Training the developing brain part II: cognitive considerations for youth instruction and feedback.

Growing numbers of youth participating in competitive, organized physical activity have led to a concern for the risk of sports-related injuries during important periods of human development. Recent studies have demonstrated the ability of integrative neuromuscular training (INT) to enhance athletic performance and reduce the risk of sports-related injuries in youth. Successful implementation of INT necessitates instruction from knowledgeable and qualified instructors who understand the unique physical, cognitive, and psychosocial characteristics of the youth to provide appropriate training instruction and feedback. Principles of a classical theory of cognitive development provide a useful context for discussion of developmentally appropriate methods and strategies for INT instruction of youth. INT programs that consider these developmentally appropriate approaches will provide a controlled efficacious environment for youth to improve athletic performance and reduce risk of sports-related injury, thus promoting a healthy active lifestyle beyond an individual's formative years.

A Commentary on Real-Time Biofeedback to Augment Neuromuscular Training for ACL Injury Prevention in Adolescent Athletes.

Anterior cruciate ligament injury and the associated long-term sequelae, such as immediate reductions in physical inactivity, increased adiposity and increased risk of osteoarthritis throughout adulthood, are a major health concern for adolescent athletes. Current interventions for injury prevention may have limited effectiveness, are susceptible to issues of compliance and have not achieved the widespread acceptance necessary to promote full adoption. Neuromuscular training (NMT) is a well-established training intervention introduced to affect change in modifiable biomechanical risk factors to reduce the risk of injury in these athletes. Despite moderate success, neuromuscular training is still limited by its reliance on subjective feedback and after the fact (i.e., offline) objective feedback techniques. The purpose of this commentary is to discuss technological tools that could be used to enhance and objectify targeted biofeedback interventions to complement NMT. Electromyography, force plates, motion sensors, and camera-based motion capture systems are innovative tools that may have realistic feasibility for integration as biofeedback into NMT programs to improve training outcomes. Improved functional deficit identification and corrective analysis may further improve and optimize athletic performance, and decrease the risk of sports-related injury during sport performance. Key pointsSpecific, targeted interventions that isolate injury risk factors and can help correct modifiable neuromuscular deficits are essential.Current training interventions for anterior cruciate ligament (ACL) injury prevention have only demonstrated limited effectiveness and have not achieved the widespread acceptance necessary to promote full adoption to reduce ACL injury rates.The paper provides an overview of innovative strategies and technological tools that could be used to enhance and objectify targeted biofeedback interventions to complement neuromuscular training (NMT) including electromyography, force plates, motion sensors, and camera-based motion capture systems.These strategies utilize biomechanical, physiological, or neuromotor variables for training, automate the quantitative measurement of those variables through a variety of technological modalities, and then feed those measured variables via software to provide information in simplified form for online, visual biofeedback displays.

Training the developing brain, part I: cognitive developmental considerations for training youth.

Based on the fundamental principles of pediatric exercise science and developmental physiology, childhood provides a critical window to develop the physical readiness of youth through age-related training programs that are designed purposely to teach and reinforce fundamental movement skills to enhance preparedness for physical activity and sport. Successful implementation of developmental programs requires age-related instruction by qualified professionals who understand the physical and psychosocial uniqueness of children and adolescents. An understanding of the interaction of physical and cognitive development is needed to design and implement training strategies that optimize training outcomes. Regular training with structured and integrative modalities throughout the developmental years as part of physical education, recreation, and sports practice can improve athletic performance while reducing common sports-related injuries and can facilitate the adoption of healthy lifestyles throughout adulthood. In this commentary, we outline cognitive developmental considerations in youth that may influence the design and implementation of training programs aimed at optimizing motor skill development in youth.

The Back Squat Part 2: Targeted Training Techniques to Correct Functional Deficits and Technical Factors that Limit Performance.

The back squat is a well-researched and widely used exercise to enhance fundamental movement competency that creates a foundation for optimal mechanical strategies during a broad range of activities. The primary commentary introduced the Back Squat Assessment (BSA): a criterion based assessment of the back squat that delineates 30 potentially observable functional deficits. This follow-up commentary provides a targeted system of training cues and exercises to supplement the BSA to guide corrective intervention. We propose a criterion driven approach to corrective exercise that can support practitioners in their goal to help individuals achieve movement competency in the back squat.

Rates of concussion are lower in National Football League games played at higher altitudes.

STUDY DESIGN: Retrospective epidemiologic investigation. OBJECTIVE: To investigate the relationship between altitude and concussion rate in the National Football League (NFL). Because of the physiologic responses that occur during acclimatization to altitude, it was hypothesized that games played on fields at a higher altitude would have reduced concussion rates compared to games played on fields at a lower altitude. BACKGROUND: Recent research indicates that the elevation above sea level at which football games are played may be associated with the likelihood of a concussion in high school football athletes. METHODS: Data on incident concussions and athlete exposures for the first 16 weeks of the NFL 2012 and 2013 regular seasons were obtained from publicly available web-based sources and used to calculate competition concussion rates for each NFL stadium. Concussion rates were analyzed in relation to game elevation. RESULTS: During the first 16 weeks of the 2012 and 2013 NFL regular seasons, 300 concussions, involving 284 players, were reported (64.3 primary cases per 10,000 game exposures). The odds of a concussion were 30% lower when playing at a higher elevation (equal to or greater than 644 ft [196.3 m] above sea level) compared to a lower elevation (odds ratio = 0.70; 95% confidence interval: 0.53, 0.94). A multivariable generalized linear model controlling for season, week, and clustering of team at home and away confirmed these results, showing that the odds of at least 1 concussion were reduced by 32% in games played at higher elevation. CONCLUSION: The results of this epidemiological investigation indicate that increased altitude was associated with a reduction in the odds of a sport-related concussion in NFL athletes. The reported relationship of concussion incidence and field elevation should be further investigated, and, if verified, further work will be needed to understand why that relationship exists. LEVEL OF EVIDENCE: Prognosis, level 2c.

The back squat: A proposed assessment of functional deficits and technical factors that limit performance.

Fundamental movement competency is essential for participation in physical activity and for mitigating the risk of injury, which are both key elements of health throughout life. The squat movement pattern is arguably one of the most primal and critical fundamental movements necessary to improve sport performance, to reduce injury risk and to support lifelong physical activity. Based on current evidence, this first (1 of 2) report deconstructs the technical performance of the back squat as a foundation training exercise and presents a novel dynamic screening tool that incorporates identification techniques for functional deficits that limit squat performance and injury resilience. The follow-up report will outline targeted corrective methodology for each of the functional deficits presented in the assessment tool.