of the game—e.g., passing—to a high standard). Of course, like almost everything in sports performance, it depends!

 

• The acceleration rhythm in team sports is descending, like track and field (meaning, if you close your eyes and listen to the athletes’ steps, you will hear the time between steps increase—stride rate decreases). However, the external influences are random. Does this make a track and field acceleration model inapplicable for team sport athletes? I don’t know, truthfully, but I am excited to look more deeply into it.

 

Somebody asked a question in the poolside chat: Are team sport acceleration mechanics the same as track acceleration mechanics? Coach Pfaff was of the opinion that they were, the difference being in how coaches train it in different sports—team sports must microdose acceleration/speed work into their program, as training time for physical development must be balanced with time devoted to technical and tactical development. (These aspects are arguably the most important.)
The second part of the presentation, on Day 2, added an unbelievable amount of clarity to questions and confusion I had from the previous day.

In order to correct an error, you must identify the genesis of that error: Is it a mechanical error or a technical error? A simple method that McMillan uses to evaluate if an error is mechanical is to check for asymmetry. A technical cue cannot fix an error like this.

The information I gathered around acceleration really started to make sense when Coach McMillan explained functional anchor points (FAPs). He defined a FAP as a “fundamental shape that may act as a metaphor to which we refer while performing a more complex variation of the skill; i.e., in context.” For acceleration, Coach McMillan listed four FAPs that are “common to all movers on the planet”:

• The stance leg has forcefully extended.
• The swing-leg thigh has flexed forward and upward.
• The swing leg ankle has flexed in anticipation of initial ground contact.
• The arms have flexed and extended to counterbalance the legs.

These four points are applicable to maximal velocity sprinting, along with one more—neutral head and torso.

Video 1. Athlete demonstrates wicket drill emphasizing upright sprint mechanics.

Coach McMillan conceded that neutral head and torso and arm position are not necessarily applicable to team sport athletes depending on the situation they are in (may need to scan playing area for a pass, may be in possession of the ball, etc.). With team sport athletes, every movement is different; this means athletes can have an infinite number of movement solutions. There are two options for a coach:

• Train an infinite number of movements.
• Train several movements or FAPs to act as metaphors for team sport athletes.

It can absolutely be said that movement is contextual; movement can be very different depending on the demands of the particular sport. However, while McMillan accepts that field sport movement differs across sports, his philosophy is that athletes should learn acceleration sprint “rules” before the context of their sport breaks those rules.

Understand Your Athletes’ Limits Before Loading

Another theme mentioned several times, in different contexts, was identifying bandwidths. Ultimately, as Coach McMillan said, this is one of the most challenging aspects of coaching—how much is too much? What is the minimum effective dose for each athlete? Establishing individual thresholds is paramount for optimal adaptation. (Paul Glazier’s recent tweet sums up this point.)

“Mailboxing” athletes is something that Coach Pfaff mentions a lot, and it can be especially useful when working with large groups. Mailboxing athletes is essentially grouping athletes with similar problems together. For example, if you have five athletes completing an A-skip for 20 meters, but each has a different issue, it will be difficult to cue each athlete to improve their technique. However, if you have five athletes with the same problems, by cueing one athlete you are essentially cueing all athletes, making your coaching more efficient.

Mailboxing athletes is grouping athletes with similar problems together so that by cueing one athlete you can essentially cue all athletes, explains @Jordy_Cass. Share on X

Another useful benefit of knowing your athlete is being aware of their normal behavior, and therefore being able to identify deviations from the norm:

“A loud athlete goes quiet—the session is over.”

“A quiet athlete starts talking—the session is over.”

Coach Pfaff went on to say that people don’t like to use this kind of feedback to evaluate training status because you cannot put it into a spreadsheet (offered somewhat tongue-in-cheek). But the utilization of talking to the athlete as a monitoring tool was shown throughout the day. Coach McMillan asked numerous questions of his athletes throughout the session: “Are you good for one or two more reps,” “How did that feel,” etc.

In his presentation, Coach Keenan Robinson identified the limitations of swimmers. Coach Robinson discussed the importance of being aware that, because swimmers may not have developed the ability to jump and catch, programming reactive medicine ball throws or depth jumps could pose a high injury risk, just from executing the exercise. This is further support for being aware of who you are working with and understanding their abilities before prescribing them a program to improve those abilities.

Understanding Context and Complexity When Coaching

Coach Kevin Tyler spoke about the importance of balancing art and science in any endeavor in life. His presentation on Day 3 was captivating and showed an incredible depth to the points he made throughout. The first point of the presentation was to identify that information requires context for an appropriate understanding. Without this understanding, we cannot subsequently act appropriately:

Information + Context = Understanding

Information received + Understanding of that Information = Appropriate action

Context is key

Coach Tyler’s presentation discussed the need for a combination of science and experience for optimal performance. Specifically, in coaching: A highly technical coach who knows what to train but has difficulty communicating their ideas will struggle to make an impact. On the flip side, a highly experienced coach who understands the process but has no appreciation for the more scientific side of sport will also struggle. Coaches should develop the “how” (process) and the “what” (technical) to deliver their message.

Critical thinking is vital throughout a coach’s career to ensure they can state a justification for any action. Coach Tyler discussed the story of a man who “saved a fish from drowning” by taking the fish out of the water. As a result, the fish died, and the man went on to eat the fish. There are two messages that we can derive from this anecdote:

• Understand who you are working with and see things from their point of view—humans would drown in water, fish do not.
• Confirmation bias: It is possible to find evidence to support your claims or reasoning—the man developed a “reason” to take the fish out of the water (to save the fish from drowning), but failed to think critically about his actions (the fish would not have drowned).

Coach Tyler then compared complex systems and complicated systems:

• Working with an athlete is a complex system.
• Launching a rocket, although difficult to understand (it is literally rocket science), is a complicated system.

For me, it comes down to the power of the conscious brain. While launching a rocket is undoubtedly a difficult task, you can break it down into a series of simpler steps and, ultimately, if programmed correctly, the rocket will launch. The launch performance will not be negatively affected by illness or injury, lack of sleep, an argument with a partner, and so on. Therefore, it is a complicated process. However, these things can negatively impact athlete performance and affect different athletes in different ways, making it extremely difficult (if not impossible) to predict how certain circumstances cause a change in athlete performance.

For me, complicated vs. complex comes down to the power of the conscious brain. Programming is a complicated process, but the human aspect of coaching is what makes it incredibly complex. Share on X

The human aspect of coaching is what makes it incredibly complex, and careful consideration must be taken when adding support staff members to a support team. This process is simply adding to the complexity of an already complex task. In team sports, there could be a backroom team of 10 people; meaning the possibility of more than 40,000 conversations or interactions. However, the ALTIS model is simply the coach, athlete, and therapist—this means that there are only six possible conversations. While this is still a complex task, having fewer options reduces the complexity of the task.

How Science Can Support the Practitioner

Coach Robin Thorpe discussed how science can be used to support the practitioner, showing that a great deal of awareness about ensuring the role of science was neither overstated nor understated, but simply a piece of the puzzle.

What does sports science help coaches achieve? It helps them ask better questions rather than finding answers. Thorpe detailed three specific aims of sports science:

• Reduce uncertainty to help make better decisions.
• Support opinions: It is important to remain data-informed rather than data-driven.
• (mis)Interpretation: Help coaches understand what is happening both acutely and chronically.

With these factors in mind, Coach Thorpe discussed his Ph.D. work at Manchester United, and how it all stemmed from the manager asking the question: “Are my players ready?” Thorpe invested time into investigating the effects of different types of fatigue on player performance and injury risk, recovery strategies to enhance recovery from specific types of fatigue, and monitoring strategies to better understand when and what type of recovery strategy to implement with each athlete.

What does sports science help coaches achieve? It helps them ask better questions rather than finding answers, says @Jordy_Cass. Share on X

In a world where data is becoming more and more prevalent, and with more and more wearable technology coming out each year, it can be difficult to decide what measures to invest time in assessing. Thorpe discussed four areas to look at when deciding:

• Reliability: Does the test give the same results if we run it twice?
• Validity: Does the test measure what we think it measures?
• Sensitivity: Is the test responsive to load?
• Usability: Is the test practical in your environment?

The last point—usability—is the factor that should come first when assessing what measures to use. Ultimately, sports science needs to be as smooth as possible to ensure there isn’t a situation of the tail (sports science) wagging the dog (coaching processes).

In order to get a complete picture when monitoring an athlete through a training program, it is important to balance both external and internal loads. Ultimately, knowing the external training load alone (high-speed running, sprints, accelerations, etc.) tells us very little as training load is contextual—depending on athlete training age, time of year, injury status. What is important is the internal training load; to better understand an athlete’s response to training load.

This presentation highlighted the importance of mindset in any sports organization at any level. When people are curious, there are no limits to the amount of learning opportunities that can occur. Being open-minded to investigating the best way to do things helps improve the support provided to both athletes/players and coaches.

Progress Relies on Different Points of View

The variety of methods and perspectives of everyone at ALTIS is a huge positive. Different perspectives stimulate different thoughts; if everyone had the same point of view, things could get very stale very quickly, and progress could stall. What enhances this is every single person at ALTIS is willing to express their point of view and be challenged. Challenging a person’s view or opinion can only be positive—the person will change their opinion for the better and their thought process will become more robust, or the person will strengthen their argument why they feel the way they do and be in a stronger position next time they come under scrutiny.

When people are curious, there are no limits to the amount of learning opportunities that can occur, says @Jordy_Cass. Share on X

The biggest take-homes were to always be kind and remain curious. In his book, Mastery, Robert Greene wrote about how important it is to maintain an inferiority complex in order to learn. A child learns quickly because they are dependent, and they need others to survive. However, as we grow older, we become more independent and less reliant on others and even develop a mindset where we feel we can’t learn anything from someone else (experienced coach vs. novice coach; head coach in one sport vs. head coach in another). Retaining this child-like curiosity is essential for lifelong learning and continued development in whatever walk of life we invest in.

Since you’re here…
…we have a small favor to ask. More people are reading SimpliFaster than ever, and each week we bring you compelling content from coaches, sport scientists, and physiotherapists who are devoted to building better athletes. Please take a moment to share the articles on social media, engage the authors with questions and comments below, and link to articles when appropriate if you have a blog or participate on forums of related topics. — SF

Eccentric training has been getting more attention across the world of sports performance, and it may allow us to take an athlete to the next level in terms of their strength and peak force capabilities. Once only found in bodybuilding and powerlifting circles, elite college programs and pro sport teams are starting to implement eccentric methods a little more. There is more and more evidence starting to show that eccentric-focused training provides greater adaptations to strength training than “traditional” training. But what is eccentric training? Why should you add it to your training, and how should you perform it?

There is more and more evidence starting to show that eccentric-focused training provides greater adaptations to strength training than “traditional” training, says @peteburridge. Share on X

Here are the key points you need to understand before undertaking eccentric training:

• There are many ways to do eccentric training, and some have a little more evidence supporting them than others.
• Eccentric training is very good for improving strength and quite good for improving muscular hypertrophy. It even helps to make improvements in speed and power as well.
• When manually overloaded, a lift can be intensified throughout the entire range of motion, leading to more positive adaptations.
• When having your athletes perform eccentric training for the first time, you need to consider the athlete’s training history, where they are in their competition schedule, and your coaching manpower to guide the session.

What Is an Eccentric, and How Can You Apply It?

An eccentric contraction is the motion of an active muscle while it lengthens under load. Eccentrics are also known as “negatives” in old-school bodybuilding circles, and pretty much every lift you do in the gym will have some element of an eccentric within it.

For example, while just doing a basic squat, the muscles work eccentrically on the descent into the hole. However, eccentric-focused training (otherwise known as AEL—accentuated eccentric loading) usually uses a variety of means to overload the eccentric portion of the lift. This accentuated eccentric loading can take different forms, with some having more scientific rationale than others.

Tactic # 1: The ‘Gym Bro’ Way

This is the most common way to overload a lift eccentrically, and it uses the same load that you would normally lift, only with a slower tempo. This helps to increase the TUT (time under tension) but doesn’t really achieve any of the major benefits of AEL, as the load is essentially the same as (or oftentimes actually lighter than) the load you normally lift with. You often see a stereotypical “gym bro” at your local gym arguing the case for doing it this way for dem mad #GAINZ. Unfortunately for him, though, there are better and more scientific ways to achieve adaptation than this.

There are better and more scientific ways to achieve adaptation than simply lifting the same load with a slower tempo, says @peteburridge. Share on X

Tactic #2: The ‘Meathead’ Way

With this tactic, you actually use supramaximal loads and can in fact go about making significant changes to your force production capabilities. More weight than you normally lift is put on the bar—usually somewhere between 100% and 130% of your 1RM. You only lift the bar for the eccentric portion of the lift, with spotters then either helping lift the weight back up to the top for you or helping strip the weight at the bottom. Your bearded, smelling-salts-sniffing meathead is often fond of this method.

You need spotters for this due to the ungodly amount of load. Obviously, because of the supramaximal nature of the lift and the need for effective spotters, this can be a more dangerous lifting strategy. More positively, you will make large improvements in force production due to the load being much greater than your 1RM.

However, as you go through the lift, the bar velocity tends to increase throughout the range of motion because you will struggle to control the bar speed once you are past your peak torque angle. This means you simply don’t have the force generation capacity to control the bar past a certain point, which can lead to the bar pancaking you at the bottom. Unfortunately for the spotter, what goes down must also come back up again! So, for multiple reps, the spotter has a lot of responsibility either lifting a whole lot of weight or doing a lot of fiddly stripping of plates.

Tactic #3: The ‘Manually Overloaded’ Way

This tactic tries to get the best of both worlds: control throughout the entire range of motion, but a supramaximal load that should help develop peak force. You still need spotters here, but the actual load on the bar is a little more manageable. The load can be quite variable—you want enough resistance so that the spotter isn’t working like crazy, but then not too much that you can’t provide a steady amount of resistance throughout the whole range of the lift.

Video 1. The spotter helps on the way up and adds extra graded resistance on the way down. The bar in front helps stabilize the lifter.

The spotter’s job is to provide variable resistance throughout the range of motion. They control the velocity by giving more resistance when you’re at your strongest and backing off at points in the lift where you are weak. For example, at the top of the bench press they would push down harder, but then only push a small amount at the bottom portion of the lift.

Video 2. In the eccentric bench press, the spotters lift the weight to the top, and then the lifter builds tension into the bar. The spotters will have to work harder at the top portion of the range for most people and back off a bit at the bottom.

Why Should You Use These Lifts?

There are a few reasons to do these types of lifts, including for increased force production, hypertrophy, and speed-power.

Force Production

The main reason we decide to do eccentric-focused training is to improve force production. Considering that, compared to concentric contractions, skeletal muscle is capable of as much as 20–50% more force production during maximal eccentric contractions⁴, it makes sense that we would be capable of having more load on the bar while doing accentuated eccentric training. In practical terms, the easiest way to think about this is that the height we can box jump is far less than the height of a box we can jump down off of. The reason for this is that the force we are capable of producing to propel ourselves up concentrically in a box jump is far less than the force we can absorb from landing eccentrically.

Keeping that in mind, you can get greater intensity in your program with supramaximal eccentric training. This has a number of positive effects: First and foremost, intensity drives adaptation. With a more potent stimulus you will get a more optimal adaptation. Eccentrics seemingly do this through an increased amount of neural drive.⁵ Although some academics dispute it, you may also be able to get preferential recruitment of HTMUs (high-threshold motor units), which has been shown to increase force production.⁶

You can get greater intensity in your program with supramaximal eccentric training, and the more potent stimulus will drive more optimal adaptation, says @peteburridge. Share on X

Video 3. A lifter can perform all eccentrics better when they can build up their tension, so rather than jumping to the top of the lift, get the lifter to climb up using the pins in the rack before pulling them down.

By doing eccentrics with manual resistance, you develop strength throughout the full range of motion as well. This enables you to generate force at long, medium, and short muscle lengths, which has a positive impact on injury prevention.⁷ This is especially important in team sports like rugby, where athletes are exposed to many different joint configurations and joint angles and have to effectively generate force to prevent against injury. 

Hypertrophy

The next reason you might implement eccentric-focused lifting into your training is for hypertrophy. In sports like sprinting this may not be desirable, but in sprint momentum-based sports like rugby and American football, getting an athlete bigger can be a big training focus. One potential way that eccentrics help is improving satellite cell proliferation and activation in type II muscle fibers¹.

Satellite cells are cells that donate their myonuclei to another cell (in this case muscle fibers), allowing for greater control of a group of muscle fibers. The easiest way to think about this complicated idea is to think of an airport: the satellite cells are like the control towers, and the runways are the muscle fibers. If you only have one control tower, you can only have a small number of runways before the control tower can’t handle the airplane traffic. If you want the airport to grow, you need more control towers—and with more control towers, you have the potential to lay down more runways (muscle fibers). If, through your lifting, you can lay down more satellite cells, then you have the potential to lay down a lot more runways (muscle fibers).

There is a strong case for exposing young athletes to this kind of training to lay down satellite calls early and give them a greater potential for growth at a later age, says @peteburridge. Share on X

This is the science behind the principle of reversibility. Even if the airplane traffic stops, the control towers remain, so there is still potential for growth if the airplane traffic comes back. This is why when someone stops training for an extended period of time, they are able to put on size much quicker than someone who hadn’t done the training previously. Because of this, there is a strong case for exposing young athletes to this kind of training to lay down satellite cells early and give them a greater potential for growth at a later age. This is also the reason people have called for lifetime bans for steroid users, because those satellite cells they lay down when juiced-up don’t go away, and so their potential for muscle growth will always be higher whether they have stopped using steroids or not.

Video 4. The eccentric leg press takes some manpower to spot, but it can be a great way to safely achieve high mechanical tension. The key is to not “lock out” the spotters and keep pushing in the deep ranges.

It is suggested you can get preferential recruitment of type II fibers with eccentric training—these fibers have bigger growth potential than type I fibers² and are arguably more important fibers for the high-intensity activities you regularly get exposed to in a sport like American football. There is also a growing body of literature that shows eccentric training has more of an effect on muscular hypertrophy when compared to concentric lifting, as this meta-analysis of studies shows³:

From my own experience, we have practice-based evidence that shows very positive results when eccentric-focused lifting has been added to players’ programs, with players putting on mass at accelerated rates in comparison to normal lifting.

Speed-Power

Eccentrics help to increase the number of sarcomeres in series, which allows for greater fascicle shortening speeds⁸. If our muscles can shorten at greater velocity, we should be able to move much, much faster. The use of eccentrics, especially when manually overloaded, allows for greater force production at long muscle lengths⁹. This then shifts the length-tension curve to the right, which can have positive adaptations in speed and power.

Not only that, but eccentric training tends to favor hypertrophy in distal portions of the muscle, which are, again, favorable to contraction velocity¹⁰. Despite there not being too much direct evidence for eccentric-focused lifting improving speed and power, there are a lot of adaptations that should help develop the muscle to be able to shorten quicker and faster. This should then lead to developments in speed and power qualities.

Video 5. Manually resisted hamstrings are a good way to get people strong at long muscle lengths and are comparable to Nordics, except you can control the resistance so the athlete works at the end range and not just at the early range. 

Why (or When) to Not Use Eccentrics

Despite there being a lot of evidence for implementing eccentrics into your program(s), you still need to consider a few things. If doing manually resisted eccentrics, you obviously need a decent amount of manpower, as it probably isn’t feasible for a coach to spot a whole team through a session of eccentrics and then get through the session without some sort of overuse injury!

So, either select athletes who need to be targeted on an individual basis or get them to work in teams to spot each other. With that, of course, you need to spend a large amount of time educating the athletes on how to spot safely and effectively. This is a key point, because ineffective or reckless spotting either reduces the adaptations you’re after or, worse, can be dangerous to the athlete if performed incorrectly.

Video 6. Eccentrics are a great way to target and isolate some of the rotator cuff muscles that are important in preventing shoulder injuries. A smooth rep is a good rep.

The next consideration is when to add manually overloaded eccentrics to your players’ programs. There is a large amount of delayed onset muscle soreness (DOMS) and muscle damage associated with training this way. They will get your athletes very sore, so they need to be well transitioned into a program. You can’t just chuck them in; you need to start with very low volumes and build up the athletes’ tolerance to eccentric-focused training—otherwise, it may limit their capability to perform on-field training or other gym work. Sometimes, as low as 2 x 3 is all that you need to do with someone to make them significantly sore, so it is key you build these strategies around physical development blocks or windows outside of competition.

You can’t just chuck manually overloaded eccentrics into a program—you need to start with very low volumes and build up athletes’ tolerance to eccentric-focused training, says @peteburridge. Share on X

The final consideration is the lift has to be maximal, otherwise athletes might as well just stick to their traditional lifts. We would all love to work with 100% honest athletes, but, unfortunately, we don’t. Especially at the pro level, there are some people who will simply pretend to push as hard as they can, when in reality they are capable of much more. So, for those athletes who don’t train with honest intent and are prone to pulling a face and just “faking it,” it may be best if they stick to traditional lifting.

An Example Program

Following is an example real-life program of a rugby back who is in season but looking to put on a bit more size and get stronger while still maintaining his speed.

Take Home Messages

Hopefully, I’ve made a strong enough case that eccentrics are a valuable tool to have in your training toolbox. If you do decide to look further into using eccentrics in your program(s), here are the key things to remember:

• There are different ways to do eccentrics, but some may get more of the physiological adaptations that you’re after than others.
• There is much evidence for improvements in strength utilizing eccentrics and some evidence of a small but meaningful improvement in hypertrophy compared to traditional training (10% vs. 6%).³
• There is both some theoretical and growing real-world evidence of improvements in speed and power following eccentric-focused training.
• Be aware of how much you prescribe and more importantly when you prescribe if implementing these strategies into your program(s).
• Some personality types are better suited than others to train this way.
• In sports, with large playing and on-field training demands, you will have to schedule athlete training intelligently around games and training.

Since you’re here…
…we have a small favor to ask. More people are reading SimpliFaster than ever, and each week we bring you compelling content from coaches, sport scientists, and physiotherapists who are devoted to building better athletes. Please take a moment to share the articles on social media, engage the authors with questions and comments below, and link to articles when appropriate if you have a blog or participate on forums of related topics. — SF

References

1. Friedmann-Bette B., Bauer T., Kinscherf R., Vorwald S., Klute K., Bischoff D., et al. “Effects of strength training with eccentric overload on muscle adaptation in male athletes.” European Journal of Applied Physiology. 2010;108(4):821–836.

2. Anderson J. and Aagard P. “Effects of strength training on muscle fiber types and size; consequences for athletes training for high-intensity sport.” Scandinavian Journal of Medicine & Science in Sports. 2010; 20(Suppl. 2):32–38.

3. Roig M., O’Brien K., Kirk G., et al. “The effects of eccentric versus concentric resistance training on muscle strength and mass in healthy adults: a systematic review with meta-analysis.” British Journal of Sports Medicine. 2009;43:556–568.< 4. Jorgensen K. “Force-velocity relationship in human elbow flexors and extensors.” Int Ser. on Biomechanics. 1976;1:145–151.

5. Aagaard P. “Training-induced changes in neural function.” Exercise and Sport Science Reviews. 2003;31(2):61–67.

6. Nardone A. and Schieppati M. “Selective recruitment of high threshold human motor units during voluntary isotonic lengthening of active muscles.” Journal of Physiology. 1989;409:451–471.

7. Timmins R.G., Bourne M.N., Shield A.J., et al. “Short biceps femoris fascicles and eccentric knee flexor weakness increase the risk of hamstring injury in elite football (soccer): a prospective cohort study.” British Journal of Sports Medicine. 2015 Dec 16.

8. Blazevich A.J., Cannavan D., Coleman D.R., et al. “Influence of concentric and eccentric resistance training on architectural adaptation in human quadriceps muscles.” Journal of Applied Physiology. (1985). 2007;103(5):1565–1575.

9. Douglas, J., Pearson, S., Ross, A., and McGuigan, M. “Chronic adaptations to eccentric training: a systematic review.” Sport Medicine. 2016;47(5):1–25.

10. Abe T., Kumagai K., Brechue W.F. “Fascicle length of leg muscles is greater in sprinters than distance runners.” Medicine & Science in Sports & Exercise. 2000;32(6):1125–1129.

Faced with the constant challenge of training fatigued young athletes whose competitive schedules are already jam-packed with sport practices and games, the daily training regimen at our facility is comprised of a combination of development, recovery, and rehabilitation exercises. Train the way you compete serves as the motto at Murray Athletic Development (MAD). And while this mindset is the driving force behind our culture, we also need to adapt to the demands placed on our athletes.

Our athletes compete hard, and we want them to bring that same fire to their training sessions. But our athletes also compete a ton, which is not always a quality we want to mirror in their training. Though we have worked extensively with professional athletes from all walks of life and still assist with the annual NBA and NCAA Basketball Combines, much of our current work is focused on youth athletes hoping to make and excel on their high school and club teams with an ultimate goal of playing in college.

Although the sources of their demands may differ from pro athletes, the challenges these youngsters face are very much the same: maximize ability, maintain health, and excel in performance, all while balancing an exceptionally busy and hectic lifestyle.

To battle the demands of the modern-day youth athlete, one tool we use is blood flow restriction training (BFR) in the form of B Strong Training Systems. Whether for rehabilitation, training, or recovery needs, B Strong has been easy, fast, and impactful.

How to Incorporate the B Strong Blood Flow Restriction System in Team and Group Training

In my opinion, the only way to truly make BFR training widely available to the public is to make it safe and effective, but most of all, simple and easy to set up and use. If it’s not quick and easy, it won’t work in a group setting, and group/team-based strengthening is where we see the big win for BFR with B Strong and why we spent months of development solving this problem.—Sean Whalen, CEO, Co-Founder, and Co-Developer B Strong

Blood flow restriction training helps our youth athletes attain adaptations without high-intensity resistance training. Share on X

Our youth athletes, like many others around the country, are typically overskilled and undertrained. Because these kids no longer have rest periods between club and school sports, we are getting athletes who are way overstressed. The B Strong Training System helps us address this issue by providing a method to achieve physiological adaptations without high-intensity resistance training.

Based on the growing body of scientific evidence, as well as our own anecdotal training evidence, we at MAD use B Strong extensively with consistent success. We use it for three key purposes:

1. For pre-workout preparation before a weight training session
2. As a post-rehabilitation modality as part of a therapy regimen
3. As an invaluable recovery tool conducting sessions between intense training days and competitions

For all of these applications, we follow a straightforward program:

• 6-8 minute duration
• High pressure, both upper and lower extremities
• Multi-joint compound movements to failure

Our B Strong BFR training approach is simple: it’s brief, it’s high pressure, and it’s multi-limb. We’ll do this before a weight training session as a warm-up or for recovery in between training days. For recovery, we use our BFR protocol with light trunk training, core stability and mobility exercises, and end with a yoga-based stretch.

Programming a Recovery Session with B Strong

In this post, we’ll touch on the basic points of programming a recovery session with B Strong and will follow up later with an entire article on the subject.

Key questions when addressing a recovery program are:

When. Off-season, pre-season, or in-season? We’ve found B Strong’s user-friendly components—easy to put on, set up, and clean—so convenient that we can incorporate a recovery session at any time during a full training macrocycle: at the end of an off-season training week, after a long tough pre-season practice, or on an off day during an intense in-season schedule. When we sense our athletes can benefit from a B Strong recovery session, we do it.

Who. Individuals or teams? Single-player sessions are simple to conduct, while larger athlete groups do pose some logistical challenges. Equipment is key—the more B Strong systems, the larger the group we can handle at one time. We also can circuit our recovery groups. For example, we’ll have one group of athletes conduct their session, which takes 15 minutes from beginning to end. The remaining athletes will do their light trunk routine. At the end of the first 15-minute session, the two groups will switch.

What. As described above, our recovery program is basic, focusing on a 6-8 minute duration, high pressure on upper and lower extremities, and multi-joint compound movements. We use 3 sets of 20 reps with a 20-second recovery between each set. Our athletes perform calf raises, grip squeezes, squat to an arm curl, push-ups (type depends on your athletes’ skill level), and an A March. Simple, fundamental movements.

Our athletes do all of these exercises using only their body weight. The key is the belt pressure. When put on safely and correctly, the intensity of the belt pressure will pose a tremendous challenge and have an amazing beneficial impact.

 

Monitoring B Strong Training: MAD Health Survey

We monitor the B Strong sessions with our subjective questionnaire, the MAD Health Survey. Sleep, hydration, nutrition, subjective RPE, and feeling of recovery are all monitored. Our athletes always report feeling much better following a B Strong session, regardless of when they use it.

Our MAD Health Survey serves a dual purpose. One, we get feedback directly from our athletes. Their answers provide insights into how they’re feeling, how they’re functioning, and how well they’re taking care of themselves.

Their answers also support the second purpose of our survey: dynamic program adjustments. Athlete communication is key to learning how they actually feel and is hugely important to guide the training process.

For example, if an athlete reports feeling tired and their answers on their sleep questions reveal that they’re getting less than 8-10 hours of sleep, we’ll cut back on their training volume for a day or two. Occasionally, when we learn that an athlete has been especially busy with school demands and had a few long nights of studying, we’ll give them a day off and send them home.

Over the past five years of using BFR (and the past three years using the B Strong Training System), we’ve kept thousands of athletes (from youth to professional) healthy and greatly improved their performances. Just like a standard training program, consistency is key. We aim for at least two B Strong sessions per week coupled with a full 2- to 4-day weight training split (depending on athlete training age and season).

Key Physiological Processes in BFR Training

The beauty of B Strong’s BFR Training System is that it’s simple to use while providing profound physiological benefits—benefits unattainable from a program that does not use BFR.

This section will address how BFR training actually works. First and foremost is the importance of properly fitting the belts to the upper arm and legs, making sure the belts are extremely snug on one’s skin. Once fitted correctly, the belts must be pumped up to an appropriate pressure. This is very subjective. Everyone is different. The key is the level of pressure an athlete can safely handle—safe intensity is imperative. The greater the pressure, the better the results. The beauty of B Strong: it’s virtually impossible to occlude wearing their belts.

Next is training. During low-intensity resistance exercises, type I fibers are immediately fatigued, and the recruitment of type IIx fibers begins, which follows with an immense increase of lactic acid. This increase of lactate then stimulates receptors in the muscle and leads to elevated levels of growth hormone, adrenaline, and anabolic hormones.

Metabolic Stress

• • Type IIx muscle fibers use The Cori Cycle for energy. Lactic acid is the key metabolite responsible for a host of anabolic signaling pathways, including the activation of mTORC1. It also inhibits the negative muscle anabolic pathways, such as myostatin.

 

• • Lactate raises systemic growth hormone, providing additional superstructure to tendons, ligaments, bone, and muscle.

 

• • Growth hormone increase: as a huge direct benefit from the increased lactate, the pituitary gland upregulates the formation of endogenous growth hormone. Growth hormone is associated with bone, muscle, and other tissue growth and repair; increased fat mobilization and metabolism; blood sugar control; muscle protein synthesis; and immune function.

 

• Myogenic stem cells: IGF-1 induces hyperplasia through the fusion of satellite cells to muscle fibers, which is thought to play a role in the donation of additional myonuclei to a muscle cell. This is accompanied by substantial muscle contractile protein synthesis, increasing muscle size and strength.

Mechanism

• Slow-twitch muscle fibers are activated soon after modified blood flow begins.
• When venous blood flow is modified, oxygen runs short in the early stages of restriction and instantly fatigues type 1 muscle fibers. This modified blood flow mimics an anaerobic environment in the limbs, which is comparable to the effects of exercise at maximal intensity.
• Due to the lack of oxygen within the limb, type IIx muscle fibers are activated.
• This leads to simultaneous stress on both type I and type IIx.
• When all the multiple working muscles are fatigued in the early stages, lactic acid is produced in a large volume.
• Lactic acid stimulates receptors in the muscles that result in signals sent to the pituitary gland, resulting in the secretion of a significant amount of growth hormone.

Benefits

• The buildup of waste products from energy production results in enhanced muscle growth and hormonal benefits, including elevated growth hormone levels.
• Growth hormone levels go up, which helps athletes recover faster between training sessions.
• The B Strong Training System is the safest and most effective BFR training method and has been shown not to occlude blood flow fully when used according to instructions.

Conclusion

From kids to pros, modern-day athletes are competing at extremely high levels while having to navigate the many challenges that confront them in today’s society. Sport participation has taken on a life of its own, making huge demands on its participants at younger and younger ages.

Long gone are the simple days of neighborhood pickup games with friends. Now, youth athletic activities are dominated by club teams and an obsession with optimizing college opportunities. Overstressed, overskilled kids are constantly pushed to handle extreme demands that today’s sports participation imposes.

As strength coaches and sports medicine providers, our task grows ever more daunting. Regardless, our goals will always remain the same: to maximize our athletes’ health and enhance their performance.

Fortunately, BFR Training and specifically the B Strong Training System provide invaluable tools to accomplish this. Whether for rehab, training, or recovery, B Strong brings amazing physiological benefits and should be part of every athlete’s arsenal.

Since you’re here…
…we have a small favor to ask. More people are reading SimpliFaster than ever, and each week we bring you compelling content from coaches, sport scientists, and physiotherapists who are devoted to building better athletes. Please take a moment to share the articles on social media, engage the authors with questions and comments below, and link to articles when appropriate if you have a blog or participate on forums of related topics. — SF

Originally from San Francisco, CA a graduate from San Jose State University with a B.S. in Kinesiology, Eric Bringas received his M.S. in Applied Exercise Physiology from Concordia University Chicago. While completing his Capstone, Bringas was involved in many academic projects that focused on Blood Flow Restriction training. In conjunction with his academic endeavors, while working at Arthur J. Ting, M.D. Orthopaedic Surgery & Sports Medicine Center, Bringas worked as an Head Exercise Physiology Specialists to the Directors of Rehabilitation John Murray and Dr. Ting. Dr. Ting’s Surgery & Sports Medicine Center was one of the first programs to incorporate Blood Flow Restriction Training.

Eric’s career in Strength & Conditioning began in 2010 at the Riekes Center, after completion of his internship, and still in college Eric transitioned to a Strength & Conditioning Coach. At the Riekes Center, (Menlo Atherton, CA) Eric coached a great variety of athletes at all levels of competition ranging from youth, high school, college, professional, and Paralympic ranks.

In 2013, Eric began his tenure as a Head Athletic Performance Coach and facility manager with Revolution Athletic Performance and Sports Health Science in Alameda, CA. At Revolution Sports Eric coached Collegiate, NBA, and NFL athletes, he also lead many team-training programs for numerous high school football and volleyball teams. As part of his leadership with the high school programs, Eric and his staff provided professional style combines with conjunction with BAM (Basic Athletic Measurement) that provided athletic performance assessments and health screenings.

Injuries are inevitable in sport. Athletes may lose weeks, months, or even years of playing based on the severity of an injury. In some drastic cases, injuries may even force early retirement. Both athletes and organizations potentially lose significant value over time due to injuries. Athletes may lose out on lucrative contract extensions or even on contracts altogether. Sport organizations are no different. In the short term, organizations get no return on their investment when the athlete is sidelined. In the long run, they may lose money on their investment due to reduced trade or sale value.

Lately, I’ve been seeing more and more cases of chronic tendinopathy keeping players away from their sport. This might be because this is actually becoming a more frequent issue and injury, possibly because of increased diagnosis from medical professionals due to more understanding of and research on the subject, or it may just be me now noticing how many cases of this type of injury there actually are. If tendinopathies are becoming a more frequent diagnosis among athletes, it begs the question of whether we’re still in the dark ages when it comes to various tendinopathies, a tendon’s role in performance, and the systems-based approach behind the rehabilitation of tendons.

If tendinopathies are a more frequent diagnosis, it begs the question of whether we’re still in the dark ages when it comes to the systems-based approach behind the rehabilitation of tendons. Share on X

Tendons connect muscle to bone and are responsible for storing and releasing energy. A tendon can be thought of as a steel spring, in that the faster and higher a degree of stretch the steel spring experiences, the more energy it will release. Like many other structures in the body, tendons also have a load capacity. The patellar tendon is not unlike other tendons in that it also has a capacity for load that is individual to the athlete.

After loading the tendon with activities such as jumping, sprinting, and changing direction, the tendon is at a reduced capacity. In a normal tendon, remodeling will occur, and the tendon will return back to full capacity (and potentially to greater capacity) as long as the stress does not greatly exceed the tendon’s current capacity. When we place stress on the tendon far beyond the tendon’s current capacity, either through a large single session stimulus or cumulative stress from multi-session stimuli without sufficient recovery, it creates a change in the tendon’s properties that prohibits it from returning to its normal state. This is generally known as the reactive state or the state of disrepair, as seen in figure 1.

In this reactive or disrepair state, tenocytes—cells located within the tendon that assist in collagen type I synthesis—no longer function normally.^2,3 This collagen is critical to the tendon, as it largely dictates the structure and strength of the tendon since it makes up nearly 80% of the dry mass of the tendon⁴. Without proper tenocyte function and collagen synthesis, the tendon’s capacity may be reduced. The further the tendon goes into the disrepair state and the longer it stays there, the harder it may be to bring the tendon back to a pain-free or normal state.

The further the tendon goes into the disrepair state and the longer it stays there, the harder it may be to bring the tendon back to a pain-free or normal state, says @john_r_grace. Share on X

There has been some notable time missed due to injuries related to tendinopathy and suspected tendinopathy. Patellar tendinopathy is not only present in jumpers, although this injury is sometimes referred to as “jumper’s knee.” It can also be present in any sport that consistently requires the athlete to load the tendon with high forces with insufficient time for the tendon to remodel. A few recent examples of this are:

• Earlier this year, U.S Men’s National Team goalkeeper Zack Steffen missed games due to patellar tendinopathy.
• Patriots receiver Julian Edelman’s current knee injury is speculated to be patellar tendinopathy or a patellar tendon tear that stemmed from tendinopathy.
• LA Clippers superstar Kawhi Leonard has been dealing with ongoing patellar tendinopathy, which has forced the Clippers to rest him significantly this season.

Tendinopathy can be a crushing blow to an athlete. Depending on the severity of the tendinopathy, athletes may lose considerable time because of pain and injury. Additionally, at times the tendon can continue to degrade, potentially causing a tear or rupture that may force retirement from the sport altogether.

Some injuries are arguably more controllable than others. Tendinopathies are one of those injuries that, if managed well, can almost become a non-issue. If managed poorly, they can turn into multimillion-dollar disasters. Many times, tears and ruptures occur because of degradation of the tendon over time. Malliaras et al. mentions that a tendon rupture in absence of systemic disease is rare.⁵ With this in mind, we could conclude that some, if not many, tendon tears and ruptures could be avoided if managed well early in the process.

We have a player who has had ongoing patellar tendinopathy for the previous few seasons. It got progressively worse over this past season—so much so that he had to change his kicking technique to be able to tolerate the pain. Since it wasn’t really an option to take the time needed during the season, we decided to work on it this off-season. The following is the general plan we used based on concepts from the current research on patellar tendinopathy and speaking with other coaches like John Evans, who has worked with many athletes with various tendinopathies.

Stage 1: Rest

Duration: 14 days

Rest sometimes gets criticized in the performance realm because the thought is that if you’re injured, you can and should always do something. While I agree with this sentiment most of the time, in this case he came off of a nine-month season with increasing pain in the patella tendon in the last two months of the season. Two weeks off would most likely do more good than harm, in this case.

If you find you don’t have the luxury of time, you could very well forego resting and move right into Stage 2, especially if you’re in-season, and a timeline for return is important. For us, resting was beneficial from a mental and physical standpoint.

Stage 2: Load the spring with no change in length

Duration: 14 days

Weight room: 6 sessions (isometrics were also performed every day)

Goalkeeper-specific: 6 sessions (paired on same day as weight room)

Focus: Reduction of pain, structural changes, low load tolerance

Restrictions: No energy storage and release activities in goalkeeper-specific training.

Isometric exercises are characterized by creating tension with no change in length to the musculotendon unit. Isometrics have been getting a lot of attention lately for their ability to reduce pain in patellar tendinopathy. Rio et al. showed that isometric exercise was more effective than isotonic exercise at reducing pain post respective exercise.⁶ Out of the six participants in the isometric group, all six athletes’ pain levels dropped to either 1 or 0 immediately after exercise and remained at low pain levels for 45 minutes after the exercise intervention. This was not the case for the isotonic exercise group.

Another benefit of isometrics is that they’ve been shown to increase strength by nearly 20% post-exercise.⁶ This could potentially be due to the reduced pain experienced and/or higher motor unit activation after the isometric exercise is completed.

The characteristics that make isometrics good for managing pain during competition periods (reduced pain and increased strength) also make the exercise a prime choice for the early stage rehab of patellar tendinopathy. Since the load on the tendon is quite low, we performed isometrics frequently. This was, in theory, to allow the tendon to be able to better accept load later on in the process and also to start to attack visible atrophy that had occurred over the course of the last couple of seasons.

The characteristics that make isometrics good for managing pain during competition periods also make them a prime choice for early stage rehab of patellar tendinopathy, says @john_r_grace. Share on X

After the first two weeks, we had 24-hour post-exercise ratings of 0–1 and the very occasional 2 (pain-free to relatively pain-free).

While we accomplished the goal for this phase of the tendon to remain relatively pain-free, this is only the initial goal. We had a long way to go for the tendon to be able to tolerate basic stretch-shortening cycle (SSC) type loading, which is the bulk of what this athlete will see when he returns to sport. The idea of being pain-free is great, but it’s not that useful when it comes at the expense of reduced performance. On top of potentially reduced performance, if the tendon returns to a pain-free state and the athlete returns to full training from this stage, the tendon will most likely return back to square one in the reactive stage because the underlying capacity of the tendon has most likely remained unchanged.

Stage 3: Load the spring with slow changes in length

Duration: 17 days

Weight room: 7 sessions (continue to perform isometrics on off days)

Goalkeeper-specific: 7 sessions (paired on same day as weight room)

Focus: Strength, hypertrophy, higher load tolerance

Restrictions: No energy storage and release activities in goalkeeper-specific training.

Due to previous research^7–9, various eccentric exercises have been long thought of as the answer to patellar tendinopathy, and practitioners sometimes view this as the place to begin with this injury. While eccentric exercises can be part of the answer, depending on the severity of the tendinopathy, even slow eccentrics may be too aggressive for some cases. This is the reason this was not our first stage of rehabilitation.

While eccentric exercises can be part of the answer, depending on the severity of the tendinopathy, even slow eccentrics may be too aggressive for some cases, says @john_r_grace. Share on X

In this stage, we want to not only perform the eccentric muscle action, but the concentric action of the exercise as well. When we performed traditional strength exercises, we wanted to implement them in a way that limits the involvement of the SSC as much as possible. Strength training in the traditional sense (squatting, lunging, etc.) does not rely on the SSC to a great degree, but in some exercises you may see an athlete use the SSC to lift more weight or move a weight faster (for example “bouncing” out of a squat).

We structured our weight room work in this stage largely around squatting. It’s important to understand that the stimulus in this stage could most likely come from many lower body strength activities (keeping in mind the degree of knee flexion that is tolerable for the athlete at this time). It’s more the concept of the progressive load we’re attempting to provide to the tendon than the exercise itself, though squatting lends itself well to goalkeepers in that it is a nice prerequisite for high levels of force production in bilateral jumping activities.

Another reason squatting was a good fit in this case is that, according to the athlete, he has not been able to squat pain-free in more than two years. Performing this exercise pain-free for the first time in a few seasons helped him see the light at the end of the tunnel and allowed him to have more confidence in the current progression.

Initially, we chose to squat to a box slightly above parallel so as to put the knee in squatting angles that were tolerable for the tendon, but also to take away any real chance of using the SSC as most proficient squatters do. After some comfort was reestablished with the movement a few sessions in, we dropped the box a few inches to a parallel squat with similar execution to the movement. We progressed in a relatively linear fashion to a 1.4–1.5x bodyweight squat.

Within this stage, pain was consistently nonexistent, and daily activities like longer car rides and walking downstairs—activities that were once bothersome—were no longer even a thought in his mind. This is a win because we now have more confidence that we’ve moved the needle on the tendon’s capacity.

Stage 4: Load the spring with fast changes in length

Duration: 31 days (and counting)

Weight room: 14 sessions

Goalkeeper-specific: 20 sessions

Focus: Energy storage and release tolerance

Restrictions: Minimal jumping/long kicking on field for first two weeks. After first two weeks, progress to unaltered jumping and long kicking.

To preface, we are currently working through this stage and will continue to work in this stage for some time, since this stage essentially morphs into a maintenance stage where our goal is to continue to develop and maintain capacity. Since the tendon’s role is to store and release energy, this is the most important stage to get right. As I said earlier, pain-free doesn’t matter unless we can achieve performance equal to or beyond what was previously established.

The early focus in this stage was on being able to tolerate relatively faster eccentric loading to the patellar tendon. We performed depth drops once a week, pairing this day with the most intense day on the field. Along with this, we performed stage 2 and stage 3 exercises within the week as well.

The athlete performed depth drops at a moderate height relative to his capabilities, and we progressed intensity over a few weeks. Once drop height roughly reached the athlete’s maximum jump height, we progressed to depth jumps and added a second day of jumping with loaded discrete CMJs. On those intense days we also continued to maintain stage 2 exercises. At this point in the process we had two relatively intense days and one relatively lighter day in the weight room, and we will continue this schedule assuming everything goes well.

In the goalkeeper training on field, we pulled off all major restrictions. We’ve progressed to kicking ~20 goal kicks in a session once a week. While he does still have a very slight amount of discomfort with this volume, that discomfort dissipates by the next morning, which is one of the hallmark characteristics of a “stable” tendon.⁵ In theory, stressing the tendon in such a way that it recovers normally should continually increase the tendon capacity over time as tendon remodeling is a continuous process that is more efficient in tendons exposed to high stress.¹⁰

In theory, stressing the tendon in such a way that it recovers normally should continually increase the tendon capacity over time, says @john_r_grace. Share on X

Ideally, if things go as planned with no major setbacks, our location on the rehab-performance continuum will continue toward a greater focus on improving global capacities and performance and continue to move slightly away from rehabilitation. With regard to progressing plyometric intensities and volumes, we’d like to move toward loaded continuous CMJs (~20–30% athlete back squat maximum) and hurdle hop types of activities while maintaining the lower body strength work. On the field, we expect the tendon tolerance to be high enough to sustain five training sessions per week, which may require 2–3 of those sessions to be very intense to closely match the type of training the athlete would see in a pre-season setting.

Further Considerations in Managing Tendinopathy

In addition to what I’ve already discussed, there are other influences on patellar tendinopathy pain and management.

Pharmaceutical and Over-the-Counter Drugs

The use of anti-inflammatories and pain meds may create an environment where the tendon pain decreases but the capacity and ability for the tendon to accept load remains unchanged. In this case, the tendon may continue to degrade over time with no symptoms, which may lead to tears and ruptures.

On top of this, opinion has moved away from inflammation being part of the tendinopathy process.¹¹ Other than for potential pain management, there might not actually be any need for NSAIDs or other medication to begin with.

With regard to this athlete, he only used anti-inflammatory and pain drugs on a few very rare occasions during the in-season to combat pain associated with the tendinopathy. Luckily, this athlete did not want to rely on these types of pharmaceuticals to get him through the season. He didn’t use prescription or over-the-counter drugs during this off-season training plan.

Supplementation

Collagen peptide supplementation has been proposed to assist in rehabilitation of tendon-related issues as participants responded positively to pain and performance-related markers.¹² Along with this, vitamin C has also shown promise in the ability to enhance collagen synthesis.¹³ Our registered dietician on staff recommends taking these two supplements together for optimal uptake.

The athlete took collagen and vitamin C either pre-field training or pre-weight-room training. While I did not control the dosage or administer the supplements, the athlete made his own supplement drink prior to training based on previous education with a registered dietician.

Rehabilitation Is Personal

This realm, as with many, has a long way to go for full understanding of the topic, but researchers such as Jill Cook, Ebony Rio, and their colleagues are putting out some tremendous work that is practical and actionable in many sport settings. While the setup outlined above has worked for us up to this point, the time of year, the athlete’s previous training history, and the severity of their tendinopathy may dictate how much time you will need to spend on exercise selections and volume/intensity progressions in each stage.

Since you’re here…
…we have a small favor to ask. More people are reading SimpliFaster than ever, and each week we bring you compelling content from coaches, sport scientists, and physiotherapists who are devoted to building better athletes. Please take a moment to share the articles on social media, engage the authors with questions and comments below, and link to articles when appropriate if you have a blog or participate on forums of related topics. — SF

References

1. Rudavsky, Aliza, and Jill Cook. “Physiotherapy Management of Patellar Tendinopathy (Jumper’s Knee).” Journal of Physiotherapy. 60, no. 3 (September 2014): 122–29.

2. Huisman, Elise, Alex Lu, Robert G McCormack, and Alex Scott. “Enhanced Collagen Type I Synthesis by Human Tenocytes Subjected to Periodic in Vitro Mechanical Stimulation.” BMC Musculoskeletal Disorders. 15, no. 1 (December 2014): 386. https://doi.org/10.1186/1471-2474-15-386.

3. Cook, J L, E Rio, C R Purdam, and S I Docking. “Revisiting the Continuum Model of Tendon Pathology: What Is Its Merit in Clinical Practice and Research?” British Journal of Sports Medicine. 50, no. 19 (October 2016): 1187–91. https://doi.org/10.1136/bjsports-2015-095422.

4. Kannus, P. “Structure of the Tendon Connective Tissue.” Scandinavian Journal of Medicine & Science in Sports. 10, no. 9. (July 2000): 312.

5. Malliaras, Peter, Jill Cook, Craig Purdam, and Ebonie Rio. “Patellar Tendinopathy: Clinical Diagnosis, Load Management, and Advice for Challenging Case Presentations.” Journal of Orthopaedic & Sports Physical Therapy 45, no. 11 (November 2015): 887–98.

6. Rio, Ebonie, Dawson Kidgell, Craig Purdam, Jamie Gaida, G Lorimer Moseley, Alan J Pearce, and Jill Cook. “Isometric Exercise Induces Analgesia and Reduces Inhibition in Patellar Tendinopathy.” British Journal of Sports Medicine. 49, no. 19 (October 2015): 1277–83.

7. Rutland, Marsha, Dennis O’Connell, Jean-Michel Brismée, Phil Sizer, Gail Apte, and Janelle O’Connell. “Evidence-Supported Rehabilitation of Patellar Tendinopathy,” n.d., 14.

8. Purdam, C R. “A Pilot Study of the Eccentric Decline Squat in the Management of Painful Chronic Patellar Tendinopathy.” British Journal of Sports Medicine. 38, no. 4 (August 1, 2004): 395–97.

9. Young, M A. “Eccentric Decline Squat Protocol Offers Superior Results at 12 Months Compared with Traditional Eccentric Protocol for Patellar Tendinopathy in Volleyball Players.” British Journal of Sports Medicine. 39, no. 2 (February 1, 2005): 102–5.

10. Zabrzyński, Jan, Agnieszka Zabrzyńska, and Dariusz Grzanka. “Tendinopathy – a Disease of Tendons.” n.d., 8.

11. Rees, J. D., A. M. Wilson, and R. L. Wolman. “Current Concepts in the Management of Tendon Disorders.” Rheumatology. 45, no. 5 (May 1, 2006): 508–21.

12. Praet, Stephan F.E., Craig R. Purdam, Marijke Welvaert, Nicole Vlahovich, Gregg Lovell, Louise M. Burke, Jamie E. Gaida, Silvia Manzanero, David Hughes, and Gordon Waddington. “Oral Supplementation of Specific Collagen Peptides Combined with Calf-Strengthening Exercises Enhances Function and Reduces Pain in Achilles Tendinopathy Patients.” Nutrients. 11, no. 1 (January 2, 2019): 76.

13.DePhillipo, Nicholas N., Zachary S. Aman, Mitchell I. Kennedy, J.P. Begley, Gilbert Moatshe, and Robert F. LaPrade. “Efficacy of Vitamin C Supplementation on Collagen Synthesis and Oxidative Stress After Musculoskeletal Injuries: A Systematic Review.” Orthopaedic Journal of Sports Medicine. 6, no. 10 (October 2018): 232596711880454.

“It becomes more important to understand the strategy of the game before the game takes place. That can only be done with film work, constant study, and attention to detail.”

–Kobe Bryant, in his new series, “Detail”

If you ask any high-performing professional athlete or sport coach to discuss the most consistent practices through each phase of their career, you will undoubtedly hear two words on repeat: film study. No matter the sport or era, most elite performers in history are on record giving praise to film study and the many benefits it brought them in their playing or coaching days.

No matter the sport or era, most elite performers in history are on record giving praise to film study and the many benefits it brought them in their playing or coaching days, says @JustinOchoa317. Share on X

Two of my favorite athletes growing up, Peyton Manning and Kobe Bryant, both have their own film breakdown shows on various networks now, which drives this point home even further.

Studying the game is a prerequisite if you want to truly master your craft. With the ever-growing popularity of technology in sports and the expanded resources available, this should be one of the most non-negotiable methods of improvement for every single coach and athlete at the high school level and above.

The Shrinking Gap

As you advance in levels of play, such as from high school to college, the gap between talent gets much smaller. As that gap gets smaller, athletes and coaches must find ways to separate themselves or their teams.

When taking it to the next level, from college to professional, that small gap between talent gets even tighter. There’s less room for error. There’s more need for separation from your competition.

Over the past few years, I’ve found unique ways to connect with many sport coaches to give them a strength and conditioning coach’s perspective on what I see. Team sports go beyond offensive and defensive play-calling. There is a lot of movement to study, and that is what a strength and conditioning coach specializes in.

Don’t get me wrong: Being big, fast, and strong is never a bad idea…but what if everyone else if big, fast, and strong too? Get smarter. Be more prepared. Fight the mental battle so you can pull away from the competition.

Weight Room to Film Room

Of course, team-wide and personal film study sessions are a phenomenal way to gain the edge, but what can the strength coach do to help the team in this realm?

Actually…a lot.

From a pure movement perspective, we are the experts in analysis. We have valuable intel from years in the trenches that can help our sport coaches and our athletes gain a competitive edge. We may not know every X and O of the sport, but we know great movement and how to achieve and improve it, as well as how to reduce injury likelihood. All of these things can help both the team and the individuals involved.

Following are some great ways you can get in on film sessions and offer some helpful insight. This includes looking at compensation drivers, center of mass, body language, and biomechanics.

Compensation Drivers

Through my experience with Reflexive Performance Reset (RPR), I’ve adopted a key term from Chris Korfist: “compensation driver.” Every human has compensation patterns in their movement, and something drives those compensation patterns. By finding out what that something is, you can then assess and correct the pattern.

For instance, if your hip flexors’ (psoas) function and strength is suboptimal, you may be compensating with your quad. Or your jaw (clenching). Or your fist (also clenching). Maybe it’s a combination of things, but something along the kinetic chain will assist your body in movement when the muscles being targeted cannot perform. This goes for weight room and competition as well. (See here for context of an “arm driver” when it comes to psoas strength.)

These compensation drivers work because they provide us with a sense of stability, strength, or general comfort. This is really important to know, because now you can identify compensatory movements and habits on film.

Most recently, someone caught onto the trend of Lamar Jackson wiping his hands on his towel before every designed pass play. When it was a designed run, he did not wipe his hands. Unfortunately, the mass media caught wind of this and blew it up, so it’s probably no longer of use for defenses. But, in general, subconsciously wiping his hands gave Jackson comfort when he knew he was going to have to throw the ball.

I recently watched basketball film with one of our athletes and noticed the star player on the other team constantly adjusted his arm sleeve. Not just once or twice, but at almost every single break in the action. Obviously, the player really likes that sleeve to fit and feel a certain way—it makes him feel comfortable.

As a defender, you can disrupt that. Throughout the game, our athlete subtly messed with the other player’s arm sleeve. Nothing crazy or malicious, of course. But the two constantly bumped, rubbed, and came into contact with each other, so a little tug on the sleeve here and there was free game.

On multiple occasions, that player adjusted his arm sleeve during play. Twice, he adjusted it as the ball was being passed to him, which threw off his rhythm for a potential catch-and-shoot situation. Once, he adjusted it as the ball was being passed to him and it caused him to bobble the catch, which created a turnover.

This valuable insight was ALL from watching film and taking a chance at thinking outside the box.

Some of things coaches can look for on film include:

• Arm action in sprints: Clenched fists? If you play a contact sport, beat up those hands throughout the game and see if you can break up the athlete’s comfort level.
• Shallow mouth breathing: If you notice on film or within the game that someone is a poor breather, expose that by making them do extra work. Never stop moving, extend plays, do anything you can to keep them heavily and poorly breathing. This will shatter their movement patterns.
• Low knees during sprints: Athletes lack knee drive? They may lack hip flexion. Expose them to high-velocity attacks to put them at a disadvantage. They are either tired or slow, or both.

These drivers of compensation can be movement-driven or comfort-driven. Athletes generally leave clues as to what they like and dislike during competition. If you can identify those factors, you may be able to take them away and make the game a little more difficult.

Athletes often leave clues as to what they like/dislike. If you can spot those factors in your opponents, you may be able to take them away and make the game a little more difficult. Share on X

Center of Mass

As a strength coach watching film, you’re more interested in weight distribution, angles, leverages, and management of forces than you are in the playbook.

There is a such thing as a unique-to-sport skill and execution of that skill. However, high-quality movement is universal and can be applied to every sport skill. Some principles of athletics can span across every sport and tactical skill.

One way to get a feel for an athlete’s movement capabilities is to look at how they manipulate their center of mass during competition. For example, in basketball there are two primary defensive close-out methods: both hands high or one hand high and one hand low (high-low). Neither is right or wrong, but as a movement expert, you can explain the non-sport benefits and drawbacks of each method.

In this example, the high hands closeout has some pros and cons. One of the pros is that your athletes don’t have to travel as much distance because the hands-up posture makes them appear closer to the offensive player than they really are. This can cause some hesitation by the ball handler due to the depth perception illusion it creates.

On the flip side, if the offensive player knows this, they can comfortably just shoot over the defender. They know the defense didn’t cover enough ground to contest the shot, and this is not a great position to change directions or jump from. So, if the offensive player doesn’t hesitate to shoot or drive, your defender could be late to recover due to the position they closed out in, as seen in video 1.

In terms of the high-low method, there are both pros and cons here too. The major pro is that defenders are in a much better position to change directions because of the improved control of the center of mass. In video 2 below, you see the defenders maintain great balance, contest the shot and drive simultaneously, and force a quick pass or hesitation from the ball handler.

The major drawback is the defender has to travel more distance on this closeout since the illusion of being close is no longer there. This increases output demands and total workload, which can increase fatigue as the game goes on. This high-low hand closeout could also expose the defender to disadvantageous angles that allow clear driving lines for the ball handler, as shown in video 3. The ball handler attacks the high arm, which causes the defender to make a false step (NOT a plyo step), and he gets blown by.

Of course, these are just a few of the examples we can recognize in the sport of basketball. You can spot these trends across every sport because these aren’t actually sport skills, but movement habits. Now you can serve as another set of eyes on film and communicate what you see to your team for consideration when creating not only opponent-specific game plans, but situational game plans as well.

Some other examples that come to mind are:

• Breaking on a ball as a defensive back.
• Lateral change of direction as a ball carrier.
• Acceleration mechanics in all sports.
• Top-speed mechanics in all sports.
• Hip internal rotation in tennis or baseball swings.

Note: Thank you to Coach Garrett Winegar from Warren Central High School in Indianapolis for allowing me to showcase real game film from his #5 ranked boy’s basketball team.

Body Language

Please take 2 minutes and 38 seconds to listen to this clip by Geno Auriemma. He mentions so many hidden gems relevant to this article, but most of all, at the end he says, “When I watch game film, I’m checking what’s going on on the bench. If somebody is asleep over there, somebody doesn’t care, somebody’s not engaged in the game, they will never get in the game. Ever. And they know that. They know I’m not kidding.”

I think this is one of the biggest bang-for-your-buck coaching methods you can follow. After you get finished breaking down the X’s and O’s of the game, take a look at your own bench. Take a look at what the athletes on the sideline are doing. Study how a player reacts when you get all over them and then walk away. What did they do or say behind your back that you didn’t catch in real time?

Studying the body language trends of your own team can tell you a lot about the culture of the team. As strength coaches, we are a key component of a healthy team environment (or culture, if you will). We judge weight room body language pretty accurately, so we may as well extend this into the real game. We may not be able to make assumptions based on one-time things we see, but if we notice repetitive behavior, it can be a major tip-off for the staff.

Studying your team’s body language trends can tell you a lot about the team’s culture; studying the opponent’s body language can help you identify dysfunction to exploit, says @JustinOchoa317. Share on X

You can also study the opponent’s body language and see if you can identify any dysfunction on their end to potentially expose them. If you’ve got hotheaded players on the opposing team, you can attack and exploit that to your advantage.

Some concerning things to look for within your own locker room or with your opponents include:

• Slumping.
• Blatant avoiding of teammates.
• Arms crossed.
• Fingernail biting.
• Attention away from the action.
• Anger outside of passion for the game.
• Back-talk.
• Non-participation in celebrations, high-fives, etc.
• Joking or talking during huddles, time out, etc.
• Trying to look “cool.”

The intensity of the game may not allow you to see these things in real time, but studying the bench or sideline on film can assist. The eye in the sky never lies.

Biomechanics

Last, but not least, strength coaches can use game film to evaluate simple biomechanics of their athletes. Training can never, ever mimic the chaotic environment of a game or the demands that athletes must meet, so what you see on film may tell a different story compared to how you see an athlete perform in the weight room.

Sports and strength training usually won’t look similar, so don’t overly concern yourself with strength training movement principles that don’t transfer to the game. However, the effects of that strength training should transfer. If you perform squats to develop strength and power in the lower body, but you see an athlete on film who clearly lacks those qualities, you can take it upon yourself to program them accordingly.

Getting the Most Value From Film Study

Watching the movements of your athletes on film can potentially tell you what they lack in terms of transfer of training. This gives you extremely valuable programming insight because you can make micro-adjustments to the program of an athlete who may need a little more of this and a little less of that, or you can simply prescribe some supplemental work tailored to their needs.

The possibilities are endless, and the results are real.

If you want to be a great coach or athlete, you have to be willing to put in the extra work. Actually, scratch that—if you want to be good at anything in life, you have to be willing to work for it. To me, film study is a no-brainer, but what you look for and how you watch the film can differentiate you even more.

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