integrative_neuromuscular_training_in_youth.2

Integrative
Neuromuscular Training
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in Youth Athletes. Part II:

Strategies to Prevent
Injuries and Improve
Performance
Azahara Fort-Vanmeerhaeghe, PhD,1,2,3 Daniel Romero-Rodriguez, PhD,1 Rhodri S. Lloyd, PhD, CSCS*D,4
Adam Kushner, BS, CSCS,5 and Gregory D. Myer, PhD, CSCS*D5,6,7,8
1
School of Health and Sport Sciences (EUSES), Universitat de Girona, Salt, Spain; 2Blanquerna Faculty of
Psychology, Education Sciences and Sport (FPCEE), Universitat Ramon Llull, Barcelona, Spain; 3Segle XXI Female
Basketball Team, Catalan Federation of Basketball, Esplugues de Llobregat, Spain; 4Youth Physical Development Unit,
Cardiff Metropolitan University, Cardiff, Wales; 5Division of Sports Medicine, Cincinnati Children’s Hospital Medical
Center, Cincinnati, Ohio; 6Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio;
7
Sports Health and Performance Institute, Sports Medicine, Ohio State University Medical Center, Ohio State
University, Columbus, Ohio; and 8Micheli Center for Sports Injury Prevention, Waltham, Massachusetts
Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided
in the HTML and PDF versions of this article on the journal’s Web site (http://journals.lww.com/nsca-scj).
ABSTRACT AGILITY, AND FATIGUE RESISTANCE. with sports-related injuries can be

THE DEVELOPMENT OF THESE 6 modified through effective integrative
THE SECOND PART OF THIS
CAPACITIES ARE INTEGRAL IN neuromuscular training (INT) pro-
REVIEW PROVIDES A FLEXIBLE
ESTABLISHING AN IMPORTANT grams to directly reduce the incidence
APPROACH TO INTEGRATIVE NEU- of injury in young athletes (81,84,87).
FOUNDATION BY INITIALLY DEVEL-
ROMUSCULAR TRAINING (INT)
OPING FUNDAMENTAL MOVEMENT For the purpose of this article, the
WITH THE GOALS TO IMPROVE
INJURY RESILIENCE AND TO
SKILL COMPETENCY BEFORE terms youth and young athletes refer
BUILDING UPON THESE SKILLS TO to both children (Tanner stages 1 and
ENHANCE SPORT AND MOTOR
ENRICH SPORTS-SPECIFIC AND 2 of sexual maturation; 10–12 years)
PERFORMANCE ABILITIES IN
ACTIVITY-SPECIFIC SKILL SETS. and adolescents (Tanner stages 3 and
YOUTH POPULATIONS. THE PRO-
FOR A VIDEO ABSTRACT OF THIS 4 of sexual maturation; 13–18 years)
POSED MODEL OF INT IN THIS
ARTICLE, SEE SUPPLEMENTAL (83). Youth fitness and motor abilities
MANUSCRIPT PRESENTS 6 ESSEN-
DIGITAL CONTENT 1 (SEE VIDEO, vary directly with maturational status.
TIAL COMPONENTS: DYNAMIC Some authors suggest that there exists
http://links.lww.com/SCJ/A190).
STABILITY (LOWER LIMB AND a critical “window of opportunity” dur-
CORE), STRENGTH, PLYOMETRICS, ing the developmental years, whereby
COORDINATION, SPEED AND
INTRODUCTION
s presented in part I, current
Address correspondence to Azahara Fort
Vanmeerhaeghe, afortvan@gmail.com. A research indicates that neuro-
muscular risk factors associated
KEY WORDS:
pediatrics; sports injuries; youth sports
Copyright Ó National Strength and Conditioning Association 9 Strength and Conditioning Journal | www.nsca-scj.com
Copyright ª National Strength and Conditioning Association. Unauthorized reproduction of this article is prohibited.
Strategies to Improve Neuromuscular Control in Youth
youth are more sensitive to training- current trend of young athletes placing beneficial structural adaptations of
induced adaptation (3,63). The central greater emphasis on success in specific muscle and tendon structures, reducing
nervous system experiences a massive organized competition rather than the risk of overuse injuries (91).
increase in myelination in the first 2–5 developing optimal movement strate- The majority of studies in youth exam-
years of life, and this process is not gies and skills related to long-term ining neuromuscular training strategies
concluded until sexual maturation or injury resilience. Although INT em- to improve performance and injury
even adulthood (11,56,107). Given this phasizes injury prevention training, prevention include multiple compo-
information, training that promotes physical adaptations from training also nents (e.g., balance, strength, plyomet-
neural adaptations may be beneficial, account for heightened sport perfor- rics, agility, speed, coordination)
especially before puberty and contin- mance skills and abilities (27,38,82). (30,84). Thus, it is difficult to assess
ued through the important adoles- Performance improvement will gener- the contribution of each component.
cent years. ally be the primary motivation of Based on the scientific evidence and
INT is defined as a conceptual training young athletes to train over injury pre- the experience of the authors, this
program that incorporates general (e.g., vention goals (60). review classified INT programs in
fundamental movements) and specific INT programs promote prevention of youth in 6 essential components:
strength and conditioning tasks (e.g., acute injuries that result from complex dynamic stabilization, coordination,
resistance, balance, agility, plyometric) sport actions (55). Previous evidence strength, plyometrics, speed/agility,
with the goal to improve injury resil- indicates that reduction in acute inju- and fatigue resistance (e.g., cardiorespi-
ience and to enhance sporting and ries should entail the following steps ratory and repeated bout endurance)
motor skill performance (79,80). This (a) identifying athletes’ specific neuro- (Figure 1). These 6 components are
training intervention model also in- muscular deficiencies and (b) incorpo- integrated across the long-term athlete
tends to develop athletes’ perceptual rating targeted exercises to promote development model, which is an accu-
and cognitive abilities during sporting physiological adaptations to improve mulation of various seasons, practices,
situations to achieve a more integrative neuromuscular control and coordina- and training sessions. Moreover, evolv-
perspective of sport performance and tion skills associated with the identified ing communication with sport coaches
injury prevention. Practitioners are deficiencies (48,50). For instance, INT can optimize development by reducing
encouraged to adopt an INT approach interventions that generate heightened unnecessary repletion that leads to
as an effective strategy to counter the coordination abilities may also result in training inefficiencies and overtraining.
Figure 1. Integrative neuromuscular training (INT) components. Components of INT (dynamic stabilization, coordination, strength,
plyometrics, speed/agility, and fatigue resistance) with the aim to achieve fundamental movement skills competence
first and sport specific skills later in a safe and fun environment.
10 VOLUME 38 | NUMBER 4 | AUGUST 2016

INT should first lay an essential foun- childhood and then refined during activity to improve power and tech-
dation by developing fundamental SSS development in adolescence (76). nique to reduce injury incidence in
movement skills (FMS). FMS are ele- The present commentary is directed youth (88). If fundamental landing
mentary units of movement and are to practitioners working with young competency is not first acquired for
commonly categorized as locomotor athletes to provide a flexible guide to lower level exercises (e.g., squat jump,
(e.g., running, jumping, hopping), implement INT concepts and hopping), athletes should not be in-
manipulation or object control (e.g., guidelines to reduce the risk of sports- structed to perform a more advanced
catching and throwing), and stability related injury and to promote perfor- exercise such as the drop vertical jump.
skills (e.g., balancing and twisting) mance improvements. The intention As a consequence of performing
(42). These skills lay a necessary foun- of this review is to present a methodol- higher-level tasks too early, the task
dation for more complex activities ogy of INT programs to be adapted by may elicit incorrect movement strate-
including sport-specific movements professional instructors and practi- gies (e.g., dynamic valgus during land-
(e.g., tennis serve, golf swing, basket- tioners for training athletes of all ages, ing), leading to a potentially harmful
ball dribbling). Physical activity in sporting backgrounds, levels of ability, absorption of impact force with
youth contributes to increased energy and previous training experience to a related higher risk for injury (4,86).
expenditure, but more importantly, reduce injury risk and enhance perfor- INT sessions are characterized by
creates a repository of FMS also mance in their athletes. short bursts of physical activity inter-
known as fundamental movement spersed with brief rest periods (80).
competence (FMC) (89). Children INTEGRATIVE NEUROMUSCULAR Although the World Health Organiza-
who are not exposed to activities with TRAINING RECOMMENDATIONS tion (WHO) recommends that youth
opportunities to enhance FMC tend FOR YOUTH
should engage in 60 minutes or more of
to be less active during adolescence, Neuromuscular training programs physical activity daily (112), it has been
which may manifest into sedentary should be individually designed to suggested that high-intensity INT
lifestyle habits during adulthood consider a number of factors including should only be performed 2–3 times
(48,50,55). FMC enables youth to level of maturation, training age, tech- per week and on nonconsecutive days
achieve specialized movement se- nical competency, individual neuro- to allow for sufficient recovery time
quences required for participation in muscular deficits, practiced sport between training sessions (35,78).
many organized and nonorganized activities, sex, genetics, and motivation. INT session duration can vary between
physical activities (6). Thus, one can Instruction and supervision by quali- 30 and 90 minutes, depending on indi-
infer that there is an interdependent fied practitioners are essential for safe, vidual characteristics and previous
relationship between FMC and phys- effective, and enjoyable INT participa- training experience. Nevertheless, for
ical activity. FMC also facilitates phys- tion by youth. It is critical that instruc- physical education, there is evidence
ical ability and reduces the risk of tion and feedback are developmentally that less time is effective as well (e.g.,
activity-related injury (101). As chil- appropriate, enthusiastic, and consis- 15 minutes) (33). Although published
dren and adolescents grow, they tent with an individual’s needs, goals, INT interventions have demonstrated
require a greater range of FMS to per- and abilities (79). It is also valuable to favorable outcomes in terms of injury
form more complex and demanding ensure an individual’s mastery of prevention (84,88), it is still essential to
physical activities such as competitive movement technique in fundamentals program training periodization that
sports participation. It is essential to before progressing to more intense considers the specific needs, limita-
foster this relationship to maintain exercise variations and derivatives. In tions, and goals of an athlete.
physical fitness and reduce risk for other words, an athlete should not be
injury. INT should enable children to progressed in exercise intensity based COMPONENTS OF INT FOR YOUTH
be confident and competent with on time in a program nor the perfor- The current review will focus on the 6
FMS before progressing to more chal- mance of their peers, but solely on their components (Figure 1) of INT to
lenging and sport-specific skills (SSS) own technical ability. Thus, training develop neuromuscular control with
(Figure 1). After an individual demon- progressions are limited by the ability principal goals of improving sport per-
strates correct and robust perfor- of an individual to first demonstrate formance and reducing sports-related
mance of FMS, practitioners can sound, consistent technique of precur- injuries. The 6 components of INT
build upon these skills by appropri- sor exercises. For example, fundamen- include: dynamic stabilization (focus-
ately progressing to more complex, tal movement skills are necessary ing on lower limb and core), coordi-
yet safe, neuromuscular training tasks before performing high impact actions nation, strength, plyometrics, speed/
(66). The age to develop FMS and SSS such as the drop vertical jump (a plyo- agility, and fatigue-resistance (e.g.,
depends on ability to demonstrate metric that involves a drop from a box, cardiorespiratory and repeated bout
precursor exercises of each child; immediately followed by a maximal endurance). We present a flexible
the authors recommend that ideally vertical jump). This exercise has been practical application guide of these
FMS are first optimally developed in suggested as an excellent plyometric components, with an initial focus on
11 Strength and Conditioning Journal | www.nsca-scj.com
achieving fundamental movement injuries to the lower extremities and Lower limb dynamic stabilization.
skill competence as the basis of INT, lower back (1,104). In INT, it is valu- Current literature describes 3 catego-
then progressing to learn sports- able to incorporate a variety of funda- ries of progression when training to
specific skills in a safe and fun environmental skills to optimize versatility improve dynamic joint stability: static
ment. INT should emphasize correct and movement strategy decisions for balance, dynamic balance, and
training methodology for FMS and a given sports-specific situation with dynamic stabilization (44). Static bal-
SSS exercise progressions indepen- various parameters (e.g., position of ance is defined as the ability to main-
dently and also consider training that the ball, opponents, and teammates). tain center of mass over a static base of
incorporates both general and specific Table 1 indicates the principal method- support and stationary supporting sur-
skills that function simultaneously. For ological parameters to focus on in each face (18). This ability is highly influ-
example, racquet sports movements, of these 6 essential components. enced by the correct function of
such as a backhand swing, require cor- sensory information obtained from
rect kinematics and kinetics of the DYNAMIC STABILITY the somatosensory (especially proprio-
lower extremities (24,100) and core Muscle pattern recruitment plays a crit- ception), visual, and vestibular systems
stability (77) for optimal performance ical role in joint stability, which de- (49). It is noteworthy that propriocep-
and injury resilience. In this case, opti- pends on the coordination of tive sensibility has been suggested to be
mal performance of this skill is espe- sensorimotor strategies to stabilize the most modifiable by neuromuscular
cially dependent on the ability of one the center of body mass and the joints training (49,94). Secondly, dynamic
to execute an explosive upper body around the body while performing balance is defined as the capacity to
displacement while orienting the body dynamic tasks (93,94). For this compo- maintain center of mass over a fixed
in timely, correct positions to generate nent, we focus on (a) lower limb and base of support under a challenge; spe-
an optimal task outcome and to avoid (b) core dynamic stability training. cifically, motion of other limbs and
Table 1
Principal methodological parameters to develop the different components of INT programs
Content of INT programs Methodological parameters for the creation of tasks
Dynamic stability Balance training on stationary supporting surface and static base of support
Lower limb dynamic Balance training on stationary supporting surface under perturbations of different characteristics
stabilization
Core dynamic stability Balance training that includes dynamic actions (SSS)
Balance training on the knees (stimulus focused on trunk and hip muscle stabilizers by no bearing
the weight directly on feet)
Coordination Develop basic and specific skills (FMS and SSS)
Variety of movements and multitasking
Unanticipated reactions with sound technique
Strength Develop appropriate strength capacity to perform FMS and SSS
Functional overload
Plyometric training Development of stretch shortening cycle ability, focusing on elastic energy, and reflexive muscle
activity mechanisms
Ensure proper movement mechanics (e.g., avoid knee valgus or emphasize soft landing)
Speed/agility Development of skills at maximum speed
Integration of COD actions
Training closely related coordination
Resistance to fatigue Development of skills under fatigue conditions
Stimulus provoking cardiovascular, metabolic and neuromuscular fatigue resistance
COD 5 changes of direction; FMS 5 fundamental movement skills; SSS 5 sport specific skills.

body segments, or unanticipated dis- and hamstrings and less dynamic val- stage and neuromuscular performance
turbance to supporting surface (26). gus (62). These 2 neuromuscular adap- ability (44). Despite this, there is a scar-
This perturbation stimulus can be con- tations are considered to decrease risk city of scientific literature on optimal
trolled or unpredictable, and multidirec- factors associated with anterior cruci- balance training progressions intended
tional forces can be applied to integrate ate ligament injury (46). Corrective to improve performance and prevent
training regimens to improve dynamic training can help the player to achieve injuries in youth (29,43,71,81,113), the
balance (103). Finally, dynamic stabili- the right automatisms and conse- present review will present an
zation, the most challenging category, is quently allow the player to better tran- evidence-based guide for balance train-
defined as the ability to maintain equi- sition from coactivation to inhibition ing progression. Dynamic stabilization
librium during dynamic actions (the strategies to achieve maximal explosive in youth should begin with static bal-
body is under some kind of displace- actions (61). Practicing correct ance exercises emphasizing the correct
ment), bringing the requirement of bal- mechanics and activation may result posture and lower limb alignment.
ance to the kind of joint stability in improved movement strategies After an athlete demonstrates correct
involved in sport-specific skills (79). In becoming more automatic to translate performance of static balance, instruc-
fact, many sports-related injuries occur to sport scenarios. In addition, training tors can progress to more complex bal-
when an athlete loses balance during can improve stabilization during ance tasks such as dynamic balance
dynamic actions such as jumping dynamic tasks such as jumping and and dynamic stabilization exercises.
(72,95,111). Several published investiga- landing. Recent studies suggest feed- Training modes in novice athletes
tions have shown a decrease of injuries forward control of the ankle and knee should focus on static balance (e.g.,
and injury-risk factors (28,71) and an stabilizers during the preparatory single-leg balance exercises on stable
improvement in sport performance phase before touchdown on landing surfaces). At this stage, we can also
(41) through balance training interven- or stopping to be the most significant introduce easy dynamic balance exer-
tions. Thus, developing a strong foun- factor in improving dynamic stabiliza- cises (e.g., double-leg stance on
dation of proprioceptive sensibility tion (12,54). With the aim to improve a BOSU) and dynamic stabilization ex-
during the developing years is essential feed-forward control mechanisms in ercises (e.g., soft landings in a stable
to promote long-term athletic success sporting situations, training programs surface). Once competency is achieved,
and health. should introduce a high variety of pro- intermediate athletes will continue
It is critical to emphasize instruction gressive tasks that also integrate unan- dynamic balance skills (e.g., single-leg
and feedback on the correct flexion of ticipated actions and conditions. balance unstable surface with or with-
the trunk-hip-knee-ankle complex Table 2 shows some practical sugges- out perturbations) and more challeng-
during proposed exercises that target tions to implement these principles ing dynamic stabilization exercises
training lower limb dynamic stability. when training lower limb dynamic sta- (e.g., single-leg hops on a BOSU). As
Closed kinetic chain exercises of the bilization in youth. the athlete maturates and improves,
lower extremities have been related to Balance training comprises numerous neuromuscular performance and bal-
greater coactivation of the quadriceps progressions that depend on maturation ance dynamic exercises can be pro-
gressed to more challenging actions
that include unanticipated actions and
conditions (e.g., single-leg hops on
Table 2
Examples of practical applications progressions to train dynamic stability
a BOSU) while catching a ball and with
a partner perturbations. Figure 2 pro-
Static balance / dynamic balance / dynamic stabilization vides an example progression of exer-
Low / high amplitude movement cises to improve dynamic stabilization
of the lower limb in young athletes.
Open / closed eyes
Because many sports activities entail
Without shoes / physical training shoes / specific sports shoes forces to be applied to the body in
Variability of perturbation types: instable surfaces, manipulative or object control, off-balance situations, unstable resis-
opposition, vibration. tance training (e.g., squat on a BOSU)
has been demonstrated to facilitate
Without / with external load greater neuromuscular adaptations
Slow / fast short-stretching cycles (e.g., more trunk muscles activation,
more cocontractions, and more limb
Without / with cognitive load/decision making muscle activation) compared with sta-
Expected / unexpected actions ble resistance training (7). In addition,
instability training is beneficial because
Without / with fatigue
it allows high muscle activation with
Figure 2. Progression from static balance to dynamic stabilization with orientation to basketball abilities (keeping position and
landing under perturbation stimulus).
less stress on joints. On the other hand, described 3 subsystems that can work often in association with hyperactivity
unstable resistance training can lead to together to maintain core integrity: (a) of superficial muscles (e.g., rectus
decrease in the force output and in- the central nervous subsystem (con- abdominis and latissimus dorsi) (70).
creases in antagonistic activity that trol), (b) the skeletal subsystem (pas- Specific core exercises are useful in
may be detrimental to absolute sive), and (c) the muscular subsystem rehabilitation and injury prevention
strength gains when resistance training. (active). that aim to integrate deep and superfi-
The positive effects of instability train- Although scientific literature provides cial muscle activities during functional
ing on sports performance have yet to support for the benefits of core train- tasks (53). For example, exercises that
be quantified. To the best of our knowl- ing on performance and injury target motor pattern relearning of in-
edge, when implementing a resistance prevention (31,70), the evidence is hibited deep muscles can be beneficial
training intervention for young ath- scarce and sometimes contradictory for individuals with deficits from prior
letes, both stable and unstable exercises for both adult and youth populations. injury or lack of primal level core
should be included to enhance both Nonetheless, available literature presents strength (92). Athletes that pass screen-
high force (stable conditions) and stres- valuable core training programs and ing examinations can focus on func-
sors to the neuromuscular system recommendations for athletic popula- tional core exercises to ensure regular
(unstable conditions) (8). tions (2,9,52,77,109). Before initiating participation in daily living tasks and
a core focused training regimen, it is sports physical activity (52,109).
Core dynamic stability. Core dynamic important to use appropriate screen- From our experience and review of cur-
stabilization (core stability) is essential ing tools to identify any underlying rent literature, core dynamic stabiliza-
to maintain spinal integrity and lower injuries or deficits to the core structure tion programs in novice athletes
extremity control during sports activi- that inhibit function (e.g., low back should consider starting with basic pos-
ties (2,77,109). Although this term is pain disorder) (2,70). If an underlying tural stability and consciousness activa-
broadly present in specialized litera- injury is suspected, an individual tion exercises (e.g., quadruped or
ture, there is no single universally should seek professional medical “big-dog” exercise or diaphragmatic
accepted definition for core stability. examination before performing core breathing) on static surfaces (see
Kibler et al. (57) defined this term as exercises and some exercises may Figure 3A–C). These exercises comprise
the ability to control the position of the worsen an adverse condition. For “low threshold” postural movements
trunk over the pelvis, allowing for opti- example, back injuries link with spe- that primarily demand endurance and
mum production, transfer, and control cific changes in muscle recruitment motor control (52,70). Another objec-
of force and motion to the terminal strategies used by the central nervous tive of these exercises is to activate deep
segment in integrated kinetic chain system to control the spine. This type muscles of the trunk and hip girdle (2)
activities that involve the spine, hips, of injury usually involves impaired while maintaining a neutral spine
pelvis, proximal lower limb, and activity of deep muscles (e.g., transver- posture (70). Intermediate youth ath-
abdominal structures. Panjabi (90) sus abdominis and lumbar multifidus) letes should progress through stability,

Figure 3. Examples of core dynamic stability exercise progression in youth starting with basic consciousness activation exercises (A:
Transversus abdominis isolation activation, B: Bird dog, C: Hip abductors activation) and progress through stability and
muscle endurance (D, E: Frontal and lateral planks on stable and unstable surfaces, F: Romanian chair on fitball),
reactivity (G–I) and functional exercises (J–L: Strength and power exercises emphasizing rotations, accelerations, and
decelerations).
muscle endurance, and reactivity exer- load and range of movement and per- activities in youth (39). Therefore, it
cises (see Figure 3D–G). There are formed with a neutral and braced is necessary to program a variety of
numerous methods to progress stability spine (70). The proposed progres- core stability exercises ensuring both
and strength with core exercises. Some sion is important to ensure correct static (i.e., isometric) and dynamic
of the more common exercises pro- motor patterns during specific sport exposure. In addition, when training
posed in the literature to develop core actions in youth athletes, where for proper core activation, it may be
strength and stability are variations of spine acceleration and deceleration advantageous to stimulate the core
the plank (front, side, and reverse) and movements occur in multiple axes muscles when the athlete is in a quad-
bridge exercises. These higher load ex- and planes. In addition, stable and ruped position, on their knees, or lying
ercises should be executed predomi- unstable training have their place in supine position to eliminate balance
nantly with the spine in a neutral core training program progressions, assistance provided from the lower
position, which represents posture dur- and they should not be isolated (8). extremities (e.g., ankle joints). For
ing speed and change of direction Unstable core exercises (e.g., plank example, core stability exercises that
movements characterized by youth exercises using a BOSU or a stability have the athlete sit on their knees on
sports (44,70). These exercises can be ball) have been used on the premise unstable surfaces (e.g., Figure 4) can be
further challenged in the athlete by add- that greater instability will stress implemented to effectively train for
ing unstable surfaces. As performance the neuromuscular system and also deep tissue activation and core
advances, functional exercises should increase activation of core muscles balance.
progress with incorporation of strength
to a greater extent than similar activ- When training core stability with
and power components (see Figure 3J
ities performed on stable surfaces. young athletes, it is also important to
and 3K). Depending on the athlete’s
Core exercises that incorporate an consider sex differences. Current
abilities, these more challenging exer-
unstable surface (e.g., BOSU) can research shows that female athletes
cises can emphasize rotations, accel-
also inhibit force, power and range on average have greater lateral trunk
erations, and deceleration movements
of motion, which are necessary in displacement and altered trunk and
(43). On the other hand, these move-
youth athletics (9). hip flexion, greater ranges of trunk
ments have been attributed to spinal
injuries and are also characterized by Moreover, it is important to note that motion, and increased hip adduction
most sports. Because of these reasons, both types I and II muscle fibers must and internal rotation during sporting
twisting movements in youth athletes be stimulated to ensure spinal in- maneuvers compared with males
should be performed under limited tegrity during sports and daily life (74,77). This discrepancy should be
(49,79,81). Related to this methodol-

ogy, other works analyzing more
complex actions as coupled skills
(e.g., jumping—change direction, dis-
placement—jumping) have also given

more information about the difficulty
of developing these kinds of tasks in
a correct way (15,21). FMS must be

developed first and then systemati-
cally combined to improve complex
coordination tasks (e.g., sport spe-
Figure 4. Female basketball player working core dynamic stabilization while passing 2
cific skills).
balls on a fitball (A) or fighting on a BOSU (B). Decrease base of support to
achieve more specific stimulation of core muscles by eliminating the Considering this content, variety and
balance action of ankle joints and their periarticular muscles. progression principles are the basis of
effective exercise program design
(14). Coordination exercise types
can be integrated. For example, use
considered when programming and development training at an early
of multiple stimuli (visual, auditory,
applying training exercises for female age is warranted (67,117). In this
kinesthetic), combination of different
athletes. Additionally, core weakness sense, prepubescence is an optimal
movements, temporal and spatial var-
and instability in females is considered period to imprint correct coordina-
iations, simultaneous use of multiple
as one of the multiple antecedents of tion abilities, whereas later stages of equipment types, cognitive loads,
sex-related discrepancy in anterior development (i.e., adulthood) present reaction drills, and asymmetrical
cruciate ligament (ACL) injuries, re- more challenging timeframes in movements are suitable methods for
flected by the 4-fold to 6-fold higher which to optimize skill development manipulating the training of coordi-
incidence of injury in female com- (63). Similarly, it is recommended nation skills. In addition, coordina-
pared with male athletes (77,109). that children participate in a variety tion work must also integrate
This altered neuromuscular control of sports activities (e.g., hockey, a variety of drills, including reaction
during sports activities can manifest handball, rugby, gymnastics) to max- drills, to encourage reflexive coordi-
in high joint loads in both lower limb imize neural adaptations for a multi- nation skills with desired technique.
and spinal structures. tude of skill sets before sport These exercise progressions should
specialization. The early work of this not compromise correct technique
variety of motor patterns will give the execution and should only progress
COORDINATION
young athlete the capacity to perform with demonstration of correct and
Coordination capacity has been
appropriate and safe responses to consistent performance.
defined in a variety of ways and en-
compasses various complex skills and sport situations.
Further, it is important to strongly
abilities. The capacity to perform With regard to the development of consider the warm-up phase of
complex motor skills (67), to control coordination abilities in youth, the a training session as a valuable time
and regulate motor actions (73), and literature provides a wide variety of to train coordination skills. The
to arrange body and limb motions rel- coordination classifications. In par- warm-up can be an excellent phase
ative to the patterns of environmental ticular, Meinel and Schnabel’s (73) of the training session to train coor-
objects and events (68) are some of the classification of coordination offers dination because the central nervous
ways humans can demonstrate coor- a comprehensive list of suitable system is not fatigued and is thus
dination capacity. Coordination in abilities: space–time orientation, primed to create or refine motor pat-
relation to environment is of particular reaction, rhythm, kinesthesia differ- terns (Figure 6).
interest for activities where the entiation, balance, adaptation or
demand for skills necessitates high transformation motion, and coupled STRENGTH
levels of perceptual and cognitive or combinatory motion (Figure 5). Scientific literature has provided evi-
qualities for performed actions (67). The aim of INT training is not to dence that resistance training has
Scientific literature emphasizes the isolate any coordination ability, but many benefits and little risk of injury
need for athletes to develop optimal rather to implement a comprehensive for youth when a program is appropri-
coordination of movements to per- training guide to develop coordina- ately instructed by qualified professio-
form a motor action (117). Because tion required for fundamental move- nals (34,37). Aside from reducing the
of the greater neural plasticity earlier ment competency and sport-specific risk of sport-related and physical
in life, initiation of coordination skills based on previous literature activity-related injury, well-designed

Figure 5. Coordination abilities definitions (Meinel and Schnabel, 1987).
resistance programs can improve mus- composition, insulin sensitivity, sports has been primarily associated with
cle strength, power production, muscle performance, self-confidence, and self- a lack of supervision that allows for
endurance, motor and coordination image in children and adolescents (35). poor exercise technique and usage of
abilities, bone mineral density, body Injury risk related to resistance training inappropriate training loads (35). For
Figure 6. The warm-up phase of an INT session can be an excellent moment to train coordination capacities. This figure shows
examples of different coordinative tasks for a youth population.
these reasons, supervision from a qual- should increase gradually and system- another important step in the direction
ified professional is essential for youth- atically to reduce possible risk of in- of the main goal of INT programs (i.e.,
based resistance training programs. juries while training. It has been the achievement of the correct neuro-
Additionally, without guidance from suggested that resistance can be muscular control to prevent injuries
a qualified instructor, athletes will not added with 5–10% increments in and improve performance). Figure 7
be provided with necessary corrective weight when predetermined repeti- shows this concept progressing from
feedback to improve technique. With- tions can be performed consistently general to specific exercises adapted
out intervention, these athletes will and correctly (32,116). Furthermore, to the sport action.
continue to produce poor and subop- training programs must factor in con- Although increasing intensity and vol-
timal technique and it will be more siderations of the needs, goals, and ume is an essential facet to strength
difficult to modify poor technique abilities of each participant (35). training, it is equally important to
and habits later in life. Table 3 shows a guide for progression ensure adequate recovery in a training
The development of muscular strength on strength training for youth based program. It is suggested that the great-
has been suggested as a priority at all on scientific literature (10,37,43,116). est adaptations occur when muscles
growing phases for both males and fe- The other major parameter related have fully recovered (106). Therefore,
males (32). Previous research has to the progression of the applied loads excessive fatigue to the musculoskeletal
shown close associations between mus- is the acceleration and speed of exe- system may greatly hinder an athlete’s
cular strength capacity and running cution. Initially, resistance training ability to progress in a strength pro-
speed, muscular power, change of should focus on technique with exer- gram and overtraining can be a serious
direction speed, plyometric ability, cises using light-to-medium loads per- health risk. Therefore, it is recommen-
and endurance (63). In addition, muscle formed at slow to medium speeds. ded to balance high-intensity and/or
strength has been revealed as a contrib- Considering the increased neural plas- high-volume workouts with less
uting factor for successful fundamental ticity associated with childhood, only intense training (LIT) (36). LIT con-
movement competency. The method- after a young athlete achieves strong sists of exercises that substantially
ology of strength training should first technical competency with initial decrease in resistance such as body
ensure correct execution of exercises low-intensity exercises, it is important weight exercises. Faigenbaum et al.
(e.g., controlled movements, proper to appropriately progress movement (2006) suggest that LIT can not only
breathing) and safety education about speeds and loads (63). promote recovery periods, but also
training equipment (34,69). Some exer- Muscle power is also trainable during enhance the recovery process through
cises will be carried out with external childhood. For youth, one of the best reinforcement of joint stability, range of
loads and special attention needs to be ways to develop power is through motion, and specific movement pat-
focused on postural control (core and plyometric training (stretch shortening terns. LIT sessions can be part of a valu-
lower limb positions and stability) and cycles), which is further discussed in able multifaceted approach to
lifting technique to promote safety at all the next section. Faigenbaum et al. optimizing performance and reducing
times. All sessions should begin with (34) recommended a progression overtraining risk (36).
a dynamic neuromuscular warm-up during resistance training for power
PLYOMETRICS (STRETCH
(i.e., coordination development and considering intensity (30–60% of max- SHORTENING CYCLE)
dynamic stretching exercises) and con- imum repetition and moderate to fast
Plyometric training has been shown to
clude with an appropriate cool-down velocity), volume (1–3 or more sets of
improve muscle power, enhance sport
period (e.g., dynamic low-speed 1–6 repetitions), frequency (2–3 ses-
performance, and reduce injury risk in
stretching exercises). The main part of sions per week), and type of exercises
young athletes (47,65,81). This meth-
the training session will introduce (multijoint exercises).
odology of training is based on the
strength training that considers applica- The variability principle of training development of stretch shortening
tion of progression, variability, and (related to the variation of the applied cycle (SSC) ability, which consists of
specificity based on training pediatric load and the exercises carried out) can a fast action of muscle stretching
exercise science principles (14). As pre- easily be applied when strength exer- (eccentric action) followed by a fast
viously mentioned, the high neural plas- cises are not directly related to sport shortening phase (concentric action)
ticity of young people calls for a great skills. On the other hand, it is more (106). As a consequence of this fast
variety of movement skills in the train- difficult to design strength exercises movement, SSC depends on elastic
ing program (e.g., upper-body and that attempt to mimic specific sport energy and reflexive muscle activity
lower-body, unilateral and bilateral exe- actions (e.g., a forehand in tennis, mechanisms (110); both of which are
cution, pushing, and pulling strength a change direction in soccer). There believed to be trainable in youth
exercises) (83). is inherent difficulty in reproducing (37,65). Despite plyometric actions
Related to the progression principle, specific sports-related skills against being the training mode most repre-
resistance load and velocity of execution resistance, but this factor will be sentative of free play (e.g., jumping in

Table 3
Strength training progression guidelines in youth population
Prepuberty or novice Puberty or intermediate Postpuberty or advanced

Type of exercises Special focus and priority on Functional strength training exercises. More complex and sport-
fundamental movement Perfection of resistance training specific exercises
exercises (squat, lunge, technique
push-up)
Range of movement Generally, full movement range on the major exercises, however, to reduce the risk of injury, moderate
movement range on some complex exercises
Muscle groups Exercises should include all major muscle groups. Focus on maintaining strength muscle balance:
trained symmetry between limbs and agonist–antagonist equilibrium. Special attention should be paid to
common strength weaknesses (e.g., lower back, rotator cuff or hip abductors muscles)
Intensity 10–15RM, moderate 8–12RM, moderate velocity (starting to 6–10RM, moderate to the
velocity (emphasis on put emphasis on a quick concentric higher velocity that weight
controlled movement) phase versus a slower or more allows
controlled eccentric phase; 1:2 s)
Volume 1–2 sets 2–3 sets 2–5 sets
Rest intervals Although it is known that rest intervals should be between 1 and 3 min between sets, these parameters
must adapt to each participant, session, repetition, level of fatigue, and aim of training.
Frequency (days 3 2–3 (on nonconsecutive 2–3 (on nonconsecutive days) 2–4 (preferable on
week) days) nonconsecutive days)
Type of adaptations Neuromuscular Neuromuscular and structural (starting Neuromuscular and structural
muscle hypertrophy) (continue development of
muscle hypertrophy and
muscle power)
Special Technique and postural Continue to improve technique in more Specific to participant
recommendations control is the priority. challenging and advanced exercises characteristics and demands
Make training enjoyable of specific physical activities
demands
multiple directions, skipping), some times (.0.25 seconds) of the muscles joints and muscles, and preparation
high-intensity plyometric exercises, involved. On the other hand, fast SSC, before doing higher intensity plyomet-
such as depth jumps, have been such as a triple jump action, consists of rics is essential when programing.
described as activities that involve smaller angular displacements and Moreover, it is also important to differ-
maximal effort and also high joint quicker eccentric-concentric coupling entiate between low-intensity and
loads. Consequently, implementation (,0.25 seconds) (97,110). In the field high-intensity exercises with regard
of high-intensity plyometric exercise of sports performance, slow SCC exer- to plyometrics (23,106). High-
should be prescribed and supervised cises are not considered adequate to intensity exercises are usually related
by qualified instructors that ensure maximize reflex potentiation force to both high-impact loads and fast
proper movement mechanics are because of the critical window of force SSC (e.g., drop vertical jumps, bound-
developing correctly. application threshold of 250 ms (110). ing, multiple box jumps). Nevertheless,
Another consideration of plyometric Komi et al. (1997) suggests that an it is also worthwhile to emphasize fast
exercise is the differences between effective SSC requires 3 critical ele- SSC with lower impact exercises such
slow and fast plyometric exercises ments: a well-timed preactivation of as skipping or jumping rope (Figure 8).
(97) when programing and instructing muscles before the eccentric phase, Because of all of these considerations
plyometric training. Slow SSC exer- a short and fast eccentric phase, and for plyometric training, exercise pro-
cises, such as a countermovement ver- an immediate transition between gression should also be optimally pro-
tical jump, are characterized by large stretching and shortening actions gramed with high consideration for
angular displacements of the lower (58,110). These requisite elements can muscle-tendon stiffness (85). Higher
limb joints with longer contraction lead to a more compromised action for stiffness increases muscle preactivation
Figure 7. Lateral lunge (A) can improve strength of lower limb muscles, but to progress in the applied strength work it will be
necessary to develop more specific actions (in the second picture [B] by inertial resistance). The drills on court (C) can
also be developed with the intention to improve strength in the change direction actions. To achieve it, we can
accentuate the speed of the player to develop a higher muscle effort in the breaking and acceleration phases and
increase the frequency of performed actions as well.
and consequently allows the muscle to load (e.g., bounding unilaterally, depth capacity to allow rapid whole-body
tolerate and absorb high impact loads jumps) (Figure 8). A key to heightened movements while changing direction
in a more efficient way during the performance in sports situations is the in response to a stimulus (99). This
ground contact phase (110). Conse- ability to quickly change direction. definition links agility to the ability to
quently, progression should be devel- Direction change is not only depen- change direction and physical qualities
oped in sport players starting with dent on vertical forces; this ability is such as strength and power. In addition
lower intensity and slower velocity predominantly performed in multiple to these abilities, rapid deceleration has
drills and progressing to higher inten- planes and axes. In fact, it is also nec- been also defined as an essential skill
sity and faster velocity exercises (65). essary to develop plyometric capacity that is closely linked to agility and mul-
Lloyd et al. (2011) described a 6-stage to improve this ability. Emphasis tidirectional movement training
model progression of plyometric train- should be placed on elastic and reflex (51,59). Agility, especially in situational
ing in youth (65). Basic progression actions for optimal change of direction, sport (e.g., opponents, teammates, a ball
recommendations focus on training consequently adapting the SSC within and a shared field of playing), also in-
intensity (from low-intensity to high- movements inherent to the sporting cludes the development of cognitive
intensity exercises), volume (one to situations (108,114). components such as visual-scanning
multiple sets of 6–10 repetitions), fre- techniques and anticipation (115). In
quency (2 sessions per week on non- SPEED AND AGILITY addition, the ability to properly change
consecutive days), velocity, and Speed and agility training are vital direction is related to other cognitive
recovery (60–180 seconds). Another components of neuromuscular training and perceptual capacities, such as
consideration for progression relates in youth and can be considered a man- decision-making processes (98,108).
to the kinematics of the action, starting ifestation of coordination capacity at With regard to INT programs, when
with fundamental movements (e.g., high speeds of performance (13). The training change of direction ability at
body weight squat, lunges) progressing definition of speed is related to the rate high speeds, special attention should
to low-intensity plyometric exercises of change of position with respect to focus on lower limb biomechanics. In
(e.g., jumps in place), medium- time and results from the product of particular, altered control of knee joint
intensity tasks (e.g., multiple bilateral stride length and frequency (5). Speed, biomechanics in the frontal plane dur-
hopping and jumping, box jumps) in context of situational sport, can be ing cutting maneuvers is considered
and high-intensity exercises that are linked to agility, which is a more mul- a major risk factor for knee injuries
more complex and entail high impact tifactorial concept defined as the such as ACL ruptures (46). The load

Figure 8. Example of plyometric exercises progression in youth.
of the ligament in change of direction landing and stepping (16%), stopping/ agility, which incorporates open and
(COD) is increased when associated decelerating (10%), and crossover unplanned changes of directions.
with fatigue and/or decision-making cutting maneuvers (5%) (22). This These authors proposed that both
processes (15). This effect is even information emphasizes the need to children and adolescents should be
greater in female adolescents who typ- develop agility training in INT pro- exposed to all 3 training components;
ically demonstrate greater dynamic grams with a large variety of COD, however, the distribution of time for
valgus than males during unanticipated as sidestepping, crossover cutting and each training component should vary
cutting actions (40). It has been shown deceleration lead to change of direc- according to stage of development/
that the most effective activation pat- tion actions. Agility training should technical competency. For example,
tern to stabilize the knee is achieved start with closed and preplanned with prepubescent and technically
when the hamstrings and quadriceps drills to promote technical competency incompetent children, the primary
muscles generate flexion or extension before progressing to more open and focus should be on FMS development
moments (62). As mentioned previ- unplanned conditions. Figure 9 shows with secondary focus to CODS and
ously, kinematics must be preserved an example of speed and agility train- RAT; whereas, with a technically
to reduce high joint loads when agil- ing by specific sport skills in young competent adolescent, greater empha-
ity is initially implemented in INT tennis players. sis can be placed on RAT development
programs with a focus on correct while maintaining FMS and CODS
alignment and flexion of the lower Despite the lack of scientific literature
regarding agility training in youth, competency.
limb (trunk-hip-knee-ankle complex).
Attention should also be placed on Lloyd et al. (64) recently developed Considering speed development, dif-
lower limb patterns during open or an example progression for each stage ferent training methods on sprinting
unplanned conditions of tasks with of technical competency based on fun- time have been studied in males 8–18
the intention of reducing the risk of damental movement skills, change of years old (96). Results showed that
injury during similar sport scenarios. direction speed (CODS), and reaction plyometric training had the most effect
For example, in Australian Football, it agility training (RAT). In this review, on sprint times in prepeak and mid-
has been observed that ACL ruptures change of direction speed is consid- peak height velocity subjects, whereas
occur during COD maneuvers such as ered to be a closed and preplanned combined training methods (e.g.,
sidestepping (37%), landing (32%), skill in nature, contrary to reactive sprinting, plyometric, and strength
Figure 9. Speed and agility training by SSS. Agility work, centered on fast change direction actions, can be developed by using
different visual references (A) (to make the needed spatial and temporal adjustments). The introduction of catching balls
(B) will provoke a lower center of gravity (if this is our intention). The progression of agility work can introduce thrown
balls (C), but always performed thinking on real situations (the way to throw a ball has to be planned by the coach in
order to not provoke altered tactical and coordinative patterns on court).
training) were the most efficient in running) (96). Nevertheless, it is exercise interspersed with active or
postpeak height velocity participants. important to emphasize agility train- passive recovery periods. In this
These authors suggested that it is dif- ing (speed with change of direction) sense, multiple possibilities of HIIT
ficult to quantify the effects of differ- over linear sprints because a majority are described in both youth and adult
ent training methods because of the of sports demand quick, multidirec- athletes: classic HIIT with short inter-
limited knowledge in this area. Based tional movements (115). vals (e.g., 15 seconds high intensity—
on scientific literature, when training 30 seconds active recovery), repeated
youth for speed improvement, the FATIGUE RESISTANCE sprint training (RST) (e.g., 10 sets
first level of training should focus In team and racquet sports, one of the of 30 seconds—recovery 30 seconds),
on developing correct running kine- keys to successful performance is the or small side games (SSG) (e.g., 5
matics and technique. This can be ability to develop repeated high- sets of 3 minutes, 3v3 basketball
accomplished through specific intensity actions; which are reliant on half court) (Figure 10) (20). Related
dynamic drills such as A-skips, B- neuromuscular and cardiorespiratory to functional methodology, a linear
skips, high knees, or ankle-quad efficiency to reduce the negative effects sprint can be performed to develop
grabs. Functional mobility is another of fatigue. This ability plays an impor- repeated sprint ability (RSA). But
element to be considered to improve tant role not only in performance but within team sports, there is a need
running form, especially mobility of also in injury prevention because neu- to use change of direction tasks when
the ankle and hip. As youth improve romuscular fatigue is considered one of performing high-intensity training,
running kinematics, attention can the higher risk factors for sports inju- so the specificity of adaptations de-
focus on power, strength, and ries (17,21). Recently, high-intensity
pends on the type of stimulus pre-
sprint-specific training development interval training (HIIT) has become
sented (116).
(64). Classic sprint training in youth one of the most effective and com-
consisted of straight line sprinting monly used methods for improving In order to study fatigue resistance
(around 5–30 meters) with passive cardiorespiratory, metabolic and neu- competency with repeated bouts of
recovery (105). Other forms of spe- romuscular components of fitness in high-intensity activity, the effects of
cific sprint training have been studied youth and adult athletes (19,45). SSG were studied in youth team sports
in youth such as resisted sprint train- Cumulatively, these are the basis to (16,25). SSG is a more real sport sce-
ing (e.g., sprinting uphill or sprinting improve the ability to produce nario of HIIT that incorporates coor-
while using weighted sleds) or assis- repeated high-intensity efforts. Meth- dinative and tactical specific skills to
ted sprint training (e.g., supramaximal odologically, HIIT involves repeated the development of fatigue resistance.
or overspeed running like downhill short-to-long bouts of high-intensity It can be assumed that athletes who are

Figure 10. Examples of different methods to improve fatigue resistance with the aim to improve both cardiorespiratory and
metabolic capacity and neuromuscular control in youth basketball players.
better able to resist a sport-specific situations to reduce injury risk. There improve cardiorespiratory, metabolic,
amount of fatigue can more favorably are also recommendations that train- and neuromuscular capacities in youth
handle potentially injurious scenarios. ing programs train movement strate- populations.
It is accepted that SSG can substitute gies under fatigued conditions to
aerobic interval training to train spe- simulate realistic scenarios when injury SUMMARY
cific energy systems during the com- risk is greater (15). The proposed model of INT programs
petitive period in athletes (102), and Given current evidence related to effi- in this manuscript presented 6 essential
some aspects related to performance cacy and approaches to training for training components: dynamic stability,
level (time spent performing high- fatigue resistance, aerobic fitness strength, plyometrics, coordination,
intensity actions during a match) have should be progressed throughout the speed and agility, and fatigue resistance.
improved by this kind of work (75). development stage considering both This review emphasizes a flexible
But, when implementing this type of maturation and technical skill (45). approach to INT with goals to improve
training, it is important to note that From our experience and review of injury resilience and to enhance sport
game-based training has been related current literature, tasks implemented and motor performance abilities in
to a higher traumatic risk of injuries to improve fatigue resistance in novice youth populations. INT in youth should
because of the higher number of con- athletes should be enjoyable and focus first build an important foundation by
tacts (with the other players) and the on technical skill acquisition during developing FMS competency and then
high variability of the game (unex- aerobic and interval-based tasks that build upon these skills to enrich sports-
pected actions) (20). Moreover, it has include gameplay. As an athlete ma- specific and activity-specific skill sets.
been suggested that lower-skilled play- tures into later development stages, The key to a well-designed INT pro-
ers may profit less from SSG compared greater emphasis can be placed on gram is to integrate all of these compo-
to classic HIIT training (45). high-intensity SSG to improve aerobic nents in an individualized manner and
Borotikar et al. (2007) indicates that fitness and technical skills. Once young to design and deliver training in an
central fatigue has shown important athletes have progressed to a sufficient enjoyable fashion to motivate youth to
effects on the decrement of the ability competency level to pursue specific incorporate and retain optimal move-
to perform complex tasks in sports. sport skills performance, a combination ment strategies.
The authors present the possibility of of SSG and classic HIIT training is rec- Conflict of Interests and Source of Funding:
introducing complex and challenging ommended (45). Figure 10 shows an We acknowledge funding support from
decision-making tasks during training example of different methods (RST, National Institutes of Health/NIAMS
to train the athlete to generate optimal classic HIIT, and SSG) to improve Grant R21AR06506801A1 and
movement strategies in various sport fatigue resistance with the aim to U01AR067997.
10. Behringer M, Vom Heede A, Yue Z, and

Gregory D. Mester J. Effects of resistance training in
Azahara Fort-
Myer is Director children and adolescents: A meta-
Vanmeer-
of Research and analysis. Pediatrics 126: e1199–210,
haeghe is an
the Human Per- 2010.
Associate Professor
formance Labo- 11. Benes FM, Turtle M, Khan Y, and Farol P.
at the School of
ratory for the Myelination of a key relay zone in the
Health and Sport
Division of hippocampal formation occurs in the
Sciences (EUSES, human brain during childhood,

Sports Medicine
University of Gi- adolescence, and adulthood. Arch Gen
at Cincinnati
rona, Spain) and Psychiatry 51: 477–484, 1994.
Children’s Hos-
a strength and 12. Besier TF, Lloyd DG, and Ackland TR.
pital Medical Center and holds primary
conditioning coach of elite female youth Muscle activation strategies at the knee
academic appointments in the Depart- during running and cutting maneuvers.
basketball players (Segle XXI team, Catalan
ments of Pediatrics and Orthopaedic Med Sci Sports Exerc 35: 119–127,
Federation of Basketball).
Surgery within the College of Medicine at 2003.
University of Cincinnati. 13. Bompa T and Haff G. Periodization:
Theory and Methodology of Training.
Daniel Champaign, IL: Human Kinetics, 2009.
Romero- REFERENCES 14. Bompa T. Total Training for Young
Rodriguez is an 1. Adirim TA and Cheng TL. Overview of Champions. Kinetics H, ed. Champaign,
Associate Profes- injuries in the young athlete. Sport Med IL: Human Kinetics, 2000.
sor at the School 33: 75–81, 2003.
15. Borotikar BS, Newcomer R, Koppes R,
of Health and 2. Akuthota V and Nadler SF. Core and McLean SG. Combined effects of
Sport Sciences strengthening. Arch Phys Med Rehabil fatigue and decision making on female
(EUSES, Uni- 85: 86–92, 2004. lower limb landing postures: Central and
versity of Girona, 3. Balyi I and Hamilton A. Long-term Athlete peripheral contributions to ACL injury risk.
Development: Trainability in Childhood Clin Biomech 23: 81–92, 2008.
Spain) and the
and Adolescence. Windows of 16. Brandes M, Heitmann A, and Müller L.
Sporting and
Opportunity. Optimal Trainability. Natl Physical responses of different small-
Technical Director of ReSport Clinic Coach Inst Br Columbia Adv Train sided game formats in elite youth soccer
(Barcelona, Spain) and Novaelite Sport Perform Ltd, 2004. players. J Strength Cond Res 26: 1353–
Center (Barcelona, Spain). 1360, 2012.
4. Barber-Westin SD, Noyes FR, and
Galloway M. Jump-land characteristics 17. Brazen DM, Todd MK, Ambegaonkar JP,
and muscle strength development in Wunderlich R, and Peterson C. The effect
young athletes: A gender comparison of of fatigue on landing biomechanics in
Rhodri S. Lloyd
1140 athletes 9 to 17 years of age. Am J single-leg drop landings. Clin J Sport Med
is a Senior Lec- Sports Med 34: 375–384, 2006. 20: 286–292, 2010.
turer in Strength
5. Barlett R. Introduction to Sports 18. Bressel E, Yonker JC, Kras J, and
and Conditioning Biomechanics: Analysing Human Heath EM. Comparison of static and
at Cardiff Met- Movement Patterns. London, United dynamic balance in female collegiate
ropolitan Kingdom: Routledge, 2007. soccer, basketball, and gymnastics
University. 6. Barnett LM, Van Beurden E, Morgan PJ, athletes. J Athl Train 42: 42–46, 2007.
Brooks LO, and Beard JR. Does 19. Buchheit M and Laursen PB. High-
childhood motor skill proficiency predict intensity interval training, solutions to the
adolescent fitness? Med Sci Sports Exerc programming puzzle: Part I:
40: 2137–2144, 2008. Cardiopulmonary emphasis. Sports Med
Adam W. 7. Behm DG, Anderson K, and Curnew RS. 43: 313–338, 2013.
Kushner is Muscle force and activation under stable 20. Buchheit M and Laursen PB. High-
and unstable conditions. J Strength Cond intensity interval training, solutions to the
a Clinical
Res 16: 416–422, 2002. programming puzzle. Part II: Anaerobic
Research Coor-
8. Behm DG and Anderson KG. The role of energy, neuromuscular load and practical
dinator in the
instability with resistance training. applications. Sports Med 43: 927–954,
Human Perfor- J Strength Cond Res 20: 716–722, 2013.
mance Labora- 2006. 21. Chappell JD, Herman DC, Knight BS,
tory for the 9. Behm DG, Drinkwater EJ, Willardson JM, Kirkendall DT, Garrett WE, and Yu B.
Division of Sports Medicine at Cin- and Cowley PM. The use of instability to Effect of fatigue on knee kinetics and
cinnati Children’s Hospital Medical train the core musculature. Appl Physiol kinematics in stop-jump tasks. Am J
Center. Nutr Metab 35: 91–108, 2010. Sports Med 33: 1022–1029, 2005.

22. Cochrane JL, Lloyd DG, Buttfield A, physical education. J Strength Cond Res biomechanical and epidemiologic
Seward H, and McGivern J. 29: 1255–1262, 2015. considerations—update 2010. N Am J
Characteristics of anterior cruciate 34. Faigenbaum AD, Kramer W, and Sports Phys Ther 5: 234–251, 2010.
ligament injuries in Australian football. Blimkie C. Risks and concerns related to 47. Hewett TE, Ford KR, and Myer GD.
J Sci Med Sport 10: 96–104, 2007.
youth resistance training. J Strength Con Anterior cruciate ligament injuries in

23. Cometti G. Los metodos modernos de Res 23: 60–79, 2009. female athletes: Part 2, a meta-analysis of
musculacion. Barcelona, Spain: neuromuscular interventions aimed at
35. Faigenbaum AD, Kraemer WJ, Blimkie CJ,
Paidotribo, 1998. injury prevention. Am J Sports Med 34:
Jeffreys I, Micheli LJ, Nitka M, and

24. Crossley KM, Zhang W-J, Schache AG, Rowland TW. Youth resistance training: 490–498, 2006.
Bryant A, and Cowan SM. Performance Updated position statement paper from 48. Hewett TE, Lindenfeld TN, Riccobene JV,
on the single-leg squat task indicates hip the national strength and conditioning and Noyes FR. The effect of
abductor muscle function. Am J Sports association. J Strength Cond Res 23 neuromuscular training on the incidence
Med 39: 866–873, 2011. (5 Suppl): S60–S79, 2009. of knee injury in female athletes. A
25. Delextrat A and Martinez A. Small-sided 36. Faigenbaum AD and McFarland J. Make prospective study. Am J Sports Med 27:
game training improves aerobic time for less-intense training. Strength 699–706, 1999.
capacity and technical skills in Cond J 2006;28: 77–79. 49. Hewett TE, Paterno MV, and Myer GD.
basketball players. Int J Sports Med 35: Strategies for enhancing proprioception
37. Faigenbaum AD and Myer GD. Pediatric
385–391, 2013. and neuromuscular control of the knee.
resistance training: Benefits, concerns,
26. DiStefano L, Clark M, and Padua D. and program design considerations. Curr Clin Orthop Relat Res 402: 76–94,
Evidence supporting balance training in Sports Med Rep 9: 161–168, 2010. 2002.
healthy individuals: A systemic review. 50. Hewett TE, Stroupe AL, Nance TA, and
38. Faigenbaum AD, Myer GD, Farrell A,
J Strength Cond Res 23: 2718–2731, Noyes FR. Plyometric training in female
Radler T, Fabiano M, Kang J, Ratamess N,
2009. athletes. Decreased impact forces and
Khoury J, and Hewett TE. Integrative
27. DiStefano LJ, Padua DA, Blackburn JT, neuromuscular training and sex-specific increased hamstring torques. Am J Sports
Garrett WE, Guskiewicz KM, and fitness performance in 7-year-old children: Med 24: 765–773, 1996.
Marshall SW. Integrated injury prevention An exploratory investigation. J Athl Train 51. Hewit J, Cronin J, Button C, and Hume P.
program improves balance and vertical 49: 145–153, 2014. Understanding deceleration in sport.
jump height in children. J Strength Cond Strength Cond J 33: 47–52, 2011.
39. Faries M and Greenwood M. Core
Res 24: 332–342, 2010.
training: Stabilizing the confusion. 52. Hibbs AE, Thompson KG, French D,
28. Eils E, Schröter R, Schröder M, Gerss J, Strength Cond J 29: 10–25, 2007. Wrigley A, and Spears I. Optimizing
and Rosenbaum D. Multistation performance by improving core stability
40. Ford KR, Myer GD, Toms HE, and
proprioceptive exercise program prevents and core strength. Sports Med 38: 995–
Hewett TE. Gender differences in the
ankle injuries in basketball. Med Sci 1008, 2008.
kinematics of unanticipated cutting in
Sports Exerc 42: 2098–2105, 2010.
young athletes. Med Sci Sports Exerc 37: 53. Hodges PW. Core stability exercise in
29. Emery CA, Rose MS, McAllister JR, and 124–129, 2005. chronic low back pain. Orthop Clin North
Meeuwisse WH. A prevention strategy to Am 34: 245–254, 2003.
41. Fort A, Romero D, Bagur C, and
reduce the incidence of injury in high
Guerra M. Effects of whole-body Vibration 54. Holmes A and Delahunt E. Treatment of
school basketball: A cluster randomized
training on explosive strength and common deficits associated with chronic
controlled trial. Clin J Sport Med 17: 17–
postural control in young female athletes. ankle instability. Sport Med 39: 207–224,
24, 2007.
J Strength Cond Res 26: 926–936, 2009.
30. Emery CA, Roy TO, Whittaker JL, Nettel- 2012. 55. Junge A and Dvorak J. Soccer injuries: A
Aguirre A, and van Mechelen W.
42. Gallahue DL and Ozmun OJ. review on incidence and prevention. Sport
Neuromuscular training injury prevention
Understanding Motor Development: Med 34: 929–938, 2004.
strategies in youth sport: A systematic
Infants, Children, Adolescents, Adults. 56. Kenney WL and Costill DWJ. Physiology
review and meta-analysis. Br J Sports
Boston, MA: McGraw-Hill, 2006. of Sport and Exercise. 5th ed. Human
Med 49: 865–870, 2015.
43. Gamble P. Approaching physical Kinetics, 2012.
31. Faigenbaum A, Farrell A, Fabiano M,
preparation for youth team-sports players. 57. Kibler WB, Press J, and Sciascia A. The
Radler T, Naclerio F, Ratamess NA,
Strength Cond J 30: 29, 2008. role of core stability in athletic function.
Kang J, and Myer GD. Effects of
integrative neuromuscular training on 44. Gamble P. Strength and Conditioning for Sports Med 36: 189–198, 2006.
fitness performance in children. Pediatr Team Sports: Sport-specific Physical 58. Komi P and Gollhofer A. Stretch
Exerc Sci 23: 573–584, 2011. Preparation for High Performance: reflexes can have an important role in
Routledge, 2013. force enhancement during SSC
32. Faigenbaum A and Myer G. Resistance
training among young athletes: Safety, 45. Harrison CB, Gill ND, Kinugasa T, and exercise. J Appl Biomech 13: 451–
efficacy and injury prevention effects. Br J Kilding AE. Development of aerobic 460, 1997.
Sports Med 44: 56–63, 2010. fitness in young team sport athletes. 59. Kovacs MS, Roetert EP, and
33. Faigenbaum AD, Bush JA, McLoone RP, Sports Med 45: 969–983, 2015. Ellenbecker TS. Efficient deceleration:
Kreckel MC, Farrell A, Ratamess NA, and 46. Hewett TE, Ford KR, Hoogenboom BJ, The Forgotten factor in tennis-specific
Kang J. Benefits of strength and skill- and Myer GD. Understanding and training. Strength Cond J 30: 58–69,
based training during primary school preventing ACL injuries: Current 2008.
60. Kushner AM, Kiefer AW, Lesnick S, 73. Meinel K and Schnabel G. Teoria del 84. Myer GD, Sugimoto D, Thomas S, and
Faigenbaum AD, Kashikar-Zuck S, and movimiento. Motricidad deportiva. Hewett TE. The influence of age on the
Myer GD. Training the developing brain Buenos Aires, Argentina: Stadium, 1987. effectiveness of neuromuscular training to
Part II: Cognitive considerations for youth reduce anterior cruciate ligament injury in
74. Mendiguchia J, Ford KR, Quatman CE,
instruction and feedback. Curr Sports
Alentorn-Geli E, and Hewett TE. Sex female athletes: A meta-analysis. Am J

Med Rep 14: 235–243, 2014. Sports Med 41: 203–215, 2013.
differences in proximal control of the
61. Lloyd DG. Rationale for training knee joint. Sports Med 41: 541–557, 85. Nigg BN and Herzog W. Biomechanics
programs to reduce anterior cruciate
2011. of the Musculo-skeletal System. 3rd

ligament injuries in Australian football. ed. Champaign, IL: Human Kinetics,
75. Mohr M, Krustrup P, and Bangsbo J.
J Orthop Sports Phys Ther 31: 645– 2007.
Match performance of high-standard
654, 2001.
soccer players with special reference to 86. Noyes FR, Barber SD, and Mangine RE.
62. Lloyd D, Buchanan T, and Besier T. development of fatigue. J Sports Sci 21: Abnormal lower limb symmetry
Neuromuscular biomechanical 519–528, 2003. determined by function hop tests after
modeling to understand knee ligament anterior cruciate ligament rupture. Am J
loading. Med Sci Sports Exerc 37: 76. Morgan PJ, Barnett LM, Cliff DP,
Sports Med 19: 513–518, 1991.
1939–1947, 2005. Okely AD, Scott HA, Cohen KE, and
Lubans DR. Fundamental movement skill 87. Noyes FR, Barber-Westin SD, Smith ST,
63. Lloyd R and Oliver J. The youth physical
interventions in youth: A systematic Campbell T, and Garrison TT. A training
development model: A new approach to
review and meta-analysis. Pediatrics 132: program to improve neuromuscular and
long-term athletic development. Strength
e1361–83, 2013. performance indices in female high school
Cond J 34: 61–72, 2012.
basketball players. J Strength Cond Res
77. Myer G, Chu D, Brent J, and Hewett T.
64. Lloyd R, Read P, and Oliver J. 26: 709–719, 2012.
Trunk and hip control neuromuscular
Considerations for the development of
training for the prevention of knee joint 88. Noyes FR, Barber-Westin SD, Tutalo
agility during childhood and adolescence.
injury. Clin Sports Med 27: 1–23, 2008. Smith ST, and Campbell T. A training
Strength Cond J 35: 2–11, 2013.
program to improve neuromuscular and
65. Lloyd RS, Meyers RW, and Oliver JL. The 78. Myer G and Faigenbaum A. Pediatric
performance indices in female high school
natural development and Trainability of Physical Activity Exercise is sports
soccer players. J Strength Cond Res 27:
plyometric ability during childhood. medicine in youth : Integrative
340–351, 2013.
Strength Cond J 33: 23–32, 2011. neuromuscular training to optimize motor
development. KRONOS X:39–48, 2011. 89. Paine V and Isaacs L. Human Motor
66. Lubans DR, Morgan PJ, Cliff DP, Development: A Lifespan Approach. 5th
Barnett LM, and Okely AD. Fundamental 79. Myer GD, Faigenbaum AD, Chu DA,
ed: McGraw-Hill, 2001.
movement skills in children and Falkel J, Ford KR, Best TM, and
adolescents: Review of associated health Hewett TE. Integrative training for children 90. Panjabi MM. The stabilizing system of the
benefits. Sport Med 40: 1019–1035, and adolescents: Techniques and spine. Part I. Function, dysfunction,
2010. practices for reducing sports-related adaptation, and enhancement. J Spinal
injuries and enhancing athletic Disord 5: 383–389, 1992.
67. Lyakh V, Sadowski J, and Witkowski Z.
Development of coordination motor performance. Phys Sportsmed 39: 74– 91. Paterno MV, Taylor-Haas JA, Myer GD,
abilities (CMA) in the system of long-term 84, 2011. and Hewett TE. Prevention of overuse
preparation of athletes. Polish J Sport 80. Myer GD, Faigenbaum AD, Ford KR, sports injuries in the young athlete.
Tour 18: 187–191, 2011. Best TM, Bergeron MF, and Hewett TE. Orthop Clin North Am 44: 553–564,
When to initiate integrative 2013.
68. Magill R. Motor Learning: Concepts And
Applications. 5th ed. McGraw-Hill, 1998. neuromuscular training to reduce sports- 92. Richardson C, Jull G, PW H, and Hides J.
related injuries and enhance health in Therapeutic Exercise for Spinal
69. Malina RM. Weight training in youth-
youth? Curr Sports Med Rep 10: 157– Segmental Stabilization in LBP: Scientific
growth, maturation, and safety: An
166, 2011. Basis and Clinical Approach. Edinburgh,
evidence-based review. Clin J Sport Med
16: 478–487, 2006. 81. Myer GD, Ford KR, Brent JL, and United Kingdom: Churchill Livingstone,
Hewett TE. The effects of plyometric vs. 1999.
70. McGill S. Core training: Evidence
dynamic stabilization and balance training 93. Riemann BL and Lephart SM. The
translating to better performance and
injury prevention. Strength Cond J 32: on power, balance, and landing force in sensorimotor system, part I: The
33–46, 2010. female athletes. J Strength Cond Res 20: physiologic basis of functional joint
345–353, 2006. stability. J Athl Train 37: 71–79, 2002.
71. McGuine TA and Keene JS. The effect
of a balance training program on the 82. Myer GD, Ford KR, and Hewett TE. The 94. Riemann BL and Lephart SM. The
risk of ankle sprains in high school effects of gender on quadriceps muscle sensorimotor system, Part II: The role of
athletes. Am J Sports Med 34: 1103– activation strategies during a maneuver proprioception in motor control and
1111, 2006. that mimics a high ACL injury risk position. functional joint stability. J Athl Train 37:
J Electromyogr Kinesiol 15: 181–189, 80–84, 2003.
72. McLean SG, Walker KB, and van den
2005. 95. Rozzi SL, Lephart SM, Gear WS, and
Bogert AJ. Effect of gender on lower
extremity kinematics during rapid direction 83. Myer GD, Lloyd RS, Brent JL, and Fu FH. Knee joint laxity and
changes: An integrated analysis of three Faigenbaum AD. How young is too young neuromuscular characteristics of male
sports movements. J Sci Med Sport 8: to start training? Acsms Heal Fit J 17: and female soccer and basketball players.
411–422, 2005. 14–23, 2013. Am J Sports Med 27: 312–319, 1999.

96. Rumpf MC, Cronin JB, Pinder SD, 103. Taylor J. Lower extremity perturbation J Strength Cond Res 22: 1705–1715,
Oliver J, and Hughes M. Effect of different training. Strength Cond J 33: 76–83, 2011. 2008.
training methods on running sprint times 104. Van Hilst J, Hilgersom NFJ, Kuilman MC, 111. Woods C, Hawkins R, Hulse M, and
in male youth. Pediatr Exerc Sci 24: 170– F M Kuijer PP, and Frings-Dresen MHW. Hodson A. The football association
186, 2012. Low back pain in young elite field hockey medical research programme: An audit of
97. Schmidtbleicher D. Training for power players, football players and speed injuries in professional football: An
events. In: The Encyclopaedia of Sports skaters: Prevalence and risk factors. analysis of ankle sprains. Br J Sports Med
J Back Musculoskelet Rehabil 28:
Medicine. Oxford, United Kingdom: 37: 233–238, 2003.

67–73, 2015.
Blackwell: 169–179, 1992. 112. World Health Organization. Global
105. Venturelli M, Bishop D, and Pettene L. Recommendations on Physical Activity
98. Serpell BG, Ford M, and Young WB. The
Sprint training in preadolescent soccer for Health: WHO Libr Cat Data, 2010.
development of a new test of agility for
players. Int J Sports Physiol Perform 3:
rugby league. J Strength Cond Res 24: 113. Yaggie JA and Campbell BM. Effects of
558–562, 2008.
3270–3277, 2010. balance training on selected skills.
106. Verkhoshansky Y. Supertraining. 6th ed.
99. Sheppard JM and Young WB. Agility J Strength Cond Res 20: 422–428,
Rome, Italy: Verkhoshansky, 2009.
literature review: Classifications, training and 2006.
testing. J Sports Sci 24: 919–932, 2006. 107. Viru A, Loko J, Harro M, Volver A,
114. Young WB. Transfer of strength and
Laaneots L, and Viru M. Critical periods
100. Soligard T, Myklebust G, Steffen K, power training to sports performance. Int
in the development of performance
Holme I, Silvers H, Bizzini M, Junge A, J Sports Physiol Perform 1: 74–83,
capacity during childhood and
Dvorak J, Bahr R, and Andersen TE. 2006.
adolescence. Eur J Phys Edu 4: 75–
Comprehensive warm-up programme to 119, 1999. 115. Young WB, James R, and
prevent injuries in young female Montgomery I. Is muscle power related
108. Vizuete J. La capacidad de repetir
footballers: Cluster randomised to running speed with changes of
cambios de dirección (especificidad,
controlled trial. BMJ 337: a2469, 2008. valoración y entrenamiento). Universitat direction? J Sports Med Phys Fitness
101. Stodden D, Langendorfer S, and de Barcelona, 2012. 42: 282–288, 2002.
Roberton MA. The association between 109. Willardson J. Core stability training: 116. Young WK and Metzl JD. Strength
motor skill competence and physical Applications to sports conditioning training for the young athlete. Pediatr Ann
fitness in young adults. Res Q Exerc Sport programs. J Strength Cond Res 21: 979– 39: 293–299, 2010.
80: 223–229, 2009. 985, 2007. 117. Zetou E, Vernadakis N, Tsetseli M,
102. Stone NM and Kilding AE. Aerobic 110. Wilson JM and Flanagan EP. The role of Kampas A, and Michalopoulou M. The
conditioning for team sport athletes. elastic energy in activities with high force effect of coordination training program on
Sports Med 39: 615–642, 2009. and power requirements: A brief review. learning tennis skills. Sport J 15, 2012.

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Integrative

in Youth Athletes. Part II:

ABSTRACT AGILITY, AND FATIGUE RESISTANCE. with sports-related injuries can be

10 VOLUME 38 | NUMBER 4 | AUGUST 2016

11 Strength and Conditioning Journal | www.nsca-scj.com

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(49,79,81). Related to this methodol-

placement—jumping) have also given

a correct way (15,21). FMS must be

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Figure 5. Coordination abilities definitions (Meinel and Schnabel, 1987).

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Prepuberty or novice Puberty or intermediate Postpuberty or advanced

19 Strength and Conditioning Journal | www.nsca-scj.com

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Figure 8. Example of plyometric exercises progression in youth.

21 Strength and Conditioning Journal | www.nsca-scj.com

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23 Strength and Conditioning Journal | www.nsca-scj.com

10. Behringer M, Vom Heede A, Yue Z, and

Sciences (EUSES, human brain during childhood,

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youth resistance training. J Strength Con Anterior cruciate ligament injuries in

Jeffreys I, Micheli LJ, Nitka M, and

25 Strength and Conditioning Journal | www.nsca-scj.com

Alentorn-Geli E, and Hewett TE. Sex female athletes: A meta-analysis. Am J

2011. of the Musculo-skeletal System. 3rd

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Medicine. Oxford, United Kingdom: 37: 233–238, 2003.

27 Strength and Conditioning Journal | www.nsca-scj.com

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