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In the last few years, breathing techniques have undergone a renaissance in the world of health and human performance. There is no shortage of social media bagpipes belting out what seems like the latest tunes in strength and conditioning. But when a tool as versatile as breath control presents itself, we have no choice but to listen.

Nasal breathing is an incredibly versatile tool that can enhance conditioning outcomes, create focus and resilience in athletes, provide novelty to training, and even serve as an insight into the CNS. Share on X

Nasal breathing is an incredibly versatile tool that can enhance conditioning outcomes, create focus and resilience in athletes, provide novelty to training, and even serve as an insight into the central nervous system. There’s a great deal of back and forth between opinionated coaches (is there any other kind?) on the inter-webs on whether or not you have to nasal breathe to get good performance outcomes in your athletes. As somebody who has been on the front lines of this work for the better part of a decade, let me clear it up right now—you don’t.

But—and this is a SirMixaLot-sized but—you will leave massive low-hanging fruit on the table for athletic development as well as general athlete health if you fail to understand the fundamental realities of this tool. The problem I see with the general way of approaching this topic at large is that it relegates performance to its outputs alone, and in so doing fails to enhance the precision processes.

You will leave massive low-hanging fruit on the table for athletic development as well as general athlete health if you fail to understand the fundamental realities of nasal breathing. Share on X

Furthermore, this kind of shortsightedness fails to ask: what kind of problems can this tool solve and where could it fit in your toolkit? It’s my hope to provide some clarity and give coaches a sound justification for including nasal breathing in their repertoire, as well as clear suggestions on sensible applications that can be used as soon as you finish reading this article.

Health and How the System Works

Human beings have the ability to walk on both our hands and our feet—but if we have to walk a mile, walking on our feet is far more efficient for even the most skilled Cirque du Soleil hand-balancer. This is due to the fact that the anatomy of the foot and low leg has evolved to use ground force reactions to help conserve energy for forward propulsion.

Similarly, both the nose and the mouth are capable of breathing, but the design of the nose is far better equipped to deal with air and offers layers upon layers of benefit. As such, the nose is the primary anatomical tool for ventilation in nearly all endeavors, and if it causes discomfort to do so, that’s not a design flaw of nature, it’s a health problem that requires resolution.

The nose and its functions are a complex and wonderful system of interrelated miracles that neutralize toxins, contribute to pulmonary function, and guide the formation of the face and jaw through pressure modulation. As one would expect in a complex biological system, when things go really right or really wrong, the ripple from the pebble goes far.

The nose is uniquely equipped to deal with incoming air: it has a filtration system that keeps particulate matter out of the lungs. (My wife and daughter think it’s funny that my personal filtration system is turning gray.) We have a system of mucosa and sinuses that are the ramparts against both bacterial and viral infections. The paranasal sinuses and their associated pressure are also uniquely responsible for the development and stability of craniofacial function and appearance, as well as having a direct impact on vestibular function.

The olfactory system also lives here, and besides the obvious job of regulating the senses of taste and smell, the olfactory system has deep ties to memory and other limbic system functions including the differentiation between safety and threat.

Additionally, nasal breathing provides twice the air flow resistance than that of the mouth and increases tidal volume in the lungs. This trains the diaphragm to become stronger and more pliable, which is an important outcome all on its own. The diaphragm plays an important role not just in respiration but in spinal stability through pressure modulation and is often co-indicated in back pain and instability issues. Controlled nasal breathing during work is a great way to get more bang for your buck and force the trunk to self-organize.

The nose is the primary anatomical tool for ventilation in nearly all endeavors and if it causes discomfort to do so, that’s not a design flaw of nature but a health problem that requires resolution. Share on X

Breathing dysfunction is rampant in both non-athletes and athletes alike. Exercise-induced asthma and sleep apnea are found even among the studliest studs. You may be able to compensate your way to high performance, but believe you me, it is not sustainable, and biology will have the last laugh. Over time, respiratory dysfunction overtaxes the cardiovascular system, reduces sleep quality, and overloads other hormonal and organ systems. There probably won’t be a catastrophic disaster, but you’ll die from a thousand cuts.

Baseline health should be the foundation of human performance, and breathing—in particular, nasal breathing—is a crucial and often ignored component of a holistic performance approach.

Carbon Dioxide Tolerance

I would be remiss to write an article on nasal breathing and fail to mention the essential role carbon dioxide tolerance plays in the whole picture. It’s not within the scope of this article to go deep into this topic, so for now a brief overview will do.

Contrary to popular belief, it’s not low oxygen that signals you to breathe—it’s carbon dioxide (CO2). There are very few sensors in human physiology that indicate low oxygen, but there are a ton of sensors for CO2. Why? Due to the very finite tolerance of pH of the human body. Too acidic? Coma, then death. Too alkaline? Coma, then death.

The body has many ways to regulate pH, but the most energy-efficient way is through the breath. Every breath we take is a management of these variables, and it never stops—especially not during exercise. There’s a feedback loop in the arterial systems (specifically the carotid bodies) that monitors pH and is the thermostat for both the volume and frequency with which you breathe.

When metabolic demands (real or perceived) go up, the system up-regulates the energy delivery mechanisms: heart rate and stroke volume, blood pressure, and, of course, breath rate. The rising levels of CO2 in the blood signal the body to breathe more through feedback loops in the autonomic nervous system. This autoregulation is generally a good thing, because as I mentioned earlier, it keeps us from dying.

However, if we use nasal breathing as an appropriately applied constraint, we can effectively improve general autonomic function and simultaneously improve the efficiency of energy metabolism both during and after work.

So, then, the big question is not really is nasal breathing necessary to improve performance? The question, rather, is how can it be intelligently applied to optimize results?

Practical Application

Nasal breathing can be used as a simple constraint in the training room for multiple effects. Practically, it’s an invaluable tool for use during general, low-to-moderate intensity conditioning, especially in aerobic conditioning that has a relatively low skill requirement.

As an example, a U17 rugby team from New Zealand I consulted with was looking for a way to incorporate breath awareness into their players. They’d tried a few different things up to that point, most of which were too complicated for a bunch of teenagers. I suggested the following: they perform their warm-up laps using nasal breathing only for 2-3 days per week. The team found success not just in getting the boys to comply, but also when they found their pre-practice and pre-game readiness went up dramatically.

Introducing nasal breathing in the warm-up is something I recommend to coaches when starting this with athletes, and it’s something I’ve found great success with in the past. Restricting breathing can be a stressor in and of itself and potentially decrease outputs in the short term. Therefore, it’s essential that you don’t start with something the athlete(s) places high value on, and the warm-up is a great place to get buy-in.

This approach should by no means be relegated to the warm-up only, and nasal breathing during general conditioning activities should be a goal over time. That said, if all training is always nasal breathing, it can rob athletes, especially in a team setting, of opportunities to communicate and build camaraderie. Like any tool, understand what it does and use it when and where appropriate.

Return to Play

Another powerful opportunity to integrate this tool is in return to play (RTP) protocols. There are massive, missed opportunities in RTP in general, and this may be one of the most overlooked pieces of low-hanging fruit there is.

Slow, smooth nasal breathing can be a constraint that keeps athletes from willing themselves through rebuilds in order to get back in action faster. The ability to keep the reins on the breath is a clear and direct line of communication with the deepest part of the nervous system. Using a simple parameter like this creates a real-time dialogue between you, the athlete, and their narrative-free response to treatment/training.

Additionally, using controlled nasal breathing at the reintroduction of progressive workloads can serve as an internal restriction on an athlete’s output during the rebuild. It’s kind of like putting a governor on a motor. You don’t get to go faster until you’ve proven that you’re a good driver. As an addendum to that, working hard while nasal breathing feels like hard work. The confidence of an athlete is directly proportional to how well prepared they feel. This tool gives them a challenge to push up against during rehabilitation to keep their mental edge.

Lastly, nasal breathing is a communication of safety to the deepest parts of the nervous system, which is essential in return to play, and nasal breathing constraints can be an amazing force multiplier for coaches and rehab specialists alike.

If I had a dogecoin for every time I saw a therapist or coach employing a “rehab exercise” while the athlete shook, sweated, and hyperventilated, I’d be a virtual billionaire. The a priori job of the nervous system is to protect us. If we cannot reasonably control breath rate while trying to rebuild a movement skill, the human body will by default build compensatory mechanisms and progress will be blunted.

If we cannot reasonably control breath rate while trying to rebuild a movement skill, the human body will by default build compensatory mechanisms and progress will be blunted. Share on X

Placing breath constraints like nasal breathing during movement reeducation is building two-way communication with the central nervous system. On one hand, it provides an opportunity to listen to what the deepest part of the nervous system is telling us about how it’s perceiving the safety of this movement. On the other, we can coax the nervous system into a place of safety by controlling breathing and thus improve the efficacy of our interventions.

Putting It Together

There are some common pitfalls I’ve experienced and observed over the years that I’d like to share in the hope it will speed up your learning curve with this tool.

1. Too much, too fast. Many athletes I’ve worked with who have a hard time sustaining nasal breathing try to maintain the same level of output in spite of the fact that they’ve put a clamp on the exhaust. This can result in wasted training time, sinus damage, and disappointing bewilderment. Work with your physiology, not against it.
2. Pushing through blockage. If you have a nasal blockage, like a deviated septum or rhinitis, don’t try to force your way through or shove some device up your nose to artificially open things up. Go slow and let your body adapt over time. If you have a serious blockage that needs medical attention, go see an ENT stat.

Short-term tip for sinusitis sufferers: during warm-ups, hum on the exhale. Research shows humming can help subdue acute nasal inflammation through the release of nitric oxide.

Training your nasal passages for progressive loading is just like any other physiological system. Introduce dosage intelligently, with a clear idea of what outcomes you’re looking for and some benchmarks along the way.

Training your nasal passages for progressive loading is just like any other physiological system. Introduce dosage intelligently, with a clear idea of desired outcomes and some benchmarks. Share on X

The rabbit hole of breathing for performance is both deep and wide. Beginning with nasal breathing is a safe and effective way to engage with this process and get the biggest bang for your buck. Nasal breathing is a powerful tool that can enhance athlete health and performance at nearly zero cost to coaches or athletes. If applied with even minimal attention, there are myriad benefits.

Why not try it? You’re breathing anyway.

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. Chaitow, Leon. Recognizing and Treating Breathing Pattern Disorders. Pgs. 11–21.

2. Chaitow, Leon. Recognizing and Treating Breathing Pattern Disorders. Pgs. 45–49.

3. Bianchini, AP, Guedes, ZCF, and Vieira, MM. “A study on the relationship between mouth breathing and facial morphological pattern.” Brazilian Journal of Otorhinolaryngology. 2007;73(4):500–505.

4. Maniscalco, M, Sofia, M, Weitzberg, E, et al. “Humming-induced release of nasal nitric oxide for assessment of sinus obstruction in allergic rhinitis: pilot study.” European Journal of Clinical Investigation. 2004;34(8):555-560.

5. Savulich, G, Hezemans, FH, van Ghesel Grothe, S, et al. “Acute anxiety and autonomic arousal induced by CO2 inhalation impairs prefrontal executive functions in healthy humans.” Translational Psychiatry. 2019;9(1):296.

High-quality speed training can happen without running a personal record (PR). You might be thinking, “well, obviously—PRs aren’t going to happen every day.” But, then, why don’t most coaches and athletes have a mindset that reflects this belief? I’ve seen countless coaches and athletes frustrated by sprint times that weren’t PRs, even though the times were very high percentages of that PR.

To truly evaluate progress, maintain athlete buy-in, and fight PR-itis (the belief that anything that is not a PR is a wasted training rep) with Charlie Francis-inspired long-term speed training, hitting 95% or better of your best threshold is an awesome goal. This threshold simply dictates that a sprint rep that’s 95-100% of your athlete’s best is a high-quality training rep and a good speed day, with under 95% being medium intensity and not fast enough to make the changes most speed training is pursuing.

We can all agree the 95% threshold is good for both the mental and physical sides of speed training, says @CoachBigToe. Share on X

We can all agree the 95% threshold is good for both the mental and physical sides of speed training. However, the questions to ask are not “Is 95% a good percentage?” or “Is 95% too high or too low?” Instead, better questions are:

• “What does the 95% threshold look like with real athletes and real data?”
• “How often are athletes under their 95%?”
• “How does this help me do my job better?”

In this article, I’ll take a dive into:

1. How often athletes are actually under 95% of their best.
2. Which data I drew this conclusion from.
3. How this information can help you be a better coach.

Knowing the Threshold

With any sprint test (a Flying 10, a 15-yard timed acceleration, etc.), multiply your athlete’s best time by 1.05 (5% slower or 95% of their best) and that’s their range to be a high-quality speed training rep. For example, if an athlete’s best Flying 10 is 1.13 seconds, their range is from a 1.13 to a 1.19.

This all makes sense in theory, but what does it look like to actually coach with it?

Here is an example of a chart that could be printed out and posted on a wall in your facility wherever you time sprints.

This all makes sense in theory, but what does it look like to actually coach with it? asks @CoachBigToe. Share on X

Methods

Within the TCBoost facility, I had 38 athletes (23 high school, 13 middle school, 2 college) with at least 10 sprint times of Flying 10’s and/or 5-15’s (15-yard acceleration with timing lasers at the 5- and 15-yard lines). During both the Flying 10’s and the 5-15’s, 28 of the 38 athletes had at least 10 entries, giving me a total of 66 series of 10+ sprint times.

The first entry of each series of sprint times did not have a percentage because it set the PR. If an athlete had 10 sprint times, 9 of those had a percentage of the PR associated with it. In total, this gave me a collection of 1,980 sprint times with a percentage to analyze.

Example Below 95%

The athlete below PR’d 5 of their first 9 sessions (not including the first one), but didn’t PR in the last 10 sessions. A situation like this of early success and late plateaus could lead the athlete and coach to lose faith in each other and stop training. However, with the 95% threshold, there’s a new narrative of what progress looks like: 16 of the 19 sessions were fantastic speed days.

What the Numbers Say

On average, my athletes sprinted at 97.84% of their best time. Within each of the 66 series of 10+ sprint times, only 12.98% of the time were my athletes under 95% of their best. It’s important to note that some athletes spent 0.0% of the time under 95%, while some spent 50% of the time under 95%. A few factors among many that could affect sprint times include:

• Outside sports influencing their readiness and performance;
• Athletes being inconsistent with their coordination and output (believe it or not); and
• Emphasis on coaching/cuing and less on full speed.

It’s remarkable to think about the consistently high outputs athletes are capable of even with all those outside factors that could negatively influence performance.

It’s remarkable to think about the consistently high outputs athletes are capable of, says @CoachBigToe. Share on X

Context of the Numbers

These numbers are specific to my athletes, the facility I coach at, the timing lasers we use, and the speed training we do. There are definitely grains of truth in these numbers, but there is a lot more context that needs to be explained.

The sprint times entered were only my athlete’s fastest ones of that day. The athlete could’ve run the first one just above 95% and all other consequent sprints below 95%. If so, that probably would’ve led to a modification of the session.

The faster the athlete and their PR, the smaller their threshold of 95% is. This could penalize faster athletes and reward slower athletes. An athlete with a PR of 1.00 has a 0.05 range, while an athlete with a PR of 1.50 has a 0.08 range. That’s why this is relative using a percentage of their best.

The faster the athlete and their PR, the smaller their threshold of 95% is, says @CoachBigToe. Share on X

Coaching Solutions: Above the 95% Threshold

If your athlete is sprinting at or above the 95% threshold, stay the course. This means the athlete’s mind and body are in a good enough state to do high-quality speed training that day. Additionally, it’s an opportunity to reassure the athlete that their speed development is on the right path.

Coaching Solutions: Below the 95% Threshold

If your athlete is under the 95% threshold—which doesn’t happen as often as you’d think—there is some gray area in deciding what to do next. First, ask how they’re feeling. When incorporating data into your training, the flow should not run directly from data –> decision. Instead, the appropriate way to apply data follows the model of data –> discussion –> decision. Ask some questions and create a conversation to figure out the context of what could be the potential source(s) of the low sprint times.

If your athlete is under the 95% threshold—which doesn’t happen as often as you’d think—there is some gray area in deciding what to do next, says @CoachBigToe. Share on X

If your athlete looked good during their sprint and says their mind and body are feeling good, run another rep to see what happens. They could’ve needed one sprint to finish warming up, been thinking too much about coaching cues, etc.

If your athlete looked slow and the conversation exposed some factors negatively influencing their readiness to train, move on to something else. There are a variety of other ways to develop speed besides all-out timed sprints. An active recovery session could be the most valuable thing you can do for your athlete that day. Pushing forward with direct speed work could do more harm by causing excessive fatigue.

Key Takeaways

It’s incredible to know that in only about 1 out of every 10 speed sessions my athletes might not be ready for a very speed-intensive session. Meaning, an overwhelmingly large majority of the time, it’s a great day for speed training.

An overwhelmingly large majority of the time, it’s a great day for speed training, says @CoachBigToe. Share on X

Knowing that athletes are not under 95% of their best as often as you might think, when it does happen, there are probably big causes negatively influencing their performance. It’s your job to be a detective before the sprints happen. Starting off each session with a simple question or two about how their day was and how ready they are to train starts giving you clues. The clues aren’t necessarily for how good their performance will be, but rather if you should be extra conscious of their first one or two sprints.

If my athlete is under their 95% threshold, I don’t end the session right away or throw my hands up in frustration. All I do is ask how they’re feeling and what’s been going on the last few days. I have my coach’s eye, my athletes know their bodies best, and the 95% threshold is just another tool in the toolbox (yes, I just rolled my eyes as well). Those three things contribute to my decision-making process by opening up discussion.

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

Speed training is a layered, multifaceted process dependent upon a range of factors. Whether linear or multidirectional speed, there are physical, technical, rhythmic, and mental components that will impact success. One piece of this layered process is the strength and stability of the trunk and spine.

When I say the trunk and spine, I refer to the areas of the midsection, lower back, and pelvis. This goes beyond having strong abdominal muscles and needs to be addressed with more than just ground-based ab exercises. Particularly when performing aggressive speed drills that involve high intensities, quick changes of direction, or sudden decelerations, the trunk and spine could be a key limiting factor and potentially even a link leading to an injury down the road.

Strength and stability of the trunk and spine goes beyond having strong abdominal muscles and needs to be addressed with more than just ground-based ab exercises. Share on X

This area needs to be prepared and strengthened with the utmost intent and specificity to not only help the athletes achieve the most out of drills but also to round out their physical capabilities and support injury reduction in any way possible.

When to Implement Trunk and Spine Training

When beginning to integrate trunk and spine training directly into speed sessions, coaches can simply place it within the preparation to help ready the athletes for the session ahead.

Another option would be to utilize the exercises in the session itself and complex or superset them with the speed drills. Doing this could help enhance the drill being performed and make it task-specific at a muscular level. We want to be able to make direct connections with our athletes and have exercises carry over for one another.

Pairing a particular trunk and spine exercise, such as an isometric hold, can help raise the body’s threshold or ability to prevent movement in that particular range, in the hope that it can also carry over when the athlete performs the speed drill again. Additionally, these drills are fantastic to include in a training design because they can be done right outside on the field!

An example would be using a band stabilization exercise to train a specific isometric in between reps of an athlete running sprints (if the coach feels this is appropriate, as each situation is different).           

Simply using the exercise as active recovery between reps is efficient and preferable to having athletes just stand around for their recovery. Yes, they need to rest, and this rest can be several minutes depending on the speed of the athlete and the distance covered, but we also know:

• The perceptions of sports coaches regarding time between reps.
• Parents may not understand this amount of rest in training.
• Total time is a limiting factor.

Also, having a determined, overzealous athlete sit for four minutes can be the most daunting task of the session, no matter how much logic you offer them.

While I will always defend my programs and sessions in a constructive way to those I work for, incorporating the trunk and spine exercises as active recovery is a win for everyone. The exercise isn’t physically taxing enough to hinder their next sprint, is beneficial enough to not waste anyone’s time, and makes a positive impact.

Incorporating trunk and spine exercises as active recovery is a win for everyone. The exercise isn’t physically taxing enough to hinder the athlete’s next sprint and makes a positive impact. Share on X

Band Stabilization Series

There is no limit to band stabilization exercises, as you can perform these exercises in a variety of ways. You can alter the position of the athlete from a kneeling to a split squat position (and everything in between), as well as where the band is anchored to the athlete. Anchoring the band around the waist allows for multiple angles of pull and anchoring the band around a single-sided shoulder allows for forward and backward motion. When going over the shoulder, the athlete will have their arms up and elbows back, making two “L’s” if we were to look down on them. Doing this helps prevent trunk rotation and fires up the upper back.

The band can even be anchored around the leg to attempt to pull the limb into a specific position, forcing the athlete to counterbalance this and work their way out. This is usually only performed in special circumstances, such as with a now-cleared athlete with a previous injury history.

When applying the resistance, I recommend going right up to the point where the athlete feels they will lose the position being held. Pull right up to that line but be careful not to cross it or you will pull the athlete over onto the ground. Going right up to the line will be uncomfortable for that athlete, though, and you may see some breakdown of position; if so, just slightly release some tension or coach them back into position.

Perform each hold for 10-30 seconds, progressing either by moving onto the next position or increasing band tension.

Video 1. Full Kneeling Position

When going from the full kneeling position, the closer the knees are together, the more difficult it is for the athlete. Widening the knees creates a wider base and more stability. 

Video 2. Half-Kneeling Position

Be mindful during the half-kneeling position to keep monitoring the down knee and keep the body symmetrical, as the leg will occasionally rotate in or get into all sorts of positions depending on how much resistance is given. The resistance can be applied to either side with the knee being down.

Video 3. Split Squat Position

The split squat position is by far the most difficult position listed here and can be performed off either side of the leg that is up. Aligning your athletes on a line can help them maintain proper body positioning of the lower body throughout this exercise if needed.

Video 4. Glute Bridge Position

The glute bridge is performed from a stronger position, so athletes can do this movement with more resistance than the others. It can be progressed by using a heavier band or taking it into a single leg stance.

Some other exercises that you can use to blend trunk and spine training into your speed sessions are resisted marches and skips.

Single Arm Band or Sled Walks

You can use a resistance band or light sled to start incorporating more dynamic exercises to challenge the trunk and spine.

I would first recommend performing these exercises with a resistance band as opposed to a sled because you can better manage the resistance added during the exercise and adjust it if needed. You can use a single resistance band or tie a couple of bands together to better distribute resistance slowly. Loop the resistance band around the athlete’s shoulder and apply just enough resistance so the athlete feels challenged and the band is trying to pull them to rotate to that side.

The exercise should be performed forward and backward. Cues for both directions are to focus on walking a straight path, with a slight lean in the direction you walk, while keeping everything in linear alignment: feet, hips, and shoulders, pointed as straight ahead as possible.

The athlete keeps their arms up and pulls their elbows back, making it easy to spot trunk rotation but also get some upper-body stability involved. If this position alone is too much for the athlete, have them simply place their hands behind the head in a prisoner position. This regressed version offers more stability.

Video 5. Band Single Arm Walks—Forward and Backward

Athletes are genuinely surprised how difficult this is if they do it correctly, and a little resistance goes a long way! Once the athlete has progressed to perform the exercise on a sled, I typically start even my strongest and fastest athletes with just 25 pounds loaded on the sled.

When using the sled, it’s easiest to loop the belt or harness of the sled around the shoulder and perform the same way. With the sled, though, the weight is what it is—there is no adjusting during the exercise, so the athlete has to remain stable and must not stop moving.

Video 6. Sled Single Arm Walks—Forward and Backward

Perform these exercises for sets of 20-40 yards, as fatigue begins to quickly affect proper body position.

Another movement to perform with the sled or bands is a drag using a single-arm isometric hold. Using a single arm forces the opposite side to remain stable, so if I’m performing the exercise with the handle in my right hand, my left side needs to contract and lock me in to prevent unnecessary movement.

Video 7. Sled Row Isometric Hold Back Walk

Weighted Offset Marches and Skips

Offset, weighted exercises such as marches and skips blend the weight room with more rhythmic and fluid drills such as skipping.

When performing these exercises, hold a kettlebell or dumbbell ranging from 5-30 pounds in one hand. The weight chosen will depend on the exercise being performed—skips are more difficult than marches and isometric holds—and you also need to consider the capabilities of the athlete.

Perform these movements for 10-20 yards, focusing on proper body posture and alignment and preventing the chest from collapsing down or crossing the knee or foot over the body’s midline. Athletes can perform these exercises in two positions:

1. By holding one weight by the side, in a suitcase carry position.
2. On one side held up in a front rack position.

Weighted Offset March Holds

Performing the offset march position in an isometric is a great way to introduce the movement and begin building a base from the ground up. While holding the implement on one side, the opposite side leg will raise, and the athlete will hold this position for the desired time.

This should be performed on both sides and done from each position: suitcase and front rack. Hold anywhere between 10 and 30 seconds per side to begin.

Video 8. Weighted Offset Marches Iso Hold

Weighted Offset Marches & Skips

Once the athlete is comfortable with the isometric position, slowly began progressing them to movements. Regardless of the variation or position, the universal cues will be having a strong, upright posture, popping the thigh up off the ground to about hip height rapidly, and maintaining a consistent, fluid, rhythmic timing throughout the exercise.

Some common errors I see during these exercises are body posture and coordination going everywhere. Even those athletes who can perform skips perfectly may struggle with the addition of the load.

When progressing this offset series, I would begin in the suitcase position first and move from marches (slow/fast) to skips (individual/continuous) before concluding with power. Then, moving through the same series from the front rack position.

Of course, this could appear differently depending on the situation and athlete, but that is a logical setup to use.

Video 9. Weighted Offset Marches and Skips—Suitcase Position.

Video 10. Weighted Offset Marches and Skips—Front Rack Position.

Video 11. Weighted Offset Power Skips.

The Next Level

Integrating trunk and spine training into speed sessions can be simple yet take your athletes and your sessions to the next level. Placing these movements into the athlete’s preparation or complexing them with specific exercises can help correct postural weaknesses and raise the body’s threshold during high-speed drills.

Integrating trunk and spine training into speed sessions can be simple yet take your athletes and your sessions to the next level. Share on X

These exercises can be performed directly out on the field with just a resistance band, sled, or a few weights and begin the necessary process of blending the weight room and field.

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

Many sport professionals believe that the quality of movement, the running and sprinting mechanics, is a big factor in the occurrence of non-contact injuries. When a player suffers a hamstring tear during a sprint, we look at the footage and oftentimes see poor form. We then focus on fixing the technique and correcting the player movement strategy. But the body isn’t ignorant and rarely chooses a suboptimal and potentially dangerous movement strategy due to ignorance. Often, the poor form we diagnose isn’t the problem but a symptom.

The easy assumption is always to blame strength and mobility. However, unless previous injuries are compromising a specific muscle group or an anthropometric particularity represents an anatomical challenge, lack of strength and/or mobility is very likely a symptom rather than the problem itself.

What if emotional state and its subconscious effect on movement pattern was the problem?

The easy assumption is to blame an athlete’s injury on their lack of strength and mobility. But what if their emotional state and its subconscious effect on their movement pattern was the problem? Share on X

Isn’t it rather interesting that strength and conditioning coaches, medical experts, and sport scientists all still debate fiercely why hamstring injuries are still a high occurrence in team sports despite all the knowledge and best practice guidelines produced on this muscle group’s mechanics? All teams have specific hamstring strength protocols and teach running and sprinting form, but injuries are still happening. However, quadriceps strains are not that much of a hot topic.

In the medical world, back pain is a scourge. It is such a widely present and complex issue that such a thing as “non-specific back pain” is an accepted diagnosis. However, people do not queue at the physiotherapist’s office to get their non-specific abdominal pain relieved.

Calf, hamstrings, low back, neck—most injuries or painful problems happen at the back of the body. Strength and conditioning programs emphasize posterior chain “prevention” work and pre-habilitation protocols more than they do the anterior chain. Has Mother Nature made us with a big flaw, a fragile backside that we ought to correct, prepare, and treat so as to be able to go through our lives without breaking?

Of course not.

Evolution and Survival Phenomenon

If we do have more pain and injuries at the back of the body, it is for a good reason. Our front side is where all the vital organs of the body are located. Our eyes (allowing us to see threats and connect to the world); jaws, tongue and throat (without which we can’t be fed); the lungs we need to breathe, the heart, stomach, liver and reproductive organs—all are located on the front side of the body. Hundreds of thousands of years of evolution have made us absolute masters at protecting our front.

If someone launches a punch toward your face, in a fraction of time, your hands will have raised up and protected your eyes and jaws. If you stand in the way of a powerfully kicked ball, in less time than it takes to breathe, your shoulder will come down to protect the lungs and heart, your arms will tuck in front of your abdominals protecting the liver and stomach, and your knee will raise toward your arms to save the genitals. If you have the time, you may even rotate, giving your back as a shield.

Maybe even more telling is to observe a fighter as he goes down. Lying on his side, his arms are on the sides of his head, his head tucked in toward his chest, his shoulders and chest curved inward, and his hips and knees flexed and raised all the way as to touch his elbows. In that curled-up position, he knows he can take more hits, he can endure more suffering; waiting for the referee to stop the beating, his survival is almost guaranteed.

The takeaway message is clear. The body will always sacrifice the back to save the front. Understanding this survival phenomenon, which is beyond our conscious control, can lead to two realizations with regard to injury prevention.

The body will always sacrifice the back to save the front. Understanding this survival phenomenon, which is beyond our conscious control, can lead to two realizations about injury prevention. Share on X

First, not everything is as simple as A=B. Hamstrings pulls are not always the consequence of improperly managed training loads, bad sprinting techniques, or poor muscular strength. No muscle ever gets injured alone, and none ever heals alone. We tend to be obsessed with very local questions and disregard the global.

For instance, in most monitoring programs conducted by professional sports teams, the same weight is not given to subjective and objective data. A player reporting not feeling great will most likely get a tap on shoulder and be given a “warning” in the monitoring system; if, however, the player instead scores lower than usual at one of the “screening” tests (sit and reach, for instance), they will receive a lot more attention from the support staff, ranging from treatment in the physio room to specific warm-up in the gym. The measurable and local aspect of an “injury prevention test” reassures us; it makes us feel as if we can intervene and control the risks. That is why we overly rely on them and build our injury prevention protocols around local and easily measurable issues.

The global is much more intimidating. There is no easy test for emotional state to do before breakfast. Yes, most high performance departments use some kind of wellness questionnaires, but they fail to give players’ answers the credit they deserve and act on the information collected, whether because they don’t appreciate how critical subjective feelings are in injury prevention or because they just don’t know what to do.

When a player reports high stress in their morning wellness questionnaire, how many of us provide them with a stress reduction protocol? A few exercises, maybe tempo breathing and mental imagery, before asking about their stress level again and deciding how to approach the rest of the day with them, just as you would if it were a poor result at the hamstring mobility test? My guess is, not many of us.

Research on Psychological Factors and Injuries

Numerous studies, however, have highlighted the role of emotions in injuries. More than 30 years ago, researchers Williams and Andersen proposed the stress-injury model, putting psychological factors and emotions at the center of their injury prediction model. Many papers reinforcing such findings have since been published, with perhaps the most telling ones led by Ivarsson¹ in 2008 and Angoorani² in 2019.

The former reveals that the use of four factors can predict 23% of injuries sustained by elite soccer players throughout a season:

1. Life event stress
2. Anxiety
3. Mistrust
4. Negative coping (poor coachability and tendency to worry)

When one thinks about the complexity of the phenomenon that is the occurrence of an injury, 23% is a rather high number.

The researchers note as well that injury occurrences in soccer games happen within five minutes of a particular event that happened on the field, such as a red card, another player injury, or a goal, once again showing the undisputable role of emotions in risk of injury.

The latter has its own wow factor too. Studying injuries in relation to various predictive markers, researchers found that emotional intelligence is the single strongest predictor of injury in Iranian professional soccer players. Low ability to control emotions was linked to higher injury occurrences but not to fool plays and cards. The reasons for such relation, therefore, isn’t uncontrolled aggression that propels players into risky behaviors for themselves and others, resulting in more injuries.

The fact that it remains undiscovered how exactly emotions are able to increase the likelihood of someone getting hurt is fascinating. Many argue that it may be due to the effect of emotions on concentration; others point out that negative emotions, such as fear, anxiety, or anger, are accompanied by physiological changes that may well be the reason for subsequent injuries.

But the truth is probably elsewhere.

When we design a monitoring program, we prescribe tests and conduct investigations with the aim of gathering information on all the essential systems of the body. Integrating data in specific algorithms, the ultimate goal of a monitoring routine is to deliver an overview of a player’s state of health and readiness as close to the reality of their physiology as possible. There is no consensus on what to include in a monitoring routine, and the complexity of the human body makes it extremely difficult to come up with a recipe that delivers more than a gross—and mostly unreliable—estimation of one’s actual risk of injury. Emotions, however, could well be the natural way the human body has to make its own health and readiness monitoring report available to our conscious state… hence, why it seems these are decent indicators of injury risks.

Emotions could be the natural way for the human body to make its own health and readiness monitoring report available to our conscious state...making them decent indicators of injury risk. Share on X

Modern affective neuroscience stipulates that it isn’t just emotions affecting changes in physiology, but physiological changes affecting emotions.

The Emotional State of the Athlete

We are very used to the idea that emotions are triggered by external factors. We feel sad after losing a match, and if the last goal was a penalty scored thanks to a controversial referee call, we may even feel anger. However, if the loss is the result of poor performance, the locker room will instead be full of shame and regrets. We are happy if we break a personal record and are stressed when congested traffic makes us late to training.

We do understand that a certain emotion triggered by a specific event or environment is certainly accompanied by physiological changes: the excitement as we run on the pitch to compete in a final raises heart rate, blood flow, focus, and strength. The anxiety and pain we suffer as we exit the field due to an injury leaves us weak, cold, and unable to digest.

However, those sorts of emotions are rare, and how we feel the rest of time is a matter of enteroception, the body-to-brain afferent signaling, central processing, and neural and mental representation of internal bodily changes.

The interoceptive effect of the immune system on emotions is an obvious one. The feeling “sick” is very often reported by someone whose immune system is attacked by a virus or bacteria before any visible symptoms have yet occurred.

At a given moment, within a given context interpreted by one’s memory and belief, the brain uses concepts to make sense of internal sensations and give us an indication about how we fare as far as our chances of survival as well as the best strategy to deal with the current state of our internal environment. From a sore stomach, the brain builds an example of hunger, nausea, or distrust based on additional sources of information available, whether it is a memory, a visual clue, or the environmental conditions, for instance. From a higher-than-normal tension in a muscle, a player may feel annoyed, tired, in pain, or anxious depending on the area affected and history of injuries.

When negative emotions, such as a lack of motivation, increased perceived fatigue, or stress, are self-reported by an athlete in the absence of concurrent meaningful life event or performance-related factors, we have to interpret it as a clear warning sign sent from their physiology that something is standing in the way of homeostasis. What we attempt to reveal through the use of a monitoring routine is handed to us by the emotional state of the athlete. We just need to pay more attention. Too often, the conscientious strength and conditioning coach harasses the athlete who screened poorly on a mobility test but claims to be feeling good, while hastily clearing the athlete who screened normally despite reporting high stress or poor motivation.

What we attempt to reveal through the use of a monitoring routine is handed to us by the emotional state of the athlete. We just need to pay more attention. Share on X

In light of the elements discussed above, we could easily argue that it is time for the table to turn, for emotions to be regarded as a critical aspect of health and readiness monitoring demanding immediate further investigation instead of being looked at only in retrospective analysis.

Emotions and Motor Behaviors

Another aspect that might contribute to the decent connection between an analysis of emotions and injury prediction lies in the relationship between emotions and motor behaviors. Indeed, it is well documented that each emotion can affect movement patterns.

Think about the blatant difference in attitudes between players who won and those who lost just after the referee blows the final whistle. On one side of the pitch, chests are held high, hands fly into the air, smiles illuminate faces, and the energy level is so high that some players jump and run around. On the other side, shoulders are rolled in, upper bodies carved up, and hands hiding faces. Energy is so low that some players lie on the ground or kneel, head on the ground. Still, both teams just played the same number of minutes of the same game, and their GPS and heart rate data are not so different.

If the physical demand of the game can’t justify such a discrepancy in motor behaviors, what we are witnessing is the power of emotions. As discussed before, when feeling under threat, the body will always focus on protecting the front, where the most vital organs are situated. The fighter assaulted, trying to ensure his survival, displays a posture and motor behaviors very similar to the anxious and depressed office worker taking their 7 p.m. commute after yet another day of conflicting and disempowering interactions. A forward-bent torso, shoulder rolled in front, chin that tends to tuck, looking at their feet: innate protective motor behavioral changes that come with negative emotions such as anxiety, fear, sadness, or stress all encourage withdrawal and are less than optimal to engage in highly demanding or explosive physical activity.

If a body under threat has already chosen withdrawal as the survival strategy and is then forced to engage in an activity that represents an additional threat, the motor behavior displayed won’t change to suit the demand of that activity. Actually, the reverse: it will worsen. A player taking part in an opposed training or a match while depressed will display motor behaviors that prevent them from optimally taking on information (looking down, carved-up posture), which can increase their chances of putting themselves in a situation prone to injury.

Put an anxious player through a speed session, and muscles located at the front of the body will tighten even more, cortisol will rise further, and eventually, some tissue located at the back of the body will end up as a casualty.

Monitoring routines and other injury prevention programs need to include more serious emotional state assessments and clear interventions. Share on X

Monitoring routines and other injury prevention programs need to include more serious emotional state assessments and clear interventions.

Finding the Right Scale and Solutions

First, a question or two asking a player to rate their stress level or motivation on a scale from one to five as part of the daily wellness questionnaire isn’t enough. There is much more to emotions than just stress and motivation. A much better assessment is to ask a player to select one or more words from among a selection of emotional states to describe how they feel today and provide them with an intensity cursor or color code associated with the words chosen in order to get information on the intensity of those emotions.

A continuum from activation to deactivation as well as pleasant to unpleasant should be used to better understand what a player needs to be ready for training on that day.

Emotions present in the high activation and pleasant quadrant are the ones associated with optimal readiness to train, whereas those of the unpleasant, deactivated quadrant describe an injury-prone state. A “low motivation” reported on the usual wellness questionnaire could mean the player feels too relaxed or too nervous or again lethargic, which are all very different states. A too-relaxed athlete can easily be moved to an excited state with some priming words from the coach and activation work prior to training, whereas a lethargic player needs to be first moved to a relaxed state through the use of some specific techniques (see below) before they can eventually be “primed.” Hence, the need for a more thorough way of assessing the emotional state.

With such an emotional state assessment, the aim of a player pre-training routine can be first directed toward “emotional” priming. Indeed, one of the beauties of emotions is that if they are a representation of our internal environment and health while being able to affect motor behaviors, they can in turn be affected by a change of physiology or posture.

Therefore, the emotional priming process could look like this:

• Step 1: Assess dominant emotion as part of a morning monitoring routine through the use of the quadratic model.
• Step 2: If needed, go through a specific protocol designed to shift a player’s reported dominant emotion from unpleasant to pleasant as a part of individual pre-training preparation time.
• Step 3: If needed, go through a specific protocol designed to raise the activation level of the dominant positive emotion as a part of the pre-training activation slot.

Shifting from an unpleasant-activated to a pleasant-activated state is possible using a variety of techniques, preferably facilitated and supervised by the team psychologist or mental coach. Those include:

• Positive mental imagery: The player consciously and purposefully closes their eyes and visualizes themselves succeeding at the upcoming training session. Five minutes of visualization can create a strong positive change.
• Reframing: The player expresses verbally or by writing what is most likely the source of the negative emotion—and then consciously and purposefully reframes the events leading to those emotions differently, using empowering and positive words only. Reframing has been shown to induce change of emotional state.
• Postural adjustments: This concept is used in behavioral therapy, when patients are encouraged to smile as a behavioral intervention to help them elevate their mood, even when the smile is initially artificial. The activation of the facial muscles into an expression associated with happiness evokes or enhances this associated emotion, leading to the improvement in mood.

Equally, a player feeling stressed or anxious can be prescribed a series of activation exercises directed toward changing the motor behaviors associated with such negative emotions. For instance, pull-throughs and other chest openers can temporarily reverse rolled-in shoulders and a bent-over torso. Face pulls and Turkish get-ups can be used to keep the head erect, and good mornings or bear hugs hold forces to straighten the back.

By changing their posture through movement, the athlete can experience a shift in their emotion. This mechanism is likely based on proprioceptive input to the brain regarding the current state of the body’s muscle activation pattern and joint configuration and existing associations in the brain between certain proprioceptive input and specific emotions.

Shifting from an unpleasant-deactivated to pleasant-deactivated state is possible using a variety of relaxation exercises such as:

• Controlled diaphragmatic breathing: The diaphragm has multiple physiological roles. The phrenic nerve that innervates the diaphragm’s functions has a connection with the vagus nerve, which can affect the whole body system. Diaphragmatic motion in breathing directly and indirectly affects the sympathetic and parasympathetic nervous systems and influences motor nerve activities. Diaphragmatic breathing is defined as breathing in slowly and deeply through the nose using the diaphragm with a minimum movement of the chest in a supine position with one hand placed on the chest and the other on the belly, inhaling and exhaling for approximately six seconds, respectively.

One study showed improvement in the biomarkers of respiratory rate and salivary cortisol levels, one showed improvement in systolic and diastolic blood pressure, and one study showed an improvement in the stress subscale of the Depression Anxiety Stress Scales-21 (DASS-21) after implementation of a diaphragmatic breathing intervention. Five minutes of diaphragmatic breathing can therefore change some pretty strong physiological markers of stress and induce a shift in emotional state.

• Progressive muscle relaxation: This anxiety-reduction technique first introduced by American physician Edmund Jacobson in the 1930s involves alternating 15 seconds of tension and 30 seconds of relaxation in all of the body’s major muscle groups. Research shows that such quick relaxation exercise can decrease cortisol and perceived anxiety, making it an easy way to help a player move away from a negative emotion to a more positive one.

Raising the level of activation of a pleasant emotion is a relatively easy task. For most strength and conditioning coaches, this is what they more or less consciously attempt to do when programming “activation” work pre-training. A well-designed warm-up (more on this in the previously published article on warm-up strategies) using sensory and mental activation techniques will likely be enough to ensure that a calm player becomes alert and a relaxed one, excited.

Going straight to the pre-activation and warm-up with a player reporting unpleasant emotions can increase injury and poor performance risks. Emotions of the unpleasant-activated quadrant, such as nervousness or anger, are conducive to stiffer muscles, high aggression, and lower self-control in duels and contacts, as well as a limited ability to learn and memorize. Hence, it’s important to try to shift a player’s emotional state from unpleasant to pleasant before raising the level of activation.

The above strategies were aimed at reducing the potential negative effect of unpleasant emotions pre-training by inducing temporary and superficial changes. When a player reports a negative emotional state for several consecutive days, or when the individual displays a strong tendency to feel unpleasant emotions, then quick short-term fixes won’t be enough to diminish their injury risk. In this situation, it is necessary to increase daily contact time with the player to understand better what may cause the tenacious and unwanted emotion and organize regular meetings between them and the team psychologist or mental coach to develop better coping mechanisms.

Emotions and the Rehabilitation Process

Understanding the power of emotions and their role in injury risk can help us finally rehabilitate the human body. Usually, injury prevention models are built on the assumption that the body is quick to fail us and, in the end, not that smart.

Understanding the power of emotions and their role in injury risk can help us finally rehabilitate the human body. Share on X

Injury prevention programs largely focus on correcting and treating the imperfect body. When an injury happens, we are quick to point out “poor movement technique” or “training load.” Models are today built to shame the poor human body, claiming it’s unable to adapt to a training load’s variation. All this gives us an image of a fragile body to be protected from all the threats thrown at it. Sprinting! Lifting heavy! Variability in volume of training! Weather conditions! And more.

This vision is the result of the still-dominant theory of the brain versus body dichotomy: the brain constantly needing to supervise and boss around a body that isn’t much more than a machine. Such a view of our physiology is obsolete, and decades of sciences have shown that no separation or hierarchy exists between the body and the brain. Unconsciously, our body and brain work together relentlessly to ensure our survival.

We may accuse our body of not being made to be as fast, as powerful, or as agile with a ball that we want it to be, but accusing it of fragility is nonsense. The human body is a master healer, able to fight numerous threats all the time, bacteria and viruses, compression and tension, heat and cold.… When non-contact injury occurs, it isn’t because our body gave up on us, but because the strategy chosen to ensure that more vital structures were preserved and our survival was guaranteed resulted in damage to less important tissues.

Nothing ever happens by mistake or chance in the body. When we accept the hard fact that pain and injuries are not system failures or punishments but protective mechanisms, and that the strategies employed by the body and brain to ensure survival are under no obligation to make sense to our conscious selves, it can free us from thinking that the enemy lies within us.

When we accept the hard fact that pain and injuries are not system failures or punishments but protective mechanisms, it can free us from thinking that the enemy lies within us. Share on X

So here we are.

If non-contact injuries are for the most part collateral nuisances of unconscious protective strategies, preventing injuries requires that we decrease the amount and intensity of threats perceived by an athlete’s body and brain. If we currently do a decent job at monitoring visible and easily controllable sources of perceived threat, such as training load or mechanical and bio-energetic fatigue, we do however need to make more of an effort to include less visible and controllable—but nonetheless critical—sources of perceived threat, such as a negative emotional state and psychological stress.

Four simple principles can easily be implemented in training programming and monitoring to address those.

1. In a high performance plan, training and recovery are balanced. The same approach needs to be implemented for emotional states. Activities or environments that induce unpleasant-activated emotions should be immediately balanced by activities or environments promoting pleasant-deactivated emotions. A tough loss during an important game on Saturday night would be better followed on Sunday with recovery at the beach or SPA and a team barbecue as opposed to individual reviews, physical top-ups, and a team meeting.

During scheduling of training, travels, and other commitments, a real emphasis should be put on avoiding cumulative unpleasant emotion-prone activities. A clear example is the quite common succession of a physically stressful and anxiety-inducing physical activity (game or hard training session), a psychologically stressful and anxiety-inducing activity (individual review), and an environmentally stressful and anxiety-inducing event (travel, press conference).

Each player has a limited and finite negative emotion bucket that, if full, can trigger a strong survival response—the kind that does not care too much about creating a muscle injury in the process. Making sure that we do not fill that bucket too much on a daily basis by alternating stressful, exhausting, confrontational activities with calm, relaxed, safe ones is definitely a great place to start. Following a similar thought pattern as the one used to define and plan training loads, emotional load should be considered. “Emotionally taxing” events such as matches, travels, tough physical sessions, tactical meetings, etc. and “emotionally boosting” ones such as social time and recovery activities must be kept balanced.

2. Language used may well have some influence on preventing injuries. Many studies have shown that negative words unconsciously prime negative emotions and positive language leads to positive states. Sometimes, as strength and conditioning coaches, we pride ourselves so much on hard work that we speak to our athletes in a negatively charged way. “No pain, no gain” is written on the gym wall, and we enjoy finishing our session brief with “this is going to hurt guys” or “it’s going to burn.” We need to understand that the more we talk about pain, about being uncomfortable and tough, the more we prime our players to feel pain, anxiety, and fear.

As the unconscious does not care about where the threat comes from, language alone can contribute to trigger a survival response, increasing injury risks. It is possible to drive a hard work culture of training with positive words. “Challenging” instead of “painful,” “rewarding” instead of “tough,” or again “transforming energy” and not “emptying the tank.”

It is possible to drive a hard work culture of training with positive words. Share on X

3. The art of resting: when in doubt, give the player a break. The best way we can help the body do its job of healer is to give athletes some rest. In professional sports, doing nothing or prescribing rest is seen as weakness or incompetence. Support staff should always be ready to pull some sort of treatment, exercise, or technology out of the hat of “the evidence-based best practices.” Preventing injuries isn’t about doing more all the time: more testing, more data analysis, more “preventive work.” Oftentimes, it is about recognizing when we need to gain some time by pulling a player out of training until we figure out what is really going on with them.

Being aware of the impact of emotional state on injury risk, an athlete reporting a negative emotional state for a few consecutive days would most likely benefit from a couple days off and a meeting with the team psychologist or mental coach in an attempt to empty a little of their stress bucket instead of continuing to push them through the planned training loads. A day or two off will always be a better option than the amount of time on the sideline that a muscular injury would require.

4. Be mindful of negative people. Emotion is a significant predictor of injury risks and can spread throughout a group like pollen borne on wind. This emotional contagion often goes unnoticed and operates via our innate tendency to mimic the emotions of other people. A recent study showed that cartoons were rated funnier if participants were first presented with a picture of a smiling face. Simply being exposed to the non-verbal behaviors of others is enough to trigger a similar emotional experience, be it positive or negative.

In group settings, social rules influence thinking and behavior, and a club culture has the ability to increase or decrease injury risks. It is critical to put rules and behavioral expectations in place that reinforce positive emotions. Social rules may also develop based on the types of beliefs, attitudes, and emotions held by particular team members.

Alarmingly, research has shown that the behaviors of just one person can set these rules. In one study, 94 business undergraduates were observed as they took part in a group discussion. Unknown to the participants, one person was actually a plant tasked by the experimenters to purposefully display negative emotions in the group setting. Overall group performance and cooperation significantly decreased because of this negative influence.

With this evidence in mind, it is simple to understand that negative emotions cannot be left freely expressed and demonstrated within the team environment, or sooner or later it will have an impact on the team’s health and readiness. Poor results, long working hours, or divergences of philosophies can be a burden at times for support staff, and sometimes frustration, anxiety linked to job security, or near exhaustion can transpire in the way we behave, talk, or look at the office.

It is, of course, impossible to go through a full season of competitive sport feeling fresh and amazing; we have to keep in mind that personally giving in to negative emotions will impact athletes and other staff members around us. No matter how difficult it may be, a real effort to be positive around other team members goes a long way in contributing to lower injury occurrences and better team performances.

It is also the responsibility of leaders within the organization to ensure that the wellness and readiness of the staff members are monitored and optimized, exactly as it is done with players. Support staff can do everything and beyond to keep the players happy, healthy, and performing on the pitch week-in and week-out. However, if it comes at the expense of their own welfare, transforming them into zombies or frustrated, angry, and overworked victims, they will contribute to an increased injury risk for their athletes despite all their good work.

Preventing injury is much more than correcting poor movement strategies, developing strength, and monitoring training loads. It is time we accept the role of less “controllable” factors, and especially the power of emotions, and do our best to get our athletes out of a subconscious survival state.

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. Ivarsson, A. (2008). “Psychological Predictors of Sport Injuries among Soccer Players.”

2. Angoorani, H., Najafi, S., Sobouti, B., Zarei, M., and Nejati, P. “The Association of Emotional Intelligence with Sport Injuries and Receiving Penalty Cards Among Iranian Professional Soccer Players.” Asian Journal of Sports Medicine. 2019;11(1). 10.5812/asjsm.97321.

3. Hartel, C. “How to build a healthy emotional culture and avoid a toxic culture.” Research Companion to Emotion in Organizations. 2008:575–588. 10.4337/9781848443778.00049.

4. Hackfort, D. and Kleinert, J. “Research on sport injury development: Former and future approaches from an action theory perspective.” International Journal of Sport and Exercise Psychology. 2011;5(4). 10.1080/1612197X.2007.9671839.

Are athletes prepared for return to sport? The current evidence suggests “no” based on reinjury rates and decreased performance upon return.^1–7 I struggle with this problem myself and was looking for ways I could improve. The easy answer was to measure workload. On the performance side, workload is often used to make sure athletes aren’t overtraining, with player availability being so important. However, on my side (rehab), I would use it to make sure I was not underloading athletes.

The easy answer to determine if athletes were prepared for return to sport was to measure workload. On my side (rehab), I would use it to ensure I was not UNDERLOADING athletes, says @MuyVienDPT. Share on X

When I investigated current tracking methods, I realized how daunting the cost could be to purchase a unit for each of my athletes. This is not a surprise, as for many, cost is consistently a barrier with the continuing emergence of improved technologies.⁸

Can’t I just grab athletes’ units from their performance coaches? This is logistically challenging since the units may be charging, uploading data, or in use, or there may be other time constraints that would affect when they are provided/returned. This does not solve the problem for practitioners working with private clients off-site, and it made me get creative.

What if I could design a system where I only needed to purchase a single unit? To answer that question, I sketched out the plan (figure 1) and made it work.

So far, so good. I have been very happy with my little system—it has changed the way I practiced by answering the question I was looking to answer. Since my system serves me well, I thought I’d share with others in a similar position. Yes, you can always just open the raw files to view; however, my method will hopefully save you time by having your data automatically calculated to get you to the meaningful measures that will answer your questions with external and internal load.

My method will hopefully save you time by automatically calculating your data to get you to the meaningful measures that will answer your questions with external & internal load, says @MuyVienDPT. Share on X

In the long term, this method should streamline and enhance a practitioner’s operations; in the short term, however, developing it does require an investment of time and mental resources.

What You’ll Need

Here is a guide to the overall steps coaches can use to set up a system that uses a single GPS unit to track and present the data of several athletes (figure 2).

Google Account or Excel

This method requires collected data to be dropped into a spreadsheet. For this reason, Google services work best since it is online. However, users can also link responses to an Excel file. If you use this for sports medicine purposes, be sure that the services you use are HIPAA compliant. G-Suite is a very cheap service that allows you to use secure Google services. If you plan to use Excel, you’ll have to make sure it is saved on a secure server, emailed using encryption, or shared through secure Microsoft Teams services.

GPS Unit

There are many different options, and this article may help you decide which unit is best for you. Each product has different measures of workload, so it would be best to purchase the same device that most of your athletes use when returning to their teams. You may also factor in what you use it for. For example, I went with STATSports Apex Series because I use the live data to dictate my sessions. You can have live data with other devices, but they may require you to spend more money on local positioning Systems (LPS) units. The Apex Series also does not work indoors, while LPS systems do.

Again, the previous linked article can review the nuances. Be sure to pay attention around the holidays, as some devices can drop from $300 to nearly $180. Lastly, the most expensive portion will be the vests. They cost about $40 a piece—you may luck out like me, and your performance coaches may have old ones they can give you. If you are using it for back-to-back clients, you will need multiple quantities of the sizes; however, I only use it with 10–20% of my clients per day, so I can wash them between uses. All in all, you have plenty of options and will need to purchase one unit.

Two to Four Hours’ Time Investment in Learning Google Sheets/Excel

This is the most time-consuming portion; however, it will be the gift that keeps on giving. For the sake of the proposed system in this article, individuals will need to know how to use three functions: filter, index, and match. There are SO many resources out there, but my favorite tutorials are from Adam Virgile. Not only does he have easy-to-follow directions and tutorials, but he is a sport scientist who understands what you may want to do with data relevant to sports performance and rehab. By watching the videos linked below, you should be able to build the same system proposed in this article or an even better one:

• Drop-down menus, index, and match functions
• Filter
• Athlete player card/dashboard

One to Two Hours to Build the Dashboard

Once you have the physical and mental tools, the actual process should only take you a couple of hours to set it all up.

External Load

Below is a guide on how I look at external load. I personally value other metrics over “player loads.” Instead, I want to look at changes over time and between certain sessions. The trade-off is that I would be unable to compare that athlete to the team’s demands with that specific metric. However, I feel like I can do well with other metrics and normative values found in research (figure 3).⁹

Additionally, I want to look at the relationships between certain measures. Did I increase athletes’ max speed and decrease their total distance? Did I ramp up their high-intensity distance but decrease their training time? Did their step balance even out at high speeds? These are all questions I wanted to consider when building my dashboard.

Internal Load

What about internal load? At the time I looked into what tech I should purchase, none of the teams I worked with tracked heart rate for internal load. Instead, most used session rate of perceived exertions (sRPE), which has shown to be valid and reliable in measuring internal load.¹⁰ You can read here how to capture and effectively use internal load without the cost of heart rate monitors. Because I could not relate my external load to the team’s data, recording RPE and wellness responses helped me have some kind of measure to compare the athletes to their teams.

You can apply the same concept to developing a method to track internal load and wellness (figure 4). Current methods of wellness measures do have their flaws, as described in this article; however, collecting responses on a numerical scale makes it easier to calculate. A comment section can always be added as well.

Pearls

All right, you did it. You now have a good understanding of the steps it will take to pull this off with minimal costs. Before you start, I’m going give you advice based on all the mistakes I made. These are not only the mistakes I made while developing this system in the beginning, but also hindsight at the end of the year when I began analyzing data for season-end reports. That’s right, this advice can save you HOURS of formatting changes and MONTHS of valuable data!

• Constraints mean easier data cleaning and process: It looks much cleaner when everything is uniform, and data may be missing from your calculations if there are grammar and/or syntax errors. I would recommend making your response options pre-defined including athlete’s names. Otherwise, you may have to deal with constantly cleaning “MaryPoppins,” “MaryPopins,” “Mary P,” or “MP” if the athlete makes typos or inconsistencies.
• Try to change everything to a numerical scale: Because your calculations require numbers, you want the responses to be entered as numbers too. This skips a potentially very time-consuming step to convert data. Although there is a trade-off, as described in this article, you can at least start with objective data before refining your methods.
• Track compliance: If all your players are not compliant with their responses, it may skew the data or make it outright invalid. There are likely many ways to do so, but personally, I have a separate tab that displays the dates of each person’s entries, so I don’t have to sort and sift through entries.

Also, those who are NOT compliant should not be punished. Many athletes do not like entering and filling out our surveys, so getting punished with conditioning or cleaning will increase their hatred for entering wellness data. Instead, have devices ready for them after lifts and practice in case they did not fill it out on their own via cellphones. Educate them on what you hope to do with it.

• Organization and planning are key: Take a look at other people’s dashboards to see what you like. Once you make your dashboards, it can be hard to add new things because of formatting. Lay out a grid and label which cells will contain which info. Despite that, just know you will likely make new iterations.
• Do something with the info: Dashboards and data are a hot topic right now. Everyone seems to be collecting massive amounts of data, but few are using that data.¹¹ What will you do if athletes have low energy? Would you target your intervention to the team or to the individual? Who is in charge of implementing said plan? Are there proactive measures? How often does follow-up data get taken?

Dashboards and data are a hot topic right now. Everyone seems to be collecting massive amounts of data, but few are using that data, says @MuyVienDPT. Share on X

There’s a reason there are entire sport science teams and PhDs dedicated to this field. This isn’t to deter you but keep you aware of the sports science field’s complexity and that measuring workload is just one aspect.

In my examples above, my method allowed me to make changes to my practice to achieve what I wanted. In early-stage anterior cruciate ligament reconstruction rehab, when athletes can hardly walk, I am still able to induce a “hard” session compared to the mid-stage rehab of the control (external PT) by modifying session pace, exercises, and session format (figure 5). In another example (figure 6), I was able to use the same GPS unit to track and display meaningful metrics for two athletes while only spending two minutes entering data after their sessions.

Conclusion

I hope my transparency with the process provides an efficient and cost-effective way to implement workload management to objectify decisions on the field, says @MuyVienDPT. Share on X

Workload management does not have to be labor intensive or expensive. The field of sports science continues to grow, and an active effort to understand it can enhance practice.^11,12 Although my system is not rocket science and is likely already done by many, I hope my transparency with the process provides an efficient and cost-effective way to implement workload management to objectify decisions on the field.

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. Ardern CL, Taylor NF, Feller JA, and Webster KE. “Fifty-five per cent return to competitive sport following anterior cruciate ligament reconstruction surgery: an updated systematic review and meta-analysis including aspects of physical functioning and contextual factors.” British Journal of Sports Medicine. 2014;48(21):1543–1552. doi:10.1136/bjsports-2013-093398

2. Ardern CL, Webster KE, Taylor NF, and Feller JA. “Return to the Preinjury Level of Competitive Sport After Anterior Cruciate Ligament Reconstruction Surgery: Two-thirds of Patients Have Not Returned by 12 Months After Surgery.”American Journal of Sports Medicine. Published online November 23, 2010. doi:10.1177/0363546510384798

3. Dai B, Layer JS, Bordelon NM, et al. “Longitudinal assessments of balance and jump-landing performance before and after anterior cruciate ligament injuries in collegiate athletes.” Research in Sports Medicine. 2021 Mar-Apr;29(2):129-140. doi: 10.1080/15438627.2020.1721290. Epub 2020 Feb 2. PMID: 32009460; PMCID: PMC7395857.

4. Webster KE, Klemm HJ, and Feller JA. “Rates and Determinants of Returning to Australian Rules Football in Male Nonprofessional Athletes After Anterior Cruciate Ligament Reconstruction.” Orthopaedic Journal of Sports Medicine. Published online February 11, 2022. doi:10.1177/23259671221074999

5. Wiggins AJ, Grandhi RK, Schneider DK, Stanfield D, Webster KE, and Myer GD. “Risk of Secondary Injury in Younger Athletes After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis.” American Journal of Sports Medicine. Published online January 15, 2016. doi:10.1177/0363546515621554

6. Kotsifaki A, Rossom SV, Whiteley R, et al. “Single leg vertical jump performance identifies knee function deficits at return to sport after ACL reconstruction in male athletes.” British Journal of Sports Medicine. Published online February 7, 2022. doi:10.1136/bjsports-2021-104692

7. Jae C, Jj M, E K, Kaj D. “Vertical jump impulse deficits persist from six to nine months after ACL reconstruction.” Sports Biomechanics. Published online September 21, 2021. doi:10.1080/14763141.2021.1945137

8. Stevens CJ, McConnell J, Lawrence A, Bennett K, and Swann C. “Perceptions of the role, value and barriers of sports scientists in Australia among practitioners, employers and coaches.” Journal of Sport & Exercise Science. 2021;5(4):285-301. doi:10.36905/jses.2021.04.07

9. Edwards T, Spiteri T, Piggott B, Haff GG, Joyce C. “A Narrative Review of the Physical Demands and Injury Incidence in American Football: Application of Current Knowledge and Practices in Workload Management.” Sports Medicine. 2018;48(1):45–55. doi:10.1007/s40279-017-0783-2

10. Halson SL. “Monitoring Training Load to Understand Fatigue in Athletes.” Sports Medicine New Zealand. 2014;44(Suppl 2):139. doi:10.1007/s40279-014-0253-z

11. Rauff EL, Herman A, Berninger D, Machak S, and Shultz SP. “Using sport science data in collegiate athletics: Coaches’ perspectives.” International Journal of Sports Science & Coaching. Published online January 21, 2022. doi:10.1177/17479541211065146

12. Hewett TE, Webster KE. EDITORIAL: “The Use of Big Data to Improve Human Health – How Experience from Other Industries Will Shape the Future.” International Journal of Sports Physical Therapy. 2021;16(6):1590-1594. doi:10.26603/001c.29856

As performance coaches, we often feel a sense of doubt about how much our training in the weight room and on the field contributes to the performance of our athletes. Are we actually moving the needle in their performance? At the very least, we constantly question how we can better tie the needs of our sports into our programming. One of the ways we have found to bridge the gap between sport and the weight room has been by using partner combatives.

Partner combatives are a way to create one-on-one physical contact between athletes in a controlled and competitive way. They connect traditional training (e.g., squat, hinge, push, pull) and crucial aspects of sport by putting athletes in a position to use their strength in a specific manner—as opposed to exerting force against an inanimate object (barbell, dumbbell, the ground), partner combatives require athletes to exert force against another person.

While traditional movements help athletes increase their ability to apply force into the ground, we feel there is a more specific way to train an athlete’s ability to apply force into another person (another aspect of force application in sport). Additionally, partner combatives enable us to introduce and program contact within training at all times of the year. This can allow for a shorter and more efficient acclimatization period when those sports reintroduce contact within practices during pre-season periods.

Partner combatives enable us to introduce and program contact within training at all times of the year. Share on X

Coaches of contact sports often bemoan an athlete’s or team’s inability to “be physical,” or they express that their athletes “shy away from contact.” Programming partner combatives with those teams allows each athlete to be exposed to the stimulus of “contact” all year round. A controlled stimulus used to improve that specific, physical quality is something that these athletes won’t get anywhere else.

Identifying the Problem

During our time working at the University of California, Davis, we often had conversations around the effect our training had on our athletes’ performance on the playing field. Our conversations generally revolved around questions like:

• Is there more we can get from a squat other than improving an athlete’s ability to put vertical force into the ground?

• Can we enable athletes to improve force application into the ground AND against other bodies?

While these were questions most applicable to sports like basketball, football, soccer, etc., we asked additional questions about sports that aren’t played on the ground. (e.g., How can a bench press help a water polo athlete manipulate an opponent’s body similarly to an offensive lineman in football?)

As we sat down to further study certain sports, we consistently came across situations of intense physicality: water polo players fighting for position in front of the net or basketball players constantly fighting for position boxing out and rebounding. Notice how these players are required to put force into the ground AND into other bodies—bodies that are not stationary but battling to carve out space. There are physical battles in almost every play in sport. These often have a large hand in deciding the outcome of those contests.

In identifying these situations, conventional weight room programs didn’t feel adequate to best prepare our athletes for the demands of their sports. In discussion, we asked:

• How can we help to prepare these athletes for such a big part of competition through what we do in the weight room?

• How can we introduce contact/physicality within the weight room in the most controlled way possible?

Our answer? Partner combatives.

Categorizing and Programming Partner Combatives

We separate partner combatives into categories. Some of the combatives are simple, some are more complex (meaning we typically don’t trust teams with the more complicated ones until they’ve proven they can handle/control themselves):

Typically, we start our teams in positions of a partner combative, but we leave out the competitive component until they get a better grasp of the movement/position. (It’s fairly subjective when that is.) For example, we may have athletes start in a standing shoulder-to shoulder line push position; however, one person is giving ground while applying resistance as their partner moves them.

Video 1. Shoulder-to-shoulder line push as one athlete gives resistance and ground to the other.

Once our athletes show they are capable of these controlled positions, we’ll start the competitive side of partner combatives. However, we can still keep it controlled by limiting their time in competition (3-5 seconds).

Video 2. Shoulder-to-shoulder line push where both athletes fight to get over the line. There’s a short timeframe and not necessarily a clear winner or loser.

As our athletes show more competency, we allow them to build out the total time of the combative or have them go until there is a winner and loser.

Video 3. Bear position lateral line push combative. We let athletes battle until there is a clear winner and loser, however long that may take.

It is important to keep in mind that not every team or athlete goes through the same progressions. Some teams/athletes we’ve trusted go right into competition on day one, or at least use different variations of full partner combatives that aren’t quite as “violent.”

Video 4. PVC SL pull-over combative, where the athlete’s goal is to unbalance their partner first (lower on the “physical”).

Programming Partner Combatives: When and Where

In the weight room, we typically superset our major movements with whatever partner combative we want to use within that day. We’ve seen combatives be a great way to set the tone for the rest of the training session and allow athletes to feel the connection between a general movement (bench press) and specific movement (rooted wrist grab).

When explaining the “why” behind our program, it shouldn’t be up to the athletes to just trust what we’re saying. They can feel how a traditional movement in the weight room can pair with and complement a sport-specific situation. Athletes enjoy competing, and programming combatives early in a session typically creates a better, higher-energy training environment. Combatives force athletes to train with high levels of intent immediately within a workout. There is nowhere to hide when you’re doing a partner combative.

Combatives force athletes to train with high levels of intent immediately within a workout. There is nowhere to hide when you’re doing a partner combative. Share on X

If a training session is outdoors—speed, conditioning, etc.—then we like to put partner combatives near the end of the warm-up. Again, similarly to the lift, we want to prioritize combatives near the beginning of the session and allow the competitive energy from the partner combatives to carry into the rest of the training session.

Choosing Appropriate Combatives

When using partner combatives, our goal is to mimic the physical nature of the sport we are programming for. For example, we use the rooted wrist grab partner combative frequently with men’s and women’s water polo teams because of the constant hand fighting/grappling that happens in the water. However, this isn’t one that we use often with basketball teams. Instead, we’re more likely to see a combative like a standing back-to-back line push. This would more closely mimic a “box out” position.

That being said, we can still implement partner combatives in a general to specific way. A basketball team may benefit and enjoy something like a rooted wrist grab in an early off-season period to build competitive energy and general strength qualities. However, as we transition through the off-season and into the preseason, these combatives can now begin to emulate the sport. This prepares athletes for what they will experience in their competitive environment. Reverse-engineer the physical nature of the sport to build the starting points for the partner combatives that best complement the training of that sport.

Reverse-engineer the physical nature of the sport to build the starting points for the partner combatives that best complement the training of that sport. Share on X

Are We Actually Making a Difference?

Since implementing partner combatives, the golden question is: What are the objective measures of increased performance that we can point to for these sports? Truth is, we don’t have any. All we have are the anecdotal and subjective feedback reviews we’ve gotten from sport coaches and athletes. That feedback has been overwhelmingly positive in an attempt to tie the needs of specific sports into the weight room.

While objective measures are obviously important, we believe that performance coaches should implement and rely on subjective measures like watching the athletes compete in their competitive environment and put value in “reviews” from the players and the sport coaches.

Closing the Gap

Partner combatives have been one of the ways that we’ve been better able to bridge the gap between training in the weight room and on the court or field or in the water. Unsurprisingly, as athletes have begun to buy into this process—seeing training that they can directly relate back to their sport—they’ve more quickly and eagerly bought into the “traditional” training as well.

Give a little to get a little—even if we aren’t actually giving anything. Partner combatives might not be the best training method for every team/coach. However, they are one attempt in a continued and constant search to find the best ways to prepare our athletes for their sports.

Authors’ Note: While this article comes with our dual byline, we have taken and applied these exercises to our environments from a few sources, including Elon Sports Performance, Michael Zweifel, and Austin Jochum. Thank you to these people for educating us and continuing to push the field forward. Finally, thank you to SimpliFaster for the platform to share our ideas within our community.

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

Hunter Eisenhower is the Associate Director of Sports Performance at the University of California, Davis. He works with men’s basketball, baseball, and lacrosse while assisting with football. He has previously worked at Southeastern Louisiana, Minnesota State Mankato, and the University of Washington. Hunter was a collegiate basketball player at Seattle Pacific University. IG & Twitter: huntereis_sc

“Water makes you weak…” 

Many of us who work in the sports industry and are of a certain age have a real-life horror story about hydration reminiscent of that scene with Coach Boone (masterfully portrayed by Denzel Washington in Remember the Titans). Thankfully, attitudes and guidelines about hydration, performance, and recovery have changed markedly over the past 40 years. Hydration breaks aren’t just modern staples of practice, they are now being included as part of game day operations for major sporting competitions at many levels of sport.

All of this is for good reason, as governing bodies of sport across the globe understand the importance and health and safety aspects of hydration. As a result, athletic trainers, sport nutritionists, and other allied health and performance staff members have taken an interest in encouraging better hydration behaviors among athletes. There are times of the year when suboptimal hydration can not only impact performance but also put lives at risk.

Having worked in professional and collegiate athletics myself—and knowing staff members in multiple leagues and levels across sports—I can attest firsthand to the level of investment that organizations make to help support athlete hydration. Annual bottled-water budgets alone can soar above $20,000 for a team of about 30 athletes—a separate cost from any other sports drink or hydration-related supplement. A team located in a region where tap water is of poor quality can expect to invest heavily in bottled water, on top of “hydration stations” and fountains around facilities. I spoke with a head athletic trainer from the NFL this past year who submitted a yearly budget with over $120,000 for hydration and hydration-related supplements for his roster.

Annual bottled-water budgets alone can soar above $20,000 for a team of about 30 athletes—a separate cost from any other sports drink or hydration-related supplement, says @MdHCSCS. Share on X

Professional teams aren’t the only ones investing in hydration at staggering rates. As of 2019, top collegiate athletic departments were spending nearly $60,000 each year on the equivalent of 21,000 gallons of sports drinks to help hydrate their athletes. In fact, the investment in hydration is only a portion of a larger budget aimed at fueling athletes for performance and recovery. Universities devote millions of dollars each year to fuel athletes, and much of this is made possible by an NCAA rule change in 2014 that allowed schools to support the nutritional needs of many more athletes within their department.

Hydration-related products are only part of the puzzle, as equipment and sports technologies also take up a sizeable portion of athletic training and performance department budgets. Despite budget cutbacks, recent surveys among collegiate and professional athletic trainers and performance staff show 44% of teams surveyed spend a minimum of $50,000 per season on sports technology monitoring aspects of health and performance. In addition to professional settings, these big budgets are nothing new at universities here in the United States, particularly in their football programs.

Despite big investments in the fueling aspect and the known impact on performance and health and safety, hydration monitoring budgets and methods in particular have largely lagged behind.

Hydration for Health and Safety

The hefty budgets devoted to hydration are justified, as fluid intake plays a big role in maintaining the health, safety, and performance of athletes. Ask any athletic trainer who has worked during the summer how often they push athletes to hydrate, and you will likely get a smile and an eye roll. Their efforts are for good reason, as NATA position statements have raised awareness around the fact that more than half of high school, collegiate, and professional athletes begin an activity while dehydrated. This is concerning from a safety standpoint, as dehydration—combined with physical exertion during activities in warm weather—reduces the ability to regulate core body temperature and subsequently greatly increases the risk of heat-related illnesses. Tragically, heat illness is one of the leading causes of death among high school athletes and has contributed to more than 30 deaths of collegiate football players since 2000.

While the magnitude of the importance of adequate hydration for athletes seems to center around focusing efforts during warm weather spells, the impact of hydration plays an important role for all athletes year-round. Dehydration has a significant impact on the body and subsequent performance output.^1–4 While muscle cramps and sluggishness in the later stages of practices and competition were once thought of as prime examples of decreases in performance, more recent research reviews have widened our understanding of the issue.

Hydration and Performing Sports Skills

Barnes & Baker (2021) completed a comprehensive research review of literature focusing on the impact dehydration has on cognition, sport-specific skills, and physical performance. Twenty-two of 34 studies reported dehydration as having a negative impact on cognition, skills, and physical performance in sports such as basketball, soccer, American football, and others.

The negative impacts of dehydration were pronounced when body mass deficit exceeded 2%, especially when combined with stress from heat. Of all the elements examined, 71% of the studies focusing on cognition reported decrements in cognitive performance due to dehydration. An additional 67% of the studies included in this review found dehydration to have a negative impact on sport-specific skills.

Nuccio et al., (2017) completed a similar comprehensive review of literature focusing on the impact of dehydration on cognitive, technical, and physical performance in sports. This review further focused on the cumulative impact of dehydration on cognition, technical skills, and physical performance as well as the effect on team sport performance. Results were mixed from sport to sport, given differences in rehydration opportunities unique to passages of play across sports; however, similar findings were reported regarding negative effects of dehydration on cognition, technical sports skills, and physical performance.

The findings described above are not groundbreaking developments, but given the frequency stated earlier about how many high school, collegiate, and professional athletes train or compete on a daily basis while dehydrated, are we missing an opportunity to better prepare athletes for their sport? There are countless discussions, many in the form of the outstanding blogs posts and roundtables on SimpliFaster, that help elucidate paths forward in training and programming. As a field, we make consistent efforts to maximize the physical performance of each athlete through those training programs, yet we are now presented with the reality that athletes are unknowingly preventing themselves from reaping the full benefits of that work. How can we make the most of our work to support athletes?

Monitoring Hydration: Methodology

Monitoring hydration status can be a simple endeavor to help mitigate decrements in performance due to dehydration. While some clinical settings have identified plasma osmolality as a gold standard for assessing hydration, these and some other methods aren’t practical for all, given budget or staffing constraints.⁷

Monitoring hydration status can be a simple endeavor to help mitigate decrements in performance due to dehydration, says @MdHCSCS. Share on X

In applied settings, there are several commonly used approaches used to monitor hydration, and efforts should be taken to move beyond overly subjective methods that can lead athletes astray. Regardless of the approach, the underlying focus should center on actually helping athletes take action to stay on top of their hydration.

Weigh-Ins for Fluid Loss

Pre- and post-activity weigh-ins are a good indicator of fluid loss and can be implemented throughout most of the week. It is common for teams to tie this process into other activities surrounding body weight maintenance or as part of a baseline assessment during force plate testing. Issues around standardization are a key consideration here, and as someone who has personally performed well over 34,000 weigh-ins in a chaotic locker room environment (amateur numbers by the standards of seasoned athletic trainers and nutritionists/dietitians), I can attest firsthand that repeatability standards can suffer greatly regardless of which staff is present.

It’s important to remember that weigh-ins only tell part of the story around hydration status, as sweat rates causing fluid loss can be highly individual, and the day-to-day trends can vary depending on the fed-status of the athlete. Given issues around reproducibility, as well as recent high profile issues around misapplication of this data, it is wise to exercise prudence in how these are implemented in order to optimize their impact.

Bio-Impedance for Body Composition and Hydration

Those who already possess the technology can intertwine weigh-ins with body composition measurements on top of a relative hydration status. There are noted limitations with bio-impedance when it comes to assessing hydration status,^5,6and given the aforementioned issues around misusing and abusing body composition data, any regular usage of this technology for the secondary purposes of hydration status may not be warranted. Additionally, this method can require staffing devoted to the process and a hefty investment in the technology itself.

Saliva Testing and Thirst

Saliva testing is seen as a minimally invasive hydration assessment and is typically a good proxy to thirst levels. This is particularly true during exercise and in high temperatures; however, there are noted individual variances observed in testing.⁸ From a practical standpoint, stopping athletes during training or immediately after a session will require dedicated staff support and athlete adherence, as well as the handling of bodily fluids. Even prior to the COVID-19 pandemic, most practitioners would admit to being less than enthusiastic about sample collection.

There are also noted issues with standardization in field testing, as athletes submitting samples at differing intervals between fluid intakes can skew results in some cases. Thirst itself is typically considered a strong subjective indicator, but it is also regarded as a sign that the athlete is already suffering from dehydration.

Sweat Rate Assessments: Patches and More

Assessing an athlete’s sweat rate and content can be done in the field using several techniques that include absorbent patches, apparel, towels, and other laboratory-grade tools. A portion of the sweat rate approach also relies on weigh-ins to factor in fluid loss, while the aforementioned tools used in the field are aimed at better understanding the electrolyte content of sweat. Sweat rate is highly individual, but it reflects what happens during any given activity and should be used in conjunction with objective measures of pre-activity hydration status.

Sweat rate is highly individual but reflects what happens during any given activity and should be used in conjunction with objective measures of pre-activity hydration status, says @MdHCSCS. Share on X

Because of high variability in sweat rate and electrolyte content, an individualized approach would be necessary as opposed to relying on generalizability from any one measurement to a larger group. Many methods typically require dedicated staff time to collect and analyze samples of bodily fluids, and immediate results may not be practical in field settings. However, the information from these assessments can be a critical part of better understanding individual trends in sweating and identifying the necessary and appropriate strategies for acute rehydration efforts.

Urine Color

Perhaps one of the most widely adopted methods for assessing hydration status is the use of a urine color chart. Urine charts have been deployed at every level of sport, and they are intended to act as an easy-to-follow method for athletes to understand their hydration status. Interestingly, the validity of urine color charts has not been systemically evaluated in clinical settings, despite widespread adoption in athletics. While in theory urine color represents a proxy to hydration status, some studies that have used urine color in efforts to validate this proxy saw trained clinicians perform the assessment—not athletes.⁹

Urine sample charts, measured in arbitrary units (AU) 0-8 (10), are subjective in nature due to their dependence on athlete interpretation against a posted color chart. These charts can provide some assistance as a very low-cost alternative, as their intended use is for implementation where close estimates are acceptable. Urine color charts are not meant as a substitute for more accurate and reliable measurements.

Urinalysis (USG) Technologies

Urine Specific Gravity (USG) examines the density of urine against the density of water and is considered a good proxy to urine osmolality and overall hydration status in most cases.¹¹ This approach is also considered the closest to a “gold standard” for non-clinical, field-based hydration status monitoring. Common instruments used by athletic trainers and sports nutritionists or dietitians are refractometers and dipsticks, with refractometers considered more reliable at assessing USG. USG is measured along a spectrum of 1.000 to 1.030+, where a widely accepted cut-off for dehydration is > 1.020.

The main issue with widely implementing this approach is the requirement of collecting and analyzing urine samples, which requires dedicated staffing time and effort, as well as relying on athlete compliance. While USG levels account for hydration status better than many field-based approaches, there are many user workflows in team settings where the athletes themselves aren’t made aware of their status prior to engaging in their athletic activities.

Intake Health has produced a first of its kind solution to help supplement these efforts, building field-leading, objective hydration monitoring into an athlete’s daily routine. This is paired with staff-customized infographics to help drive hydration behaviors to positively impact hydration status before activity. The InFlow hydration monitoring solution is a positive development, helping solve a critical problem for health and performance staff needing daily pre-activity hydration monitoring as part of their athlete fueling strategy.

Monitoring Hydration: Best Practice

There are several key takeaways to consider as staff forms their best practice approach to monitoring athlete hydration:

1. There are no silver bullets in hydration monitoring, and good, reliable information is needed before, during, and after sports activities. Any one method used in isolation can inaccurately represent an athlete’s overall hydration status⁷—context is needed to help inform action.

Any monitoring method used in isolation can inaccurately represent an athlete’s overall hydration status—context is needed to help inform action, says @MdHCSCS. Share on X

2. Hydration is important year-round and is an all-day event. Extra attention should be given during high temperatures and periods of heavy training (pre-season camps, excessive competition fixtures, etc.) as well as before, during, and after practice.
3. Hydration monitoring procedures and refueling strategies must be impactful, related to each other, reproducible, minimally invasive to athletes, not require excessive staff time, and actually support a change in hydration behaviors. Advancements in technology are enabling procedures to achieve all of the above.

Consider the template below as a reference when designing or refining your team’s hydration monitoring strategies, with emphasis given to minimally invasive, accurate, repeatable processes.

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. Sawka MN, Burke LM, Eichner ER, Maughan RJ, Montain SJ, and Stachenfeld NS. “American College of Sports Medicine position stand. Exercise and fluid replacement.” Medicine & Science in Sports & Exercise. 2007;39:377–390.

2. Armstrong LE, Casa DJ, Millard-Stafford M, Moran DS, Pyne SW, and Roberts WO. “American College of Sports Medicine position stand. Exertional Heat Illness during Training and Competition.” Medicine & Science in Sports & Exercise. 2007;39:556–572.

3. Kavouras SA. “Assessing hydration status.” Current Opinion in Clinical Nutrition & Metabolic Care. 2002;5:519–524.

4. Bernardot D. Advanced Sports Nutrition. Canada: Human Kinetics; 2006. p. 75–101.

5. Ugras S. “Evaluating of altered hydration status on effectiveness of body composition analysis using bioelectric impedance analysis.” Libyan Journal of Medicine. 2020;15(1):1741904. doi:10.1080/19932820.2020.1741904

6. O’Brien C, Young AJ, and Sawka MN. “Bioelectrical impedance to estimate changes in hydration status.” International Journal of Sports Medicine. 2002 Jul;23(5):361–366. doi: 10.1055/s-2002-33145. PMID: 12165888.

7. Barley OR, Chapman DW, and Abbiss CR. “Reviewing the current methods of assessing hydration in athletes.” Journal of the International Society of Sports Nutrition. 202;17,52.

8. Villiger M, Stoop R, Vetsch T, et al. “Evaluation and review of body fluids saliva, sweat and tear compared to biochemical hydration assessment markers within blood and urine.” European Journal of Clinical Nutrition. 2018;72(1):69–76. doi:10.1038/ejcn.2017.136

9. McKenzie AL, Muñoz CX, and Armstrong LE. “Accuracy of Urine Color to Detect Equal to or Greater Than 2% Body Mass Loss in Men.” Journal of Athletic Training. December 2015;50(12):1306–1309.

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