Football is a high-impact collision sport. Every play has the potential to cause minor to severe injury. Despite preventive measures such as protective equipment, National Collegiate Athletic Association rules, and strength and conditioning programs, college football accounts for some of the highest injury rates in sports (1). It is well documented that the majority of injuries occur in games versus practice (1,2,11). For this reason, it is important for the strength and conditioning coach to have a plan for training injured athletes in season. The goal of this plan should be to give athletes the opportunity to maintain or exceed the training levels they worked so hard to achieve during the off-season.
The in-season period is accompanied by a decrease in resistance training exposures as more time is dedicated to sport practice and competition. During this time, probability of injury dramatically increases. Injuries affect the athlete's ability to participate in the normal in-season team training regiment. In addition, soreness and fatigue may also inhibit the athlete's ability to use prescribed exercises and intensities. When the athlete is forced to decrease training stimulus such as skill practice, metabolic conditioning, and strength training, his performance may be negatively impacted on return to the field. This condition is commonly classified as detraining (4,6-8).
Research shows that in-season detraining can be minimized by using core lifts like the squat, deadlift, clean, and bench press at a reduced volume (5,10) and sustained intensity. More specifically, weight on the bar should be above or equal to 80% of a 1 repetition maximum (3).
It is important for strength coaches and athletic trainers to educate the athlete that although modified workouts may be necessary, soreness or injury does not justify excusal from strength workouts. Excusal encourages detraining, which further puts athletes at risk for injury. Noninjured areas of the body must be kept as strong as possible, whereas sore or injured sites are treated. Diligent rehabilitation and gradual reentry to normal training and practice allows the injured area to catch up with the rest of the body.
The strength and conditioning and athletic training staffs must work together to safely return athletes to their full abilities in the most timely manner possible. They must simultaneously emphasize reconditioning and training at intensities that allow the athlete to maintain or improve on previously acquired strength levels.
In the game of football, there are vast arrays of injuries ranging from mild to severe. The arms and legs are injured most often (1,9,11). When an injury disrupts the in-season resistance training program, the strength and conditioning and athletic training staffs must determine what exercises can and cannot be used. The athletic training staff must specify the injury and communicate limitations to the strength and conditioning staff. Limitations are classified into 3 general categories: no resistance training, no resistance training to affected site, or modified resistance training to affected site.
CLASSIFICATION I: NO RESISTANCE TRAINING
The strength and conditioning staff has minimal hands-on involvement with this classification. However, this period can be used to develop the modified programs the athlete will follow as he is upgraded by the athletic training staff to higher injury classifications (II and III).
It is also important to recognize that athletes who are absolutely restricted from participating in resistance training with teammates will need encouragement and support to remain positive toward returning to play. The strength and conditioning staff develops unique personal relationships with athletes and therefore may play a vital role in helping to keep injured athletes motivated.
CLASSIFICATION II: NO TRAINING TO AFFECTED SITE
When an athlete has a major surgery, breaks a bone, or tears a muscle, the affected site may need to be completely rested or only exercised during rehabilitation sessions. As previously indicated, injuries to the limbs are most common. Research shows that unilateral training of the opposite limb can have a positive training impact on the affected limb. This positive adaptation, known as “cross transfer,” can improve the immobile portion of the body opposite the one being trained (5). Following this concept, an injured athlete is encouraged to work with the team during the in-season strengthening program training all unaffected body parts, especially the unilateral side of the injury.
CLASSIFICATION III: MODIFIED TRAINING TO AFFECTED SITE
The third classification involves the use of injury-specific rehabilitation exercises as directed by the athletic training staff. Although specific limitations are identified, the athlete is encouraged to participate with the team during the in-season resistance training program. Certain strength training exercises are allowed even though they involve the injured site.
Developing a modified resistance training program requires the strength and conditioning staff to use ingenuity and creativity. It also requires a coordinated approach with the athletic training staff. Both staffs must be in constant communication to ensure that further injury is avoided.
TRAINING THE INJURED ATHLETE
Most in-season training programs designed for football comprised core lifts such as the squat, deadlift, bench press, and clean. When injured during the competitive season, athletes must be provided with options similar to the core lifts they are unable to perform to avoid detraining. The area of the body injured and extent of that injury will dictate which options are safe.
The training plan should encompass 2 main areas: reconditioning of affected site and improvement or maintenance of all healthy areas. As with any performance-related training regiment, risk of injury should always be a concern.
Table 1 provides viable alternatives to core lifts (see classification II) based on complete immobilization of an injured area of the body. Proper precautions have been taken into consideration for these exercises, but it is up to the athletic training and strength and conditioning staffs to determine which, if any, are appropriate for the strength and skill levels of the specific athlete being treated. Table 2 provides suggested sets and repetitions for the core exercise substitutions in Table 1, including periodization. These sets and repetitions should allow for performance at or above 80%, which is considered sufficient to maintain or improve strength levels gained during the off-season.
Common limb injuries that immobilize the upper or lower leg inhibit the athlete's ability to perform cleans, snatches, squats, and deadlifts. These injuries include toe, foot, and ankle fractures; severe sprains; tibia/fibular fractures; knee surgeries; and hamstring tears. These often require use of a brace, boot, or cast that cannot support the athlete's bodyweight. Because core lifts are complex movements, the strength and conditioning staff must ensure that the athlete safely executes the provided alternative. Strength and skill levels must be taken into consideration before the athlete attempts any of these exercises.
CORE EXERCISE ALTERNATIVES
Perhaps a good alternative to the clean or snatch for someone in a brace, cast, or boot is the single leg snatch and/or single leg clean pull. Initially, lighter weights should be used to ensure proper technique. Weights can be increased once sufficient skill levels are acquired.
The single leg snatch can be performed next to a jump box for added safety and support (Figure 1). The single leg clean pull can be performed inside a squat rack with catches in place (Figure 2). As a safety precaution, the athlete can simply hold onto the bar and rest it back on the safety catches if he loses balance. Both exercises allow the athlete to train consistently even while immobilized in a boot or cast.
The single leg deadlift and/or hyperextension can be substituted for squats or deadlifts. The single leg deadlift (Figure 3) allows the athlete to safely continue training the nonaffected leg in a manner similar to that of the traditional deadlift and squat. The hyperextension also has many different modifications to accommodate various lower body injuries (Figures 4, 5).
Fractures or surgeries affecting the upper body, that is, fingers, hands, wrists, lower/upper arms, elbows, and shoulders, may also inhibit the body's ability to perform core lifts. The single arm snatch (Figure 6) and/or box jump (Figure 7) are safe and effective alternatives to cleans/snatches. Shoulder and elbow injuries may be especially prone to reinjury, however, so it is important to keep the immobilized area free of movement.
Squats and deadlifts can be replaced with various single leg squats, such as the reverse lunge (Figure 8) and Bulgarian split squat (Figure 9), with implements held by the nonimmobilized limb. The bench press can be replaced with single arm bench presses (Figures 10, 11) of varying angles.
Although strength training sessions may need to be modified according to soreness, fatigue, and injury, all athletes should participate in in-season resistance training if possible. The primary goal of training the injured athlete is to return to traditional core lifts as soon as possible. There are many core lift substitutes for the injured athlete. Those that closely mimic core lifts are the most desirable. By using similar exercises, the athlete's performance drop-off will be minimized on return to normal training. Minimizing detraining makes reentry into practice or the competitive season more seamless for the athlete. Following the recommendations in this paper will help ensure that injured athletes maintain focus and are prepared for reentry into normal team participation.
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