Basketball involves repeated bouts of intense action, such as sprinting, abrupt stops, fast changes in direction, acceleration, shuffling, and jumping, separated by short bouts of low-intensity activity in the forms of walking, jogging, and recovery (2). For high levels of performance in the above tasks, it has been suggested that players must possess the following motor and functional abilities: explosive strength and rate of force development (RFD) in the legs, strength of the arms and shoulder girdle, agility with and without the ball, coordination, speed, anaerobic lactate, and alactic capacities (54). This is supported by Erculj et al. (24) identifying that explosive strength, RFD, speed, and agility contributed significantly (P < 0.05) to efficient movement with and without the ball. Thus, it can be determined that physical qualities play an important role in the requisite performance of basketball techniques.
Successful basketball performance is also influenced heavily by anthropometrics (e.g., limb length, stature, and mass), with elite players being greater in stature (30). However, evidence suggests that taller players are inferior in their general motor abilities (35), including acceleration and acyclic speed both with and without the ball (24). As such, the development of athletic qualities for basketball athletes is paramount to performance and should be considered a fundamental component of a holistic training program.
Distinct variation is evident in the physical and physiological assessment methods of a range of fitness components (strength, speed, power, endurance, agility, flexibility, and body composition) in elite basketball. This was highlighted by Simenz et al. (53) in their analysis of the practices undertaken by strength and conditioning (S&C) coaches within the National Basketball Association (NBA). Such variety prevents the establishment of normative data from which practitioners can compare basketball athletes to national standards. Additionally, the validity and reliability of the selected assessment methods may be affected. The purpose of this review is to analyze the physiological requirements and injury considerations of the sport to identify suitable testing approaches from which coaches can optimally assess the physical capabilities of their athletes.
Time-motion analysis is a key tool for determining fundamental movements of play and the frequency in which they occur. In game play, 9 specific movements have been identified, including standing, walking, jogging, running, striding, sprinting, jumping, turning, and side movements (2), with 34% of the game in active movements such as running and jumping (46). To allow the reader to fully understand the physiological demands of the sport, in this review, high-intensity activities will be defined in accordance with the study of Abdelkrim et al. (2) to include sprinting, abrupt stops, fast changes in direction, acceleration, shuffling, and jumping.
Highlighting the multidirectional nature of the sport, reported changes between movement patterns occur every 2 seconds (43). This would imply that frequent changes of direction and subsequently speed and agility are of major importance in game play. Furthermore, it was evidenced that 22% of the game distances covered involved lateral movement. This is an important consideration for S&C specialists because of the fact that lateral movements have been reported to be more metabolically demanding in comparison with straight line running (61). Therefore, the development of strength, optimal mechanics, and conditioning in multiple planes of movement (frontal, sagittal, and transverse) should be considered essential.
Initial research pertaining to game analysis has identified differential demands based on positions namely guards, forwards, and centers. Positions are then further defined by specific roles such as centers, point guard, shooting guard, small forward, and power forward. Centers are involved in less high-intensity movements than both forwards and guards, respectively, with forwards completing greater volumes of running (45). More recently, the frequency of high-intensity movements during a game has also been analyzed, with Abdelkrim et al. (2) reporting higher occurrences in guards and forwards compared with centers (17.1%, 16.6% versus 14.7%), respectively. It is also important to note that this research has been carried out since the Fédération Internationale de Basketball (FIBA) rule changes of May 2000. These FIBA modifications have resulted in shorter attack times from 30 to 24 seconds, a reduction in the time spent in the backcourt and four 10-minute quarters as opposed to two 20-minute halves. This adjustment also precipitated an alteration in the game demands leading to the increased time spent in high-intensity activities (2). As such, caution is required when referring to evidence in the literature because it may not be truly reflective of current game demands, including the study of Miller and Bartlett (45) where high-intensity movements were performed every 21 seconds and only 5% of sprints lasted more than 4 seconds. Although the above data could be deemed useful in designing assessment and conditioning strategies based on positional differences with an optimization of work-to-rest ratios, it may not be truly reflective of current game demands. Therefore, the study of Abdelkrim et al. (2) may provide a more accurate representation. However, practitioners should also be cognizant of the fact that the subjects used in the study of Abdelkrim et al. were elite U19 players, and as such, these results may not be applicable to players of all ages and levels.
To date, limited evidence is available regarding distances covered during a game. Abdelkrim et al. (1) reported that a total of 7,558 m provided a baseline figure during junior basketball games, with only 2% of game play involving high-intensity activities. Although this data may be valid for junior players, its relevance to adult and elite populations is speculative. Further to this, it should be noted that it is not the total distance covered that dictates basketball performance (1). Therefore, it has been suggested that determining the amount of high-intensity activity may be a more prudent strategy to differentiate between levels of performance (1).
PHYSICAL REQUIREMENTS OF THE GAME
For successful performance, players are required to possess a number of physical attributes including muscular power (34), aerobic power (34), speed, and agility (31). The relationship between athletic ability and playing time has been measured previously (32), with players demonstrating the greatest athletic ability (based on the fitness tests) accumulating greater playing times. As such, determining the level of appropriate physical qualities is of fundamental importance for S&C coaches for talent identification and monitoring the effects of their programming.
ENERGY SYSTEM REQUIREMENTS
It has been suggested that a large proportion of the energy required for the high-intensity bursts within a game is derived from the adenosine triphosphate (ATP) and creatine phosphate (CP) systems (5). Abdelkrim et al. (1) identified 6 seconds of high-to-moderate intensities followed by 22 seconds of submaximal work (walking, jogging, and recovery), equating to a mean work-to-rest ratio of 1:3.6. This suggests an insufficient time period in which to replenish CP stores and a subsequent reliance on anaerobic glycolysis (5). Additionally, Ratamess et al. (50) identified that the metabolic demands of basketball required a high proportion of the phosphagen system, a moderate-to-high requirement for anaerobic glycolysis, and the contribution of aerobic metabolism as a less significant factor. Collectively, these findings demonstrate the need for the inclusion of appropriate testing and training protocols for both the anaerobic alactic (underpinned by the ATP-PC systems) and anaerobic glycolytic systems (14), that is, maximal sprint tests and repeated sprint protocols.
AEROBIC VERSUS ANAEROBIC
Speculation as to whether basketball should be classified as an aerobic or anaerobic sport is present within the available literature. A reliance on the ATP-PC and glycolytic systems has been suggested (31), with the aerobic system identified as a secondary energy source. This is highlighted in the fact that mean V[Combining Dot Above]O2max values are lower than that of other more endurance-based activities (17). Further support can be derived from Hoffman et al. (32) who suggested that basketball seems to be more dependent on anaerobic power rather than aerobic power and capacity. Over a 4-year period assessing the relationships between athletic performances and playing time, a significant negative correlation was reported with aerobic capacity. Of particular note, when aerobic fitness was greater than or equal to the population average, no further benefit was derived. This suggests that once an aerobic base has been established, sport-specific practices and games may be sufficient to maintain aerobic fitness. This is especially important for S&C coaches to consider because it has been reported that continuous aerobic training in anaerobic sports leads to maladaptations and performance decrements, for example, reductions in strength and power (23).
The intensity demands are also reflected by the fact that lactate production is evident in basketball. McInnes et al. (43) reported elevated blood lactate levels throughout a basketball game with a high variability among players. This is supported by Abdelkrim et al. (2) who reported that mean (SD) plasma lactate concentrations [La] were significantly higher for guards (P < 0.05) than for centers, 6.36 (1.24) versus 4.92 (1.18) mmol/L, respectively. It was suggested that the elevated lactate levels demonstrate a glycolytic pathway, making an important contribution to energy production during a game. As well as the reported lactate production, heart rate has also been analyzed during competition (1), where it was shown that heart rate was above 95% for 19% and above 85% for 74% of game play.
Contrary to the above evidence, aerobic endurance has been reported to affect basketball performance (2). Specifically, distance covered in a maximal shuttle running test was related to basketball game variables, namely the ability to sustain high-intensity efforts (2,16). Of note, Castagna et al. (16) assessed aerobic performance using the Yo-Yo intermittent recovery 1 (IR1), detecting significant differences across the competitive level ages and demonstrating the construct validity of the Yo-Yo IR1 within basketball. This is in contradiction to the study of Hoffman et al. (32) as stated above; however, a growing body of research has highlighted the importance of aerobic performance. For example, Abdelkrim et al. (1) determined that aerobic performance (in the form of a 20-m repeated shuttle test) was associated with high-intensity performance during a basketball game. Despite this, due to the noncontinuous nature, deceleration, and changes of direction and acceleration components, this test is not a true test of aerobic performance, rather a test of repeated incremental shuttles demonstrating both aerobic and anaerobic requirements.
Accordingly, it should be considered based on the literature outlined above that successful basketball performance is underpinned by maximal anaerobic parameters (i.e., maximal sprints and jumps), the ability to repeat high-intensity movements under conditions of fatigue (namely repeated sprint ability), and periods of low-level activity involving recovery through aerobic metabolism. Based on this, S&C coaches may wish to consider a primary emphasis of testing and training protocols for both maximal acceleration and repeated sprint abilities with aerobic abilities as a secondary measure.
STRENGTH AND POWER
Strength is a key component within elite basketball, highlighted by Delextrat and Cohen (21) in their assessment of knee extensor strength using an isokinetic dynamometer, noting that first team players developed significantly greater peak torques than second team players. Therefore, elite players may be stronger than lesser skilled players. However, it should be considered that the assessment used in their study requires expensive equipment and may not reflect closed chain movement patterns inherent to basketball, such as jumping and sprinting. Of note, 1 repetition maximum (1RM) squat strength has demonstrated strong correlations (r = 0.94) with increases in vertical jump height and improved acceleration abilities in elite-level soccer players (59). Therefore, it could be argued that the 1RM squat test is a valid measure of strength in the assessment of elite basketball performance. This becomes more apparent with Hoffman et al. (31) reporting that squat strength should be considered as a staple performance variable throughout a competitive season and is also a good predictor of playing time. Additionally, 1RM squat strength has been shown to be the best single predictor of 5- and 10-m sprint times in elite basketball players (18), with the ability to squat 1.5 times bodyweight, a suggested strength prerequisite for elite-level males (32).
The ability to generate maximal force in the shortest period of time has been considered essential in achieving high levels of basketball performance (12), with elite players characterized by a significantly higher percentage of fast twitch fibers than less-skilled competitors (51,10). In support of this, Latin et al. (38) measured the physical abilities of elite collegiate players, identifying that high levels of strength and anaerobic parameters enable more powerful rebounds, in addition to enhanced shooting, shuffling, and jumping performances. With vertical jump scores ranging from 60 cm (57) to mean values of more than 70 cm (32), it is suggested that elite players achieve significantly greater vertical jump heights. Confirming this, Hoare (30) reported significant differences in jump height between the 8 best shooting guards and the other shooting guards involved in a national championship. In addition, the ability to repeat this explosive action across the course of a game is also of great importance, with reports of 44–46 jumps during a game (2,43). Consequently, jumping is a key determinant to basketball performance and should form part of the athlete assessment strategies.
Upper-body strength in the form of 1RM bench press has also been assessed with first team players displaying greater strength scores compared with those of the second team (21). This has been confirmed by Caterisano et al. (17) who reported a difference of 6.3% between the “best” and the “rest” of players with collegiate-level athletes. These findings suggest that an appropriate level of upper-body strength is necessary for optimal basketball performance. However, the primary emphasis should remain with multijoint lifts, such as squats, deadlifts, and Olympic-style lifting variations, as confirmed by Hoffman et al. (32), where 1RM bench press scores were not a good indicator of playing time.
Agility has been suggested as a key physical component in a number of team sports including basketball (21). Due to frequent changes of direction and reactive nature of the sport (43), agility has been established as a physiological prerequisite for successful performance (33). Agility is traditionally defined as the ability to change direction rapidly, without losing balance, using a combination of strength, power, and neuromuscular coordination (40). Such qualities are clearly evident within game play; however, this may be more accurately described as change of direction speed (60). More recently, Shephard and Young (52) have identified that agility is affected by the athlete's perception and decision-making skills. This is highlighted by the fact that more skilled athletes are better able to respond to kinematic and postural cues (3).
When considering appropriate change of direction speed or agility tests for basketball, it should be considered that players are not only required to sprint in linear planes of motion. Backwards gait and side shuffling movements are common, subsequently suggesting the relevance of the T test. This is supported by Delextrat and Cohen (21), where first team players achieved significantly lower times compared with the second team, further confirmed by Gillam (27), with significant differences between basketball athletes and physical education majors. Although the T test has gained support within the literature, other change of direction speed tests, including the pro-agility test or 5-0-5, may also be appropriate because of the frequent changes of direction (43) and inherent game demands where sprints will often begin while players are in motion (2), further justifying the use of the 5-0-5 test. Also speculatively, performing lateral motions in closed environments under timed conditions (as in the T test) is not reflective of the perceptual components and will likely affect movement mechanics, thus reducing the content validity of the test. An alternative option may be to perform a qualitative assessment of lateral abilities and changes of direction in response to a variety of stimuli. Finally, it should also be noted, at this point, that none of the tests suggested above are true tests of agility; however at this time, efficient, cost-effective, and reliable measures are limited (56).
When analyzing speed, the majority of the literature has reported data pertaining to distances of 20–27 m, close to the length of the basketball court (33). It should be considered that players rarely cover these distances in the same high-intensity effort with average distances of 10 m recorded or between 1.7 and 2.1 seconds in duration (2,43). Therefore, the use of shorter distance tests (5 and 10 m) to assess linear speed may be a more prudent strategy, with the measurement of maximal running speed considered inappropriate. With the requirement for quick accelerations and decelerations, this further advocates the importance of strength, due to the ability and effort, required to overcome the body's inertia (43). It was also noted by Abdelkrim et al. (2) that the percentage of high-intensity movements was reduced in each quarter. As such, the ability to repeat sprints under conditions of fatigue (i.e., the 12 × 20 m repeated sprint test) may be deemed appropriate.
An assessment and training method that is commonly used within basketball is the suicide run. Hoare (30) reported significant differences in suicide run time in the “best” versus the “rest” in their assessment of Australian male and female basketball players. However, the use of suicide runs has been questioned (21) because of their nonspecific nature in terms of game demands. Anaerobic capacity, a key component of successful basketball performance, defined as the maximal rate of energy production by the combined phosphagen and lactic acid energy systems, has been suggested as the primary component for exercises lasting 30–90 seconds (42). Although it has been proposed that this test may reflect the anaerobic capacity component of competition (42), with durations of approximately 30 seconds, validity concerns within the literature are present. This was highlighted by Delextrat and Cohen (21) who reported no significant differences between first and second team players in suicide run performance. This was likely because of the shorter higher frequency game actions as has been reported previously (2).
As mentioned above, aerobic performance has been shown to affect the game of basketball because of the ability to repeat high-intensity efforts (2,15). According to Castagna et al. (15), the Yo-Yo IR1 was able to detect significant differences across competitive levels, suggesting that basketball requires well-developed aerobic and anaerobic capabilities, as has been confirmed elsewhere (1: 46; 2). Although this evidence should be considered, further research may be necessary to support findings because it opposes the majority of previous research discussed above.
LANDING MECHANICS/UTILIZATION OF THE STRETCH SHORTENING CYCLE
It has been evidenced that maximal power production in jumping tasks is related to lower-limb stiffness (4). Furthermore, athletes from power-based sports demonstrate higher leg stiffness than endurance-trained athletes during a one-legged vertical jump (37). Stiffness is an important parameter to the power athlete because they will maximize the storage and release of elastic energy in the musculotendinous unit to improve muscle power and jump height (9). During a countermovement jump (CMJ), a stiffer musculotendinous system might benefit the performance through a faster elastic recoil during the upward concentric phase of the jump (4), as well as a more efficient transfer of force to the skeleton (58). Rabita et al. (48) speculated that in trained athletes with a skilled motor program, the neuromuscular system adopts strategies to find the optimal balance between these conflicting requirements.
Ineffective absorption of impact forces has been noted within basketball (25). In particular, it was highlighted that females demonstrated inadequate abilities to withstand eccentric forces on landing. This is an important consideration for S&C coaches because of increases in injury risk, in addition to an inability to effectively use elastic energy accumulated in the eccentric phase of the jump (8). It has been suggested that the longer ground contact times displayed within basketball athletes may be due to player-specific body constitution, differences in jumping technique, poorly developed explosive strength, and elasticity of the leg extensor muscles because of insufficient rigidity and poor landing mechanics (22). Subsequently, an assessment of the athlete's limb stiffness and reactive strength index is recommended as a measure of their effectiveness in switching from an eccentric to a concentric contraction. In addition, a qualitative assessment of landing mechanics, such as the Landing Error Scoring System, established by Padua et al. (47) will provide coaches with useful information that may aid in injury prevention.
Another consideration in the assessment of basketball players is preferred limb dominance and muscle balance. Theoharopoulos and Tsitskaris (55) noted a difference in the ankle plantar-flexor strength in favor of the preferred take-off limb in professional basketball players with observed differences of 10%. Some element of limb asymmetry is to be anticipated; however, these findings may validate the use of a single-leg CMJ to determine power ratios and imbalances between limbs. Of note, Bracic et al. (11) identified that elite sprinters who demonstrated lower bilateral deficits in CMJ produced higher peak forces (r = 0.63). This is an important consideration, as in addition to performance decrements, it has been reported that a discrepancy >15% is an important injury predictor for recurrent hamstring strains (19). Subsequently, the inclusion of a unilateral measure of performance such as a single-leg CMJ is recommended.
As highlighted above, strength, power, agility, and speed are important characteristics for elite basketball players (31,38). Based on the evidence outlined in this article, the following testing battery is proposed to assist S&C coaches in the determination of the physical abilities of basketball players (Table 1). It is suggested that the order of testing provided is the most appropriate (i.e., least to most fatiguing) and will ensure optimal efficiency. Furthermore, the specified sequencing is in agreement with National Strength and Conditioning Association recommendations (28).
INJURIES IN BASKETBALL
Previous study has reported that male high school basketball players sustained injuries at a rate of 16.9 per 1,000 hours of game exposure (44). By way of comparison, the NBA noted an overall game injury rate of 19.3 per 1,000 athlete exposures (20), suggesting that injuries are prevalent within competition, in particular, the joints most at risk are the knee (19.1%), ankle (16.9%), lumbosacral spine (9%), and foot, accounting for 7.9% (20). Additionally, 37% of all injuries occurred in the upper extremity with finger and shoulder being the most frequent sites (36).
Conversely, Randall et al. (49) reported that the highest proportion of injuries were ankle ligament sprains (26.2%), with knee internal derangements as secondary (7.4%), over a 16-year period in male collegiate basketball players. Consequently, an important consideration for the S&C coach is to provide a detailed assessment of static and dynamic unilateral stability because of reported inhibition of the gluteus maximus and gluteus medius (key hip extensors and hip abductors, respectively) after the occurrence of an ankle injury (13,26). Such neuromuscular deficiencies may result in greater frontal plane loads at the knee, coinciding with higher hip adduction moments because of reduced muscle activation during landing tasks (29). This bears relevance as anterior cruciate ligament injuries likely occur when active muscular restraints are unable to compensate and adequately reduce joint torques during dynamic movements such as landing, decelerating, and pivoting (7). Consequently, reduced neuromuscular control directs excessive stress to the passive ligamentous structures, which may exceed their strength limit, resulting in mechanical failure (39).
The primary injury mechanisms within a game have been classified as player contact, other contact (e.g., balls or the ground), and no contact, with the highest proportion of injuries being as a result of player contact (49). In the same study, the authors determined that a majority of the injuries were soft tissue in nature, to the lower limb and back, attributed to the fact that basketball is characterized by rapid changes of direction, nonlinear movements and high eccentric forces (in the forms of landing from a jump, cutting maneuvers, and sudden decelerations). A point of caution is highlighted by Besier et al. (6) in their analysis of planned versus unplanned cutting movements. In the subjects tested, unplanned cutting tasks allowed insufficient time to make the necessary postural adjustments, resulting in compromised leg placements and significantly greater loads on the knee joint. The authors summarized that learning to respond to stimuli more quickly in change of direction tasks may enhance performance and also reduce injury risk. This suggests that the development of sufficient strength and neuromuscular control is essential to tolerate the increased forces displayed in open environments. In addition, it is recommended that players develop optimal on-court movement mechanics using primarily closed drills, and when technique is appropriate, progress to more open situations with a reactive component. It is beyond the scope of this article to discuss further details of approaches to develop change of direction speed and agility; however, the reader is directed to the study of Turner (56) and for specifics to youth populations, Lloyd et al. (41) for more detailed explanations.
This article has provided an analysis of the demands of basketball with regard to the key physical, physiological, and biomechanical components. Furthermore, based on the evidence provided, a subsequent testing battery has been proposed by which S&C professionals can effectively assess and monitor the abilities of their athletes to assist in the development of optimal training provision with the aims of reducing injuries and optimizing performance.
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