HP SIRCuit Spring 2012

“Merging COACHING with SPORT SCIENCE & MEDICINE”

HIGH PERFORMANCE

SIRCuit

Haut niveau

“La fusion d’entrainement avec les sciences du sport et la médecine du sport” Spring / printemps 2012

Volume 2 (2)

MICHELLE STILWELL Canada’s Multi Games & Multi Sport Paralympic Gold medalist talks about what it takes to get to the top!

Canadien médaillé d’or paralympique multi-sports et multi-jeux parle de ce qu’il faut pour arriver au sommet!

Sport Research Intelligence sportive

www.sirc.ca

1

SIRCuit Volume 2 (2) Spring / printemps 2012

www.sirc.ca

2

SIRCuit Volume 2 (2) Spring / printemps 2012

Editorial Welcome to the 6th edition of the HP SIRCuit, whereby we are truly embracing the multi-disciplinary approach and presenting cutting edge applied sport science information, including topics in Sport Psychology, proactive preventative sports medicine, physiology and nutrition.

The exceptional article Mindfulness and Acceptance by Derek Robinson and Dr. Danelle Kabush not only provides guided questions which help athletes focus during the daily training environment but is also complemented by a video where Jeremy Wotherspoon, Olympic Silver medalist, Long Track Speed Skating, talks about the MAC approach and how he applied it to his training.

HP SIRCuit is partially funded by

Editor Creative Director Design team Content Director

Debra Gassewitz David Roberts Kim Sparling Nancy Rebel

Contributing Editor Contributors

Special Thanks

Dr. Jon Kolb, OTP Derek Robinson Danelle Kabush Dr. Trent Stellingwerff Dr. Daniel Moore Brian Johns Carl Petersen Denis Collier Leo Thornley Judy Goss Bruce Craven Willem Meeuwisse Matt Jordan Cara Thibault, OTP Paul Dorotich, OTP Michelle Stilwell Kelly McKean, OTP

Sport Information Resource Centre (SIRC) is Canada’s national sport library, established over 35 years ago.

Centre de documentation pour le sport (SIRC) est la bibliothèque nationale du sport au Canada fondée il y a plus de 35 ans.

Mailing address: SIRC 180 rue Elgin Street, suite 1400 Ottawa, Ontario, Canada K2P 2K3 Tel: +1 (613) 231-7472 Fax: +1 (613) 231-3739 Disclaimer: Author’s opinions expressed in the articles are not necessarily those of SIRCuit, its publisher, the Editor, or the Editorial Board. SIRC makes no representations or warranties whatsoever as to the accuracy, completeness or suitability for any purpose of the content.

Avis de non-responsabilité: les opinions exprimées dans ces articles n’engagent ni SIRCuit, ni l’éditeur, ni le distributeur, ni le comité de rédaction. Le SIRC ne donne aucune garantie ni ne fait aucune déclaration quant à la qualité, à l’exactitude ou au caractère exhaustif de son contenu.

Copyright © 2012 SIRC. All rights reserved.

No part of the publication may be reproduced, stored, transmitted, or disseminated, in any form, or by any means, without prior written permission from SIRC, to whom all requests to reproduce copyright material should be directed, in writing. © 2012 SIRC. Tous droits réservés.

La reproduction, le remisage, la transmission ou la diffusion en tout ou en partie de cet article sous quelque format que ce soit est interdit sans avoir obtenu au préalable la permission écrite du SIRC. Les demandes de reproduction de tout document protégé par droit d’auteur doivent être adressées par écrit au SIRC.

www.sirc.ca

Debra Gassewitz President & CEO SIRC

This issue also has great articles on strategies for training/recovery, injury prevention and physiological nutrition. Check out the very informative articles by Carl Petersen, Brian Johns (past Canadian Olympic swimmer), and Dr. Stellingworth and Dr. Moore.

We hope you learn from and enjoy listening to the insights from Michelle Stilwell, our multi-games and multi-sport Paralympic gold medalist as she shares her thoughts about physical training and the use of sport science to break world records, in our Athlete Focus section.

Special thanks to our IST Journal Club and Nancy Rebel at SIRC for their commentaries on athlete preparation articles and hydrotherapy as a recovery intervention.

And thank you to all of our readers for your comments and suggestions, please keep them coming, on other topics and articles to include in the HP SIRCuit so that we can continue to assist our coaches, sport scientists and medical practitioners in preparing our Olympic and Paralympic athletes in their pursuit to reach the podium. ∆

Jon Kolb, PhD Director, Sport Science, Medicine and Innovation, Own the Podium

Contents

Performance Performance 4 10

Maximizing Muscle Growth Mindfulness and Acceptance

Competitive Intelligence 18

Hydrotherapy as a Recovery Intervention

Proactive & Preventative Medicine 24 30

Fit to Play™High Performance Recovery Part 1 Shoulder Injury Prevention & Prehabilitation in Swimmers

Departments 16 22 35 36 37

Athlete Focus - Michelle Stilwell Stay Informed with SIRC Upcoming Events Recommended Readings from SIRC IST Journal Club

3

SIRCuit Volume 2 (2) Spring / printemps 2012

Maximizing Muscle Growth Building lean, strong bodies through science Dr. Daniel Moore – University of Guelph Dr. Trent Stellingwerff – Canadian Sport Centre-Pacific

www.sirc.ca

4

SIRCuit Volume 2 (2) Spring / printemps 2012

Performance Abstract

Muscle strength is a key performance determinate in most speed/power-based sports and is intimately linked to muscle size and function. Thus, maximizing muscle growth is a very desirable adaptive response that is dependent upon the exercise stimulus, as well as the recovery routine.

This overview highlights the very latest knowledge in optimal nutrition (timing, type and amount) and other factors, such as hormones, that may benefit muscle hypertrophy.

Résumé

La force musculaire qui est un facteur de première importance dans la majorité des sports de vitesse/puissance dépend de la grosseur et de la fonction des muscles. Par conséquent, il y a lieu de maximiser la croissance des muscles en sollicitant des réponses adaptées aux stimuli des exercices et des périodes de récupération intégrées dans le programme. Cet article présente les faits saillants des dernières études traitant de nutrition optimale (moment, nature et quantité) et d’autres facteurs, les hormones par exemple, contribuant à l’hypertrophie des muscles.

Key Points • For muscle growth, focus on key training variables such as proper exercise intensity and progression, coupled with proper nutrition.

• For recovery and in meals, aim for a protein dose of ~0.25-0.3g protein/kg body weight every 3-4 hours.

• To optimize recovery, both protein and carbohydrate should be ingested in close timing with exercise.

• It is preferable to consume leucineenriched whole foods to aid in protein synthesis and overall recovery and growth.

I

Modern methods to assess muscle protein synthesis and muscle growth

A Canadian-based laboratory led by Professor Stuart Phillips at McMaster University has been one of the world leaders in protein research. Over the last few years, Phillips’ laboratory has been systematically addressing these fundamental questions on a quest to shed new light on maximizing acute muscle protein synthesis and muscle hypertrophy. By highlighting this contemporary research, this review will tackle these key questions and will provide an overview for any athlete, coach and IST member interested in maximizing the acute muscle protein synthesis responses from training with the goal of optimizing muscle growth and hypertrophy.

Our muscles are in a constant state of remodelling whereby they breakdown old proteins (muscle protein breakdown) and make new ones (muscle protein synthesis) as a means to keep them functioning optimally. The difference between these opposing processes ultimately determines whether the muscle is gaining (i.e. muscle growth) or losing (i.e. muscle loss) protein. By far, the most important variable in athletes is muscle protein synthesis. Accordingly, modern technology has allowed scientists to develop methods to measure changes in how effectively the muscle can make new proteins over short periods of 1-4h (muscle protein synthesis), which can be used as a surrogate marker for muscle growth. This is done by providing a non-radioactively labelled amino acid (the building block of protein) intravenously and, through sampling of small muscle biopsies, using sensitive mass spectrometers to measure how much of that labelled amino acid is directly incorporated into new muscle proteins in response to exercise and/or nutrition. Together, this allows scientists to calculate the rate of muscle protein synthesis.

n 6th century B.C., the Greek legend Milo of Crotona was known as the strongest man in the world, having the ability to raise an entire full-grown cow up over his own head without assistance. Beyond his unique genetic predisposition, and certain folklore embellishment, the apparent secret to his success was to start his training program when the small calf was still light, and weight train every day with this ever growing calf to systematically improve the weight he was able to lift. Even today, this historical folklore based approach taken on by Milo of Crotona still frames the cornerstone of fundamental training principles, which focus on progressive resistance weight training leading to adaptation (aka overload principle). Certainly, our knowledge of how to maximize and optimize muscle growth/hypertrophy and strength, leading to enhanced speed/power performance, has developed since 6th century B.C. But despite this, confusion and questions still exist in the pursuit of increased muscle mass and strength, such as: How can nutrition enhance my training goals? Are there important features to consider around the optimal amount, type and timing of nutrition? Aside from nutrition, are there other factors such as endogenously produced ‘anabolic’ hormones that could impact muscle protein synthesis and hypertrophy?

www.sirc.ca

5

Various methods are available to scientists to study the impact of exercise and nutrition on muscle growth. One of the most obvious methods is by measuring changes in lean body mass. This can be done indirectly through body weight, muscle girths and skin fold thickness or directly by dual-energy x-ray absorptiometry (DEXA), the latter of which is often considered the gold-standard for determining body composition changes. However, the drawback to these various measures is that they require sufficient time (e.g. weeks to months) to allow for muscle growth to be detected and are not generally suitable for screening nutritional and exercise interventions rapidly.

SIRCuit Volume 2 (2) Spring / printemps 2012

Every time we perform exercise, our muscles increase the rate of muscle protein synthesis in the hours to days after to help repair the old damaged proteins and build new ones. When this is done repeatedly over the course of weeks to months, such as with training, the small hourly increases in muscle protein synthesis summate into measurable changes in muscle growth. In fact, studies have demonstrated that the early (i.e. ~4h) increase in muscle protein synthesis after exercise can qualitatively predict long-term (weeks & months) changes in muscle growth2.

Nutrition to Optimize Muscle Growth: Timing, Amount, and Type

It is well known that to optimize muscle growth, individuals need to be in a positive energy balance and eat sufficient protein, the latter of which provides the amino acid building blocks to make new muscle. Beyond current daily protein recommendations, which only consider the total amount of protein eaten over the entire day, strong recent evidence shows that the type, amount and timing of this protein throughout the day has a great impact on muscle protein synthesis to optimize post-exercise recovery.

www.sirc.ca

6

Amount of protein Despite the fact that body builders have long believed in very large (>50 g) post-exercise protein intakes to maximize the anabolic effect, recent data suggests otherwise. A very well conducted dose-response study examining the effects of five increasing doses of dietary protein on postresistance exercise muscle protein synthesis was recently published6. This study clearly shows that there appears to be a maximal effective dose of about 20g of dietary protein for stimulating muscle anabolism after resistance exercise in ~80kg (~175lbs) males over a 4h recovery period. Interestingly, this amount is very similar to what is required to maximize muscle protein synthesis at rest (~25g)1. Nevertheless, protein intakes greater than 20g after resistance exercise led to a greater proportion of dietary protein being used as an energy source (known as oxidation)6, which is an inefficient use of this important macronutrient if the goal is to enhance muscle growth.

Although studies have yet to clearly established whether more or less protein is needed to optimize acute protein synthesis for athletes of varying body weights, when examining the totality of acute studies, a body weight corrected protein dose of ~0.25-0.3g protein/kg BW appears to provide an effective amount. Therefore, both for recovery and in meals, aiming for this protein threshold every 3-4h is a suitable target.

SIRCuit Volume 2 (2) Spring / printemps 2012

Timing of protein ingestion Not surprisingly, the essential macronutrient needed to enhance muscle protein synthesis post-exercise is dietary protein3,9. The combined effects of exercise and postexercise protein intake can result in additive effects for improving protein synthesis compared to exercise or protein alone10, which provides the basis for traininginduced muscle growth. As well, the type of exercise stimulus targets the type of proteins to be made, with resistance exercise specifically increasing myofibrillar proteins7, which are the forcing-generating proteins primarily responsible for muscle growth. Currently, relatively few studies have specifically examined the timing of protein ingestion around exercise to maximize the protein synthesis response. Although the muscle appears sensitive to protein even 24 hours after exercise12, analogous to glycogen re-synthesis, the delayed intake of protein also appears to decrease the post-exercise protein synthesis response. For example, immediate post-exercise protein intake results in significantly greater protein uptake into the muscles versus delayed protein intake 3 hours later4. These data agree with training studies demonstrating that post-exercise protein intake leads to greater muscle hypertrophy and lean mass gain2. It also appears that it is best to take your entire protein dose at once (as a single bolus post exercise), rather than in small repeated doses during recovery 13.

In Western societies, most individuals typically consume daily protein intake in an unbalanced pattern, with a small inadequate amount (<10g) consumed in the morning meals compared to large excessive amounts in the evening meals (>40g). However, very early studies from the late 1940’s demonstrated that our bodies are better able to retain dietary protein when it is equally spaced throughout the day, which has led to a surge in recent research surrounding the optimal way to eat protein throughout the day. In fact, new unpublished data suggest that spacing protein feedings at regular intervals throughout the day (i.e. 3-4h) may help sustain muscle protein synthesis and overall net protein balance to a greater degree than an unbalanced feeding in trained young men5. The theoretical diagram in Figure 1 captures this process, showing three different daily protein dosing regimens. As shown, two doses of 40g as part of a balanced 3-meal day would stimulate muscle protein synthesis, but would also result in excess oxidation. In contrast, 8 x 10g doses, or an example of someone who ‘grazes’ during the day, would limit oxidation but likely not reach the threshold to optimally stimulate muscle protein synthesis. However, for average athletes, 4 to 6 -20g doses (or ~0.3g/kg BW doses) of protein spread www.sirc.ca

7

Figure 1. Comparison of three different daily protein dosing regimens and its theoretical effect on muscle protein synthesis

every 3 to 4 hours would likely result in the optimal amino acid profile: that is, one that reaches an optimal threshold but does not result in excessive oxidation. Further studies in this are emerging and are likely to be conducted in the near future to more thoroughly examine the impact of specific nutrient timing (especially of protein) throughout the day, and in particular around exercise, to fully characterize the optimal intake pattern for recovery and adaptation. Nevertheless, it can currently be concluded that to optimize recovery, both protein and carbohydrate should be ingested in close timing to the exercise bout to maximize the anabolic response of training.

Interestingly, a very recent study has confirmed what some weight-lifters have already suspected for years: a large dose (40g) of a slow-release casein protein (see more info below on type of protein), consumed immediately before bed, results in improved whole-body protein synthesis and balance over a 7.5h sleeping period8. This is another example of the positive impact that strategic timing of protein can have on muscle protein synthesis. Although this approach is somewhat extreme, it could be considered for athletes who are especially resistant to gaining weight and/or muscle mass as their sport-performance needs dictate.

Type of protein Most recent evidence has also shown that the type of protein can significantly influence post-exercise muscle protein synthesis. Specifically, whey protein (the soluble “fast” appearing protein fraction of milk) resulted in nearly twice the protein synthesis over 3 hours postexercise as compared to casein (the insoluble “slow” appearing protein fraction of milk) and 25% greater than soy protein11, despite the fact that these are all traditionally considered ‘high quality’ proteins sources. Therefore just choosing the right type of protein could optimize muscle growth. It has been hypothesized that one of the reasons whey protein is superior to either casein or soy protein is due to its rich concentration of branched-chain amino SIRCuit Volume 2 (2) Spring / printemps 2012

Leucine content

per 200 calorie serving: • • • • •

Egg, white, raw, fresh: 4233mg Seaweed, spirulina, raw: 3915mg Game meat, cooked, roasted: 3844mg Chicken, broilers or fryers, breast meat only: 3698mg Fish, tuna, light, canned in water, drained solids: 3574mg • Turkey, fryer-roasters: 3569mg • Fish, cod, Pacific, cooked: 3552mg • Beef, round, top round: 3005mg

Figure 2. Comparison of the quality of protein in a food and its associated leucine content and its relative effect on muscle protein synthesis.

acids (BCAA), and primarily the BCAA leucine11,13.

Although the apparent anabolic potency of the BCAA, and specifically leucine, has led some to suggest that only these amino acids need to be ingested after exercise, it should be remembered that muscle proteins are built with all 20 amino acids and not just these 3 essential amino acids. Thus, it is preferable to consume leucine-enriched whole foods to provide the body with the other necessary substrates for protein synthesis and overall recovery and growth. The list above highlights high-quality proteinbased foods that are a rich source of the amino acid leucine, which could be targeted in everyday eating to optimize the type of protein needed for ideal muscle growth.

Impact of hormones on muscle protein synthesis and hypertrophy

Physiological vs. non-physiological ‘anabolic’ hormones A common misconception that perpetuates throughout most amateur and even professional gyms is that you need massive amounts of ‘anabolic’ hormones to gain lean mass. These often cited hormones include growth hormone (GH), insulin-like growth factor-1 (IGF-1), and testosterone, all of which are produced by the body itself (endogenous production). Evidence for the importance of these hormones in normal muscle growth largely comes from clinical populations (e.g. the elderly or individuals with hypothalamic-pituitary-gonadal axis abnormalities) suffering from chronically low circulating levels.

Pharmacological supplementation of the abnormally low hormone to normal physiological levels generally results, www.sirc.ca

8

for the most part, in a normalization of muscle mass and the capacity to experience muscle hypertrophy with training in these clinical populations (see Figure 3). These data highlight the importance of normal hormonal levels for muscle growth. On the other hand, supraphysiological administration (i.e. doping) of testosterone and other forms of natural and synthetic hormones have undoubtedly been shown to augment training-induced increases in muscle mass. Aside from obvious ethical issues and potential long-term health consequences, the resultant sustained supraphysiological hormonal profile obtained from this form of doping is in stark contrast to what occurs naturally within the body whereby there can be subtle diurnal variations interspersed with periodic ‘spikes’ in response to exercise (see Figure 3). It is these ‘physiological’ variations in hormone concentrations that are most relevant to the athlete’s quest for optimal muscle growth and will be discussed below.

‘Anabolic’ hormones and muscle protein synthesis/ growth Extensive research has been devoted to elucidating the exercise paradigms that elicit the greatest increases in ‘anabolic’ hormone release, with the assumption that this drives the muscle growth process. In general, high intensity resistance exercise utilizing large muscle groups, with short inter-set rest periods, elicit the greatest increases in circulating GH, IGF-1, and testosterone. Further, all of these hormones typically peak 15-30min after a single bout of exercise, but return to basal levels by about 60min of recovery. This pattern of hormone elevations should be contrasted with changes in muscle protein synthesis, which are substantially longer in duration, as they can be elevated for up to 48h after exercise. Nevertheless, the different variables influencing endogenous hormones SIRCuit Volume 2 (2) Spring / printemps 2012

concentrations of GH (~800%), IGF-1 (~130%) and testosterone (~250%) with the arm+leg exercise bout, there was absolutely no difference in the exercise-induced increase in muscle protein synthesis in the biceps between the conditions during the 4hr recovery period14. These results contrast with the ‘hormone-hypothesis’ of muscle repair and growth, which would suggest that the arm with the concurrent leg exercise (under the greater ‘anabolic’ hormonal environment) would have experienced a greater increase in muscle protein synthesis- but this did not occur. Nevertheless, to further investigate the importance of post-exercise hormonal responses for muscle growth, the same researchers followed up this acute study with a 15-week training study employing an identical exercise regime. Unsurprisingly, despite similar differences in post-exercise hormone concentrations throughout the entire training program, both the high and low hormone conditions experienced similar muscle growth and strength increases of the trained biceps15.

Figure 3. Schematic of the effects that different levels of “anabolic” hormones may have on individual phenotype during pathological, physiological and supra-physiological situations. In contrast to the chronically high or low concentrations observed with doping or pathological conditions, there is a moderate but very transient (i.e. ~30-60min) increase in endogenous ‘anabolic’ hormones after a single bout of exercise.

means that leg-based exercises will generally lead to greater blood concentrations of these hormones than arm-based training, due to activation of a larger total muscle mass. This difference in hormone response, based on the type of exercise and muscle group utilized, has allowed researchers to exploit the body’s natural ability to synthesize these hormones to determine their relative effect on exercise-induced increases in muscle protein synthesis and muscle growth.

As highlighted earlier, increases in lean muscle mass in response to training are primarily regulated by changes in muscle protein synthesis. Recently, researchers at McMaster University investigated the effects of transient, physiological increases in circulating endogenous ‘anabolic’ hormones on muscle protein synthesis. In this study, young men performed two bouts of single arm curl exercise, with one bout being followed by heavy leg exercises, designed to elicit marked increases in circulating hormones. Despite the drastically greater circulating

Collectively, these data are consistent with the observation that post-exercise hormonal increases are not necessary for muscle hypertrophy and ultimately have little bearing on the increases in muscle strength and lean body mass with training, at least in moderately trained university males16.

This data puts into question the utilization of exercise prescription that aims to elicit maximal post-exercise ‘anabolic’ hormonal responses to optimize muscle growth.

Therefore, athletes aiming to enhance muscle growth should focus on key training variables such as proper exercise intensity and progression, coupled with optimal nutrition, rather than on a traditional dogmatic approach of optimal ‘anabolic’ hormonal responses. Nevertheless, whether manipulation of endogenous ‘anabolic’ hormones can result in enhanced training adaptations beyond muscle protein synthesis and muscle growth, or impacts elite athletes differently than recreationally trained males, remains to be clarified in future research. ∆

For references, click here

Dr. Daniel Moore completed his PhD at McMaster University in the area of exercise physiology with a focus on protein metabolism.

Dan holds a senior research position between McMaster and the University of Guelph where he will continue to study the effects of exercise and nutrition on muscle remodeling and growth.

www.sirc.ca

Dr Trent Stellingwerff completed a PhD at the University of Guelph in the area of exercise physiology and nutrition. Trent has taken a position as a senior physiologist at Canadian Sport Centre-Pacific, working with rowing, athletics and triathlon.

9

SIRCuit Volume 2 (2) Spring / printemps 2012

Mindfulness and Acceptance Current Trends and Applications in Performance Psychology Derek Robinson - Canadian Sport Centre - Calgary Danelle Kabush - Canadian Sport Centre - Calgary

www.sirc.ca

10

SIRCuit Volume 2 (2) Spring / printemps 2012

Performance

“

Where are you Dan? Here What time is it? Now What are you? This moment (Salva, 2006)

”

Key Points • The MAC approach posits that mindfulness, acceptance, and commitment based strategies can train the athlete to increase poise and focus, resulting in enhanced performance.

• Paying close attention to internal states as well as physical sensation, athletes can learn to monitor and modulate them and increase their ability to self-regulate for optimal performance.

Abstract

Sport psychology in North America has traditionally used cognitive-behavioural therapy (CBT) skills and strategies to prepare for performance. In recent years, the Eastern influence and focus on acceptance has become popular in psychology practice and research, as well as in sport psychology. The purpose of this paper is to discuss recent research on mindfulness and acceptance in mental training, how this fits with the traditional mental skills we have focused on, and suggestions in the practice and application.

Résumé

En Amérique du Nord, la psychologie du sport utilise depuis longtemps les outils et stratégies de la thérapie cognitivocomportementale à des fins de préparation à la performance. Au cours des dernières années, l’influence des pays de l’Est et l’accent mis sur l’acceptation ont pris une part importante dans la recherche et la pratique en psychologie et donc aussi en psychologie du sport. Cette étude se propose d’analyser les dernières recherches portant sur la pleine conscience et l’acceptation dans l’entraînement mental et d’en vérifier l’arrimage aux habiletés mentales traditionnelles. De plus, cette étude présente des applications et des suggestions pour la pratique.

Mindfulness and Acceptance in Sport

L

ike many athletes, if you think about a peak performance you’ve had in your life, you may use descriptions such as being in the moment, in the zone, flow, or feeling complete absorption in the task (Jackson & Csikszentmihalyi, 1999; Ravizza, 2002). The term “Ideal Performance State” (IPS) has been widely used in sport psychology to describe the mindset of an athlete who is mentally and physically prepared and in the “right” internal state to perform at his or her best (Hardy, Jones, & Gould, 1996). Many of the traditional mental skills training used by athletes in order to attain the IPS, such as goal setting, relaxation/energizing, imagery, and self-talk have recently been challenged for being too general and ineffective at controlling or reducing internal experiences as a necessary means of creating the “ideal performance state” (Gardner & Moore, 2007; Moore, 2009).

Developing and maintaining mental toughness is an individual process of learning what works best and then applying it to daily habits in training, competing, and www.sirc.ca

11

debriefing. Through experience, trial and error, as well as learning from coaches and other athletes, one can develop the ability to perform on demand at the upper end of their potential and abilities. Readers are encouraged to review the research on mental toughness by Connaughton, Hanton, and Jones (2010).

The ability to perform on demand takes great physical, mental, and emotional self-awareness. Traditionally in sport psychology, the skill of awareness as a means of performance enhancement intervention has been to identify one’s emotional states, arousal level, thoughts, and attentional focus in order to correct and adjust them (Ravizza, 2001). As defined by Ravizza, (2001, p. 171) awareness is the “recognition of the need to do something to gain control.”

However, a more recent approach applied to sport is termed mindfulness-acceptance-commitment (MAC).

While this approach also promotes developing high levels of awareness the difference is that instead of fighting to control negative thoughts and unpleasant emotions, athletes SIRCuit Volume 2 (2) Spring / printemps 2012

are taught a present-moment awareness and acceptance, thereby increasing task-focused attention and acting in the service of performance goals and values (Gardner & Moore, 2004, 2006, 2007). The MAC approach posits that mindfulness, acceptance, and commitment based strategies can train the athlete to increase poise and focus which will result in enhanced performance.

For example, Kee & Wang’s (2008) study found that athletes who tend to be more mindful are more able to hold a present-moment focus, are more likely to experience flow states, and adopt mental skills. Gardner & Moore (2004) have reported that their mindfulness and acceptance-based training interventions, which emphasize nonjudgmental

attention to present realities and the development of the skill of self-regulated attention can enhance not only athlete performance, but overall enjoyment, and wellbeing. In the next section, we will examine how training in mindfulness can activate specific circuits in the brain and alter the structure of our brain.

Mind-Brain-Body Connection Basics

Athletes spend many practice hours developing abilities specific to their sport. Physical training focuses on aspects such as endurance, speed, agility, strength, power, and technical skills. We often hear neurons that fire together wire together. In other words, when neurons in a circuit are repeatedly activated, our synaptic connections become stronger as supportive cells, called glia, produce the myelin sheath that wraps around the neurons’ axons. Myelin can increase conduction speed by 100 times, making our neural networks, and neuromuscular networks more and more efficient with practice. www.sirc.ca

12

More myelin is directly related to higher skill levels. For example, in the popular book, The Talent Code, Daniel Coyle (2009) repeatedly demonstrated the notion that “Skill is myelin insulation that wraps neural circuits and grows according to certain signals”. What is often neglected is that the mind is also like a muscle and needs training to function optimally. Like physical training, mental training takes much “deep practice”, in accordance with mindfulness and acceptance, it is built on the paradox of being open to mistakes, learning from errors, choosing goals just beyond your present abilities, much fumbling and stumbling as you go, which “end up in making you swift and graceful without even realizing it” (Coyle, 2009, p. 18). Just think of any child you know learning a sport for the first time such as alpine skiing.

They fall down a lot, their movements may look awkward and uncoordinated, but a few years down the road with plenty of practice, the same child could be seen making graceful and flowing s-turns down the same slope!

This brings us to the question of how the internal mental side of our experiences may correlate with the physical side of neural firing. Countless studies using electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) have demonstrated the physiology behind the development of a better mindset through mindfulness meditation. Training the mind has effects on neural functioning, the electrical activity patterns of the brain, and on neuroanatomy, including the activity and even relative size of specific regions of the brain (Newberg & Iverson, 2003). Furthermore, according to recent and exciting research, the underlying physiological changes that account for wide-ranging positive effects of mental and mindfulness training is neuroplasticity – the ability of the brain to change its own functional and physical anatomy in response to repeated task demands.

Characteristics such as reactivity and empathy, which psychologists have long thought of as fixed aspects of personality, can arguably be trained due to neuroplasticity (Davidson, 2002). As the author of “Train your mind, change your brain” has stated, “One can sculpt the brain’s emotional circuitry as profoundly as one can sculpt one’s pectoral muscles” (Begley, 2007, p. 231).

What sets the stage for neuroplasticity is close attention, awareness to intentionally focus on the flow of information, in turn specifying what neural circuits will become active. When athletes pay close attention to their internal states as well as their physical sensations, they SIRCuit Volume 2 (2) Spring / printemps 2012

moment, and (c) with purposeful practice. Notice that the above means applying mindful and acceptance training techniques also to difficult training experiences, observing and reacting to them non- judgmentally and objectively.

As outlined by Gardner and Moore (2007), teaching athletes the skills of mindfulness and acceptance enables athletes to perform more optimally through improving their abilities to: 1) be actively absorbed in the task, to accept their experiences and focus directly on the necessary aspects of the performance environment (in contrast to active absorption in the self through self-judgment, paying attention to external or internal threats, or a future-oriented focus on performance consequences and its ramifications), 2) positively influence emotional experiences, and 3) remain committed to their performance values, see their own thoughts simply as thoughts and not absolute realities to which they must respond.

can learn to monitor and modulate them and increase their ability to self-regulate for optimal performance. In the long-term intentionally created states become long-term traits. Whether working on the ability to hone one’s focus on the appropriate things relevant to performing well, or gaining an increased overall awareness with less reactivity to distractions, greater mental efficiency can develop after three months of focused practice (Slagter, Lutz, Greischar, Nieuwenhuis, Davis et al., 2007). Like behavioral learning in anything athletic, with enough practice, sustaining mindful focused attention can eventually become much more automatic and require much less effort (BrefczynskiLewis, Lutz, Schaefer, Levinson, & Davidson, 2007). In the final section we will look at how athletes can incorporate mindful and acceptance training techniques around daily training and competitions.

Applications to Athletes

One way of understanding how athletes’ may apply mindfulness training, is through the framework developed

by Dimijian and Linehan (2002), which consists of “what” and “how” dimensions. The “what” dimension includes three components: (a) observing what one experiences, (b) describing the experience, and (c) participating fully in the experience. The “how” dimension applies to the way in which the “what” dimension is carried out: (a) nonjudgmentally with acceptance, (b) in the present www.sirc.ca

13

The MAC approach (Moore, 2009) is a structured protocol that addresses five phases: 1) psychoeducation, 2) mindfulness, 3) values identification and commitment, 4) acceptance, and 5) integration and practice.

Attitude/Mindset During the summer of 2010, coaches and staff of several sports associated with the Canadian Sport Centre Calgary (CSCC) were presented the rational, goals, and processes of the Mindfulness-Acceptance-Commitment approach.

Mental toughness training for focus and poise were highly valued and the majority of the Canadian National Long Track Speed Skating Team attended basic training in mindfulness. Six group sessions were held by a mental performance consultant (Derek) and an expert guest teacher in mindfulness, with more than thirty years of experience. This exposed the athletes to the mindfulness and psychoeducational components of the MAC approach.

Several athletes had previous experience with mindfulness meditation and yoga practices and valued the application to sport. Here is a quote from Jamie Gregg who recently won his first World Cup Gold Medal, “With daily practice of mindfulness meditation, I have found that my attentional awareness to technique in training has increased dramatically.

I have been able to focus more acutely and for SIRCuit Volume 2 (2) Spring / printemps 2012

a longer period of time which has improved my skating in both training and racing.”

Training This basic training was then applied and integrated by some of the coaches to the dry land training that focused on imitations, body position, and technique. The goals, language, and behavioural expectations were built into the daily training habits in order to execute the program despite mental, emotional, and physical challenges.

Last summer (2011), we integrated the mindfulnessacceptance-commitment principles (Moore, 2009) into a group training program where one athlete wrote a weekly email to her teammates debriefing how she was able to “MAC it” and maintain poise and focus. This email was thoroughly embraced by her teammates (as they shared similar experiences) and they soon were asking when they would be able to write and share their performance reflections. By the end of summer training, we created a short book filled with entries from each athlete describing their resiliency training and learned experience.

Competition Another example of using the MAC approach with a Western Hockey League team occurred the last two years in which the players were educated regarding the MAC principles. One recent intervention has proved very effective in which the coach awards one player on the team who exemplified grit during the game. The term “Grit” stands for a performance with passion and action exemplifying powerful motivation and pure perseverance of effort to overcome any challenge that lay within his path. The key here is the performance value of grit as being the driving force behind the players poise and focus. Again, the ability to play with grit often rests on the player’s ability to be mindful and accepting of themselves and the situation, task-focused, as well as fully committed to acting in the service of the teams goals and values.

Post Competition Another effective mental toughness training intervention which we have used for years involves video debriefing.

Post training and competition debriefs would be videotaped as they occur between the athlete and the mental performance consultant. This would allow the athlete, coach, and mental performance consultant to observe what the athlete said as well as how they said it. The video is also very valuable in collecting video evidence that shows how the athlete has developed his or her mental performance.

An accumulation of video responses and debriefs over an www.sirc.ca

14

Olympic quadrennial is extremely informative and useful.

Here is an example of Jeremy Wotherspoon (67 World Cup victories) answering how he is able to achieve his best focus in 2007.

As you can see in the video, the athlete comments on feeling prepared so that he is free to concentrate on the task.

He articulates the importance of being able to recognize when he is not focused or distracted and how he uses this information (or is mindful) in order to refocus on the task and act on his commitment to learn from each race. The key element is that the athlete does not avoid or escape from realizing these uncomfortable thoughts, emotions, or sensations but accepts this present-moment awareness and responds to the performance situation more effectively.

This example is before we introduced and educated the athletes about the principles and terminology of mindfulness-acceptance-commitment, however, the “what” and “how” are the same. He does not react emotionally or get caught up on the fact that he is distracted, but simply refocuses and acts on his performance value to learn from each race.

Acceptance and the principles of the MAC approach have long been a part of cognitive behavioural therapy as well as sport psychology. As 6 time Olympic coach Michael Crowe observed, “I think we used to all just expect to accept things, to suck it up and get on with doing what we need to do in performance. Now it seems things have gotten easier for us in our society and we sometimes expect things to be more comfortable and have less frustration tolerance.

So now we have to be more conscious and train SIRCuit Volume 2 (2) Spring / printemps 2012

ourselves to be more resilient.â&#x20AC;?

Recent research has articulated a mental training program that seems promising for some athletes. Initial results of the MAC program suggest enhanced performance results and coach ratings (Wolanin, 2005; Lutkenhouse et al., 2007;

Danelle Kabush, PhD works as a mental performance consultant for the Canadian Sport Centre Calgary and is a professional member of the Canadian Sport Psychology Association. She currently works mainly with the National Short Track and Long Track Speed Skating teams as well as other individual athletes and teams.

Schwanhausser, 2009). Further research needs to further explore the effectiveness of the specific mindfulnessacceptance training programs in sport. â&#x2C6;&#x2020;

Derek Robinson, M.Ed. is a registered psychologist working as a mental training consultant with the Canadian Sport Centre Calgary. He is currently involved with many different sports and teams at the National and International levels, including Long Track Speed Skating and the Canadian Alpine Ski Team.

To receive the SIRC High Performance SIRCuit or SIRC newsletters

Click here

www.sirc.ca

15

SIRCuit Volume 2 (2) Spring / printemps 2012

Athlete Focus

Michelle Stilwell Sport: WC Athletics Born: 04/07/1974 Gender: Female Birth Place: Winnipeg, Manitoba, Canada Height: 170.0 cm Weight: 52.0 kg

HIGHLIGHTS • 2012 holds World Records in 100m, 200m & 400m • 2008 Beijing Paralympics Athletics 100m & 200m Gold • 2006 World Championships 100m Gold & 200m Silver • 2000 Sydney Paralypmics Basketball Gold Hard work, Dedication, Inspiration At the age of 17 Michelle was rendered quadriplegic after falling from a friend’s back while piggyback riding. Prior to her injury Michelle was involved in many sports. She excelled at track, basketball and ringette. Her injury has not put a stop to her enjoyment of these sports…just a few alterations.

A gold medalist at the 2000 Paralympic Games in Wheelchair Basketball, Michelle Stilwell is no stranger to athletic success. However, Michelle was forced to quit basketball shortly after the Games due to complications arising from her spinal cord injury. Despite this, rather than give up, she moved to a whole new sport and channeled her competitive drive and passion for sport into making one of the most meteoric rises for any Canadian athlete ever— going from a novice Wheelchair racer to World champion in just two years. In fact, in 2006 she won a Gold medal and set a new games record at the World Championships in the 200m and captured silver in the 100m.

In 2007, 2009, and 2010 Michelle won the women’s quad division at the Vancouver Sun Run 10k and the Victoria Times Colonist 10k but her specialty lies in sprints where she won numerous track and field competitions in the 100m, 200m, 400m and 800m events. In May of 2008, just seven weeks post surgery Michelle broke the World Record in both the 100m and 200m. Four months later success was found again in Beijing at the Paralympic Games where Michelle found herself on top of the podium for the 100m and 200m events breaking Paralympic Records in both. Most recently Michelle brought home 3 Gold medals and a Silver from the IPC World Championships in New Zealand. An incredible comeback after major spine surgery just 5 months prior.

Michelle is extremely dedicated to training, bringing her competitive drive to athletics after an extremely successful international career in Wheelchair Basketball. She manages to juggle full time child rearing and homeschooling, marriage and the training required to compete at the international level.

Michelle actively speaks about the stages of her life, the circumstances that brought her to become a wheelchair athlete, her major victories, and her minor disappointments. Her words to live by are “Remove self-imposed limitations – anything is possible with a positive attitude.” She is an ambassador for ActNow BC and the Rick Hansen Foundation. www.sirc.ca

16

SIRCuit Volume 2 (2) Spring / printemps 2012

Canadaâ&#x20AC;&#x2122;s Multi Games & Multi Sport Paralympic Gold medalist sets her site on London 2012! Michelle talks about physical training and the use of sports science for setting World records and prepping for London.

Click on the video to see the full interview.

Going for Gold London 2012!

Michelle looks forward to training in preparation for the 2012 Paralympic Games in London, England.

www.sirc.ca

17

SIRCuit Volume 2 (2) Spring / printemps 2012

Competitive Intelligence

K

nowledge can give an athlete the competitive edge.

Competitive intelligence equips coaches, sport scientists and practitioners with the latest information that may assist in the quest to put an athlete on the podium. SIRC receives thousands of publications from around the world each year ranging from peer reviewed journals to practical guides and our information specialists are constantly reviewing and indexing the various articles.

L’hydrothérapie comme moyen de récupération

Hydrotherapy as a Recovery Intervention A Commentary on the Literature

I

This article is also available as a podcast, click here to listen

Nancy Rebel - Sport Information Resource Centre (SIRC)

n the training cycle of an athlete, recovery is a key factor in achieving performance success. In fact more and more commonly coaches and athletes are looking to identify pathways to ensure appropriate and efficient recovery as an intrinsic part of their training and competition program. Recovering sufficiently from intense training and competition will help prevent decreased performance levels. In many cases when in high competition season there might be less than adequate time for athletes to recover between competition sessions, therefore finding the optimal recovery strategy becomes a competitive advantage (Wilcock et al., 2006).

The level of intensity and duration of the training has a direct relationship to the physiological stressors placed upon the body’s systems. For elite athletes these stressors may be associated with energy substrate depletion, hyperthermia, mechanical muscle damage, oxidative stress, inflammation, and nervous system fatigue (Leeder et al., 2012). There has been much research on recovery interventions and their physiological, biomechanical, biochemical, and performance related effects.

Water immersion therapy or hydrotherapy is known for the benefits of hydrostatic pressure. This pressure causes the displacement of gas and fluid substrates from an www.sirc.ca

18

L

a récupération est un facteur essentiel de la performance dans le cycle d’entraînement d’un athlète. Et, de plus en plus d’athlètes et d’entraîneurs sont à la recherche de moyens efficaces de récupération suffisante entre les séances d’entraînement et les compétitions. Une récupération suffisante à la suite d’un entraînement intense ou d’une compétition prévient les baisses de performance. En période intense de compétition, les athlètes peuvent manquer de temps pour récupérer d’une compétition à l’autre; il apparaît judicieux d’identifier le moyen de récupération optimale pour se démarquer en compétition (Wilcock et coll., 2006).

L’intensité et la durée des séances d’entraînement ont un lien direct avec les facteurs de stress agissant sur les divers systèmes de l’organisme. Chez les athlètes d’élite, ces facteurs de stress sont probablement associés à la déplétion des substrats énergétiques, aux lésions musculaires d’origine mécanique, à l’hyperthermie, au stress oxydatif, à l’inflammation et à la fatigue du système nerveux (Leeder et coll., 2012). Il y a beaucoup d’études sur les interventions en matière de récupération sur la performance et traitant des effets physiologiques, biomécaniques, biochimiques.

SIRCuit Volume 2 (2) Spring / printemps 2012

individual’s extremities towards the centre of the body.

The movement of these fluids may increase the athlete’s ability to recover from exercise. Immersion in water also causes the body to weigh less than when on dry land due to the net upward force on the immersed body. This upward force helps to support all or part of the weight of the body immersed in the water (Wilcock et al., 2006).

This buoyancy effect, allows for greater relaxation of gravitational muscles and conservation of energy. The research observes that there is a benefit to hydrotherapy in the reduction of perception of fatigue. This reduced perception of fatigue may come from a reduction in the neuromuscular effort to maintain posture, but also to an overall reduction in neural transmissions (Wilcock et al., 2006).

Increasingly a variety of hydrotherapy techniques, including cryotherapy, thermotherapy, and contrast therapy, are being recognized as successful in posttraining and competition recovery.

Cryotherapy is immersion in cold water, often a combination of ice and water is used. This intervention is used for shorter durations due to discomfort and is not always practical for team sports due to the time required to treat all the athletes. The research indicates that cold water immersion interventions may aid in reducing heart rate and cardiac output; increasing arterial blood pressure and peripheral resistance; decreasing core and tissue temperature, acute inflammation and perceived pain; and aid in maintaining performance (Vaile & Gill, 2008).

La thérapie par immersion dans l’eau ou hydrothérapie est connue pour ses effets bénéfiques dus à la pression hydrostatique. Cette pression déplace les liquides et les gaz des extrémités vers le centre de l’organisme.

Le mouvement de ces liquides pourrait faciliter la récupération d’un athlète à la suite d’un exercice physique.

L’immersion dans l’eau a pour effet de diminuer le poids du corps comparativement au poids sur terre, et ce, à cause de la poussée exercée par l’eau. Cette poussée facilite le maintien de parties ou de l’ensemble de l’organisme immergé (Wilcock et coll., 2006) . La poussée permet une plus grande relaxation des muscles soumis à la force de gravitation et une plus grande conservation d’énergie.

D’après les observations scientifiques, l’hydrothérapie suscite une diminution de la perception de la fatigue. La diminution de la sensation de fatigue est peut-être due à la diminution de l’effort neuromusculaire pour le maintien de la posture, mais probablement aussi à la réduction globale des transmissions nerveuses (Wilcock et coll., 2006).

On reconnait des vertus à un nombre grandissant de techniques d’hydrothérapie (cryothérapie, thermothérapie, thérapie par contraste thermique) pour améliorer la récupération postexercice et à la suite d’une compétition.

La cryothérapie consiste en une immersion dans l’eau froide comprenant fréquemment de la glace. Cette intervention est de courte durée, car inconfortable et pas vraiment pratique pour les sports d’équipe : cela prend trop de temps à administrer à tous les athlètes. D’après des observations scientifiques, l’immersion en eau froide contribue à la diminution du rythme cardiaque et du débit cardiaque, à l’augmentation de la résistance périphérique et de la pression sanguine, à la diminution de la température centrale et des tissus de l’organisme, de l’inflammation aigüe et de la sensation de douleur et au maintien de la performance (Vaile et Gill, 2008).

La thermothérapie consiste en une immersion en eau chaude afin d’augmenter la température centrale de l’organisme. Il y a moins d’études sur ce type d’intervention. La thermothérapie se fait dans des piscines ou bassins chauffés; comme il y a peu de ces installations à proximité des centres d’entraînement et de compétition, cette intervention n’est pas vraiment pratique. On administre ce traitement de chaleur durant 10 à 20 min, et ce, pour accélérer la récupération et la réadaptation. Ce traitement a pour effet physiologique

www.sirc.ca

19

SIRCuit Volume 2 (2) Spring / printemps 2012

Thermotherapy refers to immersion in water that raises core body temperature. Less research has been performed on this intervention. Thermotherapy requires use of heated pools or baths and again is not always practical due to the unavailability of hot water facilities in proximity to many training or competition centres. Thermotherapy is often used for durations of 10-20 minutes to aid in recovery and rehabilitation. Physiological changes may include increase in cutaneous blood flow, cardiac output and neural transmission. However, caution is recommended with thermotherapy due to a variety of contraindications including Inflammation, swelling, and potentially dangerous strain on the cardiovascular system (Wilcock et al, 2008).

Contrast therapy is a newer intervention and alternates hot and cold water immersion. There are a number of varying studies recommending order, duration, and number of repetitions of immersion, however, it seems the most common suggestion is ending on the hot water cycle.

Benefits of contrast water therapy may include changes in tissue temperature, blood flow, blood flow distribution, and reduce muscle spasm and inflammation, hyperaemia of superficial blood vessels, and improved range of motion (Vaile & Gill, 2008). “Contrast water therapy has been associated with an increase in the perception of recovery and a quicker reduction of lactate post-exercise” (Vaile et al., 2008).

Water immersion therapy in a thermoneutral environment has also been recommended for its hydrostatic pressure benefits. However, many of these benefits can also be found in cold water immersion as well.

Research on hydrotherapy as a recovery intervention is still developing. Overall the one thing the research agrees upon is the need for continuing studies to be performed on all aspects of the intervention. From water temperature, immersion level, duration of therapy, exercise intensity, to time between exercise and recovery therapy application, etc, there are many variables that need to be considered.

Researchers also maintain that hydrotherapy interventions should be implemented based upon each specific sport in order to optimize recovery, with adaptations for individual athlete’s physiology, time available, and access to hydrotherapy resources. ∆ For references, click here

www.sirc.ca

20

d’augmenter la circulation cutanée, le débit cardiaque et la transmission nerveuse. Néanmoins, il faut user de prudence en utilisant cette intervention, notamment à cause de contre-indications comme l’inflammation, l’œdème et un stress potentiellement dangereux pour le système cardiovasculaire (Wilcock et al, 2008).

La thérapie par contraste thermique, plus récente, consiste en l’alternance de chaud et de froid. Plusieurs études se sont prononcées sur la séquence, la durée et le nombre d’expositions; le plus souvent, on recommande de terminer par l’immersion en eau chaude. Parmi les bienfaits de la thérapie par contraste thermique, notons les variations de la température tissulaire et de la distribution du débit sanguin, la diminution des spasmes musculaires, de l’inflammation et de l’hyperhémie des vaisseaux sanguins superficiels et l’amélioration de l’amplitude de mouvement (Vaile et Gill, 2008). « La thérapie par contraste thermique en immersion est associée à une augmentation de la sensation de récupération et à une diminution plus rapide de la concentration postexercice de lactate » (Vaile et coll., 2008).

Des études recommandent aussi la thérapie par immersion en eau thermiquement neutre pour les bienfaits dus à la pression hydrostatique. Néanmoins, l’immersion en eau froide procure plusieurs de ces bienfaits.

La recherche en hydrothérapie comme moyen de réadaptation est toujours en cours. La communauté scientifique souligne la nécessité de poursuivre les études sur tous les aspects de ce type d’intervention : température de l’eau, degré d’immersion, durée du traitement, intensité de l’exercice, délai entre la fin de l’effort et l’application du traitement et bien d’autres variables qui méritent une attention. Les chercheurs mentionnent aussi que l’hydrothérapie devrait être administrée en fonction du type de sport pratiqué pour optimiser la récupération tout en prenant en compte la physiologie particulière de l’athlète, sa disponibilité et l’accès aux installations hydrothérapeutiques. ∆

Nancy Rebel is the Director of Library Services at SIRC. Nancy is responsible for content management of SIRC’s collection and its catalog database design. Nancy has been responsible for: the content submissions for the world-renowned SportDiscus database; aiding in the coordination of in-house and international terminology submissions and organizational structure of SIRCs internationally recognized SIRCThesaurus as Editor.

SIRCuit Volume 2 (2) Spring / printemps 2012

Recommendations from the Research

Recommandations issues des études

✔✔ Implement full body immersion (excluding head and neck), partial immersion will reduce hydrostatic pressure exerted on the body and may reduce effectiveness.

✔✔ Immerger l’organisme jusqu’au cou, car l’immersion partielle diminue la pression hydrostatique exercée sur l’organisme, ce qui peut diminuer son efficacité.

✔✔ If muscle damage is involved, repeating recovery strategy on subsequent days may be beneficial and contrast water therapy may be the more effective strategy.

✔✔ En présence de lésion musculaire, il est conseillé de participer à des séances de récupération sur plusieurs jours consécutifs; la thérapie par contraste thermique semble le moyen le plus efficace.

✔✔ Practical and efficient hydrotherapy sessions of 10-15 minutes appear to be effective.

✔✔ Pour obtenir des bénéfices, les séances d’hydrothérapie devraient durer de 10 à 15 minutes.

✔✔ Suggested water temperatures of 10-15°C (cold) and 38-42°C (hot) are effective. If continuous cold water immersion is being used a warmer temperature such as 15°C is recommended. However, if intermittent cold water immersion is being used a cooler temperature such as 1012°C may be more effective given the shorter exposure.

✔✔ Pour une séance efficace, la température de l’eau froide devrait se situer entre 10 °C et 15 °C et celle de l’eau chaude, entre 38 °C et 42 °C. Pour une séance continue en eau froide, on recommande une température de 15 °C. Si la séance est en mode intermittent, la température de l’eau peut être abaissée à 10-12 °C, la durée de l’immersion étant moins longue.

✔✔ In cases where the outcome of contrast hydrotherapy is to reduce post-exercise core body temperature it is recommended to avoid using more hot water exposure than cold. A ration of hot:cold should be 1:1.

✔✔ Quand l’objectif visé par une séance d’hydrothérapie par contraste thermique est l’abaissement de la température centrale postexercice, la durée de l’immersion en eau chaude ne devrait pas être plus longue qu’en eau froide. Le ratio chaud : froid suggéré est de 1 : 1.

✔✔ It is recommended that all contrast water therapy sessions should end with cold water immersion to leave the body in a “cooler” state and assist aid in in the recovery of bruising, micro-damage, and increased body temperatures (skin/ muscle/core).

✔✔ Toutes les séances d’hydrothérapie par contraste thermique devraient se terminer par l’immersion en eau froide, et ce, pour procurer une sensation de fraîcheur et faciliter la récupération en présence de meurtrissures, de microlésions et d’une augmentation de la température centrale, musculaire et cutanée.

✔✔ Athletes should be standing rather than sitting to maximize the hydrostatic pressure effects.

✔✔ Pour maximiser les effets de la pression hydrostatique, les athlètes devraient être debout plutôt qu’assis.

✔✔ Body size may influence duration of exposure due to higher or lower insulation effects from muscle and fat mass.

✔✔ Le gabarit de l’athlète conditionne la durée de l’immersion, car les masses musculaire et adipeuse modifient le degré d’isolation.

✔✔ It is important to remember that each athlete will respond individually to recovery interventions, so these differences must be built into the session even in the team environment.

✔✔ Notez que les réponses à l’immersion sont spécifiques à l’individu; il faut donc les prendre en compte notamment quand toute l’équipe est impliquée.

(Vaile and Gill, 2008) (Halson, 2011)

www.sirc.ca

(Vaile et Gill, 2008) (Halson, 2011)

21

SIRCuit Volume 2 (2) Spring / printemps 2012

Stay Informed with SIRC Dear SIRC

Is there a policy on chaperones for players on trips outside (or even within) the country? We have a situation where an under aged athlete has qualified for an event outside Canada. The player’s parents will not be in attendance. We have one male and one female coach attending and three other female players attending this event.

Thank you for sending in your request regards to Chaperone Policies for travel with Minor Athletes. I have compiled the following list of resources that may provide you with templates of policies and guidelines in this area that approach the subject from a couple of different perspectives: ◊ ◊ ◊ ◊

guidelines for travel and accommodation arrangements parental permission form Travel policies Read more Chaperone codes of conduct

Where Can I Find...

New Books @ SIRC

Understanding that coaching can be a very stressful job, is there any recent research into coaching burnout in the SIRC Collection?

Bompa, Tudor O., and G. Gregory Haff.

Periodization: Theory and Methodology of Training.

5th Ed. Champaign, Ill: Human Kinetics, 2009.

There have been a number of studies that look at athlete burnout in sport, but coaches are often identified as being equally susceptible to the stressors of training and competition as well. Coaches need to find the balance between work and life in order to perform to their fullest in the sport arena.

Cheung, Stephen S. Advanced Environmental Exercise Physiology. Champaign, Ill: Human Kinetics, 2010.

Clifford, Craig and Randolph M Feezell.

Sport and Character: Reclaiming the Principles of Sportsmanship. Champaign, Ill: Human Kinetics, 2010.

Read more

Did you know...

Manore, Melinda M., Nanna L. Meyer, and Janice Thompson. Sport Nutrition for Health and Performance. 2nd Ed. Champaign, Ill: Human Kinetics, 2009.

Coaching education is an important factor in the viewed formal, large-scale coach education programs

Reilly, Thomas. Ergonomics in Sport and Physical Activity: Enhancing Performance and Improving Safety. Champaign, Ill: Human Kinetics, 2010.

www.sirc.ca

La formation des entraîneurs contribue à leur do considèrent le programme officiel et à grande échel essentiel de leur croissance et développement.

22

SIRCuit Volume 2 (2) Spring / printemps 2012

Restez au courant avec SIRC Où trouver...

Il est connu que le travail d’entraîneur peut–être très stressant. À cet effet, y a-t-il dans la collection du SIRC des études récentes au sujet de l’épuisement professionnel des entraîneurs?

Il y a beaucoup d’études traitant de l’épuisement professionnel des athlètes.

Concernant les entraîneurs, on note souvent qu’ils subissent aussi l’impact du stress de l’entraînement et de la compétition. Il est donc nécessaire pour les entraîneurs de trouver le juste équilibre entre le travail et la vie de tous les jours pour donner le meilleur d’eux-mêmes dans le monde du sport.

Les articles suivants présentent quelques-unes des plus récentes études sur l’épuisement professionnel des entraîneurs. Ces articles sont disponibles par le service de remise du SIRC; s’ils vous intéressent, faites-le-nous savoir et nous donnerons suite à votre demande. et plus encore

Cher SIRC

Je me demande si le SIRC possède un exemplaire de la politique concernant les chaperons pour les joueurs en voyage à l’étranger ou même au pays. Dans notre organisme, il y a un athlète qui n’a pas encore l’âge minimum, mais qui s’est classé sur l’équipe nationale pour un événement à l’extérieur du pays. Les parents ne seront pas sur place. Un entraîneur et une entraîneure sont du voyage en plus de trois autres joueuses.

Nous vous remercions de nous faire parvenir cette demande au sujet des politiques concernant les chaperons sur la route avec des athlètes mineurs. J’ai colligé la liste suivante de documents qui vous donneront des exemples de politiques et de directives sur ce sujet; leur approche respective varie quelque peu : ◊ Directives relatives au voyage et au logement ◊ Formulaire d’autorisation des parents ◊ Politiques en matière de voyage ◊ Codes de conduite des chaperons

et plus encore

Saviez-vous...

e confidence of coaches… youth sport coaches have as a critical part of their growth and development.

onner confiance… les entraîneurs de jeunes athlètes lle de formation des entraîneurs comme un élément

www.sirc.ca

23

SIRCuit Volume 2 (2) Spring / printemps 2012

Fit to Playâ&#x201E;˘ High Performance Recovery (part 1)

Carl Petersen BPE, BSc(PT) - City Sports and Physiotherapy www.sirc.ca

24

SIRCuit Volume 2 (2) Spring / printemps 2012

Proactive & Preventative Medicine Abstract

This article, the first in a three part series, will provide the reader with insight into overtraining (overstress) and recovery. It will allow them to recognize stressors, signs and symptoms of overstress and under-recovery. It will also introduce the rules of recovery and their role in prevention of overstress for both athletes and coaches.

Résumé

Cet article est le premier d’une série de trois qui renseignera davantage le lecteur sur le surentraînement (trop de stress) et la récupération. Il présente des façons de reconnaître les agents stressants, les signes, les symptômes de surentraînement et du manque de récupération. De plus, il introduit les règles de la récupération et leur rôle dans la prévention du surentraînement de l’athlète et du surmenage de l’entraîneur.

H

igh performance athletes are exposed to a very demanding schedule, often training two or more times per day. Under these circumstances athletes may be pushed beyond physiological and psychological limits which can result in decreased function (Bompa, 1985) and have the potential for overstress or under-recovery to occur. The existence of the condition ‘overtraining syndrome’ has been well documented (Mackinnon & Hooper, 1991), (Fry, 1991), (Krieder et al, 1998), (Uusitalo, 2001). In fact training and subsequent overtraining concerns have been recognized in the literature for over 75 years (Herxheimer, 1930). Overtraining syndrome is a serious problem marked by decreased performance, increased fatigue, persistent muscle soreness, mood disturbances, and feeling ‘burnt out’ or ‘stale’ (Uusitalo, 2001).

Descriptions and Definitions from the Literature

Overtraining is described as an imbalance between training and recovery (Kuipers & Keizer, 1988) or an imbalance between stress and recovery, that is too much stress combined with too little regeneration (Lehman et al, 1999). It is the final stage of an advanced state of fatigue which is characterized by a decline in the athlete’s performance capability and their inability to adapt to training (Marion, 1995). Recovery is a process in time for the re-establishment of performance abilities. It varies between and within individuals and exists at multi-levels (e.g. psychological, physiological, social) (Kellmann & Kallus, 2001). Whereas under-recovery is described as the failure to fulfill current recovery demands (Kellman, 2003).

The diagnosis of overtraining is complicated. There are no exact diagnostic criteria, and physicians must rule out other diseases before the diagnosis can be made (Uusitalo, 2001).

The general causes of under-recovery and subsequent www.sirc.ca

25

Key Points • Being aware of potential internal and external stressors and taking steps to minimize their impact can help prevent overstress.

• Subjective symptoms of overtraining syndrome may include: persistent fatigue, muscle soreness, reduced coordination, weight loss, and mood change.

• Adequate time for recovery should be built into the design of the training program.

overtraining are thought to include too rapid increases in intensity, volume or density of training that overwhelm the body’s ability to adapt. Other factors include single sport overload, monotonous or poor periodization of training and too many competitions without adequate rest and insufficient recovery. Being aware of potential internal and external stressors and taking steps to minimize their impact on athletes can help prevent overstress (see Table 1).

Recognition of Overstress

The factors contributing to the increase or decrease of overstress are complex and multifaceted. The response to overstress and overtraining appears to be highly individual with the signs and symptoms varying greatly from athlete to athlete. Thus, a particular training schedule may improve the performance of one individual, be insufficient for another, and be damaging for a third (Raglin, 1993).

Reliable clinically proven tests for diagnosis have not been established, and the underlying mechanism for performance decreases is not known (Urhausen & Kinderman, 2002; Armstrong & VanHeest, 2002; Hawley & Schoene, 2003) or fully understood.

Detecting underrecovery, overstress and subsequent overtraining can be a big problem for athletes and coaches alike. Coaches and team medical staff who know their athletes well have a distinct advantage in early detection of overtraining and can minimize the potential for overstress or overtraining and optimize performance.

Physical and Psychological Signs & Symptoms

Overtraining remains more easily detected by decreases in physical performance and alterations in mood state than by changes in immune or physiological functions (Shephard & Shek, 1998) (see Table 2).

SIRCuit Volume 2 (2) Spring / printemps 2012

It is usually a temporary condition disappearing within a few hours or a few days provided the athlete has access to adequate and appropriate recovery strategies. These must include nutritional, physical, psychological and emotional support. If too much training is done too fast and too soon (before recovery has occurred) the fatigue level can remain and lead to a decrease in performance in the immediate, short or longer term. Under such conditions, the reaction of many athletes is to increase the volume and/or intensity of their training, thus establishing a vicious circle that only serves to aggravate the problem.

Table 1 (adapted after Petersen, 2003) Training and Practice Stressors

• Too much training or practice done too hard, too fast, too soon (main cause).

• Lack of recovery time.

• Too many competitions.

• Training or competing while injured or ill.

• Returning from injury or illness too quickly.

-Compensation from weak and damaged tissues that are unable to fully bear weight.

-Potential increased damage to already vulnerable injured tissue.

-Prolonged recovery time.

Periodizing Recovery Strategies

Travel and Lifestyle Stressors • • • • •

Ideally you should divide your yearly training plan into five phases as outlined below (Petersen, 2006). The recovery program may vary with the phase of training as the athlete needs to recover from the fatigue of whatever fitness characteristics are being developed in the short term and continue to practice applicable longer term recovery strategies.

Unfamiliar or poor quality of food.

Poor accommodation or living conditions.

Irregular routine.

Lack of sleep (quality and quantity).

Jet lag and travel concerns.

Environmental Stressors • • • • • •

Constant competitive environment.

Inadequate acclimatization to heat, cold, humidity or altitude.

Lack of support from family and friends.

Lack of adequate finances.

Employment or scholastic concerns.

Personal relationships.

Pre-competition 1 Phase A - ‘Training for Training’ 2 Phase B - ‘Building the Base’ 3 Phase C - ‘Getting Specific’ In-competition 4 Phase D - ‘Competition & Maintenance’ Post-competition 5 Phase E - ‘Rest & Recovery’

Health Stressors • • • • •

Illness or injury.

Medication, alcohol and other substances.

Cold and Flu, infections, allergies or other health concerns.

Poor nutrition and/or hydration.

Large fluctuations in body weight and composition.

Subjective symptoms remain the most sensitive indicators of overtraining syndrome (Fry et al, 1991; Uusitalo, 2001; Urhausen & Kinderman, 2002; Marion, 1995; Armstrong & VanHeest, 2002). These can include persistent fatigue, muscle soreness, reduced coordination, weight loss, and mood changes. Frequent illness may accompany performance decrements, but they may also be signs of underlying medical conditions (Hawley & Schoene, 2003).

One of the best indicators of overstress or overtraining is how well the athlete is coping. A decrease in their general sense of well-being, pain in muscles upon rising, and poor quality of sleep appear to be linked with excessive fatigue, and could be signs that precede overtraining (Marion, 1995).

Fatigue–Underrecovery–Overtraining Continuum

Fatigue is necessary to develop the physical abilities or fitness factors of stamina, strength, speed, skill and power. www.sirc.ca

26

The yearly training plan must be treated as a flexible tool.

The types of recovery strategies used will remain somewhat constant but the weighting of each may vary with the phase of training. For example during the in-competition phase more weighting may be put on psychological and emotional recovery strategies and recovery from travel.

During the post-competition phase and immediatley precompetition, one should familiarize themselves with the recovery menu and start self-monitoring. During Phase A, ‘Training for Training’, pay particular attention to the physiological recovery that is needed to alleviate symptoms associated with heavy training loads. During Phase B and C as the training gets more sport specific and one is doing more speed and power work recovery of all systems must be optimized. Psychological and emotional recovery should be reinforced throughout the pre-competition training and recovery process.

During the in-competition Phase D recovery strategies SIRCuit Volume 2 (2) Spring / printemps 2012

Table 2: Commonly Agreed Upon Overtraining Signs & Symptoms Physical

• Increased feeling of fatigue.

• Decrease in performance.

• Increased muscle tension and tenderness.

• Increased susceptibility to illness or injury.

• Decreased appetite & weight.

• Increased resting heart rate.

• Increased blood pressure.

Psychological • • • • • • • • •

Decreased motivation to train.

Decreased motivation to compete.

Disturbed sleep or ability to relax.

Increased irritability.

Decline in feelings of self-worth.

Uncontrollable emotions.

Increased anxiety or insecurity.

Oversensitive about criticism.

Listlessness or melancholy.

should be automated and built into the daily, weekly and multi-week training routine. Psychological and emotional recovery strategies that may involve others are important to be implemented during this time. It is important to provide adequate time for recovery when planning the training program. This should include at least one recovery day or rest day in the weekly microcycle, an easier week each three-four weeks in the longer term macrocycle and rest periods (away from competition) of up to four to six weeks should be included in the yearly training cycle.

The following list of short term rules of recovery have been developed with the help of current literature as well as from anecdotal evidence from athletes, coaches and sports medicine and science personnel.

They are strategies that athletes can do for themselves or others can do for athletes to aid recovery. Ensuring that they are implemented on a regular basis will help optimize recovery and prevent overstress.

Short Term Rules of Recovery

Rule #1 - Rehydration The most important nutritional considerations for recovery relate to fluid and fuel replacement strategies (Burke, 2000) therefore drink plenty of water. The goal is to have light coloured urine. The harder, higher and hotter conditions you train or compete in, the more you need to drink. Prehydration and immediate re-hydration are key. Losing as little as 2% of body weight through sweat can impair an athlete’s ability to perform due to low blood volume and less than optimal utilization of nutrients and oxygen.

Also, younger players may need to be more vigilant about hydration strategies as dehydration seems to be more detrimental to children than to adults. (Bar-Or, 2001) Rule #2 - Re-fuel Athletes can minimize the effects of metabolic fatigue by starting each session with their fuel tanks full (Calder, 2003). Adequate supplies of glycogen in the muscle and in the liver are needed to support the energy demands of the player and promote recovery for the next training session. Ensure that adequate nutrition (carbohydrate fuel) is consumed pre and post-training. Dietary carbohydrate is the primary source for the body to manufacture glucose (Coyle, 1995). Since glycogen stores take 24-48 hours to replenish, they must be replaced daily (Costill & Hargreaves, 1992). Each gram of glycogen is stored with approximately 3 grams of water, so ensure adequate hydration to ensure maximum glycogen synthesis.

There is a window of opportunity within the first 20-30 minutes after strenuous exercise, to replenish muscle fuel stores at a faster rate than if carbohydrate intake is delayed for longer. Small amounts of protein taken with carbohydrates before, during and after hard training helps to minimize muscle protein breakdown as a result of heavy workloads. Athletes should consume between 1.2-1.5 g/kg body weight of simple carbohydrates as soon as possible

Figure 1- The Fatigue-Overtraining Continuum diagram (with permission Coaching Association of Canada)

www.sirc.ca

27

SIRCuit Volume 2 (2) Spring / printemps 2012

after exercise (Costill & Hargreaves, 1992).

It is the duty of every athlete to familiarize themselves with the contents of all substances they put in their bodies. Be sure to check the label on the sports drinks and bars to know what you are consuming. Use nutritional supplements with caution due to the chance of cross contamination as it is frequently impossible to know from batch to batch what contaminants they may contain.

rates there is a greater recruitment of slow twitch fibres.

Since slow twitch fibres are more resistant to fatigue a higher pedalling rate will prove advantageous and less likely to cause premature fatigue (Hagan et al, 1992).

Other modalities such as pool running or walking can be used in the absence of a bike.

Practical Application

Practical Application Consume 1.2-1.5 grams of carbohydrate per kilogram of body weight immediately after exercise and then follow that with an additional 1.5-2.0 grams of carbohydrate per kilogram at a meal or snack within two hours (Parsons, 2006). A banana has about 30 grams and 2 cups of 1% chocolate milk 54 grams of carbohydrate. Other good recovery foods are dried fruit bars, yogurt and low fat granola cereal.

Table 3: Short Term Rules of Recovery Short Term Rules of Recovery (daily)

(adapted after Petersen, 2003, Petersen & Nittinger 2007, Petersen, 2009)

Rule #1 - Re-hydration Rule #2 - Re-fuel Rule #3 - Recovery work Rule #4 - Re-align the body Rule #5 - Re-set the balance clock Rule #6 - Re-connect the core Rule #7 - Release the soft tissue Rule #8 - Regain & maintain muscle length Rule #9 - Re-play & review your training or competition Rule #10 - Reinvigorate with recovery menu Rule #11 - Relaxation Rule #12 - Rest (passive)

Use light resistance and cycle at 85-90 RPM (revolutions per minute) for 15-20 minutes.

Conclusion

Rule #3 - Recovery work The utilization of recovery techniques must become habitual and be performed daily (Bompa, 1985). Studies suggest that light aerobic exercise following anaerobic training (e.g.-sprint) might facilitate recovery of force or speed/power by increasing lactic acid removal, thus possibly helping restore normal calcium levels within muscle fibers (Signorile et al, 1993).

To help flush out the lactic acid and other waste products that built up in the muscle during training and competitions, try using the â&#x20AC;&#x2DC;spin onlyâ&#x20AC;&#x2122; cycle routine. At higher pedalling www.sirc.ca

28

Training for and competing in sports is both physically and mentally demanding and recovery sessions must be incorporated into sports specific training programs. There is little hard scientific research on overtraining and recovery and what has been done is somewhat unsystematic with overlapping terminology and varied study protocols. Never the less many practical solutions can be implemented.

Proper recovery depends on many factors and individuals who know and understand this can selectively apply techniques on an individual basis to facilitate recovery and improve performance. The upcoming two articles will complete the rules of recovery and will further elaborate on short term recovery strategies. â&#x2C6;&#x2020; Carl is a partner and Director of High Performance Training. He treats and trains athletes to keep them Fit to Play for a variety of sports. Throughout his over 25 years as a physiotherapist and fitness coach he has worked with numerous gold medal winners from a variety of sports most notably alpine skiing. He traveled on the World Cup Ski Circuit from 1984-2003.

SIRCuit Volume 2 (2) Spring / printemps 2012

www.sirc.ca

29

SIRCuit Volume 2 (2) Spring / printemps 2012

Shoulder Injury Prevention and Prehabilitation in Swimmers Brian Johns - Masters Student, UBC

www.sirc.ca

30

SIRCuit Volume 2 (2) Spring / printemps 2012

Proactive & Preventative Medicine Abstract

Shoulder injuries are a source of concern in swimmers, particularly at the elite levels. Studies conducted in this area have taken a long time to reach coaches and swimmers in order to make a difference for current athletes. This article serves to consolidate current research on shoulder injury prevention in swimmers by scrutinizing the ‘swimmer’s shoulder’ myth, outlining common injuries in swimmers, recognizing why these injuries occur, and identifying how coaches can minimize the occurrence of shoulder injuries in their swimmers. By consolidating this knowledge, it will help coaches understand current issues in shoulder injury prevention in their swimmers and help establish a shoulder prehabilitation program in their program.

Résumé

Les blessures aux épaules sont une source de préoccupation chez les nageurs, particulièrement au niveau élite. Les études dans le domaine ont mis du temps à se retrouver dans les mains des entraîneurs et des athlètes, et donc, à profiter aux athlètes d’aujourd’hui. Cet article vient consolider les études actuelles sur la prévention des blessures aux épaules des nageurs par l’analyse détaillée du mythe de « l’épaule du nageur » ainsi que par la description sommaire des blessures les plus courantes chez les nageurs et leurs causes; on se penche aussi sur l’identification des moyens que les entraîneurs peuvent employer pour diminuer la fréquence des blessures aux épaules de leurs nageurs. Par l’approfondissement de ces connaissances, les entraîneurs pourront davantage comprendre la problématique de la prévention des blessures de leurs nageurs et élaborer des séances de préadaptation dans leur programme d’entraînement.

S

wimmers typically swim with pain for long durations before making any comments to the coach. When a swimmer does complain of shoulder pain, some (note: some) coaches will advise their swimmer to seek medical attention. Due to the duration the swimmer has waited to seek medical attention, the pain has spread from one centralized spot in the shoulder to the entire shoulder.

Since the swimmer can no longer identify where the pain is specifically, the general diagnosis of ‘swimmer’s shoulder’ is given while the root cause of the pain is never truly known.

This scenario happens all too frequently in swimming and it is thought to stem from a lack of knowledge from all parties. The connotation is that ‘swimmer’s shoulder’ is unavoidable if you swim for a long period of time. This is not true. By understanding the underlying causes of shoulder pain in swimmers, a prehabilitation program can be integrated to help prevent shoulder injuries in swimmers.

Common Injuries in Swimming The most frequent injury in swimmers is supraspinatus tendinopathy. A tendinopathy is any acute or chronic inflammation of a muscle tendon and is often referred to as tendinitis (acute) or tendinosis (chronic). Subscapularis and biceps tendinopathies, as well as subacromial bursitis, are also common. All of these injuries have similar pathologies and presentations and an effective prehabilitation program will address each one.

If ignored, there is the risk of a more serious injury www.sirc.ca

31

Key Points • Common reasons for shoulder injuries in swimmers include: genetics, stroke technique, muscle sequencing, and fatigue.

• Establishing a prehabilitation plan and ensuring that the training plan will not expose the swimmer to overloading and overtraining, will decrease the chance of injury as well as decrease the time to recover from an injury.

• Elements of a prehabilitation plan include: screening/education, shoulder stabilization, technique based on injury prevention, building strength and endurance, and maintenance of any rehabilitation program.

occurring such as chronic and secondary inflammation in other muscles of the shoulder (the aforementioned ‘swimmer’s shoulder). Any muscle that has a tendinopathy has compromised functioning, which increases the chance of tearing the muscle, as well as the labrum.

Although rare, swimmers can incur acute injuries without associated tendinopathy. Muscle and labrum tears and shoulder dislocation are all far more likely to occur in swimmers that are experiencing tendinopathies or have pathological shoulder instability. Referring pain from a herniated cervical discs, AC joint separation, impinged blood vessels in the upper extremities, tumors, arthritis and infections can all cause shoulder pain and should be a part of any differential diagnosis but will not be the addressed in this article.

Reasons For Shoulder Injuries in Swimmers Genetics When diagnosing shoulder pain, there are several congenital abnormalities, such as a downward sloping or spurred acromion, as well as referred pain from a neck injury and epiphysitis, must be ruled out because adjustments to training will not remedy the pain. While there seems to be some congenital effects on shoulder pain and injuries in swimmers, they appear to have less of an effect than other contributing factors. Fortunately, the other factors are influenced greatly by the training program that is initiated by the coach, putting injury prevention largely in the coach’s hands.

SIRCuit Volume 2 (2) Spring / printemps 2012

Technique Any swimming technique that forcibly causes the shoulder to be internally rotated can result in shoulder impingement that can lead to injury. While the shoulder muscles can be impinged in almost every stroke, freestyle technique has the highest occurrence of impingement.

Hand crossing over midline

The most significant biomechanical indicator of potential injury in swimming technique is the tilt angle of the scapula. Tilt angle is the range of movement done by the shoulder girdles about the frontal axis of the trunk. If the medial portion stays retracted while the lateral portion moves freely during movement, this results in a large tilt angle that is suitable for swimming.

Several techniques can lead to impingement or a small tilt angle, such as unilateral breathing in freestyle, overreaching on the catch phase of any stroke, hands crossing the midline of the body at anytime in the stroke and a pinky-led recovery in any stroke.

Muscle Sequencing Abduction/adduction and shoulder stabilization are primary concerns for the health and performance of the swimmer. In order for the scapula to maintain stability during these movements, muscles work mainly in grouped pairings in order to stabilize the scapula during gross

It is believed that pain within the shoulder can lead to muscle inhibition in any of these muscles, which can result in scapular instability. Muscle inhibition is not just a muscle’s inability to produce force and stabilization, but is also a disorganization of the normal muscle firing patterns in the shoulder, breaking the kinetic chain for efficient shoulder movement.

In swimming, the serratus anterior is shown to be active during the entire freestyle stroke. As a result, it is also one of the most susceptible muscles to complete inhibition.

The inhibition of the serratus anterior will lead to other muscles, typically the smaller rotator cuff muscles, having to provide the stabilization of the shoulder which can lead to rotator cuff muscles becoming inflamed, causing impingement.

Fatigue Fatigue is the factor that has shown to cause injury the most consistently. Incidentally, it is also the factor that coaches control the most. There are two types of fatigue that can affect a swimmer’s susceptibility to shoulder injuries: overloading and overtraining. Overloading is short-term fatigue and occurs when muscles are worked to exhaustion in a single training set or workout. Overtraining is longterm with the swimmer has trained an exorbitant amount over a long period of time, often in a constant state of overloading.

Overloading will lead to muscle inhibition and will frequently result in the recruitment of less efficient muscles to perform in place of the inhibited one. While overloading is important for strength building in an athlete, the key is to ensure that the athlete is not continuing to perform an exercise when the primary muscles are no longer capable of doing so and to allow for adequate rest prior to continuing the activity. As mentioned earlier, serratus anterior, as well as subscapularis, are active throughout the entire swim stroke and are most susceptible to overloading. Swimming with paddles, heavy resistance training, improper stretching and large volumes of butterfly swimming can all result in inhibition of the serratus anterior and subscapularis. Swimming continuously with no rest, as well as swimming with a pull buoy, have also been contraindicated in overloading these muscles.

Overtraining can occur when the volume or intensity of swimming and dryland is increased too rapidly, or improper technique is used for a long period of time. Two

Serratus Anterior Dysfunction

www.sirc.ca

movements.

32

SIRCuit Volume 2 (2) Spring / printemps 2012

Figure 1: Mechanism of shoulder injuries in swimmers

items have a significant correlation with the occurrence of supraspinatus tendinopathies: number of hours swum per week and the number of kilometers swum per week.

Statistically speaking, swimmers who swam for more than 15 hours per week were twice as likely to have a supraspinatus tendinopathy than those who swam less.

As well, those who swam more than 35 kilometers a week were four times as likely to have a supraspinatus tendinpathy than those who swam less.16 With this in mind, a new model for the mechanism of shoulder injuries in swimmers should be proposed (see Fig. 1).

The focus here is the role that fatigue plays in an injured swimmer. Fortunately, it is also the factor that the coach can control the most.

Prehabilitation Plan

Injury prevention should be a part of every coach’s annual training plan and there are activities that should be done during specific times throughout the year. Coaches are typically good at designing training plans that will build the swimmers strength and endurance while tapering them into major competitions and the same needs to be done for shoulder prehabilitation.

Following a prehabilitation is not a guarantee that the swimmers will avoid injury. However, if the coaches establish a prehabilitation plan and ensure that their training plan will not expose their swimmers to overloading and overtraining, then the chance of injury, as well as the time the swimmers need to recover from an injury, is significantly decreased. The following are items that all shoulder prehabilitation programs should include.

Screening/Education At the start of each year, as well as at the start of each training cycle, each swimmer in the program should be screened for potential injuries. The most purposeful test is the Lateral Scapular Slide Test, which tests for dysfunction in the serratus anterior. Other useful tests are the Hawkin’s Test (shoulder impingement), Speeds Test www.sirc.ca

33

(bicep tendinopathy) and Empty Can Test (supraspinatus tendinopathy).

The swimmers should also be educated as to what is appropriate pain and what is not. Pains that can be described as sharp, stabbing, radiating or electrical are cause for immediate concern and discontinuation of practice. Pain that is described as sore, heavy, aching or stiff are typical of an increased workload and do not signify an underlying injury concern.

Swimmers should also have their previous swimming history recorded. The following is a checklist of questions that a coach should ask an incoming swimmer.

Shoulder Stabilization At the start of dryland, the first focus should be on shoulder stabilization. Isometric exercises to maximize stabilization in the serratus anterior, subscapularis and lower trapezius muscles should be the starting point of a shoulder prehabilitation program. This should be done in conjunction with what the swimmer is doing for core stabilization, such as strengthening the transverse abdominis and lower back muscles. A resistance-training program should be introduced AFTER a shoulder injury program has been established. This will ensure that a swimmer’s shoulder is healthy prior to exposure to heavy lifting.

Technical Foundation Technique that is focused on injury prevention is also ideal for elite performance. Not only will swimmers swim faster, but they will also be able to swim for longer periods of time. The coach should focus on techniques that avoid excessive internal rotation and enhance body balance between the left and right side, as well as between the arms and legs. Coaches should be as particular with technique during dryland as they are with technique in the water. If the dryland exercises are not done with the appropriate technique then the strength gained in dryland will not transfer to the pool and may actually be harmful to the swimmer in terms of performance as well as injury prevention.

SIRCuit Volume 2 (2) Spring / printemps 2012

repetitions as they build strength and endurance in their shoulders much like a coach gradually increases the work done in the water. A swimmer should build up to be able to do 3 sets of 10-12 exercises that focus on the serratus anterior, subscapularis, lower trapezius and rhomboids (with some inclusion of abdominal core exercises) 3 times a week to be done after workouts and throughout the entire swim season.

Swimmer’s History Checklist • How many years have you been swimming competitively?

• What is the average number of workouts you do per week (swimming AND dryland)?

• Do you breathe to both sides in freestyle or just one side? Which side?

• Have you undergone significant technique changes recently?

• What is the highest volume of training you’ve ever done?

• What is the average volume of training you typically do?

• How long does it take for you to taper into a peak meet?

• What are your best times and when did you do them?

• What resistance training exercises do you have experience with?

• Have you ever had pain associated with resistance training in the past?

• What sports have you played outside of swimming?

Maintenance Discontinuing shoulder rehabilitation programs is a large part why swimmers who suffer shoulder injuries tend to get re-injured. Once the program has been established and the swimmers have gained strength and endurance in their shoulder stabilization muscles, swimmers must stay vigilant in maintaining their exercise program throughout the year.

If a swimmer does present with shoulder pain, an appropriate response is the immediate discontinuation of swimming and consultation with a sports medicine doctor.

This quickly addresses the problem before it becomes chronic. It will also show the value of the shoulder prehabilitation program and how, by doing the program, they can avoid the pain and not have to miss time in the water.

Build Strength/Endurance Coaches should apply the training principle of progressive overload to shoulder prehabilitation, just as they would to increasing training volume and intensity. A shoulder prehabilitation program should start at least 2 weeks prior to the start of swimming or weight training to ensure the health of the swimmer when full training begins.

The swimmer should be increasing the number of sets and

Avoiding injuries while training towards an elite performance is a difficult balance in swimming. Coaches who can effectively use a shoulder prehabilitation program for their swimmers will not only help prevent injuries, but will also allow the swimmers to miss fewer days in the water, make practice time more effective by increasing muscular efficiency in the swimming stroke and enjoy practice without swimming in pain. By understanding how to prevent shoulder injuries and effectively incorporating shoulder prehabilitation into the swimming program, swimmers will not only be healthier, but will perform better as well. ∆ Brian Johns is a 13 year National Team veteran on the Canadian National Swim Team, including 3 Olympic Games, one World Record and several international medals and national records. He is currently in his last year of swimming and is enrolled as a Master’s Student at UBC in Coaching Science, where he assists with the UBC Thunderbirds varsity teams. As a part of his studies he was able to do an independent study on shoulder injuries in elite swimmers, as he has sought out reasons why he was injured and how he can help future swimmers avoid the same injuries.

Excessive internal rotation

www.sirc.ca

Conclusion

34

SIRCuit Volume 2 (2) Spring / printemps 2012

Calendar

Calendrier

For more events, check out the SIRC Conference Calendar.

Pour d’autres événements, veuillez consulter le calendrier SIRC des congrès.

April / avril 2012 21-22

XXI International Conference on Sports Rehabilitation and Traumatology Stamford Bridge Stadium, Chelsea FC, London, England

21-25

2012 American Medical Society for Sports Medicine (AMSSM) 21st Annual Meeting Atlanta, Georgia

May / mai 2012 2-5 26- 27

29 - 2

15th ESSKA Congress Geneva, Switzerland

Annual Quebec Sports Medicine Conference (AQMS)/ Association québécoise des médecins du sport (AQMS) Congrès annuel 2012 Grenville-sur-la-Rouge in Laurentians, Quebec

ACSM’s 59th Annual Meeting and 3rd World Congress on Exercise is Medicine San Francisco, California

June / juin 2012 25-28

25-28

8th Annual International Conference on Kinesiology and Exercise Sciences Athens, Greece 9th International Sports Science Conference/9e Conférence internationale des Sciences du Sport Conférence Kota Bharu, Kelantan

July / juillet 2012 4-7

11-14 19-24

25-28

www.sirc.ca

17th Annual Congress of European College of Sport Science Bruges, Belgium 35th NSCA National Conference Providence, RI

The 2012 International Convention on Science, Education and Medicine in Sport (ICSEMIS 2012) Glasgow, Scotland World Congress of Performance Analysis of Sport Worcester, Worcestershire, United Kingdom

35

SIRCuit Volume 2 (2) Spring / printemps 2012

Recommended Readings from SIRC When 30,000 articles cross your desk each year, you start to notice trends as well as the research that seems particularly strategic.

We are pleased to highlight some of the key articles in various topics that have attracted our attention.

Psychology

Injury Prevention

The Challenges Encountered by Immigrated Elite Athletes. Schinke R, Yukelson D, Bartolacci G, Battochio R, Johnstone K. Journal Of Sport Psychology In Action. January 2011;2(1):10-20

The Relationship Among Femoral Neck Angle and BMD, and Lower Extremity Injury Incidence in Elite Athletes: Based Upon Gender. Nam-Ku L, Jong-Kyu K, Mi-Sook L, et al. International Journal Of Applied Sports Sciences. December 2011;23(2):383-393.

The Role of Self-Regulatory Skills in Sport and Academic Performances of Elite Youth Athletes. Jonker L, Elferink-Gemser M, Visscher C. Talent Development & Excellence. October 2011;3(2):263-275.

Coaching

Long-term Athlete Development

The Value of Emotional Intelligence for High Performance Coaching. Chan J, Mallett C. International Journal Of Sports Science & Coaching.

September 2011;6(3):315-328.

Riding the Wave of an Expert: A Successful Talent Development Environment in Kayaking.

Henriksen K, Stambulova N, Roessler K. Sport Psychologist. September 2011;25(3):341-362.

The Role of Athlete Narcissism in Moderating the Relationship Between Coaches’ Transformational Leader Behaviors and Athlete Motivation. Arthur C, Woodman T, Chin Wei O, Hardy L, Ntoumanis N. Journal Of Sport & Exercise Psychology.

February 2011;33(1):3-19.

Why do they engage in such hard programs?

The search for excellence in youth basketball.

Gonçalves C, e Silva M, Carvalho H, Gonçalves Â.

Journal Of Sports Science & Medicine. September 2011;10(3):458-464.

Health & Nutrition

General Conditioning

Dietary Supplementation Practices in Canadian High-Performance Athletes. Lun V, Erdman K, Fung T, Reimer R. International Journal Of Sport Nutrition & Exercise Metabolism. February 2012;22(1):31-37.

Balance Ability and Athletic Performance.

Hrysomallis C. Sports Medicine. March 2011;41(3):221-232.

Position Statement Part one: Immune function and exercise. Walsh N, Gleeson M, Simon P, et al.

Exercise Immunology Review. January 2011;17:663 Position Statement Part two: Maintaining immune health. Walsh N, Gleeson M, Kajeniene A, et al.

Exercise Immunology Review. January 2011;17:64103.

www.sirc.ca

Induction and Decay of Short-Term Heat Acclimation in Moderately and Highly Trained Athletes. Garrett A, Rehrer N, Patterson M. Sports Medicine. September 2011;41(9):757-771

36

Effect of hyperoxia during the rest periods of interval training on perceptual recovery and oxygen resaturation time. Peeling P, Anderson R. Journal Of Sports Sciences. January 15, 2011;29(2):147-150.

Effect of Two Different Weight-Loss Rates on Body Composition and Strength and Power-Related Performance in Elite Athletes. Garthe I, Raastad T, Refsnes P, Koivisto A, Sundgot-Borgen J. International Journal Of Sport Nutrition & Exercise Metabolism. April 2011;21(2):97-104

SIRCuit Volume 2 (2) Spring / printemps 2012

The IST Journal Club The goal of the IST Journal Club is to share ‘must reads’ on cutting edge performance based applications, training/competition variables, and proactive medical interventions, selected by performance service experts representing various professional disciplines associated with Integrated Support Teams.

Positive Organizational Psychology in Sport: An Ethnography of Organizational Functioning in a National Sport Organization.

Wagstaff, C., Fletcher, D. & Hanton S. (2012) Journal of Applied Sport Psychology, January 2012;24(1):26-47

Commentary by Dr. Judy Goss This is one of the first analyses that I have seen examining the functioning of an NSO from a psychological perspective. Even though the research was completed in Great Britain, I certainly think that the findings are relevant and applicable to any Canadian NSO or PSO as well as their ISTs. As an IST member, many of us have had experiences with NSOs and ISTs that are what we might term “high functioning” and some that we would term “low functioning”. You might attribute the low functioning to lack of proximity to others or lack of communication because IST members are spread across the country. However, when you really think about it, it also has to do with the relationships that are formed by the members of the IST. If you are feel engaged, respected, connected, appreciated, and not threatened to express ideas or opinions, does distance really matter? Probably not.

The basic findings of the research indicated the importance of interpersonal relationships, understanding that relationships are dynamic and evolve constantly. From the research, they determined that in organizations that are successful, people have a greater ability to manage conflict, communicate emotions, manage and express emotions as well as regulate their emotions. Much of www.sirc.ca

this information has been long asserted by organizational and industrial psychologists.

The research provides a good illustration of the importance of emotional abilities and skills that are essential to the development of international relationships. It brings into focus emotional intelligence which is certainly a component that mental performance consultants work specifically with coaches to develop, enhance and understand. It points to the importance of relationships and emotional intelligence within the members of the IST and NSOs. It is always an advantage to have highly intelligent and experienced people in their respective area however, their ability and desire to work on relationship building with the other members is essential to the overall functioning of the group. As OTP conducts its sport reviews, they consider the functioning of the NSO as an indicator of a sports ability to succeed. However, are they looking at it from a psychological or interpersonal standpoint?

I use to work with someone who just by her nature couldn’t help but build relationships, even with the server at the Starbucks or the delivery person from Federal Express. Her name was Donna. By the time, an athlete left her office, he/she would never forget meeting her, and the foundation for the relationship had been created. I often explain to coaches, administrators, and work colleagues about the importance of taking the time to develop the relationship. I tell them that they have to “do the Donna”, take the time, listen and engage.

Many sports will be judged this summer on their success at the Olympic Games in London. Sports 37

that exceed their benchmarks will be highly praised. These NSOs and ISTs have work tirelessly to plan and preparation the environment for success for the athletes and coaches. I think we need to keep in mind that it is not so much what the IST or NSO does it is also how they do it. ∆

Late specialization: the key to success in centimeters, grams or seconds (cgs) sports

Moesch K, Elbe A, Hauge M, Wikman J. (2011) Scandinavian Journal Of Medicine & Science In Sports. December 2011;21(6):e282-e290

Commentary by Leo Thornley As we approach another summer Olympic Games we inevitably reflect on the athletes that are in their final preparation stages, the level they have reached and the level of their international rivals. Many sports discuss which of their top performers will be around for another quadrennial and where the next ones will come from. It is the examination of what current elite performers have done that can offer us some insight into where the next round may come from.

Moesch and colleagues take a thorough look at 148 Danish elite and 95 “near” elite athletes in sports measured by length, weight or time.

The information gathered includes the number of hours of practice at the early stages of development and the number of sports played.

The key findings are that the elite athletes specialized later than their near elite counterparts and interestingly accumulated less training during childhood. It is not until later adolescence that those who became elite surpassed the nonelite counterparts in training hour accumulation.

SIRCuit Volume 2 (2) Spring / printemps 2012

An interesting point here is that the number of sports played at an early age was not different between elite and nearly elite with both groups participating in approximately “1.5” sports on average. This is in contrast to previous research that suggests a multisport background was beneficial.

Under closer examination however this may be less surprising as the vast majority of sports sampled here are focused on time, in contrast to previous research on this topic that has included other types such as team sports.

Many experts argue that the underlying reason for this lack of evidence is due to the sensitivity of PAP to the loading parameters of the conditioning activity such as its timing, intensity and volume.

In looking at this cross sectional information we can see that when training increases is an important factor in elite athlete development.

We should look to close any gaps we might have in letting talent go within our sports as well as examining ways to perhaps identify, develop and fast track new talent. ∆

Study Design Twelve elite male volleyball players participated in the study. Following a standardized warm up the subjects performed maximal jumps to establish a baseline. A conditioning activity of half squats was then performed and done with volumes and intensities ranging from 10 repetitions at 70% of maximum to 1 repetition at 90% of maximum. Each conditioning activity was administered in a randomized order and done on separate days.

Following the conditioning activity the subjects performed maximal jumps at various intervals over a 15-minute period to see whether or jumping was potentiated.

Volume, intensity, and timing of muscle power potentiation are variable

Chaouachi A, Poulos N, Behm D, et al., Applied Physiology, Nutrition & Metabolism.

October 2011;36(5):736-747

Commentary by Matt Jordan Background Post-activation potentiation (PAP) is the enhancement in muscle force production that occurs following a conditioning activity involving submaximal or maximal muscular contractions. For example, a coach may prescribe a set of heavy back squats done at 90% of an athlete’s maximum followed by explosive jumps with the intent of eliciting greater force production in the jumps than would have been seen otherwise.

While PAP has been well documented in controlled laboratory settings, supporting scientific evidence in realworld situations such as the weight room or field of play is more tenuous. www.sirc.ca

Purpose of the Study The purpose of this study was to assess the effectiveness of conditioning activities performed with a variety of intensities and volumes on functional muscular performance over a 15-minute time period.

Main Findings 1. There was great inter-individual variability in the potentiation of jump power and velocity leading the authors to state the importance of individualizing potentiation protocols.

2. With weak statistical support it appeared that the moderate loads and volumes (5 reps @ 70%; 3 reps @ 85%) were most likely to potentiate jumping power.

3. Despite potentiation of jumping power, the actual jump height was not augmented by any of the PAP protocols. This was attributed to the possibility of a fatigue effect.

Strength, Limitations and Future Considerations 1. They studied an elite athlete 38

population, which is rare and significant.

2. The conclusions confirm how difficult it is to study PAP in a real-world situation with scientific rigor.

3.

The fact that potentiation occurred in certain parameters of the vertical jump such as power and velocity but not the actual jump height may question the relevance of the findings to athlete performance. Nevertheless, this remains an important area of study for the high performance athlete and this study adds to our overall understanding. ∆

Dietary supplementation practices in Canadian high performance athletes.

Lun V., Erdmann KA, et al. International Journal of Sport Nutrition & Exercise Metabolism, 2012 Feb, 22: 31-37

Commentary by Denis Collier Expanding on earlier work by these same authors, this article provides the most recent summary of the dietary supplementation practices and perspectives of high performance athletes from across Canada. It is a must-read for all stake-holders in Canadian sports nutrition.

Registered Dietitians from eight Sport Centres across the country administered a sport supplement questionnaire. Data was obtained from 440 athletes (63% female, 37% male, average age ~20 year old) from 34 different sports.

Many of the results supported previous well-known findings. The vast majority of high performance athletes elect to supplement their diets (in this case 87% of the 440 athletes surveyed). The most popular reason given for taking supplements was to maintain health / prevent nutritional

SIRCuit Volume 2 (2) Spring / printemps 2012

deficiency. The most frequently consumed supplements (in order) were: 1) sports drinks 2) multivitamin/ minerals 3) carbohydrate sport bar and 4) protein powder. Findings such as these should come as no surprise.

However, this dietitian would like to draw attention to one particular question that produced answers which should be of grave concern to anyone interested in Canadian athletes achieving top performances: These athletes were asked “What is your primary source of supplement advice?”

The number one reported answer to this question was family and friends (as sited by 75 of the 440 athletes).

Strength trainer, teammates and coach took spots two, three and four. Of course, who could neglect that mecca of all reputable information – the internet; this came in at number five.

You may be wondering where did registered dietitian come in on this list? The one profession specializing entirely in evidence-based nutrition, with four years of university training on the subject, plus another year of a practical internship, held to the highest standard of practice by regulatory provincial bodies, came in at spot number 16. Below naturopaths and the health food store, both of which made the top 10.

With a true scientific spirit, these authors offered the conclusion: “Consistent with the findings of previous studies it appears that athletes are in need of enhanced education about their use of nutritional ergogenic aids”.

Put less scientifically, this dietitian would like to suggest this conclusion is a gross understatement. ∆

Recent Advances in the Rehabilitation of Anterior Cruciate Ligament Injuries

K. E. Wilk, L. C. Macrina, E.L. Cain, J. R. Dugas and J. R. Andrews Journal of Orthopaedic and Sports Physical Therapy 42(3), March 2012

Commentary by Bruce Craven With almost 200,000 Anterior Cruciate Ligament (ACL) injuries occurring annually in the United States and nearly half of them requiring reconstructive surgery, years of research have been conducted on this common orthopaedic surgery. Following the surgical procedure, the need for a scientifically based rehabilitation program and a well-designed return to sport plan are essential. This article provides the reader with a review of the recent advancements and treatment goals for a successful rehabilitation following ACL surgery.

The success of the accelerated rehabilitation program was reported

by Shelbourne and Nitz in 1990, indicating that the patients exhibited better strength and range of motion (ROM) with fewer complications and secondary knee complaints following surgery when compared to the conservative rehabilitation approach. To have success with the accelerated rehabilitation program there are 9 goals that should be attained: 1. Start Rehabilitation before Surgery Post-operative Goals 2. Regain full passive knee extension 3. Restore Patellar Mobility 4. Reduce Post-operative Inflammation 5. Range of Motion 6. Voluntary Quadriceps Control 7. Restore Neuromuscular Control 8. Gradually Increase Applied Loads 9. Progress to Sport-Specific Training

to discuss the specific rehabilitation issues surrounding the female athlete, non-isolated ACL injuries with concomitant procedures and/or cartilage lesions. Further discussion is provided around the different surgical procedures to repair the ACL based on these secondary conditions. The authors state that following surgery the rehabilitation program needs to be altered based on the type of graft used, any concomitant procedures performed and the presence of any articular cartilage lesion. Current rehabilitation programs must not only focus on strength but more importantly the development of range of motion, proprioception and neuromuscular control drills to develop the dynamic stability necessary for successful return to sport and competition.

This article has a very good reference list and series of tables and figures outlining the current trends in the rehabilitation of anterior cruciate ligament injuries. ∆

British Journal Sports Medicine

of

January 2012, Volume 46, Issue 1

Commentary by Willem Meeuwisse Its a good time for a bit of extra reading.

Rather than identifying an article, this time I would like to highlight an entire issue of interest. The British Journal ofSports Medicine recently published an entire issue on “What really limits performance”. Dr. Timothy Noakes acted as a guest editor, and wrote a great piece on the Central Governor Model and the regulation of human exercise performance. There are eight papers that provide great reading and are thought provoking. Recommended reading! ∆

This article by Wilke et al, goes further www.sirc.ca

39

SIRCuit Volume 2 (2) Spring / printemps 2012

For more information

www.sirc.ca Pour plus dâ&#x20AC;&#x2122;information

www.sirc.ca

40

SIRCuit Volume 2 (2) Spring / printemps 2012