Hpsircuit special edition 2014 by Sport Information Resource Centre (SIRC)

HIGH PERFORMANCE

SIRCuit

“Merging COACHING with SPORT SCIENCE & MEDICINE” Special Edition 2014

SOCHI RECAP

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Editor

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Contributing Editor

Special Thanks:

Dr. Jon Kolb, OTP

Cara Thibault, OTP

Content

Photos Courtesy of:

Debra Gassewitz, SIRC

Nancy Rebel, SIRC Michelle Caron, SIRC Joshua Karanja, SIRC

Design

David Roberts, SIRC Josyane Morin, SIRC

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

Marcel Nadeau

Athletics Canada Canadian Olympic Committee Canadian Paralympic Committee Own The Podium SIRC Speed Skating Canada

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Mailing address: SIRC 180 rue Elgin Street, suite 1400 Ottawa, Ontario, Canada, K2P 2K3 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. Copyright © 2014 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.

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WHAT’S INSIDE

SPECIAL EDITION

Welcome to this special Olympic Recap edition of the High Performance SIRCuit. SIRC and OTP are pleased to highlight a couple of topics and their respective published literature that emerged immediately following Sochi 2014

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Under Armour and the Mach 39 Speed Skating Suits

Polarized Training: How do elite endurance athletes actually train?

Injury Risk in Olympic Winter Sports

Must Reads … Read, Learn, Excel • Ask SIRC • New Books @ SIRC • Recommended Readings

Polarized Training: How do elite endurance athletes actually train?

Sparked by the success of the Dutch long track speed skating team at the Sochi Games, recent research has looked into the distribution of training intensity in high performance athlete training plans.

Under Armour and the Mach 39 Speed Skating Suits

A look into the science and marketing management behind the United States speed skating team’s Mach 39 racing suits.

Injury Risk in Olympic Winter Sports

Does high risk sport equate to high risk for injuries? How will new events introduced at the Sochi Games impact injury rates at future Games?

Must Reads … Read, Learn, Excel • Ask SIRC • New Books @ SIRC • Recommended Readings

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POLARIZED TRAINING How do elite endurance athletes actually train? Josh Karanja Photos Courtesy of: Speed Skating Canada

raining intensity and how to distribute it within the training plan is a highly debated topic in the endurance community. The success of the Dutch Olympic speed skating team at the Sochi Winter Games and a recent study on how they train and distribute training intensities has shed a light on how elite endurance athletes actually train.

What constitutes intensity? Training intensity can be divided into 3 zones or 5 zones and all have to do with ventilatory threshold 1 (VT1) and ventilatory threshold 2 (VT2). VT1 is the intensity at which ventilation starts to increase in a non-linear fashion and VT2 is the point at which high intensity exercise can no longer be sustained due to an accumulation of lactate.

There are two types of training models commonly used by endurance athletes, the Threshold Model and the Polarized Model. The threshold model dictates that 57% of training is at low intensity; 43% at medium intensity; and 0% at high intensity. The polarized model dictates that 80% of training is at low intensity; 0% at medium intensity; and 20% at high intensity. Both low intensity (aerobic) and high intensity training (anaerobic) are important in the development of endurance performance.

Using blood lactate measurements, intensity can be divided into three zones: zone 1 (lactate â&#x2030;¤2 mMol/L), zone 2 (lactate 2-4 mMol/L) and zone 3 (lactate â&#x2030;Ľ4 mMol/L). Zone 1 is low intensity (high volume), zone two is moderate intensity (lactate threshold) and zone three is high intensity training. In the 3 zone model (see Table 1) it is generally accepted that training in zone 1 is below VT1 and training in zone 3 is above VT2.

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Intensity can also be measured in a 5 zone scale (see Table 2) as used in endurance sports in Norway. FranĂ§ais

Table 1: 3 Zone Model

For the purpose of this article we will be using the 3 zone model. How coaches train their elite athletes using polarized training The polarized training method subscribes to more low intensity training with some high intensity training. The training intensity distribution recommends that about 80% of the training should be done in zone 1, about 15% to 20% in zone 3 and very little training in zone 2, <10%. It is polarized as it emphasizes less of zone 2 and more of zone 1 and zone 3. www.sirc.ca

Table 2: Essential in the 5 zone model , zone 1 and 2 in the 5 equate to zone 1 in a 3 model zone. Zone 3 in the model equates to zone 2 in the 3 model zone and zone 4 and 5 in the zone 3 in the 3 zone model.

Polarized training emphasizes that endurance athletes should spend most of their training hours in the low intensity, high volume training. The idea is by staying away from moderate intensity on those low intensity days you are able to train harder on the high intensity days. Moderate training is viewed as too slow to be specific to training objectives and too high of an intensity to allow for recovery. In a recent study done on the Dutch Olympic speed skating program from the last 38 years showed that the team has shifted to a more polarized training approach. They looked at Olympic medalists training programs from 1972, 1988, 1992, 2006 and 2010 and concluded that during this time period there was no increase in total net training hours, no systematic trends of on-ice training hours and a decrease of inline skating training hours done during the summer training months5. The program had also won 8 gold, 5 silver and 4 bronze Olympic medals.

Looking at the training intensity during the six Olympic years the team spent most of their time training at low intensity, zone 1. The only exception was in 1972 where low intensity and moderate training had about similar training durations. Though trends have shown a decrease in the moderate training zone it is still slightly more than high intensity training. More research has also looked at elite rowers, cross country skiers, cycling

and endurance runners and has shown that elite athletes train very little at the moderate, lactate threshold, intensity9. Polarized training suggests that elite endurance athletes should be doing 75%-80% of their training hours in low intensity zone and about 15%-20% at the high intensity zone. By training more in zone one, endurance athletes can minimize over training, injuries and increase performance. â&#x2C6;&#x2020;

Managing the distribution of training intensity: The Polarized Model Stephen Seiler PhD Faculty of Health and Sport Science University of Agder, Kristiansand, Norway And Norwegian Olympic Federation Dr Seiler addresses three questions on the subject of managing training distribution: 1. How do elite endurance athletes actually train? 2. Is this pattern based on history or physiology? 3. HIT â&#x20AC;&#x201C; How are intensity and accumulated duration integrated as a stimulus signal? www.sirc.ca

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Polarized Training References 1. Laursen P. Training for intense exercise performance: highintensity or high-volume training?. Scandinavian Journal Of Medicine & Science In Sports. October 2, 2010;20:1-10.

6. Seiler K, Kjerland G. Quantifying training intensity distribution in elite endurance athletes: is there evidence for an “optimal” distribution?. Scandinavian Journal Of Medicine & Science In Sports. February 2006;16(1):49-56.

2. Muñoz I, Seiler S, Bautista J, España J, Larumbe E, EsteveLanao J. Does Polarized Training Improve Performance in Recreational Runners?. International Journal Of Sports Physiology & Performance. March 2014;9(2):265-272.

7. Seiler, S. MANAGING THE DISTRIBUTION OF TRAINING INTENSITY: THE POLARIZED MODEL (Video) 8. Seiler S. What is Best Practice for Training Intensity and Duration Distribution in Endurance Athletes? International Journal Of Sports Physiology & Performance. September 2010;5(3):276-291.

3. Neal CM. Training-intensity distribution, physiology adaptation and immune function in endurance athlete [Dissertation]. Stirling, Scotland: University of Stirling, October 2011.

9. Seiler S, Tønnessen E. Intervals, Thresholds, and Long Slow Distance: the Role of Intensity and Duration in Endurance Training. Sportscience. December 2009;13:1-27.

4. Neal CM, Hunter AM, Brennan L, O’Sullivan A, Hamilton DL, De Vito G, Galloway SDR. Six weeks of a polarized training intensity distribution leads to greater physiological and performance adaptations than a threshold model in trained cyclists. Journal of Applied Physiology. May 12, 2013;114:461–471. 5. Orie J, Hofman N, de Koning J, Foster C. Thirty-Eight Years of Training Distribution in Olympic Speed Skaters. International Journal Of Sports Physiology & Performance [serial online]. January 2014;9(1):93-99.

10. Tan, F. Polarized Training: Striking a Balance Between HighVolume and High-Intensity Training. [PowerPoint Presentation]. Singapore Sports Institute.

Calendar

For more events, check out the SIRC Conference Calendar

June June 12-15 June 18-20 June 18-21

6th IWG World Conference on Women and Sport, Finlandia Hall, Helsinki 2014 National Coaching Conference,, Washington, DC 33rd FIMS World Congress of Sports Medicine and Canadian Academy of Sport and Exercise Medicine International Conference 2014, Quebec City, Quebec

July July 2-5

European College of Sport Science Annual Congress, Amsterdam, Netherlands

July 12-16

32nd International Society of Biomechanics in Sport, East Tennessee State University,

July 14-17

2014 Conference of the International Sports Engineering Association, Sheffield, Yorkshire

Johnson City

August August 14-15

10th Annual International Conference on Kinesiology and Exercise Sciences, Athens, Greece ICOSM 2014: International Conference on Orthopaedics and Sports Medicine,

August 22-24

The 2014 Medicine of Cycling Conference, Colorado Springs, CO

August 4-7

Venice, Italy

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Committed to Making Canada a World Leader in High-Performance Sport

Faisons du Canada un meneur mondial dans le sport de haute performance

To ﬁnd out more about Canadian athletes’ quest to own the podium, please visit us at

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Pour en savoir plus sur les efforts des athlètes canadiens à gravir le podium, veuillez vous rendre à

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UNDER ARMOUR and the Mach 39

Speed Skating Suits Michelle Caron

ne of the most interesting stories to come out of Sochi this year was the controversy surrounding the American Speed Skating team’s Mach 39 speed skating suit created jointly by Under Armour (UA) and Lockheed Martin. Touted as the sport’s “game changer”, the suits garnered quite a bit of media attention in the 6 weeks leading up to the Sochi 2014 Olympic WinterGames. The US speed skating team was heavily favoured to win a few medals, including gold. Very quickly into the Games, with no podium finishes for the US Olympic team, and a few athletes claiming that they felt that the suits were slowing them down, the positive attention UA received before the Games quickly started an avalanche of media backlash. Once again, social media played a large role in the public’s perceptions of the Under Armour brand and the company had to work fast to stem the tide of criticism aimed their direction.

Under Armour organized their plan of attack in three different ways. First, some of the suits were sent to an Under Armour seamstress to have the back panel modified, this would eliminate the possibility that the vents were ballooning the suit and creating a drag. Secondly, they had Olympic skier, Lindsay Vonn publicly praise the quality of their products via Twitter – without specifically mentioning the suits. Thirdly, they sent out proactive statements that promised that Under Armour was

actively working on determining if the suits were, in fact, to blame. CEO Kevin Plank and Matt Mirchin, executive VP-global marketing were the official speakers for the brand, and both were adamant about the rigorous testing procedures for the Mach 39. They held multiple TV and print interviews, always pointing out groups of athletes who found success in world events while wearing Under Armour gear. After six days of racing without a podium finish, the team swapped back to their old Under Armour uniforms, yet still failed to produce

Crisis Management

When a brand decides to sponsor a team or an individual athlete, they are essentially looking to share in the athletes’ stories – their training and eventual success. For sponsors that support Olympic teams, it can be a great way for the sponsors to show how innovative their company is. With almost $1 million dollars invested in the project, expectations were high.

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Interview with Joshua Robinson reporting on the US Speed Skating team’s performance in Sochi. Includes a discussion on whether Under Armour’s high-tech suits were to blame for the team’s lack of medals or if the team failed to effectively prepare for the event.

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results. Ultimately, the US Speed Skating team’s performance was disappointing – with the team leaving the Olympics without a medal for the first time since 1984. Despite the criticisms of the team and the brand, Under Amour recently announced that the company has extended its sponsorship of the US Speed Skating team for the next eight years.

Sport Technology

The suits were the product of two years of research and officially labeled the Mach39 US Speed Skating Skin, which was then introduced to the public. The suits were engineered for superior aerodynamic performance on the ice through a close working relationship between Lockheed Martin, a top aerospace and development technology company and Under Armour, an innovative athletic clothing designer. A team of engineers used 3D motion-capture filming (high-speed cameras) to help create computational fluid dynamic models in order to analyze how the air flows around a skater during a race. This was paired with over 300 hours of wind-tunnel testing on reinforced fiberglass mannequins in various racing postures, with hundreds of different skin setups and textile configurations to establish how to build the new suit. Kevin Haley, vice president for innovation at UA, said wind tunnel tests proved it was faster to disrupt the air with small bumps and dips in the design, just like the surface of a golf ball. The final suit was made up five different textiles that focused on key areas of the body in order to achieve the best results. The new technologies introduced in the suit were: • Flow molding – This is a process that is used to disrupt the airflow around the athletes body and make them faster. • Soflex Zipper – This zipper was designed more for comfort than for aerodynamic purposes. Many athletes find the zippers on their suit dig into their throats, so this zipper was designed to cross diagonally along the chest to avoid discomfort. • AmourVent – Under Amour designed this specially for the suit to provide extra breathability and comfort as well as prevent sweet from building up and weighing the athlete down. • AmourGlide – The material used around the thighs was built-in to help reduce friction by 65%.

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Kevin Haley, Under Armour’s senior vice president for innovation and polymer scientist and engineer Sarah Morgan, of the University of Southern Mississippi, explain how speed skating competition suits help improve athlete performance by reducing friction and improving aerodynamics. Discusses in detail the process involved in developing the US Speed Skating Team’s Mach 39 suits.

With this exciting new technology and the hype surrounding them, the US Speed Skating technical staff and the athletes felt that the best strategy was to keep the suits a secret. The suits were used in training and with a unanimous decision, were never used in competition before the Olympics.

References:

Conclusion

Capizzo, L. (2014, February 19). AdAge: Under Armour Turns to Endorser Lindsey Vonn to Defend Brand. Carbon Media Group. Retrieved April 17, 2014.

Many times technology is thought of as a ‘silver bullet’ that guarantees success, when the truth is that a multitude of factors play into a desirable outcome. Many have speculated on exactly what went wrong in Sochi, a lack of leadership, poor training strategies, or did the athletes just lose confidence in their abilities? Getting to the podium takes gifted athletes as well as the combined efforts of many specialists; engineers, scientists, coaches, and sponsors. Seeing the final results of the Olympic Speed Skating competitions, you can see that the US team wasn’t the only one that got dominated by the Dutch. With Under Armour ready to support the team for the next two Winter Olympic Games, UA CEO Michael Plank says “we accept getting dust on ourselves, we’ll come back taller, stronger, bigger and better.” ∆

Anderson, M. (2014, February 21). Under Armour extends speedskating suit deal. Yahoo! News. Retrieved April 17, 2014.

Bernstein, J., & Bernstein, E. (2014, February 27). Under Armour’s Olympic Crisis Management: Was Under Armour’s crisis management podium-worthy?. Blog: Free Management Library Blogs. Retrieved April 17, 2014

Chappell, B. (2014, February 14). Maybe It’s The Suit: U.S. Speedskaters Swap Gear In Sochi. NPR. Retrieved April 17, 2014. Gloster, R. (2014, February 28). Under Armour Goes to Damage Control Instead of Gold in Sochi. Bloomberg. Retrieved April 17, 2014. McCarthy, M. (2014, March 10). Under Armour’s Olympic Experience Is Textbook Case For How to Handle Crisis: Here’s How Apparel and Shoe Company Skated Past Controversy. Advertising Age. Retrieved April 17, 2014. McDermott, J. (2014, February 18). Winter Games put Under Armour brand in a bind. Digiday. Retrieved April 17, 2014. Newcombe, T. (2014, January 16). U.S. Speedskating finds edge with high-tech engineered skins. Sports Illustrated. Retrieved April 17, 2014. Peters, J. (2014, February 14). Is the Under Armour Speedskating Suit the Worst Product Placement in Sports History?. Slate. Retrieved April 17, 2014. Robinson, J., & Germano, S. (2014, February 13). Sochi Olympics: Under Armour Suits May Be a Factor in U.S. Speedskating’s Struggles. The Wall Stree Journal. Retrieved April 17, 2014.

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Injury Risk in Olympic Winter Sports Nancy Rebel

ith the addition of 12 new events to the 2014 Winter Olympic schedule, all eyes were on the slopes, rinks and courses in Sochi to see how they would fit into the Olympic competition. The addition of events such as slopestyle skiing and snowboarding, halfpipe skiing and women’s ski jump have been making a splash in the media leading up to the Games and grabbing spectator interest. The International Olympic Committee (IOC) added the new events to provide an “increase in universality, gender equity, and youth appeal.” Including these new sports events appeals to a broader, more youthful audience. And many of these new events come from the X Games competitions that are tailored to a younger, more adventuresome audience. Along with these events come more speed, higher-flying jumps and acrobatics. All can agree that the addition of the new events injected a heightened sense of excitement and anticipation to see the best in the world compete in new ways. Along with the excitement of new sports also comes the element of risk. High performance athletes with their sights on Olympic competition, by their very nature, train and compete with an almost single-minded intensity and drive. When hundredths or even thousandths of seconds or fractions of points meaning the difference between podium and placing, every athlete pushes their limits to be at their best. Many of the sports included on the schedule of the Winter Olympics are defined by their high-risk

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nature. Those sports identified as having a higher risk of injury include bobsleigh, ice hockey, short track speed skating, alpine, freestyle and snowboard cross. While sports with the lower identified risk include Nordic skiing, luge, curling, long track speed skating and freestyle moguls.

that leads to accidents, it is when the danger is combined with a lack of precaution that the risks may turn into accidents3. There will always be individuals who will push the limits of their sport whether it is a high-risk sport or otherwise.

The difference that lies with these high-risk Risk is often at the heart of progress and sports that define them as “dangerous” is that development; it is fundamental to human while accidents are common in many sports, nature. For high performance athletes risk- the very nature of the high-risk sports means taking is often a required characteristic. that when accidents do happen they are “Those who will win will take risks and make likely to be more severe and even potentially no mistakes,” men’s parallel giant slalom fatal. Of the 38 athletes who competed in the snowboarder Andrey Sobolev of Russia said. boardercross event at Sochi’s Rosa Khutor “You obviously always have to take some Extreme Park on February 18th, 13 were risks, because without it you’ll never make disqualified or didn’t finish due to crashes or it.”5. However, research shows that there is falls5. However, the early research shows that a difference in the behaviour surrounding engaging in the precautionary behaviours this risk-taking. And while this research is mentioned earlier reduces the likelihood of still in it’s early stages, evidence suggests these injuries including those severe traumas that in these high risk sports, one of the main and fatalities3. attractions for the athletes is the management and control of the risk rather than the risk itself3. While many athletes in high-risk sports exhibit this risktaking characteristic, these behaviours are also often accompanied by intentional precautionary behaviours. It is when risk-taking behaviour is accompanied by less conscientious behaviours that there is a higher likelihood of injury4. As the research suggests, it is not necessarily the Source: ABC Grandstand Sport: Sochi 2014 - See the extreme toll the danger of the sport itself Winter Olympics takes on athletes’ bodies

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Source: ABC Grandstand Sport: Sochi 2014 - See the extreme toll the Winter Olympics takes on athletes’ bodies

So what are the IOC and International Federations doing to mitigate the risk of injury in high-risk sport? As demonstrated through the research done for this paper, individual sports such as the International Ski Federation and others have instituted Injury Surveillance Systems to record and monitor injury trends over time, and also allows for the evaluation of the implementation of rule or equipment changes6. The data gathered in these studies forms the basis of long-term injury prevention research. The IOC is cooperating with the International Federations, enabling them to engage in studies to make participation in the Games safer.

Through this study on the Vancouver Games, information was also gathered in relation to the location of injury. Of greatest concern was the trend identifying that for both genders, the face, head and cervical spine represented the most common location of injury at approximately 20% of the injuries, followed closely by the next most common injury, the knee. In Vancouver, 20 concussions were reported, affecting 7% of the registered athletes1. The researchers also were careful to note that while the response rate to the injury monitoring was quite good, there were likely to be a notable number of unreported injuries since some athletes are reluctant to report them due to competitive factors.

The IOC Medical Commission has been conducting injury surveillance for the Beijing 2008 and London 2012 Olympics and the Vancouver 2010 Winter Olympics. In terms of winter sport, at least 11% of athletes at the Vancouver Games incurred an injury during the Games (training or competition)1. Within the higher risk sports mentioned earlier (bobsleigh, ice hockey, short track, alpine, freestyle and snowboard cross) injuries in each sport ranged between 15-30% of all registered participants2. For those sports identified as lower risk, the rate of injury to participants was less than 5%. Interestingly enough the distribution of injury rates between training and competition was relatively evenly distributed, with 54% of injuries occurring training and 46% occurring during competition1. The statistics also showed that of these injuries, 22.6% of the injuries were of a severe enough nature to cause the athlete to miss training or competition.

Injury surveillance was again conducted at the Sochi 2014 Winter Games and it will be interesting to see if the trends identified in Vancouver remain consistent. It will also be important to see if these new high-risk events added to the program will parallel the trends as well. Accumulating the data from the Olympic Games as well as through the International Sport Federation championships will enable measures to be developed to help identify high risk areas and injury prevention opportunities. The increasing popularity of high-risk sport calls for serious and intentional implementation of safety measures and accident prevention strategies. International Federations for these sports have recognized this need and are continuously identifying course design and safety equipment measures (e.g. Arena board pads in short track and air bags on the sides of the halfpipes) that can be put into place to mitigate accident risks.

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Research in the future should continue to be focused around injury monitoring and evaluation of safety measures. Added to these studies should also be psychological inquiries into risk-taking behaviours and personality characteristics that relate to these behaviours. Combining these domains may provide sports with a clearer picture of injury risk, mechanism and prevention. ∆

References 1. Engebretsen, L. Sports injuries and illnesses during the Winter Olympic Games 2010. British Journal Of Sports Medicine. September 2010;44(11):772-780. 2. Hildebrandt, A. Injuries rack up during Sochi Games. CBC Sports. 2014. Retrieved from the Internet April 30, 2014. 3. Kupciw, D. and MacGregor, A. High-risk Sport Research. The Sport and Exercise Scientist. Spring 2012;(31):28-29. 4. Pinchbeck, J. Sensation Seeking in Sochi 2014. 2014. Retrieved from the Internet April 30, 2014. 5. Spillane, C. Olympic Athletes Risk Limbs in Crashes at Sochi Extreme Park. Bloomberg. 2014. Retrieved from the Internet April 30, 2014. 6. Steffen K , Engebretsen L. The importance of sports medicine at the Sochi Games. British Journal Of Sports Medicine. January 2014;48(1):1. 7. Steffen K, Soligard T, Engebretsen L. Health protection of the Olympic athlete. British Journal Of Sports Medicine. June 2012;46(7):466-470. 8. See the extreme toll the Winter Olympics takes on athletes’ bodies. Retrieved from the Internet April 30, 2014.

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MUST READ... Read, Excel, Learn

New Books @ SIRC SIRC, in collaboration with Human Kinetics, features four books of interest to high performance sport.

Developing speed Jeffreys, I. (2013). Human Kinetics.

Stretching Anatomy 2nd Edition Nelson, A.G. and Kokkonen, J. (2014). Human Kinetics.

Ask SIRC I’ve been hearing a lot about ACL injuries in soccer, specifically for girls, could you give me some information on this topic? Anterior Cruciate Ligament (ACL) injuries are one of the most common injuries in sport; for girls who play soccer the chance that they will sustain an ACL injury is 19%. An ACL tear usually occurs when an athlete changes directions rapidly, pivots, decelerates quickly or lands from a jump. When an athlete injures their ACL, they may hear a ‘popping’ sound and their knee may give out under them. Symptoms include*: • loss of full range of motion, • tenderness along the joint line, • discomfort while walking, • swelling and pain Common ACL injury prevention methods involve a combination of plyometrics, stretching, and hip-strengthening exercises. An appropriate treatment for an ACL injury depends on a number of factors, the severity of the injury, the age of the athlete or the presence of a previous condition, such as osteoarthritis. If you wish to learn more about ACL injuries there are plenty of resources available. Most recently, the Canadian Academy of Sport and Exercise Medicine (CASEM) released a position statement titled Neuromuscular Training Programs Can Decrease Anterior Cruciate Ligament Injuries in Youth Soccer Players. *See your healthcare practitioner if you think you have an ACL injury. Do not play sports or other activities until you have seen a doctor and been treated.

References from the SIRC Collection: Motor learning and performance

Sport first aid

Flegel, M.J. (2013). Schmidt, R.A., Lee, T.D. Human Kinetics. (2013). Human Kinetics.

1. Hartwick M, Meeuwisse W, Vandertuin J, Maitland M. Knee pain in the ACL-deficient osteoarthritic knee and its relationship to quality of life. Physiotherapy Research International. June 2003;8(2):83. 2. Laible C, Sherman O. Risk Factors and Prevention Strategies of Non-Contact Anterior Cruciate Ligament Injuries. Bulletin Of The Hospital For Joint Diseases. January 2014;72(1):70-75. 3. Marshall S. Recommendations for Defining and Classifying Anterior Cruciate Ligament Injuries in Epidemiologic Studies. Journal Of Athletic Training. September 2010;45(5):516-518. 4. Pantuosco L. ACL Injury Prevention. Soccer Journal. July 2007;52(4):18-22. 5. Paszkewicz J, Webb T, Waters B, McCarty C, Van Lunen B. The Effectiveness of InjuryPrevention Programs in Reducing the Incidence of Anterior Cruciate Ligament Sprains in Adolescent Athletes. Journal Of Sport Rehabilitation. November 2012;21(4):371-377. 6. Thome P, Währborg P, Börjesson M, Thome R, Eriksson B, Karlsson J. Self-efficacy, symptoms and physical activity in patients with an anterior cruciate ligament injury: a prospective study. Scandinavian Journal Of Medicine & Science In Sports. June 2007;17(3):238-245.

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