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Pre-season training programme

Prehabilitation - How to design a pre-season programme

Scott Smith explains the principles and how they are applied in the Aussie Rules AFL

As a physiotherapist for a sports team, I am well aware that the pre-season period is the time of year when I can have the most impact on the team’s performance. Evidence has shown us that a well-managed pre-season ‘prehab’ programme can significantly reduce the risk of injury to participants(1,2).

By well-managed I mean a programme that is specific to the particular sport/sporting style (or code), and which has variable intensities and starts three to four months prior to competition.

It has taken us a while as sports support professionals to get the formula for pre- season training exactly right. For instance, a number of rugby league studies have shown that if you make your pre-season training too intensive, you can increaseyour athletes’ injury risk(3).

With research, trial and error we have evolved a good understanding of what works: how to time the gradual build-up, peak and decrease in training intensity; when to cross-train; and which muscle groups and joints to target.

As practitioners we encourage pre-season training not only to minimise the risk of injury in healthy, fit players, but importantly, also to aid the rehabilitation of injuries that might be carried over from the previous season. I have often had clients come to me at the start of a competition series complaining that they have re-injured an area that they hurt at the end of the previous season. On further questioning it transpires that they didn’t take the time to attend the pre-season training, and therefore started the season ‘cold’.

Just as each sportsman or woman has individual needs, so, too, each sport or sports style has its specific biases/priorities. The team physiotherapist must be able to identify which injuries are associated with their particular sport and adapt the pre-season training programme to maximise their players’ preparation.

Strong encouragement may be needed to persuade all players to attend pre-season training, so that they give their bodies the best possible build-up. One danger point to watch for is the new recruit or ambitious young player, who is going to be trying hard right from the start of the season to impress the coach in order to make the ‘A’ team – and is highly likely to overdo it early on.

Does it really make a difference?

While each sport will have its own unique formula for pre-season preparation, the research highlights the following as prime benefits of all well-managed programmes:

*increased maximum aerobic power

*increased muscle power

*improved aerobic endurance and capacity

*development of speed and agility

*development of individual and team skills.

In simple terms, if you conduct a few fitness tests before the start of a pre-season programme, you should find by the end of the three- to four-month period that test results show clear improvement in these areas compared to athletes who do not do the training.

The specific improvements, of course, will depend upon the sport for which you are training and therefore the type of training you are prioritising, eg strength circuits for muscle power; interval-based running for acceleration, speed and aerobic endurance; drills with ball skills for balance and agility.

Prehab principles

Sport-specific: The key principle is that of ‘sport-specific’ training. Take, for example, AFL (Australian Rules football) and soccer. Both sports have been shown to have a high incidence of hamstring tears, which occur because of intensive repeated sprinting by players over relatively prolonged periods. Pre-season training must therefore target drills and skills that gradually prepare the hamstring muscles for both the volume and the intensity of power expected in a full 90-minute game. And the hamstring training should involve both concentric and eccentric work.

Balanced:It is important not only to train the prime mover muscles specific to the sport, but also those that counteract them (the antagonists), to ensure proper control and balance. Our bodies are very dynamic and rely on coordinated control to move us about. If our prehab training were to concentrate too much on the hamstring and not on the opposing quadriceps group, we would upset the ratio between them, setting the quads up for injury even while we are trying to protect the hamstrings from damage.

Richardson and Bullock (1986)(4)demonstrated that with increasing speed of knee extension and flexion (as occurs in running), rectus femoris and the lateral hamstrings increase their muscular activity levels. This did not occur in the lateral and medial quadriceps muscles. Therefore imbalances of the muscle groups occur and corrective drills should be performed to aid this. Separate research(5)shows that maintaining a good length of the rectus femoris muscle is a significant factor in preventing hamstring injuries, as it helps to maintain good passive hip extension, thereby reducing the workload on gluteals and hamstrings. This study’s findings can be used in the development of hamstring injury prevention programmes.

Overall, the principle of balanced training implies a combination of weight strengthening, active movement drills and balance exercises so that the target muscles are forced to work in varied environments.

How it works in the AFL

Pre-season training sessions are typically high volume and low intensity. Prehab should commence three to four months prior to the first round of competition. Sessions are held twice a week and last 60 to 100 minutes.

The main aim of these sessions is extensive aerobic and anaerobic interval training, to build cardiovascular fitness while focusing on game-specific cardio requirements. Skill work is woven into the cardio activity drills.

So, for example, the warm-up might be followed by hand-passing drills (for AFL) or touch-control drills (for soccer); then slow laps of the oval; then higher intensity run-throughs and longer endurance speed sessions. Finally, there would be stretching and some core stability control work. As hamstrings are prone to injury when fatigued, the session would incorporate static and dynamic stretches of the athletes’ tired muscles.

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The skills component might target speed, power and agility by using drills for:

*passing

*catching

*ball-carrying technique

*tackling.

If the sport makes specific strength demands on its players, a suitable prehab component needs to be included (see box above).

The coach should undertake a range of fitness tests at the start of the prehab programme and again towards the end. These might include:

*shuttle run test (over 10m, 20m and 40m sprints)

*anthropometry (height, weight, body mass and body composition)

*muscle power (vertical jump height)

*agility (timed L run: straight line speed plus change of direction).

AFL-specific exercises

1. Hamstring stretch with varying degrees of knee flexion

2. Change of running speed combined with trunk flexion

3. Change of running speed combined with trunk flexion while tapping/rolling a ball

4. Change of running speed combined with trunk flexion while tapping/rolling a ball, while someone is tackling

5. Lying eccentric hamstring exercise

6. Forward lunges stepping on to an AFL ball (yes, you step on to the ball – it’s hard)

7. Hand passes while squatting on an air disc.

These last two are favourites of mine. Both challenge the athlete in controlling lateral direction strain, which is important in minimising groin injuries.

Conclusion

It has taken many years to refine the formula for pre-season training, so that intensity levels are not set so high as to lead to early injury and burnout. The take-home message for support professionals is to be rigorously sport-specific and balanced in pre-season programming, with a high priority given to educating players about the need to focus on injury prevention as an integral part of their fitness build-up, if they are to avoid becoming early casualties once competition gets under way.

References

1.Askling C, Karlsson J, Thorstensson A, ‘Hamstring injury occurrence in elite soccer players after preseason strength training with eccentric overload’ Scand J Med Sci Sports2005; 15(1):1-2

2.Petersen W, Zantop T, Steensen M, Hypa A, Wessolowski T, Hassenpflug J, ‘Prevention of lower extremity injuries in handball: initial results of the handball injuries prevention programme’ [Article in German] Sportverletz Sportschaden 2002; 16(3):122-6

3.Gabbett TJ, ‘Reductions in pre-season training loads reduce training injury rates in rugby league players’, Br J Sports Med 2004; 38:743-749

4.Richardson C, Bullock M, ‘Changes in muscle activity during fast, alternating flexion-extension movements of the knee’ Scandinavian Journal of Rehabilitation Medicine1986; 18: 51-58

5.Gabbe BJ, Finch CF, Bennell KL, Wajswelner H, ‘Risk factors for hamstring injuries in community level Australian football’ Br J Sports Med2005; 39(2): 106-10.

Pre-season training programme