P ERFORMANCE CONDITIONING INJURY PREVENTION TRAINING FOR YOUNG VOLLEYBALL PLAYERS AND THE ROLE OF ISOLATED VS. INTEGRATED EXERCISE SELECTION

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Bartholomew McCormick
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This is a result of the great deal of pressure placed on the athletes to become successful.

1 P ERFORMANCE VOLLEYBALL CONDITIONING A NEWSLETTER DEDICATED TO IMPROVING VOLLEYBALL PLAYERS INJURY PREVENTION TRAINING FOR YOUNG VOLLEYBALL PLAYERS AND THE ROLE OF ISOLATED VS. INTEGRATED EXERCISE SELECTION Wendy Hurd, P.T., University of Delaware, Newark, DE Through observation, what the health profession has seen is that athletes are specializing in their sports at a much younger age. This is a result of the great deal of pressure placed on the athletes to become successful. The consequence of this phenomenon is that many athletes don't develop fundamental coordination and body control. This impacts their long-term ability to develop sportspecific skills. An example in the sport of volleyball occurs when older players are required to do a fall or roll on defense. Due to the lack of total body conditioning and athleticism at an earlier age, the players might not have the requisite skills or may lack flexibility to do these gymnastic type activities. To pick up these skills at a later age is often harder for older volleyball players to do. Another thing that happens is athletes repetitively expose their body to recurring stresses, which add up over time and create problems later on. That is why things like patellar tendonitis show up at a later age. This is a result of jumping micro traumas that build over time. It takes time for these cumulative stresses to manifest as an overuse injury. If a volleyball athlete does a variety of activities, the stresses aren't isolated to a single body part and this provides recovery time because the stresses are distributed. An added benefit of doing a variety of activities is challenging multiple body segments, which strengthens the entire body and distributes stress absorption. One other issue for young athletes is the type or nature of an injury that results from doing the same thing over and over again. At an adolescent age, doing a repetitive "single action" shoulder activity can result in the bone actually rotating-this is something that is seen in young baseball pitchers. We haven't looked at this phenomenon with volleyball players as of yet, but it is something to consider. Beyond Playing Other Sports These injury factors should encourage athletes to play a wide variety of sports; however, this is easier said then done. The pressure to specialize earlier has created an atmosphere where the three-sport athletes are not as common they once were. So, if specialization is happening earlier, is this a sure prognosis of overuse injury in the future? Not necessarily. Conditioning activities can be designed to complement repetitive activities and help create better balanced athletes. This is a theory but most experts have accepted the concept of using conditioning as a means of injury prevention. Strength can be developed in children through strength training, but there is a risk. If this form of training is done improperly, athletes could suffer injuries, which may be worse than what they are trying to prevent. Following proper strength training protocol is extremely important for young athletes. (See NSCA position paper on the topic at the end of this article for more information). Optimal Training to Competing Ratios This is an important consideration. I'm a big advocate of balance between the amount of time an athlete competes and the time spent developing technical and athletic skills. Istvan Balyi with his fourstep approach to long-term athlete development addresses this issue for volleyball in great detail. His information is published in The Complete Guide to Volleyball Conditioning, Volume 2. The optimal ratio of training-to-competition is speculation at this time. One thing that I believe based on my experience is that young athletes, age eight to ten, don't have the arm length and musculature to typically generate enough force to create an injury. These athletes can go out and have all the fun they want. In my opinion, the amount of competition should be relatively low my guess would

2 be 20 to 25 percent competition to play/practice ratio at this young age. If you want to do body development for these young athletes, it should be in the form of a game. They aren't going to want to stretch for 20 minutes.we have to be creative and do activities and games that enhance flexibility, stability, dynamic strength, coordination and balance. It should be fun and not too structured. When the younger athletes reach about 12 years of age, more formal types of activity can be introduced. In addition, at this age they should begin to be aware of the rationale behind certain training activities, such as stretching. At this point we can introduce more competition into the equation. Puberty Considerations The American Pediatric Association recommends avoiding aggressive, rigorous resistance training until the young athletes have reached what is medically termed Tanner Stage 5 of Development. Generally speaking, for males, this is around the start of high school at the earliest. For females, this may come a year or two sooner. These general considerations are highly subject to individual differences. Serious weight training can start anywhere from 14 to 16 years of age. One's family physician can offer more guidance in helping determine Tanner Stage 5 and provide physical clearance to start. What is aggressive, rigorous weight training? This question is open for debate. Use of the Olympic style explosive lifts 4-5 times a week with 75%-85% of a one repetition maximum would, in my opinion, be one such definition. The take home message from the NSCA and the American Pediatric Association is to provide proper supervision for young athletes as they initiate any type of resistance training program. Also, utilize the family physician if coaches or family are uncertain about what activities may or may not be safe for young athletes. As discussed earlier, because of small lever length and lack of strength, young athletes can do a lot of game type activities in a relatively unstructured environment; but, when puberty hits, growth and strength accelerates, which creates a need for more formal training structure in order to prevent injury. Practice, resistance training, competition all have to be planned and balanced (periodized). If you practice two hours, five times a week, the opportunity to do rigorous resistance training may be limited. At certain times during the competitive year, practice may be reduced and rigorous resistance training increased. Another important consideration is the workload of a practice. If an hour of continuous jump training is done five days in a row, rigorous resistance training should be scaled back for the lower extremities. Change the dosage of activity during practice by structuring activities on an intermittent basis. An example is to follow a serving drill by a defense drill, then switching to a blocking drill. Don't plan on backto-back-to-back drills where the athletes are doing the same skills without a break. Planning, periodization and practice are very important in providing the key elements of variety and recovery. It comes down to not how much you do but when you do it and dosing it out over time. Types of Injury Injuries manifest themselves based on age, skill level of the athletes and their time in the sport. Younger athletes will more likely get ankle sprain injuries and finger trauma because they are developing their setting and blocking skills. These injuries may be termed skill errors. But you also get tendonitis injuries as well. Tendonitis is most typically secondary to excessive loads on the musculotendinous unit. Sometimes this is from not performing the skill properly, but also can be because younger athletes lack the strength necessary to do the skill. If an athlete experiences repeated bouts of tendonitis, s/he may get true tissue degeneration as s/he gets older. These problems surface around the patellar tendon, Achilles tendon, and rotator cuff areas. You also see ACL tears as the athletes become more competitive. One example of a mechanism for anterior cruciate ligament injury is when an athlete lands from a jump in an unbalanced position. The unbalanced position may be secondary to poor jump timing on an attack, or simply poor trunk control. Landing in an unbalanced position puts the athlete at high risk for ankle and ACL injury. Another injury outcome of poor core strength is shoulder problems such as tendonitis and instability. Ideally, the trunk provides a significant amount of the power to accelerate the arm during arm swing of the spike and serve. If the trunk is not providing this power, athletes typically compensate by generating the power and acceleration from their shoulders. Over time, this leads to injury. Core Training Concept: Isolation vs. Integration Functional Training Individuals that the coach can identify as having a weak core should receive specialized training in this area. The ability to objectively and functionally test core strength is highly controversial, with no research-based reports in the literature to support these types of tests. The best way to assess functional core strength is to look at body control as the athlete performs a skill, such as landing from a jump or playing floor defense. As a coach, ask yourself if your players are landing in a balanced position and maintaining proper trunk alignment a majority of the time, even while fatigued. If the answer to this question is yes, chances are they have good core conditioning (PROBABLY). If the answer is no, your athletes may need core training. This training should utilize the concept of both isolated and integrated strengthening. If the coach sees poor posture, specific muscles should be isolated and trained. It should be noted that if you suspect any of your athletes suffer from a significant musculoskeletal imbalance that is affecting their movement abilities, consultation with a health care provider or strength and conditioning specialist would facilitate appropriate exercise selection. However, the way we function on the volleyball court is not in isolation. Therefore, the need to combine core training with other activities becomes important. Using a medicine ball in doing such exercises as the wall sit is an excellent way of integrating core work. This is done by holding the ball extended away from the body while contracting the abdominals. This challenges the trunk while other body parts are working dynamically through a range of motion. Another exercise is holding a medicine ball overhead with both arms. Stand with feet shoulder width apart, bend at the waist, hips and knees to allow the ball to pass between your legs.

3 Return to the start position. (See the exercises that accompany this article for more information). When to do isolation vs. functional core training is the next question. As an advocate of the concepts of periodization, isolation-specific strength training should be done in the off-season when it's best to work on specific weaknesses. When the preseason rolls around, this is the skill time. It is the time when more core integration skill activities should be done. But, if an athlete has poor skill technique, integration core training should stop and the athlete should go back to the more isolated type exercises before focusing on skill advancement. Core training is best done as part of a warm-up circuit. The athletes move from station to station doing different activities. Another time could be during down time at practice when the athletes are waiting to do a drill. Finally, it can also be done as a component of a strength-training workout. These exercises don't require a great deal of resistance so the coach doesn't have to worry about overloading the athletes, per se. Injury Prevention and the Shoulder The rotator cuff of the shoulder is comprised of four small muscles. These muscles are important since the shoulder, by its nature, is an unstable joint. These small muscles control the joint through an arc of motion in hitting. They keep the shoulder from sliding in and out. The large muscles, the pectoralis, the lats and traps of the shoulder are the prime movers they create the force when hitting. The smaller muscles around the shoulder are responsible for joint stability. It is when the small rotator muscles cannot stabilize the shoulder properly that tendonitis or functional instability can occur. It is the dynamic muscular control of these muscles that gives us good shoulder health. Shoulder Training Concept: Isolation vs. Integration Functional Training The concepts of training the shoulder and the core are somewhat different. I don't believe that athletes should over train the force development (large) muscles of the shoulders. Bench presses and lat pull downs are not exercises that give players healthy shoulder joints. A mistake in thinking that is often made is that if you overdevelop the large muscles, this aids in stabilizing the joint. You can do simple, isolated shoulder exercises but you need to progress to more complex, integrated exercises soon after the start of training. Here we would consider the bench press as a simple, isolated exercise for the shoulder and diagonal medicine ball exercises as complex integrated exercises. (See the exercises that accompany this article for more information). By understanding how injuries occur; the importance of keeping a proper training to competition ratio as one develops; and the proper implementation of isolated simple and integrated complex exercises, young volleyball players can enjoy a long, productive, relatively injury free career in our sport. More Information Please! Wendy is a previous contributor to Performance Conditioning Volleyball. For two years she was sports medicine lecturer for the USA Volleyball, Volleyball Conditioning Specialist course. She works with several high school volleyball teams as a sports medicine resource. Recently, she presented a paper on an interval hitting program for collegiate volleyball players. She has her P.T. degree from the University of Missouri and is working on her Ph.D. in biomechanics at the University of Delaware. [Ed.] Contact the author at her address: wjhurd2001@yahoo.com. For a copy of the The Complete Guide to Volleyball Conditioning, Volume 2, Item # VB 130, go to website National Strength and Conditioning Association Guide for Prepubescent Strength Training 1. Strength training can begin at any ageathletes should have pre-participation physical; should be emotionally mature enough to handle instructions; should never be left unsupervised. 2. The strength training program should include a variety of different physical activities in addition to strength training; it is recommended that 50%-80% of the prepubescent athletes' program includes a variety of different activities to enhance their abilities and keep them interested. 3. When introducing a child to strength training exercises with free weights and machines, no weight should be used initiallywhen the child has mastered the exercise, then weight can be added. Using exercises that employ body weight as resistance; i.e., chin-ups, dips, sit ups, is excellent for prepubescents as well as adults. 4. A prepubescent training program should consist of high repetitions and low weight. The NSCA recommends 6-15 repetitions per set. One repetition maximums should never be attempted. 5. The training program could be performed three times a week, with a day of rest in between. In a 60-minute session, the workout should consist of minutes of weight training, minutes of games, and a cool-down. 6. In conclusion, there are risks to a prepubescent athlete's strength training; however, there does not appear to be any greater risk to a prepubescent or adolescent in a supervised strength-training program when compared to wellknown and respected sporting activities.

Exercises Core: Simple (Isolated) 1. Crunches: Lie on the floor on your back with knees bent and hands behind head.

Reverse Crunch: Keep upper body on floor as you pull knees in toward chest c. Integrated Crunch: Pull knees in toward chest as you raise chest up 2.

Bird Dog: Begin on your hands and knees holding your spine in a neutral position throughout the exercise. Slowly lift one arm to shoulder level. Lower. Alternate arms. Variations a.

Raise one arm and the opposite leg at the same time. Repeat with the opposite arm and leg. c. You may add cuff weights to wrists or ankles with these exercises. Core: Integrated (Complex) 1.

Take one large step forward with your right leg; slowly lower your body straight down, allowing the back leg to bend and stop when a 90-degree angle is reached with the front leg.

Continue 2. Medicine Ball Woodchops: Hold medicine ball overhead with straight arms. Stand with feet shoulder width apart.

4 Exercises Core: Simple (Isolated) 1. Crunches: Lie on the floor on your back with knees bent and hands behind head. Keep chin up toward ceiling as you raise your chest until your shoulder blades lift off the floor. Slowly lower back to floor. Variations a. Weighted Crunch: Hold a weight plate against your chest b. Reverse Crunch: Keep upper body on floor as you pull knees in toward chest c. Integrated Crunch: Pull knees in toward chest as you raise chest up 2. Back Extension: Lie on the floor face down with arms at side. Lift chest and shoulders off the floor, arching the lower back. 3. Bird Dog: Begin on your hands and knees holding your spine in a neutral position throughout the exercise. Slowly lift one arm to shoulder level. Lower. Alternate arms. Variations a. Same exercise as above except lift up one leg at a time. b. Begin on your hands and knees holding your spine in a neutral position throughout the exercise. Raise one arm and the opposite leg at the same time. Repeat with the opposite arm and leg. c. You may add cuff weights to wrists or ankles with these exercises. Core: Integrated (Complex) 1. Walking Lunges: Hold medicine ball with both hands outstretched in front of body. Take one large step forward with your right leg; slowly lower your body straight down, allowing the back leg to bend and stop when a 90-degree angle is reached with the front leg. While holding this position, rotate trunk to right side and bounce medicine ball on floor; rotate to left side and bounce medicine ball. Then, push body up and take step forward with left leg. Continue 2. Medicine Ball Woodchops: Hold medicine ball overhead with straight arms. Stand with feet shoulder width apart. Keeping arms straight, bend at the waist, hips and knees to allow ball to pass between the legs. Return to start position. 3. Cone Touches: Hold small dumbbell or medicine ball in each hand. Have 3 cones positioned on floor in triangle such that touching farthest cone requires you to fully extend the arm and bend at the waist. Standing on one foot, take one hand and touch the cone to the left; completely return upright maintaining balance on single leg. Using same hand, touch middle cone; return upright. Then touch cone on right. Use same hand and leg for balance, reverse the procedure (right to left). Repeat for each hand and leg. May stand on unstable surface to increase challenge. 4. Mini Squats: Stand on unstable surface (rocker board, sand, foam, trampoline, etc.); hold medicine ball outstretched in front of body with both hands. Perform traditional squat while maintaining trunk in an upright position during the squat. Feet should be positioned with toes pointed forward or slightly toed-out. 5. Lateral Step-up with Tubing: Stand on step on single leg and perform a partial squat (do not allow opposite leg to actually touch down-continuously maintain single leg balance). While you perform step-up, simultaneously perform D2 shoulder exercise with

tubing (see integrated shoulder exercises for description of D2 shoulder exercise). Shoulder: Simple (Isolated) 1.

Raise arms to shoulder level at 30 angle in front of body (thumbs should be pointed up toward ceiling).

seconds and slowly lower. 2. Side-Lying External Rotation: Lie on side with top arm at side of body and elbow bent 90.

External Rotation at 90 : Stand with upper arm out to side and parallel to floor, elbow bent to 90.

Maintain elbow flexion of 90. Slowly return tubing and hand to start position. 4.

Punch arm up toward the ceiling, allowing the shoulder blade to lift off the table. Slowly return to the start position. 5.

Return to starting position. Shoulder: Integrated (Complex) 1. Diagonal Patterns a.

Starting with thumb pointed down and out; rotate hand so thumb is pointing up.

Return to start position by first turning thumb down toward opposite thigh and reverse arm movement to start position.

For both exercises, tubing should move in line with pattern of exercise as shown in diagram. 2.

5 tubing (see integrated shoulder exercises for description of D2 shoulder exercise). Shoulder: Simple (Isolated) 1. Full Can: Stand with elbows extended and thumbs up. Raise arms to shoulder level at 30 angle in front of body (thumbs should be pointed up toward ceiling). Do not go above shoulder level. Hold for 2 seconds and slowly lower. 2. Side-Lying External Rotation: Lie on side with top arm at side of body and elbow bent 90. Keeping the elbow of top arm fixed to side, rotate forearm upward. Hold two seconds and slowly lower. 3. External Rotation at 90 : Stand with upper arm out to side and parallel to floor, elbow bent to 90. Grip tubing (opposite end of tubing is fixed straight ahead). Keeping shoulder fixed, rotate forearm back (away from floor). Maintain elbow flexion of 90. Slowly return tubing and hand to start position. 4. Punches: Lie on your back holding a medicine ball or dumbbell. Punch arm up toward the ceiling, allowing the shoulder blade to lift off the table. Slowly return to the start position. 5. Latissimus Pull Downs: Recline body to a 45 angle. Maintain this position as you pull the bar down toward chest. Return to starting position. Shoulder: Integrated (Complex) 1. Diagonal Patterns a. D2 Flexion: Dominant hand grips tubing across body and against thigh of opposite side leg. Starting with thumb pointed down and out; rotate hand so thumb is pointing up. Proceed to bring arm up and over dominant arm in a diagonal movement pattern. Maintain elbow extension throughout. Return to start position by first turning thumb down toward opposite thigh and reverse arm movement to start position. Perform this exercise with tubing fixed to floor. b. D2 Extension: As above, but with tubing fixed overhead. For both exercises, tubing should move in line with pattern of exercise as shown in diagram. 2. Plyometrics: Stand facing a plyoback (brand name for trampoline) or may also use a wall or throw to partner; perform all exercises rapidly. a. Chest Pass: Use both hands to hold a medicine ball against the chest. Snap the ball off your chest while stepping forward into the motion. The back of your hands should come together when releasing the ball. b. Overhead Throw: Stand and hold the ball behind your head with arms extended. Throw the ball over your head while stepping forward into the motion. c. Diagonal Throw: Stand facing sideways to a trampoline with your lead foot pointed toward the trampoline. Starting with the ball at shoulder level, throw it over your head to the trampoline while keeping your arms extended and allowing your upper body to rotate.

PGYVC Volleyball Circuit Athletic Plan

PGYVC Volleyball Circuit Athletic Plan Workout Plan: This workout plan is to introduce and promote off court training for PGYVC athletes as well as to build confidence for athletes who have not done physical