VOLLEYBALL CONDITIONING ANEWSLETTER DEDICATED to IMPROVING VOLLEYBALL PLAYERS Volume 16, Number 3 WHAT’S INSIDE?

ERFORMANCE P VOLLEYBALL CONDITIONING ANEWSLETTER DEDICATED TO IMPROVING VOLLEYBALL PLAYERS Volume 16, Number 3 WHAT’S INSIDE?

Knee Injury Prevention and More Jill Wosmek 1

nd Welcome to the 2 Edition of the All Electronic Movement Training Systems Performance Conditioning Volleyball- A newsletter Present: Avoiding the False Step dedicated to Improving the Volleyball Player 4 the Real 1st Step in Speed Training Thomas Sheehan We hope you enjoyed our first issue. Of the many effi- ciencies this change provides we are most excited about the ability to instantly expand your knowledge through our new Chain- TM Links. When you see this link that means when you click you Postural Restoration Institute learn more. The link might be a past article from our world's Presents - The New Off-Season: largest conditioning library of over 500 articles. It may be a Balanced Regeneration Series #4 6 video clip showing you how to do an exercise properly or the Gluteus Medius Facilitation research study or abstract behind a particular statement within an Lisa Bartels article. Another benefit this change will provide is your ability to ask a question or gain more information from an author or the services s/he provides. Also you can contact us directly to make Putting Research into Practice - Mild a comment, give us ideas on things you would like to see or Anxiety Training May Prevent answer a question. Give it a try at [email protected] 9 “Choking” When It’s “All on the Line” These are just a few of the benefits our new format pro- MJ Engstrom vides. Many more will come as we evolve into this exciting new medium. We hope you enjoy!

Ken Kontor, Publisher Gaining Volleyball Durability: A Performance Conditioning Cycling Preseason Training Program for Varsity and Junior Varsity Girls 11 Bob Takano

Understanding and Preventing Age Specific Injury in the 13 Young Volleyball Athlete Bruce Morgan ALL NEW!! The Fit for Life-Volleyball The Athlete’s Way planning book and companion DVD provides you all the information you need to start an advance athlete’s fitness/conditioning program.

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Meet the Author Ken Kontor is publisher of Performance Conditioning Volleyball newsletters, now in its 13th year of publishing and 11 volleyball-specific conditioning books. He is a founding member of the USA Volleyball Sports Medicine and Performance Commission and is the Curriculum Developer for the USA Volleyball, Volleyball Conditioning Accreditation Program (VCAP). ORDER FORM Yes!Rush via 2-3 day U.S. Mail FOR FASTER SERVICE CALL: 1-800-578-4636 OR, VISIT OUR WEB SITE: WWW.PERFORMANCECONDITION.COM Item # FFL-VB —$29.95 Name ______QTY ITEM NO. DESCRIPTION PRICE Address______City ______State_____Zip ______Phone: ( ______)______E-Mail: ______Mail check or purchase order with this form to: Subtotal ______Performance Books and Videos, P.O. Box 6819, Lincoln, NE 68506 Shipping charges ______Payment Information: Charge my Visa MasterCard AMEX Discover Total enclosed ______Shipping charges U.S. and Canada: Card Number: ______Expire date: ______First item...... $4.95 Signature ______Date ______Each additional item ...... $1.00 Each item international surface mail add ...... $2.50 Allow 7 to 10 days for delivery—4 to 6 weeks international. ERFORMANCE P VOLLEYBALL CONDITIONING ANEWSLETTER DEDICATED TO IMPROVING VOLLEYBALL PLAYERS Volume 16, Number 3 Knee Injury Prevention and More Jill Wosmek, MA, ATC, U.S. Women's National Volleyball Team

Jill Wosmek (Silver Lake, Minn.) is in her first year as the full-time certified athletic trainer for the U.S. Women's National Volleyball Team as part of USA Volleyball's sports medicine program. She has six years experience in the athletic training field in four collegiate athletic departments. With USA Volleyball, Wosmek is in charge of evaluating and assessing injuries, design and implementation of treatment and rehabilitation plans, and providing injury prevention methods to the U.S. Women's National Team players. As a traveling member of the staff, her daily duties include pre-practice treatments, lengthy core and dynamic warm-up with the team, monitor practice, rehabilitation, post-practice treatments, designing and implementing the weight training program and providing recovery treatments. Wosmek worked two academic seasons (August 2007 to May 2009) as the athletic trainer for the Penn State University women's and men's volleyball teams. During her time, the Nittany Lion women's volleyball team won two NCAA Division I titles and the men's volleyball team won a NCAA National Jill Wosmek Collegiate Volleyball Championship title. INTRODUCTION ince the institution of Title IX of the Educational Assistance Act in 1972, there has been a subsequent BEG rise in sports participation by 900 percent with females in high schools and 500 percent at the colle- INT giate level. The dramatic rise in female sport participation was soon coupled with the rise in knee ADV injuries seen between the sexes. Current statistics show that a female athlete is anywhere from 4 to 7 times more likely to suffer from a knee injury in comparison to an equal male counterpart [Myer et al. 2005].S Researchers, sports medicine professionals, coaches and athletes have been exploring the topic of why the increased injury rate and what can we do to prevent these injuries The research goes to great lengths to decipher where the gender gap with knee injuries becomes so prevalent. Statistically it is clear that puberty plays a role with the increased incident rate with female athletes. Not only will age be a predictor - we must analyze overall muscular strength, hormonal changes, sport demands, biomechanical technique along with volume, intensity and recovery with your sport. Net Link: View the NCAA's full report HERE! Symbols to Success THE RESEARCH IS TELLING US… Articles preceded by So what have we learned from the research? I have had the BGN indicates author believes content is for beginning-level athletes with training age of 0 to 2 opportunity to be semi-involved in this epidemic. During my career I years. have spent multiple years as a certified athletic trainer in the NCAA INT indicates author believes content is for sport (intermediate)-level athletes with training Division I and II levels. I participated in both the NCAA Injury age of 2 to 4 years. Surveillance System [ISS] data collection and local research projects ADV indicates author believes content is for expert-level athletes with training age of over 4 looking at injury incident rates and factors. years.

Recently, I have had the opportunity to meet and discuss with ODV indicates author believes content is for outdoor volleyball. Dr. Tim Hewett what truly are the take-homes in the research and what NOTE: Training age year is continuous, year-round conditioning beyond just playing volleyball. is the next step in implementing a prevention program. Dr. Hewett R and his staff at the Cincinnati Children's Hospital are truly leading the following article indicates the content has been reviewed by the editorial board. way in state-of-the-art biomechanical analysis and implementation of O following article indicates the content is the sole opinion of the author. appropriate programs starting with the athletes at an early age. This publication brought to you I could spend a significant amount of time explaining their in cooperation with research and how they are implementing prevention programs within the school districts, but will opt to bypass the topic and move onto what we are doing with the elite athletes on the U.S. Women's National Volleyball Team. We have incorporated Dr. Hewett's work into our own program design and have been seeing a positive correlation with overall injury rates Sports Medicine and and sports performance. I encourage you all to take a few minutes and edu- Performance Commission KNEE INJURY PREVENTION cate yourself on the work completed by Dr. Hewett's group and how it links with the current research that is somewhat repetitively seen in the sports medicine journals. Dr. Hewett's group is one of the few that specifically designed prevention programs that are statistically proven to positively affect the knee injury rates and overall performance of a female athlete. Net Link: Please refer to Dr. Hewett's work at the Cincinnati Children's Hospital [Retrieved April 2010 http://www.cincinnatichildrens.org/svc/alpha/s/sports-med/default.htm] Known factors seen in the research to be playing a role in ACL tears specifically in female athletes include: • Anatomical differences: size differences between the pelvis width, Q-angle, size of ACL and size of intercondylar notch • Hormonal differences: the ACL has hormone receptors for estrogen and progesterone. Studies have shown some statistical differences in rates of ACL injury during the different phases of the menstrual cycle. However, there has been some conflicting data, and the effect of hormone concentration is not truly defined. • Biomechanical differences: note the differences in static and dynamic stabilizers of the knee. The static stabilizers are defined as the major ligaments [ACL, MCL, LCL and PCL]. The dynamic stabilizers for the knee are the muscles and tendons that sur- round the knee joint. Females have been found to have differences in biomechanical movements of the knee seen in pivoting, jumping and landing. Consider limb dominance, overall strength, endurance and flexibility • Other variables to consider: level of competition, skill level, shoes and equipment, playing surface, ligamentous laxity, neuromuscular control and prior injuries. Net Link:[Retrieved April 2010 http://orthopedics.about.com/od/aclinjury/f/women.htm] The NCAA Injury Surveillance Program 2009 report shows injury incidence data from 2004 through 2009 with a breakdown between 15 male and female sports. Specifically looking at women's volleyball states that ankle injuries comprise 22.3 percent of injuries during competition [versus knee at 16.1 percent] and the knee at 15.5 percent of injuries during practice [versus ankle at 13.5 percent]. Injury rates tend to be higher in Division I and II relative to Division III. [Marshall et al. 2009] I think we could spend a lot of time analyzing the differences between injury incident rates among gender, sports, body parts and so on. That can be somewhat exhausting, so we will continue to let the NCAA ISS compute that for us and take away what is truly per- tinent to us. PREVENTION! Sport -any sport- comes with an inherit risk of injury. As sports medicine professionals, coaches and athletes we need to treat and train our body to its optimal level. So what can we do to address these 'epidemic' knee injuries in the female athlete? Please refer the table constructed by Myer et al. [2008] in association with Dr. Hewett's work: One of the primary focuses of their research and preventative program design incorporates neuromuscular control. There is not an abundance of evidence comparing different training styles, neuromuscular implementation, biomechanical testing and technique. For me as a clinician, these are the most intriguing components. As a sports medicine professional working with the U.S. Women's National Volleyball team, I know I have limited control to these components: • ACL size, location and tensile strength - no control • Hormonal levels and menstruating cycle - no control • Prior injuries and training patterns [or lack thereof] - no control • Joint laxity throughout the body - no control • Shoe type, equipment and playing surface - limited control • Strength, flexibility, neuromuscular control, tissue recovery, training patterns, along with biomechanical analysis and movement education - YES! Knowing what we know now when it comes to injury and sport demands, we need to refocus on what we can do increase the successes of the female athletes. Figure 1. simply states how neuromuscular training when incorporated correctly can play a huge role. Dr. Hewett and colleagues demonstrated that not only are we trying to prevent ACL tears and patellofemoral injuries, but we are trying to improve the overall health of the knee, specifically looking that the risk of osteoarthritis. Neuromuscular training could be promoted in pre- and early pubertal athletes to help prevent the development of poor knee joint biomechanics. A preemptive approach that imple- ments these training styles may also reduce the peak rate of ACL injuries that occur by the age of 16. Because of the near 100 percent risk of osteoarthritis in the ACL injured population it is indicative we implement these programs [Myers et al. 2008]. The U.S. Women's National Volleyball Team has pros and cons to their training patterns as well. Time spent with us in the USA National Team Center may be limited, length of competitive season, age, previous injury, time to implement programs and so on. However, we have taken the initiative to implement what we can - something is always better than nothing! In 2005 a great article was written by Myer, Palmbo, Ford and Hewett concerning the four components to program design for knee injuries. This included [1] plyometrics and movement training; [2] resistance training; [3] core strength and balance; and [4] speed training. I have worked to design a similar program incorporating these concepts and using their work as a guide. The great thing is - that with the appropriate tools and concepts - anyone can design a program that works well with their team in spite of any factors that may be hindering the process. WHAT ARE WE IMPLEMENTING WITH THE U.S. WOMEN'S NATIONAL VOLLEYBALL TEAM…? I think for this purpose of this article - we will use our in-season/summer schedule. This time of year presents the most chal- lenges when we consider training regimen, travel demands, competitions and recovery period from winter professional season.

PAGE 2 PERFORMANCE CONDITIONING VOLLEYBALL, VOLUME 16, NUMBER 3 KNEE INJURY PREVENTION Goals and Implementations: 1. CORE STRENGTH: Each day we spend approximately 10 minutes as a team completing both static and dynamic core exercises. Remember the core is not just the abdominals - it includes the lumbar spine musculature, hip and gluteal complex and posterior shoulder musculature. Core exercises are also integrated in the strength training program. Net Link: Developing Core Power with Courtside Conditioning Circuits 2. FLEXIBILITY: Each day prior to practice we incorporate a dynamic stretching routine - static stretch post-activity - independent foam roll pre- and post- activity - active release, positional release, Graston treatment and PNF techniques when indicated. Net Link: Secret to Reaching New Heights in Blocking-The Shoulder Elevation Strengthening/Stretching Routine 3. PROPRIOCEPTION/BALANCE: Each day we integrate unilateral and challenging proprioceptive exercises for the entire body during our pre-practice and strength training program. 4. NEUROMUSCULAR CONTROL: Each day pre-practice we integrate a couple exercises focusing on neuromuscular activation and those same concepts are seen in the strength training program. 5. STRENGTH: Two days per week are spent as a team completing the detailed strength program. We put a strong emphasis on functional training and using the body in efficient movements. One additional day the athletes are split by position or needs and complete another workout including functional strength training, movement, speed, agility and plyometrics. Net Link: Around the court strength circuit 6. FITNESS: Our philosophy is that we get fit by playing volleyball! But in reality, if there are athletes that need additional cardiovascular fitness to reach her potential, we will set-up those programs on an individual basis. 7. BIOMECHANICAL TECHNIQUE AND MOVEMENT: Each day pre-practice we assess movements and give appropriate feedback [this can be part of our dynamic warm-up, blocking footwork, and agility drills]. We also utilize Dartfish video and DVR during our practice and plyometric workouts to provide feedback and educate the athletes. 8. SPEED AND AGILITY: Daily practice incorporates at least one agility activity. Speed and agility is also incorporated three times a week [two team workouts and one breakout workout] Net Link: Mobility Training for Spiking and Court Movement 9. POWER: Implemented into all strength workouts and weekly plyometric workout. Net Link: Combining Olympic Style Lifts and Jump Training to Improve U. S. Women's Volleyball Performance National Team 10. MUSCLE REGENERATION: A healthy athlete needs to care for his or her Member - Foluke body. As an athletic trainer, I incorporate a lot of manual work in my daily routine. Akinradewo Therapeutic modalities include: nutritional recovery, hydration, various types of demonstrates a couple exercises massage, active release therapy, muscle energy techniques, positional release ther- used on a daily apy, Graston technique, PNF, foam roll, massage stick, contrast bath, GameReady, basis. Single leg ice, ice massage and full-body stretching. Net Link: The Hands-On Sports balance on the Massage Techniques for Lower Body Recovery Bosu Ball with the CONCLUSION Body Blade and To be honest, this article is just a fragment of the subject matter. Knee Side-Lunges with injury and prevention in a female athlete needs to be taken seriously at all levels - the medicine ball. especially with our youth. In my position, it is my job to make sure each athlete is as healthy and athletic as they can be. In the back of my mind, I realize that after the Olympics and into an athlete's retirement, I want them to be healthy. I do not want to set-up these elite athletes for a future of debilitating injuries or conditions. I urge us all to do our part in creating a well-rounded, healthy and successful athlete. O Net Links: Contact Jill at [email protected] For a complete ACL program order the 3 Step ACL Injury Prevention Program for Female Athletes Training Card System Heavy Duty Paper $7.95 AZ-220P 3 Step ACL Injury Prevention Program for Female Athletes Training Card System Laminated $14.95 AZ-220L REFERENCES 1. About.com Orthopedics Retrieved April 2010 http://orthopedics.about.com/od/aclinjury/f/women.htm 2. Cincinnati Children's Hospital Retrieved April 2010 http://www.cincinnatichildrens.org/svc/alpha/s/sports-med/default.htm 3. Marshall S., Corlette, J. Fall Sports Qualifying Report: 2004-2009 Academic Years. Datalys Center for Sports Injury Research and Prevention: Indianapolis, IN. Dec. 2009. 4. Myer, G., Ford, K., Hewett, T. The effects of gender on quadriceps muscle activation strategies during a maneuver that mimics a high ACL injury risk position. Journal of Electromyography and Kinesiology. 2005:15(2):181-189. 5. Myer, G., Ford, K., Palumbo, J., Hewett, T. Neuromuscular training improves performance and lower-extremity biomechanics in female athletes. Journal of Strength and Conditioning Research. 2005:19(1):51-60. 6. Myer, G., Chu, D., Jensen, B., Hewett, T. Trunk and hip control neuromuscular training for the prevention of knee joint injury. Clin Sports Med. 2008:27:425-448.

PERFORMANCE CONDITIONING VOLLEYBALL VOLUME 16, NUMBER 3 PAGE 3 AVOIDING THE FALSE STEP Movement Training Systems Present: Avoiding the False Step the Real 1st Step in Speed Training Thomas Sheehan CSCCA, MS, MEd, Director of Strength and Conditioning, Columbia University Tommy Sheehan is in his 11th year at Columbia, his ninth as Director of Strength and Conditioning. In that position, he supervises a two-person staff in all aspects of strength and conditioning for Columbia's 29 inter- collegiate teams. He was named Director of Strength and Conditioning in 2001. Well-known throughout the strength and conditioning profession, he was asked to produce an instruc- tional DVD during the past year for the Cleveland Indians, on movement training in an off-season conditioning program.

What is a false step? BEG false step is an inefficient initial movement often in an unintended direction, e.g., forward to INT go backward, backward to go forward, or lateral to go forward or backward. It is a movement Thomas Sheehan ADV of the body without gaining ground in the direction you are trying to go. It occurs when you are off balance prior to your first step, requiring a weight shift to regain balance before first step is made. Some examplesA of false steps include the following: • When you hold your body weight on your right foot and want to move right, you're required to shift your weight to your left foot to enable you to push off. This shift is inefficient movement - a false step. • Lifting the leading foot and putting it back down in the same place, and then crossing over to move in the intended direction. • Moving the upper body first, then the lower body following it can be considered a false step even though you haven't taken a step. It is a movement without gaining ground. Your upper body moves leaving your hips behind.

How do you correct it? A balanced body position and initializing movement in the feet are the two keys to efficient movement and eliminating false steps. Balanced body position includes the chest over your feet, hips back and down in a ¼ squat position, weight centered on the mid foot. Hips must be centered over your feet on each step or you will not gain ground in a balanced position, setting you up for inefficient movement. Initializing movement with a push through the foot results in parallel movement of the opposite hip - in other words, the opposite hip releases. This keeps you in a balanced position, ready for your next movement. If movement is not initialized from the foot, the movement starts with a lifting of the leg, which results in less force through the ground. SUMMA- RY SENTENCE Balance and stability work as partners to create the support necessary for efficient movement.

The Movement Training System The progression of all the movement is as follows: The movement training system we use conditions the body to cre- >Walks ate an on-balanced condition. This series of movement drills emphasizes >Bounces pushing through the foot to move rather than lifting the leg or moving the >Fires upper body first. Initially the foot is strengthened, and educated in reaction >Change of direction with bounces and fires and timing. The body is then trained to respond in synchronized motion >Deceleration training from the foot up through the rest of the body. As this is achieved, the ath- >Sport specific movement lete is more balanced, explosive, quick, and more efficient. Repetition in >Low pushes can be added at any point developing these balanced positions is critical. >Add cone drills Trains the body to maintain the perfect athletic Movement Training Keys stance for long periods of time Body Position (stance) • Chest and hips over mid-foot (back of the ball of the foot) • Weight on the mid-foot • Feet shoulder-width apart • ¼ squat position

Efficiency (gaining a step every movement) • Push through the foot and release the opposite hip to move. • Push through the foot to turn the upper body or change direction. • Avoid turning the upper body without pushing through the foot (slower movement) • Avoid lifting one leg to move - this results in an upward rather than horizontal movement

Arm action while in motion • Always keep arms bent at 90 degrees and swing through the shoulder on all movements

PAGE 4 PERFORMANCE CONDITIONING VOLLEYBALL, VOLUME 16, NUMBER 3 AVOIDING THE FALSE STEP • Arms and legs must be synchronized at all times

Power • Synchronization of the body • Create force through the ground starting with the push through the foot and transfer to the upper body

Foot Training Drills The body needs to be trained to move efficiently. The foot needs to be strengthened and used properly to move the body. The following drills, if mastered, will provide a solid foundation for improving performance by training the foot and its balance points.

1. Walk through the foot: The first and most critical drill. This drill works on timing of the push through the foot and the release of the opposite hip. • Start with feet parallel with chest over the mid foot (back of the ball of the foot). • Push through heel to mid-foot and release opposite foot and hip. • Keep legs straight and toes dorsiflexed.

2. Snap • All principles from the walk through the foot drill apply, but the foot strike is with the mid-foot and not the heel.

3. Bounce Forward (need to be able to release the foot and hip in all directions) this drill teaches how to hold balance points on foot contact and to get your feet on and off the ground quickly. • Keep legs straight, chest over mid-foot on each ground contact, strike with mid-foot and push quickly through the foot to release the opposite foot and hip. • Push and release forward and not up. If you are spending a lot of time in the air your timing is off.

4. Bounce Backward • Push through the foot to release the leg and hip backward. • Body position is the same as forward bounce. • The entire body must move backward maintaining body position. • Avoid leaning forward. • Each foot strikes with hips and chest over mid-foot.

5. Bounce Lateral • Body position is the same as forward and backward bounce. • Push laterally across the foot and release the other hip • As the push leg gets to shoulder width apart… push again • Be sure to push and not lift • Gain ground laterally not vertically (push out and not up….slower movement) • Arm action must match foot action

Push Training Push training is about being in a balanced stance to start and being able to push and release to move. The low pushes train you to push on first movement. For example an infielder stance or a base stealer stance is the low push position. In volleyball this is usually bent over in a lower position to receive the ball during a serve. In soccer this position is maintained during a multitude of ball skill and defensive movements. It is a loaded stance that every athlete should be in. The push drills train body position. Low Pushes do the following to enhance performnce: • Train the body to maintain the perfect athletic stance for long periods of time. • Maintain body position through entire movement avoiding a rise and fall. • Push from the foot to release opposite hip to gain ground. • Pushing horizontal and not vertical.

Low Push Forward • Start with square stance, feet shoulder width apart. • Push off the right foot releasing the left foot and hip forward. Bring the right foot square to the left getting feet under your hips as quickly as possible. • Arm action should match the push. Push and release with full arms swing from the shoulder. • Stay low on the push, get full extension of the push leg, release the opposite hip at the same time as the push, and push out not up. Exercise Prescription: Perform 2 sets of 25 meters or 10 each leg. PERFORMANCE CONDITIONING VOLLEYBALL VOLUME 16, NUMBER 3 PAGE 5 AVOIDING THE FALSE STEP / THE NEW OFF-SEASON #4

Low Push 45 • Start with square stance, feet shoulder width apart. • Push off the right foot releasing the left foot and hip at a 45-degree angle. Keep shoulders and toes square facing the same direction. Bring the right foot square to the left getting feet under your hips as quickly as possible. • Arm action should match the push. Push and release with full arms swing from the shoulder. • Stay low on the push, get full extension of the push leg, release the opposite hip at the same time as the push, and push out not up. Exercise Prescription: Perform 2 sets of 25 meters or 10 each leg.

Low Push Backward at 45 • Start with square stance, feet shoulder width apart. • Push off the right foot releasing the left foot and hip at a 45-degree angle backwards. Keep shoulders and toes square facing the same direction. Bring the right foot square to the left getting feet under your hips as quickly as possible. • Arm action should match the push. Push and release with full arms swing from the shoulder. • Stay low on the push, get full extension of the push leg, release the opposite hip at the same time as the push, and push out not up. Do not lean forward on push, stay square and in athletic position. Exercise Prescription: Perform 2 sets of 25 meters or 10 each leg.

Low Push Lateral • Start with square stance, feet shoulder width apart. • Push off the right foot releasing the left foot and hip lateral. Keep shoulders and toes square facing the same direction. Bring the right foot square to the left getting feet under your hips as quickly as possible. • Keep feet shoulder width during entire movement. • Arm action should match the push. Push and release with full arms swing from the shoulder. • Stay low on the push, get full extension of the push leg, release the opposite hip at the same time as the push, and push out not up. Do not lean forward on push, stay square and in athletic position. Exercise Prescription: Perform 2 sets of 25 meters or 10 each leg. O

More Information Please! If you would like video of these drills or breakdowns of your athletes' movements contact Tommy Sheehan at [email protected] To Learn more about movement training based on Tommy's programs go to: http://www.movementtrainingsystems.com To get all the exercises on DVD go to Alex Kovalev's web site http://www.ak27.com Postural Restoration Institute™ Presents the New Off-Season: Balanced Regeneration Series #4 Gluteus Medius Facilitation Lisa Bartels, Omaha Sports Center, Omaha, NE Lisa was a member of the University of Nebraska volleyball team from 1995-1997. She was introduced to the science of Postural Restoration as a patient under the care of Ron Hruska. She had suffered from long-standing injuries sustained during her collegiate volleyball career and found success with the treatment techniques she learned at the Hruska Clinic and later received from the Postural Restoration Institute. Lisa returned to practice physical therapy at the Hruska Clinic Restorative Physical Therapy Services in Lincoln, Nebraska after completing her Doctorate of Physical Therapy from the University of Nebraska Medical Center in Omaha. Lisa is a member of the American Physical Therapy Association.

BEG elcome to the new off-season: Balanced Regeneration- a series of articles dedicated to Lisa Bartels INT creating balanced athletes participating in a side dominate sport. A side dominate sport ADV is defined as a sport in which skills are performed utilizing a "preferred" side of the body on a repeated basis. Each issue of this publication will present a new installment that develops a progressive step-by-step plan, basedW on Postural Restoration Institute® (PRI) concepts and methodology. This plan is designed to create a balanced athlete who can manage asymmetrical sports demands without pain and injury. The first installment of the Balanced Regeneration series explained AF IR performance testing that can be utilized to measure core stability and identify imbalanced athletes. The second and third install- ments initiated the first two steps in the Balanced Regeneration program; correct left hamstring facilitation followed by recruitment of the left ischio-condylar adductor. Left gluteus medius training application is the next step in the program. PAGE 6 PERFORMANCE CONDITIONING VOLLEYBALL, VOLUME 16, NUMBER 3 THE NEW OFF-SEASON #4

The Problem-Anatomy of Imbalance If the members of an athletic team were instructed to stand shoulder to shoulder in a straight line with their arms at their sides, it would appear that the pelvis and trunk of all players was neutral, facing straight ahead. Despite appearances, the pelvis may not be in a neutral resting position in several of those athletes. Most competitive athletes that are evaluated with PRI methodology initially present with significant left side versus right side differences; differences in bony position, differences in muscle strength/function, and differences in the integrity of various joint sockets. Asymmetrical sports demands coupled with uncontrolled right side dominance can produce these postural imbalances. The most common postural presentation is left pelvic torsion with compensation via the trunk and upper extremities. The most common functional strength impairment is inability to achieve left AF IR when the left leg and hip is loaded during upright activity. Acetabular (socket) femoral (ball) internal rotation (AF IR) is a term that PRI has coined as an individual's ability to shift their weight into one side of the pelvis. The pelvis is comprised of a pair of innominate bones that sit on either side of the sacrum (Figure 1). When discussing gait mechanics it is appropriate to divide the pelvis into halves; the left hemi pelvis and the right hemi pelvis. The hemi pelvis should achieve a maximum and appropriate amount of AF IR when the same side leg is in a midstance position of gait. When a leg and hip are loaded during gait, muscles on that side of the body must activate to support the weight of the body as the opposite leg clears the ground. The position the pelvis is in dic- tates which muscles will function in this capacity. In a hip with healthy AF IR ability the primary force couple that should be active at midstance to support the weight of the body is the left ischiocondylar adductor and the left gluteus medius. Many athletes lose this ability because their right lower extremity dominance cou- Figure 1 pled with asymmetric sports demands has lead to an acquired position of left pelvic torsion. Left pelvic torsion is rotation that should occur when the right leg is loaded into stance phase of gait. The opposite should occur when the left leg is loaded into stance phase; right pelvic torsion should occur when the left leg is loaded. Athletes mal- positioned in left pelvic torsion are remaining in a shifted state on the right hip. They have no problem achieving right AF IR during right stance phase, but when they load the left leg they can not shift into the left hip despite transferring all weight to the left leg. This is because of adaptive weakening of some muscles and adaptive shortening of others. To simplify, this improper bony position essentially eliminates the ischio-condylar adductor and the left gluteus medius. The remaining muscles that possess abductor leverage across the hip will compensate. The top two muscles that will likely increase their tonic activity are the tensor fascia latae and the lateral quad group, vastus lateralis. Interesting to note, the vastus lateralis does not cross the hip joint. In a closed chain position, muscles do not have to cross the hip joint to rotate or abduct the hip. When the left lateral quad begins functioning as a primary hip abductor you can develop pain syndromes such as lateral knee pain, iliotibial band restriction, and patellar tracking issues that are not typically resolved with bracing and surgical interventions such as the lateral release. The Solution Conditioning programs need to have a built in counter mechanism that significantly reduces an athlete's tendency towards left pelvic torsion. The important concept to review is the likelihood of altered muscle function with changed bony position. The potential of a muscle to generate force across a joint in a given plane of motion depends upon its position and length. Paired muscles of the body may have significant differences in levels of strength, tone, and endurance relative to one another if bony position has altered the position and length of one of them. In the case of left pelvic torsion, the left hip flexors will adaptively shorten, the left hamstrings will lengthen and weaken and correct proprioceptive ability of the left hip is lost. The solution is to asymmetrically train and isolate musculature that restores AF IR ability to the left hemi pelvis. The initial training focus should emphasize posterior pelvic rotation, i.e. sagit- tal repositioning via hamstring facilitation, followed by recruitment of the ischio-condylar adductor. Left hamstrings reposition the pelvis so the hip socket (acetabulum) is oriented at the correct angle and direction. The ischio-condylar adductor functions to pull and seat the femoral head into the hip socket. The next step is to begin retraining the left gluteus medius to enable restoration of the ischio-condylar adductor/gluteus medius force couple. There are three primary hip abductors that provide abduction leverage as the pelvis internally rotates and adducts from heel strike to midstance; gluteus medius, gluteus minimus, and tensor fascia latae. Gluteus medius is classified into three independent and functional sets of fibers: anterior, middle and posterior (Figure 2). All fibers contribute to abduction but the anterior fibers internally rotate the hip and the posterior fibers extend and externally rotate. In Figure 2 addition to functioning as a primary anti-gravity single leg support muscle, the gluteus medius also functions to keep the hip socket congruently aligned. When pelvic and femoral position are correct the gluteus medius approximates the hip joint by pulling the acetabulum (socket) onto the femur. This function automatically occurs when the gluteus medius is active during gait.

PERFORMANCE CONDITIONING VOLLEYBALL VOLUME 16, NUMBER 3 PAGE 7 THE NEW OFF-SEASON #4 In many athletes, as soon as you have repositioned the pelvis with the left hamstrings and they strongly perceive the ischio-condylar adductor, you can try and recruit the left glut med. The best way to begin training the left gluteus medius is in standing. If athletes can engage the left ischio-condylar adductor in a standing position, most will also automatically turn on the left gluteus medius secondary to neuromuscular feed forward activation in an antigravity position. The first training technique that should be attempted is Retro Stairs (Figure 3). Retro stairs could be considered the standing version of the Right Sidelying Left Adductor Pullback activity that was explained in the last article. Net Link: For the how-to do the exercise click HERE! This exercise is basically an exaggeration of stance phase of gait. It is also a very effective way to stretch the posterior hip capsule. The first step with Retro Stairs is to stand backwards so both heels are touching the rise of the step. The left foot is then placed on the next step up. Instruct your athletes to push the heel down. Make sure they do not bend over when they do this; many will feel the heel cords stretch. Now they shift into the hip by pulling the thigh/knee straight back. The actual amount of motion is very small, two to three inches. If this step is performed correctly it should look like the left knee pistons back- Figure 3 wards as the zipper/seam, knee, and foot align vertically. The right leg and pelvis remain motionless. Don't let your athletes twist or lean back; this is not true AF IR motion. The left quads will also engage, but the athlete should strongly feel the left inner thigh with the left outer hip. They should have 80-90% of their bodyweight on the left leg and hip. You can dampen the quad activity by telling your athletes to push via the heel. Once you are confident your athletes are consistently engaging the left gluteus medius, you can have them stand up from the shifted position. Instruct them to maintain the piston pull on the thigh as they push via the heel to stand. The glut med should remain engaged until the knee begins to terminally extend. Have your athletes perform 10-12 sets primarily on the left. If you are using stairs, just have your athletes work themselves up the flight. Most athletes will be able to correctly perceive and facilitate the left gluteus medius with the first attempt at Retro Stairs. There will be athletes however who will only perceive the quads. In this situation you will need to use the Standing Passive Left AF IR technique (Figure 4). Have your athlete begin by standing with 90% of their weight on the right side with the left knee very bent and the left foot on a 1.5 inch block. Instruct them to pull the left hip straight up as the left knee straightens and their weight shifts to the left. Have them hold the position for 20-30 seconds with 70% of their weight on the left, making sure they don't lock the knees or let the right heel come off the ground. Both feet stay flat at all times during this activity. After a 30 second hold have them shift off the left, back to the starting position. Repeat this activity several times. Standing in double limb support with a block under the left foot is a passive left AF IR position. The theraband is the inte- gral piece that forces neuromuscular facilitation of the gluteus medius. If you anchor theraband around the back of the knee so it is essentially pulling the knee forward (placing flexion torque via the knee joint), the gluteus medius will engage as they pull the hip vertically and extend the knee. The gluteus medius fibers lengthen and engage with the adductors. Not all athletes will feel the gluteus medius work, Figure 4 but tell them to be patient. The gluteus medius is working; they just don't feel it because the proprioceptive ability of that hip and the muscles are impaired. The theraband would pull the knee forward if the gluteus medius was not turned on. Use this activity daily if possible for 1-2 weeks, and then reattempt the stairs. If the gluteus medius is now correctly perceived, focus on shifting and holding for several days before you add the lift. There are several other exercises in both standing and gravity eliminated positions that are effective for gluteus medius strengthening that will be introduced later. The majority of these require correct right gluteus maximus integration. Right AF ER, acetabular femoral external rotation, is a new concept that will be introduced in the next installment. Right AF ER is the gait function of the right glute max. If the right glute max is severely impaired, consistent AF IR ability on the left hemi-pelvis will be difficult. O Figure 1 credit: Netter Presenter Image Copyright 2008, Elsevier Inc., All rights reserved. Figure 2 credit: Myofascial pain and dysfunction, the trigger point manual, the lower extremities, Volume 2, Travell and Simons, 1992, by permission of the publisher Williams & Wilkins. Figure 3 & 4: Postural Restoration Institute®. Please note that techniques provided in Figures 3 and 4 are only examples of the many non-manual Postural Restoration Institute™ techniques that could be considered appropriate for addressing the underlying biomechanical deficit described. For more information and references, please visit www.posturalrestoration.com. Net Link: Contact Lisa at [email protected] PAGE 8 PERFORMANCE CONDITIONING VOLLEYBALL, VOLUME 16, NUMBER 3 Elite MILD ANXIETY TRAINING VV LLEYLLEYBBALLALL PPerformanceerformance DDigestigest Putting Research into Practice Mild Anxiety Training May Prevent "Choking" When it's "All on the Line" Presented by USA Volleyball Sports Medicine and Performance Commission Complied by MJ Engstrom, Head Volleyball Coach, University at Albany, Member USAVSMPC Engstrom completed her third season at Albany. She helped guide UAlbany to its third conference championship in the last four seasons and produced the program's first NCAA Tournament victory. UAlbany finished 24-10 overall and reached the NCAA's second round for the first time in team history. Engstrom has also worked with the USA Men's and Women's National Volleyball Teams. She served as an assistant coach with the women's A2 summer program squad in 1999. She is on the editorial board for the International Journal for Volleyball Research and is a member of the USA Volleyball Sports Medicine and Performance Commission. The USA Volleyball Sports Medicine and Performance Commission has created this col- MJ Engstrom umn to briefly explain findings from primary research in various fields and extrapolate a prag- matic message that could be a benefit coaches in the practice/competitive environment-something coaches can use. USA Volleyball Sports Medicine and Performance Commission mission is to serve volleyball coaches and athletes through the assimilation, generation and dissemination of information in the areas of sports medicine and performance and to coordinate future research in these areas. The Research Training with Mild Anxiety May Prevent Choking Under Higher Levels of Anxiety. Raôul R.D. Oudejans, and Pijpers, J.R. (Rob) Psychology of Sport and Exercise:11, 44-50 (2010) NET LINKS: To read the entire research paper click HERE he purpose of this study was to explore whether training under lesser levels of anxiety can aid against "choking" when performing in situations perceived to evoke high levels of anxiety. The theoretical basis for the experiment was "attentional control theory" developed by Eysenck et al (p.44). According to this theory, anxiety responses are of two forms: First, a pre-task effect where "worry" essentially hi-jacks space in the working memory system, possibly causing a detriment in performance. And second,T as a result of this primary response, the system has to work harder to compensate for this decrease in working memory resource, thus, the subject perceives an increase in effort to maintain or improve performance. Studies in the past have found an increase in performance when practice was given under anxiety levels similar to that which they were tested (p45). However, there remains an open question as to whether practice under mild conditions of stress would have a similar effect on performance when the test level of anxiety is much higher. To put it to a question: is there transfer of this preventative effect to higher stress levels much like a vaccination works (e.g., mild cowpox inoculation staves off the more virulent smallpox)? The experiment consisted of 24 Dutch college students (16 males, 8 females) - average age of 22.5 m 3.2 years. Prior to the experiment, participant's anxiety levels were measured using the A-Trait scale of the State-Trait Anxiety Inventory, verifying that all were within the normal range for college students. Heart rate was also taken to obtain a baseline rate. The participants were randomly assigned to two groups. Subjects (all novices) threw darts at a target while on a "climbing wall" - the target was 1.45 meters away. Both groups threw from very near the floor (0.14 meters or

PERFORMANCE CONDITIONING VOLLEYBALL VOLUME 16, NUMBER 3 PAGE 9 MILD ANXIETY TRAINING approximately 6 inches) for the pre-test and practice sessions. The pre-test consisted of the participants throwing 24 darts (8 sets of 3 darts) to obtain a base performance measure. Initial ratings for baseline anxiety scores were measured using an "anxiety thermometer" where the subjects were asked to rate their feelings of anxiety on a scale of 0-10. Heart rate was also measured as a means to assess physical arousal. Finally, to measure the theoretically predicted increase in perceived effort with increased levels of anxiety, participants were asked to measure their effort on a 0-10 scale, much like the anxiety thermometer. The first practice session was performed on the same day as the pre-test and consisted of 40 trials of 6 throws each (240 total). The second practice session was 2-4 days after the first (determined by class schedule) and was 32 sets of 6 throws (192 total). Again, all practice trials were done at 0.14 meters from the ground. The control group simply threw the darts and their scores were recorded. The experimental treatment differed from the control in several ways. First, they were videotaped and told that their footage would be used for a popular Danish television program. Second, they were informed that they had been paired with another participant and their combined scores for both sessions could earn money based on their performance. To further increase pressure, each was told that their partner had performed well and it was up to them to score well enough to win. And third, the experimental group was told the last dart of each set (6th) would score double points. All the same conditions applied for the groups and measurements were again acquired for perceived anxiety and effort and their heart rate was monitored. On the same day as the second practice session, both groups performed three post-tests of 8 sets of 3 throws (24). Each test was done at different elevations from the floor to manipulate anxiety levels: Low = 0.14m; Medium = 3.96m; and High = 5.66m. For safety purposes, the subjects wore a climbing harness and the target was raised up the wall so it remained in the same relative position to the thrower throughout all phases of the experiment. The test conditions were administered in random order to neutralize any habituating effect of gradually increasing elevation. As the participants completed each test and were safely on the ground, they were asked to report their "anxiety thermometer" and "perceived effort" once again (heart rate was monitored while on the wall). Results: The findings showed that the experimental group's anxiety levels during the first training session were significantly higher than the control group's. However, this difference disappeared in the second training session. The authors noted that this training effect has been found in other experiments (p.48). Post-test results revealed no significant changes to the performance scores of the experimental group over each of the anxiety (elevation) conditions. This is despite systematic elevations in the participants' heart rate, and self-reported measures on the anxiety thermometer and level of effort. Performance for the control group during the post-test was surprisingly consistent between the low and medium anxiety condition. However, performance dropped significantly in the high anxiety condition. The authors the- orized that the control group was able to compensate with increased effort from the low to medium condition, however the highest level of anxiety simply was too overwhelming for performance to be maintained. Comparing the two groups, during the post-test, the experimental group's average anxiety level was not as high as the control group's - however, the difference did not reach a .05 level of significance. The authors note that based on other studies using the same measures, the level of stress reported by the experimental group was significant enough to cause decreases in performance (p.48). Because of the high levels of perceived anxiety in both groups for the post-test Medium and High conditions, the authors suggest that exposure to the milder levels of stress appears to have caused the experimental group to "acclimate" to higher states of anxiety. They conclude: "Together the results show that practicing with certain levels of anxiety is not just effective in preventing choking under similar levels…." (p 48). Essentially, practice under any level of anxiety seems to help maintain performance. Putting It Into Practice These findings suggest that including mild forms of anxiety producing situations in practice, will help your players from suffering from "choking" under higher stress levels. It is interesting to note that the "stress" for the experimental condition was NOT PHYSICAL stress, it was emotional stress. The participants where not put in a condition that involved any perceived physical danger. They were only told that they performance was going to be watched and that another was counting on them to perform well. This would suggest that weighting certain opportunities with greater meaning for winning a game may be as effective as a high anxiety situation. As an example, if you are practicing serv- ing under pressure, manipulating points may be as effective as running a succession of sprints for missed serves. The goal of "acclimating" the players to performing under pressure seems to be achieved in both ways. However, using mild forms of anxiety producing stimuli may be preferable due to decreased risk of injury. More research needs to be done to look at this effect over time - is there decay in the acclimation effect, and if so, what is the rate? Additionally, it would be interesting to study how closely does the mild anxiety have to approxi- mate the "real" situation it to be effective? NET LINKS: To find out more about the SMPC go to the usavolleyball.org, to contact MJ email her at [email protected]

Link to the interactive version click HERE! PAGE 10 PERFORMANCE CONDITIONING VOLLEYBALL, VOLUME 16, NUMBER 3 VOLLEYBALL DURABILITY Gaining Volleyball Durability A PRESEASON TRAINING PROGRAM FOR VARSITY AND JUNIOR VARSITY GIRLS Bob Takano, CSCS, Member-USA Weightlifting Hall of Fame This review and prologue is being written specifically for the reprinting of this article in Performance Conditioning Volleyball newsletter. As this is written I've now been supervising female volleyball athletes in their strength and conditioning regimens for 17 years. When I wrote this article and the accompanying training program in 1993 I was already aware of the obvious benefits-that it would improve explosive running, jumping and hitting ability. As I continued to coach over the past several years I've come to realize that the training provides even greater benefits that I had not even anticipated when I first embarked on this path. The first obvious benefit that comes to mind is the durability of the athletes. In 17 years I've never trained a high school, club or college level female volleyball player that incurred a non-contact ACL injury The only ACL injury that has occurred to one of my players was caused by a team mate lunging for a ball and colliding with the first player's knee from the side. Furthermore in the 10 years that I worked with the Van Nuys High team (a span during which they won 6 city championships) we only had six games in which all of the starters were not available to play because of injuries. Of the six games in question, four were the result of one player with a pre-existing ankle injury, and the other two were the result of a second player with an ankle injury. None of the other players has ever had a problem with hang injuries or shoulder injuries because of the development of these structures through the strength training regimen. One of the reasons for the durability of these athletes is that the Olympic lifting based movements teach athlete to break downward movement against resistance. Thus not only do they have stronger joints, they know how to react to downward impact through muscular coordination. The second benefit has been the development of anaerobic endurance. The majority of strength training sessions took place after two hour volleyball practices. The athletes were being asked to perform explosive movements against resistance while fatigued. This resulted in them being capable of playing explosively during the fourth and fifth games of a match. Consequently they were able to win frequently against teams with more talent, but lesser conditioning. A third benefit that I was previously aware of, but had rarely been reported by my volleyball athletes was increased kinesthetic awareness. That was partly because I didn't always have time to engage them in much conversation about their athletic development. Nowadays I take the time to talk with my athletes and try to let them put their changes in awareness into their own words. Almost all of them find themselves capable of performing actions during play that were previously impossible or highly unlikely. Among these is the ability to react and control their bodies better during the course of play because of heightened body position awareness. Although the intervening years have produced some small alterations to my training approach this original training program is still an excellent, result producing model that upon implementation will produce more explosive, durable and kinesthetically superior athletes.

his program is one that I developed for the volleyball program at Van Nuys INT High School. This was the first year that they strength trained prior to the ADV season. The training continued throughout the season and the ultimate result T was the winning of the Los Angeles Unified School District 3A Championship. The team had been runners-up on three occasions prior to this and their coach Dave Bessler felt that the strength and conditioning work was the deciding factor. Most of the varsity had trained periodically the spring before and had developed serviceable technique in the Hang Power Snatch, Hang Power Clean, Hang Split Snatch, Hang Split Clean and Power Jerk. The Junior Varsity players had to do more remediation work and technical training and therefore the workouts were different for the first two weeks or so, hence the split. Both teams finished off the final two weeks of the pre-season with the same workouts. The format for the set and rep schemes is as follows: (X/3)5 means that X (the Bob Takano weight to be determined by the coach) is lifted for three repetitions for five sets. Please keep in mind that calling the proper weights is the key for this program to succeed and is the domain of the supervising coach. The inclusion of plyometrics does not indicate the load, but rather the position within the sequence of exercises. Only a small portion of the load should be given over to jumping movements since the athletes perform them in large amounts during team practices and games. Some athletes may be in need of technical jump training since they do not know the proper biomechanics of jumping. In some cases it may be wise to excuse the starters from jumping. Please keep in mind that these workouts are for learning purposes only so that coaches can understand the program writing process. They are not recommended for usage by anyone that is not under the supervision of a competent professional strength and conditioning coach.

PERFORMANCE CONDITIONING VOLLEYBALL VOLUME 16, NUMBER 3 PAGE 11 VOLLEYBALL DURABILITY VOLLEYBALL--VARSITY 4) Overhead Dumbell Side Lunge: the JV had caught up in skill levels to the (X/3+3)4 varsity. Of course, the weights varied by MONDAY 5) Plyometrics: individual. 1) Hang Power Sntch: (X/3)4 6) Abdominals: (X/10)5 2) Hang Power Clean & Power Jerk: MONDAY (M/3+1)4 VOLLEYBALL-Junior Varsity: This is 1) Hang Split Snatch: (X/3+3)5-This nota- 3) OH Sq.: (X/3)4 the training program for the JV members tion means that three reps are performed 4) Good Morning: (X/4)4 who had not much training background, with the left foot forward and three reps although most of them had learned the with the right foot forward. The feet are WEDNESDAY proper technique during some sessions alternated so as to provide equal fatigue to 1) Hang Power Snatch: (X/4)5 that took place during the spring. both sides. 2) Hang Power Clean: (X/4)5 2) Hang Split Clean: (X/3+3)5 3) Power Jerk: (M/3)4 WEDNESDAY 3) Split Jerk: (X/3+3)5 4) Back Squat: (X/4)2, (X/3)4 1) Overhead Duck Walk: (X/3)3 4) Back Squat: (X/6)4 2) Hang Clean Shrug: (X/3)4 WEDNESDAY 5) Fast Good Morning: (X/5)4 3) Behind the Neck Power Jerk: (X/3)5 6) Abdominals: (X/20)4 1) Hang Power Snatch and Overhead 4) Front Squat: (X/3)5 Squat: (X/1+3)5 5) Abdominals: (0/20)2 WEDNESDAY 2) Hang Power Clean and Front Squat: 1) Hang Power Snatch: (X/4)5 (X/1+3)5 FRIDAY 2) Hang. Power Clean and Power Jerk: 3) Push Press: (X/3)4 1) Hang Power Clean: (X/3)5 (X/4+2)5 4) Good Morning: (X/5)4 2) Behind the Neck Push Press: (X/4)5 3) Overhead Squat: (X/4)5 5) Abdominals: (0/20)2 3) Overhead Squat: (X/3)4 5) Press.: (X/5)4 4) Good Morning: (X/8)4 6) Abdominals (X/20)2 FRIDAY 5) Abdominals: (0/20)2 1) Hang Power Snatch: (X/3)5 FRIDAY 2) Hang Power Clean & Jerk: (X/3+2)5 MONDAY 1) Hang Power Snatch and Overhead 3) Back Squat: (X/5)6 1) Hang Muscle Snatch: (X/3)5 Squat: (X/2+3)4 4) Good Morning: (X/8)4 2) Hang Power Clean: (X/3)5 2) Hang PowerClean and Power Jerk: 5) Abdominals: (0/20)2 3) Press: (X/5)6 (X/3+3+2)5 4) Back Squat.: (X/5)6 3) Hang Clean Pull: (X/4)5 MONDAY 5) Jumping Good Morning: (X/8)4 1) Hang Power Snatch and Overhead 4) Front Squat: (X/4)6 6) Plyometrics 5) Straight-legged Good Morning: (X/6)4 Squat: (X/3+3)4 7) Abdominals (0/20)2 2) Hang Power Clean & Jerk and Front 6) Abdominals: (X/20)5 Squat: (X/3+3)4 WEDNESDAY MONDAY 3) Behind Neck PowerJerk: (X/4)5 1) Hang Power Snatch: (X/3)5 1) Hang Power Snatch: (X/3)5 4) Snatch Deadlift: (X/4)4 2) Hang Power Clean and Power Jerk: 2) Hang Split Clean: (X/3+3)4 5) Back Squat: (X/4)4 (X/3+3)5 3) Behind the Neck Power Jerk: (X/3)5 6) Plyometrics 3) Snatch Deadlift: (X/3)4 4) Back Squat: (X/4)5 7) Abdominals: (X/20)2 4) Front Squat: (X/4)5 5) Fast Good Morning:(X/5)4 5) Plyometrics 6) Abdominals: (X/15)4 WEDNESDAY 6) Abdominals (X/15)4 1) Hang Power Snatch: (X/4)5 WEDNESDAY 2) Hang Power Clean & Power Jerk: FRIDAY 1) Hang Split Snatch: (X/3+3)5 (X/3+2)5 1) Hang Power Snatch: (X/2)5 2) Hang Power Clean: (X/3)4 3) Clean Extension: (X/4)5 2) Hang PowerClean and Power Jerk: 3) Front Squat: (X/4)5 4) FrontSquat: (X/4)5 (X/2+2)5 4) Press: (X/4)4 5) Good Morning: (X/8)4 3) Clean Deadlift: (X/3)4 5) Abdominals: (X/20)4 6) Plyometrics 4) Overhead Squat: (X/)4 7) Abdominals: (X/15)4 5) Press: (X/4)5 FRIDAY 6) Plyometrics 1) Hang Power Snatch: (X/3)4 FRIDAY 7) Abdominals: (0/20)2 2) Hang Power Clean: (X/3)4 1) Power Snatch: (X/2)4 3) Overhead Squat: (X/4)5 2) Power Clean & Power Jerk; (X/2+2)4 VARSITY & JV-At this point the two 4) Good Morning: (X/6)4 3) Back Squat: (X/6)4 groups began to use the same program as 5) Abdominals: (X/20)2 O

NET LINK: To learn a step by step progression of learning to do the Power Snatch click HERE Contract Bob through his web site at http://www.takanoathletics.com

PAGE 12 PERFORMANCE CONDITIONING VOLLEYBALL, VOLUME 16, NUMBER 3 PREVENTING AGE SPECIFIC INJURY Understanding and Preventing Age Specific Injury in the Young Volleyball Athlete Bruce Morgan, A.T.,C. Athletic Trainer, San Jose Earthquakes s it pertains to athletic injury teens and preteens should not be thought of as merely smaller versions of ourselves. BEG Owing to their unique skeletal anatomy children are vulnerable to a litany of injuries which are common and often INT completely unique to their population. Because early recognition is the key to successful management and ultimately resolution of a given condition, being mindful of the signs and symptoms that warn of these injuries will, it is hoped, decrease the delay in accessing health care, and as a result, decrease the pain and disability these injuries can cause. AAt the root of many of the orthopedic disorders confronted by children is the underlying issue of skeletal maturation. For the vast majority of us the passage from childhood to adulthood occurs without incident and is relatively uneventful from an injury perspec- tive. However, for some number, particularly those engaged in volleyball activity, pain may follow. For when subjected to the trauma or the repetitive micro-trauma associated with volleyball, selected bony sites can become irritated and inflamed. A frequent site for this bony irritation is the tibial tuberosity. This anatomic structure is the site of attachment for the tendon (patellar) of the quadriceps. In the child this bony bump or prominence (situated just below the knee) is not fully fused to the shin or tibia. As a consequence, when subjected to the stresses common to jump- Patella (kneecap) ing and running, the tuberosity may become swollen and in some cases exquisitely tender to touch. Known in medical parlance as Osgood-Schlatter's disease those who suffer its affects (commonly girls 12-13 and boys 13-15 years of age) typically report pain with jumping, squatting, kicking and other activities which require the Area of pain forceful contraction of the knee extensors (quadriceps). In all but the most intractable cases Osgood-Schlatter's is Tibial tuberosity what your doctor might refer to as a "self-limiting condition", which (bump is enlarged) is to say, it will resolve without the need for extensive medical treat- Tibia (shinbone) ment. Resolution in this case is not found in a pill (although anti- inflammatory medications are sometimes helpful) or a surgical pro- cedure. Erasing the pain that goes along with this condition is instead a function of time and the temporary limitation or cessation of the offending activity. Owing to the aforementioned sensitivity it may also be advisable to utilize a simple soft knee pad to deflect or absorb any direct trauma which might occur during athletic activity. The youthful athlete who presents with heel pain may be offered similar recommendations. And appropriately so because like Osgood-Schlatter's this heel pain (see Sever's disease) often grows out of sports participation. In this case the pain originates at the calcaneus (heel bone) at and about the site for attachment of the Achilles tendon. Anatomically the sites involved with Osgood-Schlatter's and Sever's are similar. Each is referred to as an apophysis which is the boney insertion site for a tendon. With Sever's this boney attachment is continuous with a growth plate (epiphyseal plate). It is the growth plate that becomes inflamed when subjected to the pulling and pounding that occurs at heel strike during running. The repetitive and often aggressive weight bearing associated with athletic participation (particularly while wearing a cleated shoe) is that which sets this disease process into motion; once active Sever's is capable of making even a casual stroll a painful experience. Heel cups or padded insoles have been shown to be of benefit in tamping down the pain brought on by this condition, however, some period of rest may ultimately be required. Neither condition thus far discussed is what physician would consider an urgent or acute injury. Acute injuries typically result from a single incident or traumatic event; which is not to say that children are impervious to such injuries. Whether it be falling from a tree or falling as a result of an aggressive dig acute injuries do occur. What form these injuries take may again be a function of the age of those who sustain them. The same mechanism which in adults might produce a ligamentous injury may cause fracture in children. That which makes children more vulnerable to fracture is the presence of growth plates. Located near the end of long bones these structures allow for increases in bone length and girth. During active growth these plates (epiphyseal plates or physes) are less stress resistant than are the ligaments that attach to them. It is this reduced resistance to stress that makes the epiphyseal plates suscep- tible to a variety of fractures. The need to distill the differences between the fractures and what those differences portend lead to the creation of a classifica- PERFORMANCE CONDITIONING VOLLEYBALL VOLUME 16, NUMBER 3 PAGE 13 PREVENTING AGE SPECIFIC INJURY tion system. That system (Salter-Harris) assigns these fractures to one of five types based upon severity and the relation of the fracture to the surrounding bone. Rather than dwelling on the characteristics which distin- guish one type from another it is most important to understand that the worst among them may result in growth disturbances for a portion of the growth plate leading to the potential for angulation, over or undergrowth or to premature closure with arrested development of the involved bone. Given the potential for severe con- sequences should your son, daughter or young volleyball athlete under your charge present with a history or symptoms consistent with fracture, waste no time in having them evaluated by your physician/orthopedist, or if the circumstances dictate, in an emer- gency room. The preceding sampling of injuries, although by no means exhaustive (afterall, text books have been written on the subject of Apophysis Calcaneus musculoskeletal injury in children), does provide some insight into (growth plate) (heel bone) the differences which exist between the mature and immature skeletons and how each responds to the stresses placed upon them. At the very least, it would be my hope that those who read this would, when confronted with an adolescent athlete whose complaints seem out of proportion with the suspected nature of injury, leave open the possibility that a potentially more serious injury is at work. For those who make their living working with young athletes becoming acquainted with the entire panoply of injuries likely to befall that population, while seemingly oner- ous, is appropriate. Particularly if among your duties is the management of those injuries. It is not possible to properly manage that which is not correctly identified. Recommending ice and rest to a child com- plaining of posterior thigh pain, as one might for a suspected hamstring strain, without con- sidering the possibility of an avulsion is a mis- take. Similarly, writing off back, hip, knee or ankle pain as an expected consequence of growth is foolhardy. All pain has its source. Whether deter- mining that source or providing direction to someone who will, your interactions with injured children must be guided by the intention of erring on the side of caution. Only by adopting such a philosophy will those children under your charge receive the speedy and appropriate care their injuries require. O

Net Link: Contact Bruce at [email protected]

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