nsca tsac report | 38 · · 2015-09-024 nscas tsac report issue 38 trisha stavinoha, ms, rd,...

TSAC REPORT ISSUE 38

2015 PERSONAL TRAINERS CONFERENCE

OCTOBER 10 – 12, 2015 | ANAHEIM, CANSCA.COM/PTCON2015

http://www.nsca.com/ptcon2015

NSCA’S TSAC REPORT | ISSUE 38 3

TSAC REPORTTABLE OF CONTENTS

NSCA MISSIONAs the worldwide authority on strength and conditioning, we support and disseminate research-based knowledge and its practical application, to improve athletic performance and fitness.

TSAC EDITORIAL REVIEW PANELMark Abel, PHD, CSCS,*D, TSAC-F

Jon Barba, MS, CSCS

Jerry Bean, MS, ATC, LAT, CSCS, TSAC-F

Jon Carlock, MS, CSCS,*D

Patrick Conway, MS, CSCS,*D

Brett Crossland, MS, CSCS

Jason Dudley, MS, CSCS,*D, TSAC-F, FMS-1, RSCC

Jason Hartman, MS

John Hofman, MS, CSCS

Travis Ireland, MS, ATC, CSCS

Katie Miller, RD, LDN, CSCS

Brian Schilling, PHD, CSCS, FNSCA

Katie Sell, PHD, CSCS

Kevin Serre, PHD, MS, CSCS

Courtney Shinost, MS, CSCS, NSCA-CPT

Stew Smith, CSCS

Tony Soika, MS, CSCS

Mick Stierli, MS, CSCS

Henry “Hal” Williamson, TSAC-F

STAFFEditorRob Orr, PHD

Assistant EditorBritt Chandler, MS, CSCS,*D,

NSCA-CPT,*D

Publications DirectorKeith Cinea, MA, CSCS,*D,

NSCA-CPT,*D

Managing Editor Matthew Sandstead, NSCA-CPT,*D

Publications Coordinator Cody Urban

CONTACTNSCA TSAC1885 Bob Johnson Drive Colorado Springs, CO 80906phone: 800-815-6826

TSAC Report email: [email protected]

Managing Editor: [email protected]

© 2015 National Strength and Conditioning Association.Reproduction without permission is prohibited.

ISSN:

ISSUE 38

NSCA MISSIONAs the worldwide authority on strength and conditioning, we support and disseminate research-based knowledge and its practical application, to improve athletic performance and fitness.

TSAC EDITORIAL REVIEW PANELMark Abel, PHD, CSCS,*D, TSAC-F

Jon Barba, MS, CSCS

Jerry Bean, MS, ATC, LAT, CSCS, TSAC-F

Jon Carlock, MS, CSCS,*D

Patrick Conway, MS, CSCS,*D

Brett Crossland, MS, CSCS

Jason Dudley, MS, CSCS,*D, TSAC-F, FMS-1, RSCC

Jason Hartman, MS

John Hofman, MS, CSCS

Travis Ireland, MS, ATC, CSCS

Katie Miller, RD, LDN, CSCS

Brian Schilling, PHD, CSCS, FNSCA

Katie Sell, PHD, CSCS

Kevin Serre, PHD, MS, CSCS

Courtney Shinost, MS, CSCS, NSCA-CPT

Stew Smith, CSCS

Tony Soika, MS, CSCS

Mick Stierli, MS, CSCS

Henry “Hal” Williamson, TSAC-F

STAFFEditorRob Orr, PHD

Assistant EditorBritt Chandler, MS, CSCS,*D,

NSCA-CPT,*D

Publications DirectorKeith Cinea, MA, CSCS,*D,

NSCA-CPT,*D

Managing Editor Matthew Sandstead, NSCA-CPT,*D

Publications Coordinator Cody Urban

CONTACTNSCA TSAC1885 Bob Johnson Drive Colorado Springs, CO 80906phone: 800-815-6826

TSAC Report email: [email protected]

Managing Editor: [email protected]

© 2015 National Strength and Conditioning Association.Reproduction without permission is prohibited.

ISSN: 2378-7392

ACCOUNTING FOR MENTAL AND PHYSICAL STRESS IN THE LAW ENFORCEMENT PHYSICAL TRAINING SCHEDULEMARCUS TRUSTY, CSCS

PHYSICAL ASSESSMENT OF AN AIR NATIONAL GUARD PARARESCUE TEAM AND THE IMPORTANCE OF A SPECIALIZED TRAINING PROGRAMKARA FEDEROWICZ, ATC, CSCS, JAMIE OSMAK, CSCS, USATF-1, JASON MACHOWSKY, MS, CSSD, CSCS, AND POLLY DEMILLE, MS, RN, CSCS, USAT

PROGRESSION FOR FIRST RESPONDERS TO HELP PREVENT LIFTING INJURIESBRYAN FASS, ATC, LAT, EMT-P, CSCS

THE IMPORTANCE OF PROPER MOVEMENT FOR MARINES— PART 3: EVIDENCE-BASED MOVEMENT ASSESSMENTMATT ZUMMO, MS, USAW-1

DEVELOP THE BASIC MOVEMENT PATTERNS BEFORE TRAINING FOR SPECIFICITYROBB ROGERS, MED

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TSAC RESEARCH REVIEWROD POPE, PHD

STRESS INOCULATION TRAINING IN TACTICAL STRENGTH AND CONDITIONINGCRAIG WELLER

PICK YOUR PROTEINTRISHA STAVINOHA, MS, RD, CSSD, CSCS 04

0610

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mailto:matthew.sandstead%40nsca.com?subject=

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NSCA’S TSAC REPORT | ISSUE 384

TRISHA STAVINOHA, MS, RD, CSSD, CSCS

PICK YOUR PROTEIN

Protein supplements alone are a $7 billion industry (2). Selecting a protein supplement is of particular importance in the military since protein makes up the second most

frequently used supplement in military populations (multivitamins are the most common supplement) (6). Protein supplements are not tested for safety, quality, or purity by the Food and Drug Administration (FDA) or any federal or state agency prior to sale. A 2010 review found that 31% of selected protein supplements failed quality testing (6). Additionally, Forbes Magazine recently published an article shedding light on how some protein supplements may contain far less protein than what is listed on the label (2). For example, the label for one such protein supplement claimed that it contains 27 g of protein, however, third party testing confirmed the product only contains 12 g of protein. This is partly due to companies using the weight of amino acids to contribute to the entire protein content. In the aforementioned example, the product may have contained 12 g of protein, plus 15 g of amino acids to equal 27 g of “protein.” This is of particular concern to the tactical population because incorrectly labeled products could result in either a protein deficiency or overuse. Considering this, using supplements that have been third party tested can help in avoiding poorly made products that contain potentially dangerous contaminants.

Before taking a protein supplement, the tactical athlete should determine if protein supplementation is even needed. Most tactical athletes need about 1.5 – 2.0 g of protein per kg of bodyweight for active military personnel or 0.8 – 1.5 g per kg of bodyweight for the average tactical athlete (4). The concern is less about how much protein the athlete is getting, but how it is spread out over the course of the day. Athletes should keep a food log for a couple of days. This log may be a simple pen-and-paper diary or one of the many food log websites or phone/tablet applications. They should then review not only their total daily protein intake, but also how it is spaced. This will also allow them to determine if their protein intake is sufficient, particularly after workouts. A protein intake of 120 g is better utilized in four 30-g doses as opposed to two 60-g doses (1).

If the athlete is falling short of protein requirements or needs a convenient option for post-workout protein, then a protein supplement may indeed be warranted. Conversely, if the athlete is getting enough daily protein but just not enough specifically after the workout, the athlete should aim to distribute the doses evenly throughout the day and base some of their intake according to the time of the workout. Table 1 provides an example of a modified meal plan to spread protein intake out throughout the day efficiently while accommodating for a workout.

Most protein powders contain 20 – 30 g of protein per scoop. Some ready-to-drink protein supplements will contain about 15 –

45 g per drink. The ideal dose of protein is 20 – 40 g per serving (1). If the product is 100% protein or has very little carbohydrates, a recommended intake method is to mix the protein powder with almond milk, juice, or a sport drink for some additional carbohydrates, if additional carbohydrates are deemed necessary. If it is a ready-to-drink supplement, an intake option could be to pour the drink over dry cereal or drink it with a fruit. Many protein bars, protein powders, and ready-to-drink protein products already contain sufficient carbohydrates, but again, the tactical athlete should take time to verify the accuracy of the label before assuming it is correct. Choosing unprocessed food is another viable option; however, some protein foods need to be kept cold and may not be as convenient as previously mentioned options.

The final consideration, and most critical to safety, is to select a reputable brand. Most retail and online supplement stores have well over 100 protein supplement options. NSF International® is an organization that conducts third party testing on a variety of supplements, including protein (3). Supplement companies pay a fee to have their products tested and inspected. If they pass, they are then officially “certified for sport.” Supplements on this list have a low risk of being contaminated with banned substances such as steroids or other drug products (3). Additionally, consumers can be confident that the amount of protein on the label matches what is in the actual product. The list is updated regularly and includes brands that are available at most retail stores. It is worth noting that just because one product from a particular brand is certified, it does not mean that all products from that brand are certified. Another resource that tactical athletes can use to evaluate supplements is consumerlab.com. They have reviews on protein supplements and protein/meal bars, which are not technically considered supplements, but may have issues with quality (5,6).

Types of protein to choose from that are considered complete proteins (i.e., contain all nine essential amino acids) include whey, casein, soy, egg, pea, hemp, and combinations thereof. People looking to get more branched-chain amino acids (BCAA) should aim for whey protein. This form of protein is also found to be most effective with stimulating muscle protein synthesis (1). Those allergic to milk may want to choose egg or soy protein sources. Vegans can consume protein via soy, pea, or hemp products. However, military service members may be advised to avoid hemp products due to concern of consuming excess amounts of tetrahydrocannabinol (THC). Most products claim to have low levels of THC; however, neither consumerlab.com nor NSF International have hemp proteins on their list of reviewed products (3).

Protein supplements can be a great way to improve protein intake, if necessary. To ensure safety and quality, tactical athletes should


VERY LONG ARTICLE TITLE GOES HERE AND TAKES UP LOTS AND LOTS OF ROOM

never assume that all products are risk-free and try to only select products that have undergone and passed a third party review.

REFERENCES1. McLain, T, and Escobar, K. Protein applications in sport nutrition – Part I: Requirements, quality, source, and optimal dose. Strength and Conditioning Journal 37(2): 61-71, 2015.

2. Morrell, A. Lawsuits say protein powders lack protein, ripping off athletes. Forbes. Retrieved 2015 from http://www.forbes.com/sites/alexmorrell/2015/03/12/lawsuits-say-protein-powders-lack-protein-ripping-off-athletes/.

3. NSF International. Certified for sport products. NSFsport.com. Retrieved 2015 from http://www.nsfsport.com.

4. Pasiakos, S, Austin, K, Lieberman, H, and Askew, E. Efficacy and safety of protein supplements for U.S. Armed Forces personnel: Consensus statement. Journal of Nutrition 143(11): 1811-1814, 2013.

5. Product review: Nutrition bars (energy bars, fiber bars, protein bars, meal replacement bars, and whole foods bars. Consumerlab.com. October, 2013. Retrieved 2015 from https://www.consumerlab.com/reviews/High_Protein_Bars_Low-Carb_Diet_Bars_Energy_Bars_and_Meal-Replacement_Bars/NutritionBars/.

6. Product review: Protein powders and drinks review. Consumerlab.com. March, 2015. Retrieved 2015 from https://www.consumerlab.com/reviews/Protein_Powders_Shakes_Drinks_Sports_%20Meal_Diet/NutritionDrinks/.

ABOUT THE AUTHORTrisha Stavinoha’s United States Army and dietetic career began in 1998 after earning her Bachelor of Science degree in Nutrition from Texas State University and being accepted into the United States Army’s dietetic internship program. Stavinoha earned her Master of Science degree in Sport Nutrition from Long Island University while concurrently competing on their track and field and cross-country teams. She has been a credentialed sport dietitian and strength and conditioning coach since 2008. Her credibility in sport nutrition comes from being a soldier, scholar, and athlete. Stavinoha’s experience with athletes includes a wide range of Olympic hopefuls in the Army’s esteemed World Class Athlete Program, high school and collegiate cross country runners, triathlon and endurance athletes, tactical soldiers, Wounded Warriors, and overweight service members trying to pass body fat and physical fitness standards.

PICK YOUR PROTEIN

TABLE 1. SAMPLE MODIFICATIONS TO A DAILY MEAL PLAN

ORIGINAL MEAL PLAN: ATHLETE IS GETTING ENOUGH PROTEIN BUT IT COULD BE DISTRIBUTED BETTER

MODIFIED MEAL PLAN: ADDED A POST-WORKOUT PROTEIN SUPPLEMENT, INCREASED PROTEIN AT BREAKFAST, AND DECREASED

PROTEIN AT DINNER

Workout: Cardio in the morning before breakfast and strength training around 12:00 – 3:00 pm

Breakfast at 8:30 am:

Bagel, peanut butter, and banana = 10 g of protein

Lunch at 12:00 pm:

6” turkey sub, pretzels, and soda = 20 g of protein

Dinner at 7:00 pm:

10 oz of chicken, vegetable, milk = 85 g of protein

Snack:

1 oz of almonds = 6 g of protein

Breakfast at 8:30 am:

3 egg whites, bagel, and banana = 25 g of protein

Lunch at 12:00 am:

6” turkey sub, pretzels, and milk = 30 g of protein

Post-workout snack at 3:30 pm:

Protein shake containing 25 g of protein

Dinner at 7:00 pm:

4 oz of chicken, rice, and vegetable = 35 g of protein

Snack:

1 oz almonds = 6 g of protein

Total: 121 g protein Total: 121 g protein


CRAIG WELLER

STRESS INOCULATION TRAINING IN TACTICAL STRENGTH AND CONDITIONING

Most jobs come with some stress; but perhaps none more so than those that can be experienced in tactical occupations such as firefighting, law enforcement, and

military. In these tactical jobs, demands are fast-paced and job tasks can be physically and psychologically intense. Adding to these demands, very complex situations may arise on-the-job where failure can yield catastrophic consequences (14,29). People may perform poorly under these conditions: in a tough situation they might panic, lose focus, get paralyzed, or burn out over the long term. Yet not everyone breaks down under pressure. Both individuals and teams vary in how they perform under these high-stress conditions (9,20,25,26,27). Therefore, it is a paramount to train tactical athletes to perform better under stress.

HUMANS OVER HARDWARESome tactical organizations may focus more on quantitative improvements (e.g., upgrading weapons, technology, or other hardware; or simply adding more personnel) than on qualitative improvements (e.g., improving the resilience, robustness, and job task effectiveness of people). For example, purchasing more expensive cars would not create excellent drivers. In other words, human operators are more important than the nature of the equipment they use (17). In addition, it is a lot easier, cheaper, and more efficient to train people to do a better job than it is to develop weapons or technology of comparable effectiveness (28). As the first Special Operations Forces (SOF) Truth states, “humans are more important than hardware,” (31).

STRESS INOCULATION TRAININGOne training methodology used to enhance performance under stress is known as stress inoculation training (SIT). SIT is composed of three stages:

1. Stage one: Conceptual education

2. Stage two: Skills acquisition and consolidation

3. Stage three: Application and follow-through

SIT is therefore less a set of specific tasks than a set of general principles (23). The most familiar versions of SIT used in military training are drills designed to improve water confidence, such as drownproofing. In this case, trainees have their feet and hands bound behind their back and get into a deep swimming pool. Then, they must swim, bob from the bottom of the pool to the surface for breaths of air, and perform a variety of maneuvers. As described in the Air Force Pararescue plan of instruction for indoctrination training, these drills “build the student’s strength and endurance; ability to follow critical instructions with emphasis on attention to details and situational awareness; ability to work

through crisis and high levels of stress in the water,” (30). This specific exercise has several goals (30):

• To help students recognize and understand their own natural stress responses

• To help them learn to control these responses when they emerge

• To gradually increase the level of difficulty and challenge

• To do this in a controlled, relatively safe training environment before exposing students to real-life, more dangerous situations

In tactical training, it is assumed that stress will degrade thinking and reasoning so students are trained to respond automatically and correctly, using thousands of repetitions to engrain the right behavior patterns. For example, from the first day a tactical athlete handles a weapon, they will learn to never place their finger on the trigger until they have made a conscious decision to fire. This rule is rigidly enforced during training so that it can be followed reliably and automatically under real-world stress.

TRAINING PERFORMANCE UNDER STRESSEfficient training to perform in stressful situations has four requirements (21):

1. Trainees must learn and become familiar with the stressors that could be part of a given situation, such as the mental and physical impacts of extreme fatigue

2. Those stressors must be progressive and cumulative—difficult enough to challenge the trainee, but not overwhelming

3. Each stage of training should prevent or manage the build-up of anxiety

4. Each training activity should develop the required technical skills (such as movement quality and positioning or control of stress responses) and not interfere with the development of those skills

For instance, a beginner tactical athlete learning to handle a weapon must first learn the fundamental skills (like finger-off-trigger) in a low-stress, slow-paced environment before applying them in a high-stress, fast-paced situation. SIT only works when individuals can first perform the target tasks in a non-stressed environment. If tasks are too complicated or the learning environment is too stressful, trainees will have a very



difficult time attempting to learn the skills. Additionally, they may get frustrated, lose confidence, or quit (21). The strategic application of non-stressed skill acquisition, familiarization with relevant stressors and their effects, and then, training in conditions that successively approximate real-world conditions is known as phased training (1,15,21).

PHYSICAL FITNESS AND SITAlong with specific skills training, successful tactical training and operational effectiveness requires physical fitness training. Physical fitness not only creates a foundation for task performance, it also builds two key qualities: resilience and toughness. Resilience is the ability to successfully tolerate and recover from traumatic or stressful events. It includes a range of physical, behavioral, social, and psychological factors (22,24). Toughness describes a range of psychological and physiological processes that enhance performance under stress (8,25,26). In general, individuals who are tough can usually choose their responses and activate performance under intense stress, deploy those responses only when needed, and quickly calm down once the stressful situation is over.

As with other aspects of training, the principles of SIT can be applied to building physical fitness. First, physical training should never be needlessly complicated or difficult, especially in the early stages. Initially, programs should focus on building skills in non-stressful situations and work towards helping the tactical athlete to reliably perform those skills under increasingly stressful situations. Over time, tactical athletes can do progressively more complex and difficult things.

THREE PHASES OF MOTOR LEARNINGMotor learning occurs in three phases (1,21). These phases are not distinct; but rather, they are more like a continuum.

THE COGNITIVE PHASEA simple example to show this is to look at the process of learning how to type. At first, most people do the “hunt and peck” method. This usually makes the person have to think about and remember where to find specific keys. The typing is generally very slow and the cognitive process takes up most of a person’s attention. At the cognitive phase, most individuals are making a lot of mistakes and are unable to manage more than one or two simple tasks at a time (3,5).

THE ASSOCIATIVE PHASEIn the associative phase, individuals can typically type entire words and sentences. At the advent of working proprioceptively, individuals start to reduce mistakes and feel rather than think about where the letters are located (16). In this phase, individuals start getting faster, more consistent, and more accurate. They are able to string the individual steps together into larger chunks, which reduces the demand on the working memory and attention. Motor memories at this phase are fragile immediately

after learning, but become more robust as they are consolidated over time (4). This phase ends with perceived mastery of the movement (16,25).

THE AUTONOMOUS PHASEIn the autonomous phase, a person should be able to type automatically, quickly, accurately, and perhaps even while paying attention to something else. They do not have to consciously think, they can just “do,” (13,16). An interesting shift happens at this phase: while asking beginners to be conscious of their movements helps them to improve, asking experts to pay attention to their movements makes them worse. This is because expert movement is now intuitive, “in the body,” and made up of an integrated, subconscious sequence that processes faster than conscious thought (2). People can still learn and refine their technique, but gains are slower and more difficult (13).

Interestingly, at this final phase, more effort or repetition does not necessarily improve skill. Without targeted coaching or skill development, people get as good as they need to be, and no more. Once a person learns to type emails reliably, they are not likely to get any faster or more accurate. In the same vein, once someone learns to parallel park well enough to pass their driver’s license test, they are probably not going to become an elite stunt driver even if they drive for several more decades. In fact, it is more likely that eventually their performance will degrade (7,11). At some point, older typists or drivers will probably get worse, not better.

This leveling-off is known as the hypothesis of par, or tolerance (13,18). People reach the level required to meet the basic requirements. Then, unless they are pushed or trained to get better, their level generally remains the same—well below what they could potentially achieve.

THE ART AND SCIENCE OF TACTICAL TRAININGTactical athletes need to be good at their job, and ideally, always improving or at least maintaining a high level of performance. This means participating in ongoing training and targeted skills coaching. It also depends on the individual’s performance: the more an individual succeeds, the more motivated and able they will be to keep succeeding. Conversely, consistent failure will increase anxiety, decrease confidence, and degrade skills performance (6). In other words, without change or intervention, success breeds success and failure breeds failure.

Thus, a tactical facilitator should design training so that tactical athletes can learn, be appropriately challenged by, and ultimately succeed at increasingly complex or stressful tasks. As the skills are built and consolidated, they become increasingly proficient and, more importantly, reliable (13,15,23,27). To build expert performance and mastery, tactical athletes must also spend time in the first and second phases of motor learning, rather than relaxing too easily or often in the third phase (12).


CRAIG WELLER

DEPTH OVER BREADTHBruce Lee once famously said that he was not afraid of the man who had practiced 10,000 different kicks once, he was afraid of the man who practiced one kick 10,000 times. In tactical skills training, depth is better than breadth. Better performers spend more time on deliberate, conscious, targeted practice of fundamental skills rather than just “going through the motions,” (10). In the gym, this could be the difference between doing a lunge mindlessly and doing one with attention applied to the quality of a particular component of the movement, such as the position of the pelvis, spine, and femur throughout the motion.

The more training time spent in the cognitive and associative stages, the higher the baseline of performance will be once the skills are performed in the autonomous stage. This is where SIT can be applied to physical training, within the context of phased training.

PHASE 1: CONCEPTUAL EDUCATIONIn the conceptual education phase of SIT, the tactical athlete can be educated about performance standards and what to expect during training, both cognitively and physiologically. Athletes can be taught the types of skills and concepts used in various special operations units to optimize performance under stress. This can include control of autonomic arousal, confidence-building, and basic mental skills such as the link between performance and psychological states, goal-setting, attention control, visualization, self-talk, and compartmentalization (30).

PHASE 2: SKILLS ACQUISITION AND CONSOLIDATIONIn the skills acquisition and consolidation phase of SIT, the primary skills involve physiological and cognitive control of (and familiarization with) stress responses, as well as “overlearning” of motor patterns in order to automate them at a high level of proficiency. This is where depth of movement quality is developed.

PHASE 3: APPLICATION AND FOLLOW-THROUGHIn the application and follow-through stage, tactical athletes learn to apply the motor patterns and mental skills previously learned under increasing stress and complexity. This can be performed through changing motor pattern complexity (e.g., a goblet squat moving to a barbell front squat), program complexity, and physiological stress in the form of increased intensity, volume, and density. During this stage, it is important to retain the qualitative factors learned in the previous two stages (such as managing the stress response). Remember, without conscious, deliberate attention towards motor skill refinement in this stage, performance will degrade over time.

BALANCE CHALLENGE AND SUCCESSAs with all the stages, deliberate practice and creating successful outcomes are essential. The goal here is always to perform movements and skills properly and confidently, rather than creating situations where the tactical athlete breaks down. There is no limit to the level of performance that the tactical athlete can

attain, as long as the performance is built on quality. There is no use in training to do something at a faster rate if it is done poorly.

In addition to providing ongoing feedback, tactical facilitators should always carefully observe where and when fatigue or psychological stress begins to degrade performance. If a tactical athlete is unable to maintain good mechanics and mental composure under fatigue and heavy loading, then the tactical facilitator should intervene immediately to change or regress the exercise to a level that permits successful performance and positive skill acquisition. The art of coaching using SIT principles is to keep athletes in their “zone of optimal challenge.” In other words, this involves working at the edge of their skill level to produce the best training effect possible, all while not pushing into the limits of fatigue or psychological stress that then degrade skills and habits.

CONCLUSIONA tactical facilitator’s job is to develop physical capacities, the motor patterns that drive them, and the psychological resilience and toughness that produce those capacities and patterns reliably. The physical training of tactical athletes should be designed to make all fundamental physiological processes easily and autonomously support their physical training and performance. When these pieces are combined, it may create resilient, tough, and physically fit tactical athletes who are built to succeed under stress.

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2. Beilock, SL, Carr, TH, MacMahon, C, and Starkes, JL. When paying attention becomes counterproductive: Impact of divided versus skill-focused attention on novice and experienced performance of sensorimotor skills. Journal of Experimental Psychology: Applied 8(1) 6-16, 2002.

3. Beilock, SL, Wierenga, SA, and Carr, TH. Expertise, attention, and memory in sensorimotor skill execution: Impact of novel task constraints on dual-task performance and episodic memory. The Quarterly Journal of Experimental Psychology: Human Experimental Psychology 55(8): 1211-1240, 2002.

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5. Choudhrey, NK, Fletcher, RH, and Soumeria, SB. Systematic review: The relationship between clinical experience and quality of healthcare. Annals of Internal Medicine 142(4): 260-273, 2005.

6. Christina, RW, and Corcos, DM. Coaches Guide to Teaching Sport Skills. Champaign, IL: Human Kinetics, 1988.

7. Cofer, CN, and Appley, MH. Motivation: Theory and Research. New York: Wiley; 1964.



8. Dienstbier, RA. Arousal and physiological toughness—Implications for mental and physical health. Psychological Review 96(1): 84-100, 1989.

9. Driskell, JE, Salas, E, and Johnston, J. Does stress lead to a loss of team perspective? Group Dynamics: Theory, Research, and Practice 5(1): 291, 1999.

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12. Ericsson, KA. The scientific study of expert levels of performance: General implications for optimal learning and creativity. High Ability Studies 9(1): 90, 1998.

13. Fischman, MG, and Oxendine, JB. Motor skill learning for effective coaching and performance. In: Williams, JM (Ed.), Applied Sport Psychology: Personal Growth to Peak Performance United States: Mayfield; 13-28, 2001.

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15. Flin, R. Selecting the right stuff: Personality and high reliability occupations. In: Roberts, RW, and Hogan, R (Eds.), Personality Psychology in the Workplace. Washington, DC: American Psychological Association; 253-276, 2001.

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17. Gorman, PF. The military value of training. Institute for Defense Analysis Paper. P-2515, 1990.

18. Helson, H. Adaptation-Level Theory: An Experimental and Systematic Approach to Behavior. New York: Harper and Row; 1964.

19. Johnston, JH, and Cannon-Bowers, JA. Training for stress exposure. In: Driskell, JE, and Salas, E (Eds.), Stress and Human Performance. Mahwah, NJ: Erlbaum; 223-256,1996

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21. Keinan, G, Friedland, N, and Sarig-Noar, V. Training for task performance under stress: The effectiveness of phased training methods. Journal of Applied Social Psychology 20(18) 1514-1529, 1990.

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24. Meredith, LS, Sherbourne, CD, Gaillot, SL, Hansell, L, Ritschard, HV, Parker, AM, and Wrenn, G. Promoting Psychological Resilience in the U.S. Military. Santa Monica, CA: RAND Corporation; 2011.

25. Morgan, CA III, Cho, T, Hazlett, G, Coric, V, and Morgan, J. The impact of burnout on human physiology: A prospective study of soldiers enrolled in the combat diver qualification course. In: Yale Journal of Biology and Medicine 75(4): 199-205, 2002.

26. O’Donnell, A, Morgan, CA, Jovanov, E, Andrasik, F, and Prevost, MC. The warfighter’s stress response: Telemetric and noninvasive assessment. Naval Aerospace Medical Research Lab Pensacola, FL; 2002.

27. Orasanu, JM, and Backer, P. Stress and military performance. In: Driskell, JE, and Salas, E (Eds.), Stress and Human Performance. Mahwah, NJ: Lawrence Erlbaum Associates; 89-126 1996.

28. Orlansky, J. The military value and cost-effectiveness of training. NATO Defense Research Group Panel 7 on the Defense Applications of Operational Research. Research Study Group 15 on the Military Value and Cost-Effectiveness of Training. Institute for Defense Analyses. Alexandria, VA; 1989.

29. Picano, JJ, Williams, TJ, and Roland, RR. Assessment and selection of high-risk operational personnel. In: Kennedy, CH, and Zillmer, EA (Eds.), Military Psychology: Clinical and Operational Applications. New York: Guilford; 353-370, 2006.

30. Robson, S, and Manacapilli, T. Enhancing Performance Under Stress: Stress Inoculation Training for Battlefield Airmen. Santa Monica, CA: RAND Corporation; 2014.

31. United States Army Special Operations Command. Special operation forces truths. Retrieved 2015 from http://www.soc.mil/USASOCHQ/SOFTruths.html.

ABOUT THE AUTHORCraig Weller spent six years as a Naval Special Warfare Combatant Crewman, with special operations deployments on three continents. He has also worked on the Diplomatic Security team protecting the United States Ambassador to Iraq in Baghdad as a Department of State-certified Worldwide Personal Protective Services (WPPS) II security specialist. Weller founded or co-founded two different fitness businesses named Barefoot Fitness and Rogue Performance, including three total facilities currently in operation. Weller currently works for Precision Nutrition as their Exercise Specialist, and runs their military and tactical unit coaching programs.


AUTHOR NAME CREDENTIALS

TSAC RESEARCH REVIEW

ROD POPE, PHD

This article is the third of a continuing series of tactical strength and conditioning (TSAC) research reviews. It is designed to bring awareness to new research findings of relevance to tactical strength and conditioning communities.

EFFECTS OF POLICE OFFICER EQUIPMENT LOADS ON TACTICAL MOBILITY AND ASSOCIATED RISKSRisks for police officers, like other tactical athletes, must be purposefully identified and actively managed—risk aversion is not an option, as risk management decisions and indecision can mean the difference between life and death (8). With regard to tactical equipment, on one hand it is clearly necessary to provide police officers with lethal, non-lethal, defensive, and protective equipment. These types of equipment are selected in accordance with specific roles to enhance their tactical effectiveness and their capacity to counter threats to their own lives and the lives of others (8). On the other hand, there are risks that some of this same equipment could be taken and used by unauthorized personnel to harm police officers or civilians, that carrying and using the equipment could lead to excessive physical and psychological stresses, and that carrying the equipment could reduce the tactical mobility of the police officers (1,3,4,5,6,7,8). While the first two of these risks have been recognized and managed for many years, reductions in mobility attributable to wearing tactical equipment have been only much more recently researched as a source of risk (3,4,5,7,8). However, already it is evident that such reductions in mobility can impede tactical effectiveness of police officers in a variety of ways and limit the capacity of police officers to move strategically and rapidly evade threats (4,5,7).

Noting the risks posed by tactical equipment for tactical mobility, it is informative to consider a recent study by Lewinski and colleagues which examined the effects of simulated tactical equipment loads on the mobility and particularly the speed of movement of 20 law enforcement students (7). In this study, the 20 participants were asked to attend the police college gymnasium on two separate occasions, one week apart. They wore their police training uniforms both times, and on the second occasion they also wore a 9.07 kg diver belt to simulate the weight of a police officer’s protective vest and duty belt. At each of these testing sessions, the participants were videotaped as they twice undertook each of the four different types of sprints over a distance of 9.1 m, with a 1-min recovery period between sprints. The first was a normal forward sprint and the second was a backward sprint. The final two sprints were forward sprints that started from a sideways facing position—one started with the participant facing to the left and the other with them facing to the right. In addition, each participant undertook a vertical jump test during each testing session.

From the video footage, for each sprint the average stride length, step time, speed, and acceleration were evident in the first six strides from the standing start. When compared to the sprints where no load was worn, sprints performed with the belt were characterised by an average:

• Decrease in rate of forward acceleration of 12 – 13% (0.31 – 0.36 m/s2) resulting in a reduction in final speed of forward movement at the sixth step of 0.5 m/s.

• Decrease in average forward sprinting speed (averaged across the six steps) of 0.19 – 0.23 m/s, equating to a decrease of 1 m in the distance that could be moved during 4 – 5 s of sprinting. It should also be noted that this reduction in distance moved during every 5 s of movement was around 2.5 m by the sixth step, as by then the rapid acceleration during the preceding steps had built the speed of forward motion.

No difference was observed in stride length when participants wore the load belt, but the time spent with each foot in contact with the ground increased when the load was worn. Additionally, the vertical jump height achieved by participants reduced by an average of 17% (approximately 9 cm) when they wore the load belt (7).

This study by Lewinski and colleagues in tandem with the results of another study by Dempsey and colleagues, provide detailed information on the substantial additional risks to police officers that arise from wearing tactical equipment loads, and on the associated risks to their tactical effectiveness (4,5,7). These studies also suggest that if police officers need to wear tactical equipment, they require specific lower limb strength, power, and agility training on a regular, ongoing basis to counter the negative impacts of the equipment loads on officer mobility and tactical effectiveness and safety (4,5,7).

Tactical facilitators can use this information to educate and motivate police officers to undertake lower limb strength, power, and agility training to counter the adverse impacts of tactical equipment load carriage (7). In addition, tactical facilitators can assess and track lower limb strength, power, and agility of officers and their speed of movement in simulated tactical scenarios. On this basis, they can develop and conduct very specific training programs for police officers, which may provide adequate progressions to minimize injury risks. Specifically, these programs should involve officers wearing clothing and loads that closely simulate their uniforms and tactical equipment, and they should involve exercises that simulate occupational tasks in realistic environments. Some examples of training protocols include rapid stair climbing and descent, fence and other urban obstacle negotiation, rapidly going to ground and rising from the


VERY LONG ARTICLE TITLE GOES HERE AND TAKES UP LOTS AND LOTS OF ROOMTSAC RESEARCH REVIEW

ground, sprinting for realistic forms of cover and between sources of cover, and controlled jumping and landing over obstacles and up and down from ledges. To further develop agility, progressing to exercising on a variety of realistic terrains (e.g., grass, sand, concrete, gravel, etc.) and including controlled multidirectional movements would be ideal.

MILITARY OCCUPATIONAL SPECIALTY AND OTHER RISK FACTORS FOR INJURIES IN SOLDIERS FROM AN OPERATIONAL UNIT OF THE UNITED STATES ARMYAnderson and colleagues recently conducted a retrospective review of records pertaining to 2,101 soldiers from a single United States Army light infantry brigade (2). The records were extracted from two sources and linked by soldier for the study. One source was the U.S. Military Defense Medical Surveillance System and the other was a survey that had previously been conducted by the soldiers, asking them to report demographic data like age and gender, along with data on height, weight, whether or not they smoke, physical fitness scores, military occupational specialty, and injuries sustained in the prior 12-month period. Information on the assessed physical demands of the different military occupational specialties were also extracted from formal documents.

Studies on operational military units like this are scarce—most are conducted in basic training or initial employment training contexts. The results are therefore valuable and informative. The results indicate that 43% of the soldiers recalled they had sustained an injury in the prior 12-month period. The authors note this was a lower rate than the rates reported by prior studies in similar populations, but difficulty recalling their injuries and other contextual factors may have affected the numbers of injuries reported by soldiers. Similar to prior studies, soldiers older than 21 years of age, those with a high body mass index, smokers, and those with the lowest levels of fitness were most prone to injury. Each of these groups demonstrated 1.3 – 1.7 times the odds of being injured compared to the alternative groups (2).

Perhaps most interesting was the reporting and comparison of injury rates for each military occupational specialty with regards to the physical demands of each specialty. Military police had the lowest rate of injury, but this was only slightly lower than that of infantry soldiers (35% and 36% respectively). Soldiers with a military occupational specialty of chemical, explosive, and ammunition had the highest rate of injury (60%). Those with military occupational specialties of armor, signals and communication, engineering, military intelligence, and electronic warfare ranged in injury rates from 47 – 55%, in that order. Overall, there was a trend in injury rates by military occupational specialties such that soldiers in less physically demanding specialties reported higher injury rates than those in the most physically demanding specialties. It was also noted that those in the armor and in the chemical, explosive, and ammunition specialties were significantly older than those in the infantry soldier specialty, and those in the armor specialty were also less aerobically fit.

The results of this study serve to confirm that there are modifiable risk factors for injury in military personnel. Such risk factors include aerobic fitness, weight, and whether or not they smoke (2). Perhaps more importantly, though, the results of this study highlight the need for soldiers to maintain adequate physical conditioning to meet the demands of their specific occupational roles. It would appear from this study that those soldiers who were more active and had greater routine physical demands associated with their roles maintained a better level of conditioning and a lower injury rate than those whose roles were not as routinely demanding. While further research is required to fully elucidate the causes of the differences observed between occupational specialties, it is probably reasonable to conclude that more regular and routine physical conditioning of soldiers and other tactical personnel is protective for injury. In contrast, less regular physical conditioning in combination with spasmodic heavier occupational physical demands may increase injury risk.

For the tactical facilitator, it would appear that the main lesson to be learned from this study is that all soldiers need to maintain a well-designed, consistent program of physical conditioning that will enable them to readily meet the routine and sporadic demands of their occupational roles without injury. This means that the tactical facilitator will need to familiarize themselves with the routine and occasionally heavier demands of the occupational roles of the soldiers they train. On this basis, they can then ensure that the soldiers’ needs to maintain the required levels of conditioning for all of their military roles, including those that are less frequent but demanding, are met through specifically tailored training sessions. This training should be closely aligned to the actual occupational roles of the soldiers, simulating the context and demands of the role, including the wearing of simulated or actual equipment.

EFFECTS OF PROTECTIVE CLOTHING AND SELF-CONTAINED BREATHING APPARATUS ON FUNCTIONAL AEROBIC CAPACITY IN FIREFIGHTERSPerroni and colleagues recently conducted a study with 197 Italian firefighters to determine the impacts of wearing protective clothing (PC) and a self-contained breathing apparatus (SCBA) on performance of a submaximal test used to predict maximal aerobic capacity (or maximal oxygen uptake) (10). In this study, they employed the Queen’s College Step Test (QCST), a validated submaximal test for this purpose. This readily conducted field test mandated participants to step up and down from a 40-cm step for 3 min at a fixed rate of 24 steps per min, after which their heart rate was immediately assessed over a 15-s period (10). Testing was conducted in two separate sessions, one week apart. The first session involved assessment without wearing PC and SCBA, whereas the second session involved wearing PC and SCBA.


ROD POPE, PHD

When the PC and SCBA were worn, 26 (13%) of the participants were unable to complete the 3-min stepping component of the QCST and had to withdraw from the study. This observation and the results for the remaining firefighters are a good indicator and reminder of the impacts of PC and SCBA on functional cardiovascular capacity and performance. In the session where PC and SCBA were worn, the average estimated maximal aerobic capacity measured in milliliters of oxygen that could be taken up per kilogram of total loaded bodyweight per minute fell from 49 ml/kg/min to 40 ml/kg/min (a drop of 18%). This reduction was directly attributable to the addition of substantial inert weight which effectively increased their total loaded bodyweight, increased their oxygen consumption during the task, and thus, reduced their functional aerobic reserve capacity. When total loaded bodyweight was removed from the calculation and an absolute estimate of maximal aerobic capacity was calculated, the estimated maximal aerobic capacity did not change significantly between the unloaded and loaded measurement sessions—remaining around 3.8 L/min.

These findings indicate that the actual maximal oxygen uptake that each firefighter could achieve was not altered between the testing sessions; the firefighters could still take in and utilize the same maximal number of liters of oxygen per minute, whether unloaded or loaded with PC and SCBA. Rather, their functional aerobic reserve capacity was substantially reduced when they wore PC and SCBA, because a substantial proportion of the oxygen that their bodies could consume in each minute was required to enable their bodies to simply bear the load of the PC and SCBA while undertaking other tasks (like the step test or occupational tasks). This left them with less remaining aerobic capacity reserve to use in undertaking occupational tasks and meant that some of them could not complete the 3-min stepping task of the QCST.

For the tactical facilitator, these findings are a timely reminder of the critical importance of maximizing the cardiorespiratory fitness of firefighters, especially given their requirement to wear PC and SCBA while undertaking occupational tasks. The impacts of PC and SCBA on fatigue and functional performance of firefighters in their occupational context have been extensively discussed in the two previous “TSAC Research Review” columns in the TSAC Report. What these findings add to that discussion is direct measurements of the impacts of wearing PC and SCBA on the functional cardiorespiratory reserve capacity of firefighters. As indicated by the inability of 13% of participating firefighters to complete the occupationally relevant, 3-min QCST in the current study when wearing PC and SCBA, the cardiorespiratory systems of firefighters are under substantial strain even before occupational tasks are performed, simply from the burden of carrying PC and SCBA. It is critical for tactical facilitators to consider how they can assist firefighters to maximize their functional cardiorespiratory reserve capacities to optimally

prepare for occupational tasks while wearing PC and SCBA. Similar to the need for specific load carriage training of Army soldiers, to ensure they maintain capacity for load carriage and mobility in the load carriage context, firefighters also require regular aerobic training conducted under loads that include PC and SCBA (10). This training should be specific to the occupational role of firefighters and should involve occupationally-relevant activities or simulated tasks. The typical durations of firefighter tasks should also be considered, to ensure that endurance elements of the training are well matched to occupational tasks. Further guidance is available from the two previous “TSAC Research Review” columns in the TSAC Report, and the work of Orr and colleagues may also provide useful guidance on how to approach the planning and implementation of training for heavy load-bearing roles that require considerable endurance capacity in complex and hazardous environments (9).

REFERENCES1. Achim, A-C. Ergo-policing. Improving safety and ergonomic requirements of human resources involved in police duties. Procedia – Social and Behavioral Sciences 124: 20–26, 2014.

2. Anderson, MK, Grier, T, Canham-Chervak, M, Bushman, TT, and Jones, BH. Occupation and other risk factors for injury among enlisted U.S. Army soldiers. Public Health. Retrieved 2015 from http://dx.doi.org/10.1016/j.puhe.2015.02.003.

3. Carlier, IVE, Voerman, AE, and Gersons, BPR. The influence of occupational debriefing on post-traumatic stress symptomatology in traumatized police officers. British Journal of Medical Psychology 73(1): 87-98, 2000.

4. Dempsey, PC, Handcock, PJ, and Rehrer, NJ. Body armour: The effect of load, exercise and distraction on landing forces. Journal of Sports Sciences 32(4): 301-306, 2014.

5. Dempsey, PC, Handcock, PJ, and Rehrer, NJ. Impact of police body armour and equipment on mobility. Applied Ergonomics 44(6): 957-961, 2013.

6. Leonardatos, C, Blackman, PH, and Kopel, DB. Smart guns/foolish legislators: Finding the right public safety laws, and avoiding the wrong ones. Connecticut Law Review 34: 157-219, 2001.

7. Lewinski, WJ, Dysterheft, JL, Dicks, ND, and Pettitt, RW. The influence of officer equipment and protection on short sprinting performance. Applied Ergonomics 47: 65-71, 2015.

8. Mayhew, C. Protecting the occupational health and safety of police officers. Trends and Issues in Crime and Criminal Justice 197: 2001.


9. Orr, R, Pope, R, Johnston, V, and Coyle, J. Load carriage: Minimising soldier injuries through physical conditioning – A narrative review. Journal of Military and Veterans’ Health 18(3): 31-38, 2010.

10. Perroni, F, Guidetti, L, Cignitti, L, and Baldari, C. Absolute vs. weight-related maximum oxygen uptake in firefighters: Fitness evaluation with and without protective clothing and self-contained breathing apparatus among age group. PLoS ONE 10(3): e0119757.

ABOUT THE AUTHORRod Pope is currently an Associate Professor of Physiotherapy at Bond University in Australia. Pope provided clinical physiotherapy, rehabilitation, and injury prevention services at the Australian Army Recruit Training Centre before establishing and leading the Australian Defense Injury Prevention Program, at the request of the Defense Health Service Branch. In this role, he worked closely with senior military physical training instructors to optimize physical training practices. As part of this work and more recently in his university roles, Pope has conducted and supervised wide-ranging research and consultancy projects on preventing injuries and enhancing performance during physical activity in tactical training and operational contexts. Very much a practitioner researcher, Pope’s research invariably stems from questions about practice in the field and aims to usefully inform this practice.

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ACCOUNTING FOR MENTAL AND PHYSICAL STRESS IN THE LAW ENFORCEMENT PHYSICAL TRAINING SCHEDULE

MARCUS TRUSTY, CSCS

At the 2014 TSAC Conference, John Hofman presented a lecture that featured the phrase “do no harm,” (1). As the conference continued, this simple phrase became

a recurring theme. The basic concept behind doing no harm suggests that physical training should never cause injury and furthermore that physical training should not have a residual negative physical or mental performance impact (1). While commonly applied to the health profession, this concept of doing no harm can likewise be applied when designing a training program for the tactical population. To achieve this, several factors should be taken into account to not only maximize the desired physical training results, but to also minimize potential injury concerns or any fatigue that could negatively affect physical performance the next time the tactical athlete goes on duty (1). Tactical facilitators should be aware that each individual tactical athlete will be different in how the “do no harm” philosophy applies to their specific training program. Job descriptions, schedules, personal responsibilities, and physical training experience are all factors that should be taken into account, as each tactical athlete should have a unique and specialized training schedule.

The “do no harm” concept sometimes gets lost with the implementation of new and popular methods of training such as the high-intensity exercise programs, for example. Mental stress, as it relates to and affects the ability to recover from physical stress, is something that has been getting more attention lately. If applied appropriately, the “do no harm” training concept can be useful in dealing with the dynamic on-duty and physical training schedules of tactical athletes.

For example, law enforcement professionals know all too well the amount of job-related stress that can be incurred and how this can compound and potentially create more stress in their personal lives. While these law enforcement officers might be aware of the types of stresses the job creates, they may not be as cognizant of how this stress affects their physical performance and how it might impair their ability to recover from physical training workouts (2). Some recent research dealing with this topic may be useful to consider when planning a physical training schedule.

One study looked at physical recovery rates for both high stress and low stress groups following an exercise training protocol that included several sets to failure and exercise at very high intensity (3). Both groups were similar in physical ability and performed the same physical training protocol. The results from this study

suggest the timeframe for full recovery for highly stressed individuals is around 96 hr compared to 48 hr for the non-stressed group (3). Most individuals training to failure usually rate this in the 8 – 9 range (out of 10) on the Rating of Perceived Exertion (RPE) scale. In simple terms, the RPE is a rating scale for how hard an individual thinks they are working, in terms of physical activity (4). That being said, single studies do not necessarily paint the whole picture. The results of the aforementioned study do not mean that an individual who works out while being stressed will take 96 hours to recover from their workout; however, these results suggest that cognitive stress should factor into how a training schedule is planned and implemented.

As a practical example of how this concept can be applied, most of the deputies at a local Sheriff’s Office are on a four-day on/three-day off shift schedule. With this in mind, the planned workouts are separated into two categories: high-intensity and light/moderate-intensity. High-intensity workouts focus on a heavy strength training day and a metabolic conditioning/power training day. Both these days should be in an RPE range of 8 – 9. The light/moderate-intensity workouts consist of a light cardiovascular conditioning day and a mobility/range-of-motion day. Both of these days should be in an RPE range of 6 – 7. Using RPE as a guide, the deputies perform the two higher RPE days on their last day on-duty and their first day off-duty. The two lower RPE days are scheduled on their last day off-duty and their first day back on-duty. This allows the deputies to get high quality workouts in during their week, but they are also able to recover from the two higher intensity days and still be at their best physically before they go back on-duty. Table 1 provides a sample program of a weekly schedule.

The “do no harm” philosophy can be a great way to help with scheduling future workouts or training programs. Tactical facilitators should keep in mind the fact that this is merely a guide; as on-duty shifts change, the program will also have to change accordingly. Additionally, stress level changes may mandate further adjustments in the training schedule. There will most likely never be an absolute perfect schedule. In some cases, the tactical facilitator may have to plan the training schedule on a week-to-week basis because work schedules change every week. This can be manageable when using these concepts to organize a training schedule. However, by taking these concepts and variables into account during the program design and scheduling, a tactical facilitator can help avert some of the pitfalls that plague poorly planned physical training for tactical athletes.


ACCOUNTING FOR MENTAL AND PHYSICAL STRESS IN THE LAW ENFORCEMENT PHYSICAL TRAINING SCHEDULE

REFERENCES1. Hofman, J. “Everything You Knew about Back Pain is Wrong?” TSAC Conference. Lecture conducted at the Marriot Mission Valley: San Diego, CA; 2014.

2. Nuckols, G. Stress: The silent killer (of gains). Strength Science. Retrieved September 22, 2014, from http://gregnuckols.com/2014/08/13/stress the-silent-killer-of-gains/.

3. Stults-Kolehmainen, MA, Bartholomew, JB, and Sinha, R. Chronic psychological stress impairs recovery of muscular function and somatic sensations over a 96-hour period. The Journal of Strength and Conditioning Research 28(7): 2007-2017, 2014.

4. Yamauchi, SM. Rating of perceived exertion for quantification of the intensity of resistance exercise. International Journal of Physical Medicine & Rehabilitation 1(9): 1-4, 2013.

ABOUT THE AUTHORMarcus Trusty graduated with a Bachelor’s degree in Exercise Science from Fort Lewis College. He is currently a Certified Strength and Conditioning Specialist® (CSCS®) through the National Strength and Conditioning Association (NSCA), and holds both a Performance Enhancement Specialist (PES) and Corrective Exercise Specialist (CES) certification from the National Academy of Sports Medicine (NASM). He is also certified as a Precision Nutrition Level 1 and holds a Certified Personal Trainer (CPT) certification from the American Council on Exercise (ACE). Trusty has been a trainer and strength coach since 2005. In 2012, he co-founded Performance Tactical, a training company focused on strength and conditioning and weapons training for the tactical athlete.

TABLE 1. SAMPLE LAW ENFORCEMENT TRAINING SCHEDULE

DAY SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY

Schedule On-duty On-duty On-duty On-duty Off-duty Off-duty Off-duty

Training Plan Workout RPE

at 6 – 7Rest Rest

Workout RPE at 8 – 9

Workout RPE at 8 – 9

RestWorkout RPE

at 6 – 7


KARA FEDEROWICZ, ATC, CSCS, JAMIE OSMAK, CSCS, USATF-1, JASON MACHOWSKY, MS, CSSD, CSCS, AND POLLY DEMILLE, MS, RN, CSCS, USAT

PHYSICAL ASSESSMENT OF AN AIR NATIONAL GUARD PARARESCUE TEAM AND THE IMPORTANCE OF A SPECIALIZED TRAINING PROGRAM

Human Performance Optimization (HPO) programming is a service provided to the military in which the needs of the athlete are focused through the lens of strength and

conditioning. Research has been done with military personnel that look at musculoskeletal injuries, but none specific to United States Air Force (USAF) Pararescue. The purpose of this article is to examine the effects and results of a training program designed specifically for this population.

Pararescuemen, also known as PJs, are United States Air Force (USAF) Special Operations Command and Air Combat Command Air Force personnel tasked with the recovery and medical treatment of personnel in humanitarian and combat environments. The physical standards, capabilities, and long-term requirements of these individuals are particularly vigorous. As such, there is a need to expand current practice within their HPO programming to meet the high physical demands required by these extraordinary personnel. Typical physical demands of PJs include but are not limited to muscular strength, muscular endurance, mobility, explosive power, power endurance, and ultra-endurance.

In order to help meet the high physical demands of this tactical population and address various dysfunctional movement patterns, the Hospital for Special Surgery (HSS) created and implemented a program for performance to look at the quality, not just the quantity, of movement performed by PJs.

The Functionally Integrated Exercise to Restore and Correct Equilibrium (FIERCE) program was created by the HSS performance staff for the USAF PJs of the 103rd Rescue Squadron. The goals of the annual FIERCE program included:

• Deliver targeted corrective exercise and strength training

• Develop foundational base strength

• Provide postural and core restoration

• Use diverse training methodologies

• Provide an underlying foundation of resiliency and recovery

The exercise regime for the FIERCE program was a 12-month periodized protocol that consisted of the following:

• 3-month mesocycles

• 4-week microcycles

• Each week consisted of:

» 1 endurance/cardio session

» 2 strength sessions

» 1 recovery session

Each PJ received their own physical therapy assessment, which was followed by a prescription of specific exercises customized to their needs. In addition to these exercises, a corrective hip and shoulder program was given to the athletes to perform at least twice per week.

Upon creating and implementing the FIERCE program, HSS performance staff assessed static, dynamic, and power movements to determine if the program helped address or improve the movement patterns of the PJs. This also determined whether the program helped improve their performance in selected fitness tests. The following measurements were used to help determine the effectiveness of the FIERCE program as well as the methods for gathering the information:

Anthropometrics: Height, weight, and body fat (Lange Skinfold Caliper).

Static Posture: Photos with an Alignabod® (The Posture Company) in four positions: facing forward, to the rear, to the left, and to the right.

Dynamic Posture and Balance (bilateral): 8” forward step down, single-leg squat, sit and reach, and bend and pull (4,6,7).

Isometric Strength (bilateral): 90-s forward plank, 60-s side plank, and 30-s single-leg glute bridge.

Core Strength: The Core Cuff pressure (pressure of the low back against the floor, stable as the arms and the legs are moved) (5).


PHYSICAL ASSESSMENT OF AN AIR NATIONAL GUARD PARARESCUE TEAM AND THE IMPORTANCE OF A SPECIALIZED

TRAINING PROGRAMMobility and Stability: The Functional Movement Screen™ which assesses common athletic movement patterns (ability to complete the movement pattern without pain was the first focus of the screen) (1).

Lower Body Power and Multidirectional Movement: Timed 5/10/5 agility test and 40-yard dash. Vertical jump test on a Jump Mat®. The best of three attempts was recorded (2,3).

Upper Body Power: Push-up test to metronome set at 50 beats per minute (2,3).

Hand Grip Strength (bilateral): Hand grip dynamometer from Saehan Corporation® (2,3).

Thirty-six USAF PJs were assessed initially, with participation dependent on logistical and musculoskeletal safety concerns. Synopses of their capabilities are shown in Table 1. Later, 12 of these PJs participated in a six-month follow up. The results of the program are shown in Table 2. The preliminary findings of the initial assessments demonstrated the importance of a specific HPO program for this tactical population. The physical demands placed on the musculoskeletal system lead to many different movement dysfunctions. These movement dysfunctions can create compensatory movements, which in turn can lead to orthopedic injuries and affect time away from work and decrease job performance. Many previous injuries were reported in the initial assessment, ranging from foot and ankle, shoulder, spine, and most often, the knee, as seen in Table 3. Additionally, in the initial assessment, many asymmetrical and dysfunctional movement patterns were found during the overhead squat, single-leg squat, active straight-leg raise, bend and pull, and sit and reach.

Not unlike other populations, a regular training program should be established to maintain function and preserve the effectiveness of the PJs to ensure they are performing at the highest capacity and function possible.

CONCLUSIONThis special group of tactical athletes endures years of hard physical training and occupationally caused physical stress, which often results in movement compensations. These compensations can lead to faulty movement mechanics that can cause many different orthopedic injuries and time away from work. The FIERCE program was designed to implement functionally integrated exercise to restore and correct the equilibrium and dysfunctional movement patterns. Implementing a sound strength and conditioning program, similar to the FIERCE program that focuses on movement mechanics, core, hip, and shoulder function appears to be highly beneficial for the longevity of PJs.

REFERENCES1. Cook, G, Burton, L, Hoogenboom, B, and Voight, M. Functional Movement Screening: The use of fundamental movements as an assessment of function Part 1 and 2. International Journal of Sports Physical Therapy [Part 1] 9(3): 396-409, 2014 and [Part 2] 9(4): 549-563, 2014.

2. Heyward, V. Advanced Fitness Assessment and Exercise Prescription. (6th Ed.) Champaign, IL: Human Kinetics; 2010.

3. Hoffman, J. Norms for Fitness, Performance, and Health. Champaign, IL: Human Kinetics; 2006.

4. Kritz, M, Cronin, J, and Hume, P. Screening the Upper-Body Push and Pull Patterns Using Bodyweight Exercises. The Journal of Strength and Conditioning Research 32(3): 72-82, 2010.

5. Sahrmann, S. Diagnosis and Treatment of Movement Impairment Syndromes. St. Louis, MO: Mosby, Inc,; 2002.

6. Stickler, L, Finley, M, and Gulgin, H. Relationship between hip and core strength and frontal plane alignment during a single-leg squat. Physical Therapy in Sport 16(1): 66-71, 2015.

7. Ugalde, V, Brockman, C, Bailowitz, Z, and Pollard, CD. Single leg squat test and its relationship to dynamic knee valgus and injury risk screening. Physical Medicine and Rehabilitation 7(3): 229-235, 2015.


ABOUT THE AUTHORKara Federowicz is a Certified Athletic Trainer (ATC) and Certified Strength and Conditioning Specialist® (CSCS®) who is currently working at the Tisch Sports Performance Center at Hospital for Special Surgery. Federowicz received her degree in Kinesiology – Athletic Training from Pennsylvania State University. She has worked with many athletes, military, and special population performance clients. Federowicz continues to deliver presentations on tactical athlete populations groups to expand awareness of the importance of warfighter human performance optimization programing.

Jamie Osmak is a Certified Strength and Conditioning Specialist® (CSCS®) and a member of the Sports Rehabilitation team at Hospital for Special Surgery James M. Benson Sports Rehabilitation Center and Tisch Sports Performance Center. He is also a United States of America Track and Field Level 1 Coach with a degree in Exercise Science from Rutgers University. Osmak has a strong passion for human movement and corrective exercise. He has worked with athletes ranging from youth to professionals recovering from a wide range of injuries. Osmak has spoken on various topics ranging from youth athletics and sports specialization to golf and throwing performance and injury prevention.

Jason Machowsky is a Board Certified Sports Dietitian (CSSD) and Certified Strength and Conditioning Specialist® (CSCS®) who works at the Tisch Sports Performance Center at Hospital for Special Surgery. He currently serves as an active member of the United States Olympic Committee Sports Dietitian Registry. Machowsky has presented on nutrition for endurance athletes and athletic recovery at the regional and national levels, including events for the American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine (ACSM), and the New York City Marathon Expo. In addition, he was a selected reviewer for the “Nutrition and Rehabilitation” section of the Sports Nutrition Care Manual published by the Academy of Nutrition and Dietetics. Machowsky currently serves as an Instructor of the Sports Nutrition Practicum at his alma mater, Teachers College at Columbia University, where he received his Master of Science degree in Applied Physiology and Nutrition.

Polly deMille holds a Master’s degree in Exercise Physiology in addition to being a Registered Nurse (RN). She holds numerous certifications including Certified Strength and Conditioning Specialist® (CSCS®) from the National Strength and Conditioning Association (NSCA) and Registered Clinical Exercise Physiologist, Cancer Exercise Trainer, and Exercise Test Technologist from the American College of Sport Medicine (ACSM). deMille is also a certified United State of America Triathlon (USAT) Level 1 Triathlon Coach. Her experience includes years of critical care nursing as well as over 15 years in corporate fitness. She has lectured extensively on return to play following anterior cruciate ligament (ACL) injury, endurance physiology, female athlete triad, and bone health.




TRAINING PROGRAM

TABLE 1. INITIAL ASSESSMENT DATA (N = 25-36)

TEST SUBJECTS AVERAGE STANDARD DEVIATION

Age 36 34.6 7.0

Height (cm) 25 69.4 3.0

Weight (lb) 35 182.3 18.9

Body Fat % 32 13.6 4.6

Forward Step-Down (right) 32 2.0 0.6

Forward Step-Down (left) 32 2.0 0.6

Single-Leg Squat (right) 32 1.9 0.5

Single-Leg Squat (left) 32 1.8 0.6

Sit and Reach 33 26.8 8.0

Bend and Pull 34 2.1 0.6

90-s Front Plank 31 81.3 16.5

60-s Side Plank (right) 32 56.5 8.2

60-s Side Plank (left) 33 56.5 9.4

Right Leg Glute Bridge 35 23.8 8.5

Left Leg Glute Bridge 35 23.1 8.8

FMS Score 33 14.9 2.4

Trunk Stability Push-Up 34 2.5 1.0

Rotary Stability 34 2.1 0.4

Overhead Squat 35 1.8 0.8

Active Straight-Leg Raise 35 2.0 0.9

In-Line Lunge 34 2.4 0.7

Hurdle Step 34 2.1 0.4

Shoulder Mobility 35 1.9 0.9

5/10/5 26 5.6 0.5

40-Yard Dash (s) 26 5.5 0.4

Vertical Jump (in.) 27 24.2 4.4

Push-Ups 26 44.5 12.3

Right Grip Strength (kg) 33 55.3 7.6

Left Grip Strength (kg) 32 54.5 9.8

Injuries 35 3.6

FMS Under 14 33 30%



TABLE 2. 6-MONTH INTERVENTION GROUP

INITIAL REASSESSMENT

TEST AVERAGE SD 95% CI AVERAGE SD 95% CI % CHANGE

Vertical Jump (in.) 23.9 5.90 (12.1 – 35.8) 23.9 5.3 (13.2 – 34.5) -0.4%

Push-Ups 40.2 10.92 (18.4 – 62.1) 40.5 9.0(22.5 – 58.5) 0.7%

Sit and Reach 26.3 7.27 (11.8 – 40.8) 28.2 6.2(15.7 – 40.6) 7.2%

Overhead Squat 1.8 0.94 (0.0 – 3.7) 2.3 0.5 (1.4 – 3.2) 22.7%

Active Straight-Leg Raise 1.9 0.90 (0.1 – 3.7) 2.4 0.5 (1.4 – 3.5) 26.1%

Bend and Pull 2.0 0.77 (0.5 – 3.6) 2.6 0.5 (1.6 – 3.6) 29.2%

Glute Bridge 21.7 8.87 (3.9 – 39.4) 20.3 9.5 (1.3 – 39.2) -6.5%

Trunk Stability Push-Up 2.2 1.19 (-0.2 – 4.6) 2.8 0.9 (1.0 – 4.5) 26.9%

Rotary Stability 2.3 0.45 (1.4 – 3.2) 2.3 0.5 (1.4 – 3.2) 0.0%

Forward Step-Down (right) 2.1 0.54 (1.0 – 3.2) 2.3 0.5 (1.4 – 3.3) 11.6%

Forward Step-Down (left) 2.2 0.60 (1.0 – 3.4) 2.1 0.8 (0.5 – 3.8) -4.5%

Single-Leg Squat (right) 1.7 0.49 (0.7 – 2.7) 2.6 0.5 (1.5 – 3.6) 55.0%

Single-Leg Squat (left) 1.6 0.51 (0.6 – 2.6) 2.3 0.9 (0.6 – 4.1) 47.4%

In-Line Lunge 2.3 0.89 (0.6 – 4.1) 2.3 0.9 (0.6 – 4.1) 0.0%

Hurdle Step 2.2 0.39 (1.4 – 3.0) 2.4 0.5 (1.4 – 3.5) 11.5%

Shoulder Mobility 2.4 0.90 (0.6 – 4.2) 2.4 0.9 (0.6 – 4.1) -3.4%

FMS Score 15.1 2.43 (10.2 – 19.9) 16.8 2.3 (12.2 – 21.4) 11.0%

Less than 14 33% 8% -75.0%

TABLE 3. INJURIES REPORTED IN INITIAL INTAKE




TRAINING PROGRAM

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BRYAN FASS, ATC, LAT, EMT-P, CSCS

PROGRESSION FOR FIRST RESPONDERS TO HELP PREVENT LIFTING INJURIES

There is little dispute that fit individuals typically get injured less often. It has even been shown that with a 28% risk of potential injury from training on duty, the benefits

still outweigh the risks of not training at all (2). In addition to the benefits of training, fit but fatigued first responders will outperform 70% of untrained responders (1). For first responders, the majority of back injuries will occur during tasks that involve lifting and bending, while most knee injuries will occur during tasks which involve stepping and lunging (1,2).

Looking at the typical job requirements of a first responder, the average powered stretcher weighs 130 to 140 lb (depending on configuration) while manual lift stretchers weigh in at roughly 98 to 105 lb. In addition, a patient that can weigh 200 lb or more. As such, first responders will have to lift a sizable load at least twice per call (once to lift and load the stretcher, and once to remove and lower the wheels of a stretcher). When faced with varied terrain and ambulance load heights requiring a higher than normal load height, a first responder is often faced with a heavy and dangerous lift. Looking at the mechanics of the movement, they occur in predominantly in the sagittal plane and involve dynamic contractions with potential isometric holds. To complicate matters, the patient may be combative, shifting position during the lift, or very tall which can obstruct the responders performing the load/unload.

A seemingly normal task like a bed-to-bed patient transfer (moving a patient that is supine from a bed to a stretcher and then from a stretcher to a hospital bed) also poses risks for a first responder. These moves require excessive trunk flexion angles and are often performed kneeling or reaching over and around in a confined space. Many times these seemingly benign transfers can place 2 – 3 times the recommended compressive load on the spine (4).

The National Institute for Occupational Safety and Health (NIOSH) lift equation is used to determine the recommended weight limit, or load, for a first responder. This equation takes into account variables such as lifting task, load weight, horizontal location, vertical location, angle, body position, frequency, duration, coupling classification, and control (3). The NIOSH equation shows the recommended lifting limit for an individual and provides the potential compressive load that will be placed on the spine.

If normal job tasks performed by first responders causes compressive loads substantially above NIOSH standards, then tactical facilitators face a new challenge. In this population of first responders, upper crossed and lower crossed syndromes are common, and the vast majority have lost the functional ability to perform a full squat or perform a bed-to-bed transfer without

a profound flexion in the lumbar spine. Essentially these first responders have trained their bodies to compensate for external loads from unstable and suboptimal lifting positions. So, what is seen is a constant loading of the spine during critical job tasks from suboptimal positions. What is also seen is the inability of many first responders to maintain a neutral spine during job tasks.

Tactical facilitators must understand that no matter how much they coach exercises, the job tasks will always beat the bad patterns back into the first responder, especially in high call volume departments. The following is a sample progression to use with high call volume departments to help maintain mobility while building job-specific strength, yet being careful to not provoke a hyper-fatigued state (due to the high job demand). It is also important to realize most departments and responders have not used or been trained in many of these techniques so coaching and mentoring each individual is incredibly important for the tactical facilitator.

SAMPLE PROGRESSION FOR FIRST RESPONDERS1. Warm-up: It may seem strange that most first responders

have never been on a foam roller. If they have used one, they may still have never been formally coached on how to apply the roller to the job. In addition to myofascial release, tactical facilitators should make sure that mobility and warm-up occurs early in the shift; a good mantra to apply is “check off the truck, check off your body.” Make sure that the calves, glutes, adductors, hip flexors, and thoracic spine have all been “checked off” before fully engaging in job tasks.

2. Trigger point: After the warm-up, if anything is still feeling tight or restrictive, a tennis or lacrosse ball can be utilized to go after the more active trigger points that may be too deep for the foam roller to massage. Again, the responders must be coached and educated about the importance of these techniques and be aware of the risks before implementing trigger point release. Some common restrictions that tactical facilitators should focus on coaching include in the hips (glute minimus, medius, piriformis, and TFL), paraspinals at the thoracolumbar junction, levator scapula, pec minor, and subscapularis, to name a few.

3. Kettlebell progression: Keeping with the theme of efficiency, a specific kettlebell (KB) routine that is both progressive and serves as a self-check can be effective in preparing first responders for job tasks. At this point, if anything does not move or feel right during the movements, the first responder should return to foam


PROGRESSION FOR FIRST RESPONDERS TO HELP PREVENT LIFTING INJURIES

rolling, warm-ups, and trigger point release. Initially, first responders can be asked to perform KB Turkish get-ups before working into the exercises below.

a. The KB Sumo Squat focuses on hip hinge, heels down, spine neutral, and the concentric drive through the hips to teach the glutes to fire without utilizing the back. If this exercise proves difficult, which in many cases it does, then move to the floor for bridging progressions.

b. The KB Bottom Down Squat (empty goblet) focuses on scapular retraction while keeping the kettlebell slightly off the body. This is very important as it mimics many equipment-lifting tasks commonly faced on the job.

c. The KB Bottom Up Squat (full goblet) focuses on the same points as above. With any movement deviation, the first responder should immediately refer back to the mobility tools and earlier steps in this progression.

d. The Single-Arm KB Suitcase Carry is an effective exercise to train lateral stabilization and unilateral hip stability while still reinforcing spine position.

4. Once the first responder can perform all the above movements, move up to a traditional sumo deadlift using a barbell. The wide stance with narrow hand position is very similar to many of the floor lifts a first responder performs and further teaches the specifics of mobility and biomechanics. No extension or flexion moment in the spine should be tolerated with this exercise.

5. Suspension training progressions are used as adjuncts to introduce the stability needed while not inducing fatigue patterns. Tactical facilitators should prescribe saws, rows of all kinds, squats (building up to single-leg if possible), and some overhead movements. However, the responder being conditioned must be able to execute the movement with proper mechanics before advancing to more complex movements.

While some of these exercises may seem simple, many first responders are unable to squat or lunge without profound biomechanical abnormalities. Implementing a progression like the sample provided may help first responders improve their job-specific mobility and help reduce the compressive loads that cause so many injuries in the field.

REFERENCES1. Abel, M. “Training Firefighters On-Duty: Recommended or Irresponsible?” TSAC Annual Training. Lecture conducted at the Wyndham Resort: Orlando, FL; 2015.

2. Frost, D. “Can Firefighter Injuries be Prevented? Movement Screening and Exercise Progressions.” TSAC Annual Training. Lecture conducted at the Wyndham Resort: Orlando, FL; 2015.

3. Waters, TR, Putz-Anderson, V, and Garg, A. Applications Manual for the Revised NIOSH Lifting Equation. Published through the U.S. Department of Health and Human Services, Centers for Disease Control and Prevention – National Institute for Occupational Safety and Health. Accessed June 2015 from http://www.cdc.gov/niosh/docs/94-110/pdfs/94-110.pdf. 1994.

4. Weiler, MR, Lavender, SA, Crawford, JM, Reichelt, PA, Conrad, KM, and Browne, MW. A structural equation modelling approach to predicting adoption of a patient-handling intervention developed for EMS providers. Ergonomics 56(11): 1698-1707, 2013.

ABOUT THE AUTHORBryan Fass is an expert on public safety, injury prevention, fitness and wellness, speaking, consultations, as well as being an author of the “Fit Responder” and column writer for officer.com, firerescue1.com, and ems1.com. Fass works nationally with departments, corporations, and state and local governments to design and run targeted injury prevention and wellness programs for public entities and private organizations. He is frequently contacted for expert opinion and content contribution for all aspects of public safety. President and Founder of Fit Responder, Fass also functioned as a paramedic for over eight years.


THE IMPORTANCE OF PROPER MOVEMENT FOR MARINES—PART 3: EVIDENCE-BASED MOVEMENT ASSESSMENT

MATT ZUMMO, MS, USAW-1

One way for movement assessment to be taken seriously and given due diligence by tactical personnel is if the assessment is directly related to an outcome on a

Marine’s performance evaluation. An evidence-based movement assessment will hold Marines accountable for mobility and stability by systematically assessing a Marine’s movement patterns. Movement assessment should have either equal weight to physical events or serve as a gateway to allow them to take the Physical Fitness Test (PFT) or Combat Fitness Test (CFT) because these programs are not directly tied to a performance evaluation metric. In order to incorporate an injury prevention program of this magnitude across the Marine Corps, evidence-based implementation science must be used. Caroline Finch and Alex Donaldson are two experts concerning applying implementation science to sports injury prevention. Their approach is remarkably similar to John Kotter’s eight steps for implementing organizational change, which is a process that is taught to Marine Corps Officers at the Command and Staff College and a model for change that many Marine Officers are familiar with (14). Finch and Donaldson recommend their RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework to implement a new injury prevention program (9). In executing these five implementation steps, Finch and Donaldson discuss the need for implementation drivers which “act in an integrated and compensatory way to drive widespread, high fidelity implementation of evidence-based practices across relevant sectors,” (9). In their model, there are “Competency drivers (selection, coaching, training), Leadership drivers (technical and adaptive), and Organization drivers (systems intervention, facilitative administration, decision support data system),” (9). These drivers are all intertwined and must work cohesively in order to produce an accurate performance assessment, which then drives a consistent use of the innovation and ultimately produces reliable benefits (9). Finch and Donaldson’s RE-AIM framework and extensive research were used in developing the strategy that this article proposes to implement the Functional Movement Screen™ (FMS™) into the Marine Corps effectively.

There is evidence to suggest that poor mobility and stability are leading causes of musculoskeletal injuries among military personnel (11). The FMS is an evidence-based movement assessment tool that systematically attempts to assess an individual’s fundamental movement patterns (2,6). Through seven different screening movements and a simple grading system, the FMS examines movement patterns and assesses overall movement quality. Each screening movement is given a score of 1 - 3 with 21

being the highest possible total score. Lower total scores indicate more dysfunctional movement and suggest greater chances of injury (7). FMS then assigns corrective exercises and stretches based on an individual’s score to improve their movement patterns. It is well established that dysfunctional movement is associated with an increased risk of injury and the FMS is an evidence-based tool to systematically assess movement patterns and identify individuals likely to be injured should they engage in a fitness program, sporting activity, or combat conditioning program (7,19). Identifying that an individual’s movement is dysfunctional and then correcting these discrepancies is a viable step in preventing injuries. No systems currently exist in the Marine Corps to address this problem.

The FMS is currently used by professional sports teams in the National Football League (NFL), National Hockey League (NHL), and several other professional sports organizations, as well as by Division I National Collegiate Athletic Association schools (8,16). In addition, several law enforcement and fire departments have also realized the importance of assessing movement quality prior to allowing employees to conduct physical training. In 2007, the Orange County Fire Authority in Irvine, CA began assessing movement quality using the FMS with their training academy recruits. Over the course of four academy classes that spanned 18 weeks each, 112 recruits were screened using the FMS. Fifty-three percent of the recruits had a score of 15 or higher and 47% had a score of 14 or lower. Those with a score of 14 or lower proved to be twice as likely to sustain a musculoskeletal injury as those with a 15 or higher and ultimately cost the Orange County Fire Authority over $750,000 more in medical claims than the 15 or higher group (6). Through a series of physical performance tests, the 15 and higher group also consistently outperformed the 14 and lower group (6). In executing their duties, firefighters often perform duties in a dynamic environment under load, very similar to the demanding requirements Marines face. This study illustrates the consequences of dysfunctional movement in a group of people who move quickly in multiple directions under load. One can surmise that similar results would arise from the same size group of Marines over the same time period.

To further illustrate the idea that quality movement assessed through the FMS prevents injuries during physical activity, a study was conducted in 2009 with Marine Corps Officer Candidates at Officer Candidate School (17). There were 874 candidates screened prior to commencing training and 10% (87 candidates) had a score of 14 or less. The 14 or less group proved twice as likely to suffer



a musculoskeletal injury and not graduate as the 15 or higher group. In addition, 79.8% of the candidates with scores less than 14 had a PFT score less than 280, while only 6.6% of candidates that scored above a 280 on the PFT were in the 14 or less group (17). Officer Candidate School is very physically demanding and musculoskeletal injuries continuously plague candidates during their time there. While the physical therapy resources and associated trainers at Officer Candidate School are effective at returning injured candidates to training, entering Officer Candidate School with quality movement patterns is an effective means to prevent being injured in the first place.

The NFL is currently a multi-billion dollar a year industry where injured players result in huge losses both in reduced time on the field and in financial terms (18). Several NFL teams currently use the FMS to examine movement patterns and identify players that are at greater risk for injury (7). In 2005, a comprehensive study was conducted by three movement and injury prevention experts on an unnamed NFL team using the FMS to assess player movement quality during the pre-season (12). Players whose movements were identified as dysfunctional by having a score of 14 or less on the FMS proved to be 11 times more likely to suffer an injury than players who scored 15 or higher (12). Athletic trainers and rehabilitation facilities in the NFL use the most up-to-date techniques and modern equipment to ensure that players quickly heal from injuries and do not lose playing time. However, by assessing movement quality prior to the season, then implementing corrective measures for players that are more prone to injury, it appears teams can prevent injuries from even occurring. Movement quality is critical for any profession that requires people to exert themselves physically, from the NFL to local law enforcement agencies to the Marine Corps. Ensuring that personnel can perform movement patterns properly, and with good quality, is essential to preventing injury and remaining operationally effective.

This RE-AIM program incorporates screening large groups and then developing a warm-up that will address the majority of the discrepancies. Many fire departments, law enforcement organizations, and military units have shared techniques that they found effective in dealing with large groups in developing the tactical FMS protocol and it provides a framework that Marines could follow to effectively implement FMS (5).

In accordance with the 1st Marine Special Operations Battalion Performance and Resiliency Program (PERRES), all Marines are screened via FMS and prescribed appropriate corrective exercises until they achieve a symmetrical score of 14 or higher (3).

Adoption is the next step and this is where much debate exists on how to effectively implement an evidence-based movement assessment into the Marine Corps. Prior to a Corps-wide introduction, the FMS needs to be implemented incrementally

among various populations, to include new recruits prior to posting to recruit training, newly commissioned officers, students at the Senior Non-Commissioned Officer (SNCO) Academy, and two active duty infantry battalions.

In order to ensure new recruits move optimally as soon as possible, FMS screening needs to occur at the Military Entrance Processing Station (MEPS) during the initial physical. To do this the recruiting force needs to be educated and involved in correcting identified dysfunctional movement. Knowing that individuals are twice as likely to experience a musculoskeletal injury with an FMS score of 14 or lower, recruits should not be allowed to commence recruit training until they are a 15 or higher. Currently, the physical requirements to ship to recruit training are all performance based. Male and female recruits must pass an Initial Strength Test (IST) prior to posting to recruit training (4). The IST consists of a 1.5-mi run, pull-ups, and crunches.

Educating the Marine Corps as a whole, and especially the recruiting force, on the importance of moving functionally is a critical element to improving movement within the Marine Corps. Recruiters already have many competing requirements and limited resources to accomplish a demanding mission. However, mandating an FMS screening into the recruiting process can assist recruiters in identifying quality applicants. One of the many things that recruiters do is ensure their applicants are physically prepared for recruit training. In accomplishing this mission they generally rely on their personal experience to develop a physical training program to assist applicants in improving their pull-ups, crunches, and run scores. Through increased education on movement and the corrective exercises associated with FMS, recruiters can learn how to develop more effective physical training sessions and will likely discover that by focusing on movement first, then performance, their applicants will increase their performance faster than had the movement step been skipped.

Educating and involving the recruiting force is critical to improving the Marine Corps’ overall movement quality. Not involving the recruiting force will prevent the program from achieving success. If a recruit is screened by a neutral third party at MEPS on their processing day, then handed a piece of paper with the corrective exercises they need to do prior to posting, but the recruiter is not involved, the corrective exercises likely will not be done. The applicant will do what his/her recruiter tells him/her to do, and if the recruiter is not aware of the FMS program or how to properly supervise the applicant doing the corrective exercises, the recruiter will probably revert to personal experience and have the applicant skip the movement development step and move straight into performance related exercises (pull-ups, running, crunches). Mandating that recruits have an FMS score of at least 15 prior to posting to recruit training ensures accountability on both the applicant and the recruiter. If the applicant has a very low score, but there is no incentive or requirement to improve that score,


MATT ZUMMO, MS, USAW-1

then correcting the dysfunctional movement may not be given due diligence. If recruits understand how to effectively stabilize their torso and have demonstrated an adequate FMS score prior to commencing their recruit training, their chances of sustaining injury at recruit training can be reduced and they may enter the Marine Corps with functional movement patterns that set them up for long-term success (17).

For initial implementation, FMS could then be used at Marine Corps Recruit Depot (MCRD) San Diego and MCRD Parris Island only on recruits that sustain an injury prior to their return to training and on recruits that fail their Initial Strength Test and spend time in the Physical Conditioning Platoon. Screening applicants and entering the scores in the Marine Corps Training Information Management System (MCTIMS) allows MCRD to view the scores of all recruits prior to arriving, to implement appropriate corrections to their physical training program, and to track how recruits with particular FMS scores perform during recruit training. In addition, individual data will be able to be tracked for an individual’s entire enlistment to assess long-term effectiveness, which is a key component to the Maintenance step in Finch and Donaldson’s model.

The Basic School (TBS) is the next place to implement FMS because student data can be easily tracked through the MCTIMS database. In addition, students are there for six months and they are the Marine Corps’ future leadership. The next major population whom to introduce mandatory FMS are students of the SNCO Academies. There are six SNCO Academies across the Marine Corps and each has four classes per year. The students are Non-Commissioned Officers (NCO) and SNCOs who are proven leaders and represent the Marine Corps current and future leadership. While students at the SNCO Academies are only there for a limited time, they are guaranteed to be on active duty for two years after graduation and their data could be tracked for monitoring long-term effectiveness. The final group for initial implementation is an active duty east coast infantry battalion and active duty west coast infantry battalion. These two units pose the largest challenges as they have constant personnel rotation, deployments, and large numbers of Marines. In order to be effective in an infantry battalion, each company needs to have at least two trained screeners to establish interrater reliability among the tests and implementation. With the appropriate equipment and two trained screeners, an infantry company with 120 Marines could be screened within four hours according to the tactical FMS guidance (5). Ideally, there would be an initial screening of the entire company to identify who moves well and who does not. An FMS would also then become part of the check in process for any new Marines. Subsequent screening would then occur before a PFT/CFT and anytime a Marine is returning from light duty.

The key to implementation is accountability. If improved movement is introduced as something nice to have, but not mandated, there will be no change in behavior. A Marine who scores a nine cannot be allowed to continue training knowing that he/she has a higher risk of sustaining a musculoskeletal injury, spending weeks on light duty, and costing the Marine Corps time and money in medical expenses. The desired outcome for the FMS is to not allow a Marine, whose score makes him/her more likely to sustain a musculoskeletal injury based on statistics, to conduct organized unit physical training or take the PFT/CFT until the FMS score is improved to an acceptable range. Therefore, it is the responsibility of that Marine, his/her small unit leaders, and ultimately the commander to ensure he/she takes appropriate corrective action in order to establish functional movement patterns and be able to take their required semi-annual PFT/CFT. Knowing that he/she will receive poor proficiency and conduct (pro/con) marks or an adverse Fitness Report (FitRep) if he/she is unable to take a PFT/CFT, which directly affects future promotion, serves as the metric directly related to performance evaluation that can hold the Marine accountable. Reliable studies have shown that the FMS corrective exercises work, so long as they are executed properly (1,6,10,13). Therefore, as long as a Marine puts in the time and effort, they will be able to quickly rejoin their unit for organized PT and be permitted to take the semiannual PFT/CFT. Finally, the FMS is incredibly simple and combined with increased movement knowledge and formally trained Combat Conditioning Instructors, small unit leaders will be able to informally screen their Marines on a daily or weekly basis and know exactly where everyone is with regards to their mobility and stability.

The major challenges associated with FMS implementation are training screeners, requiring time for a unit to be screened, and having the required screening equipment. Novice active duty service member screeners with no formal exercise science background are shown to be reliable screeners (15,20). Screener training requires approximately eight hours and the unit Combat Conditioning Instructor would serve as a unit’s primary screener. So long as screener training was routinely made available locally to Marine Corps installations, a unit could train as many screeners as they desire. Ideally, the screening would occur up to four weeks prior to a PFT/CFT. Four weeks would allow a Marine who scored below the acceptable threshold to take corrective action, be screened again, and still potentially be able to take the PFT/CFT with his/her unit as scheduled. With respect to required equipment, a screening kit purchased from Functional Movement Systems costs $100 each and so long as they are properly maintained, will last several years. An effective alternative to the purchased kit is a homemade screening kit that can easily be constructed with PVC pipe, string, and a 2x6 for under $30. A battalion size unit, with proper scheduling, could conduct effective screening with 10 – 20 screening kits. While the three tangible challenges to FMS implementation can be overcome, resistance to change is likely to be constant. In keeping with the



RE-AIM framework, leadership will be paramount to effective implementation. The FMS provides a much needed evidence-based movement assessment that may increase movement quality, increase physical performance, reduce musculoskeletal injuries and ultimately increase combat effectiveness by improving the individual warfighter.

REFERENCES1. Bodden, JG, Needham, RA, and Chockalingam, N. The effect of an intervention program on functional movement screen test scores in mixed martial arts athletes. Published ahead of print. The Journal of Strength and Conditioning Research, 2013.

2. Butler, RJ. Summary of Literature Reviews of the Functional Movement Screen. Accessed November 20, 2014 from http://www.functionalmovement.com/articles/Research/2012-09-05_fms_summary_of_literature_reviews.

3. Commanding Officer 1st Marine Special Operations Battalion. Performance and Resiliency Program Policy Letter. Battalion Order 7-11, signed February 2012.

4. Commanding Officer, Marine Corps Recruiting Command. Marine Corps Recruiting Command Order 1100.1: Marine Corps Recruiting Command Enlistment Processing Manual. 9 Nov 2011.

5. Contreras, MA. FMS for Tactical Athletes. Functional Movement Systems. Published Sep 2013.

6. Contreras, MA. The Performance and Financial Benefits of Using the Functional Movement ScreenTM in the Fire Service. Working Paper, Orange County Fire Department, 2010.

7. Cook, G, Burton, L, Kiesel, K, Rose, G, and Bryant, M. Movement: Functional Movement Systems: Screening, Assessment, Corrective Strategies. Aptos, CA: On Target Publications; 2010.

8. Farnsworth, C. Seahawks return to a series of movement tests. Seahawks.com. Published April 2013. Retrived 2015 from http://www.seahawks.com/news/2013/04/15/seahawks-return-series-movement-tests.

9. Finch, CF, and Donaldson, A. Applying implementation science to sports injury prevention. British Journal of Sports Medicine 47: 473-473, 2013.

10. Goss, D, Christopher, GE, Faulk, RT, and Moore, J. Functional training program bridges rehabilitation and return to duty. Journal of Special Operations Medicine 9(2): 29-48, 2009.

11. Hauret, KG, Jones, BH, Bullock, SH, Canham-Chervak, M, and Canada, S. Musculoskeletal injuries: Description of an under-recognized injury problem among military personnel. American Journal of Preventative Medicine 38(1 suppl): S61-S70, 2010.

12. Kiesel, K, and Plisky, P and Voight, M. Can serious injury in professional football be predicted by a preseason functional movement screen? North American Journal of Sports Physical Therapy 2(3): 147-158, 2007.

13. Kiesel, K, Plisky, P, and Butler, R. Functional movement test scores improve following a standardized off-season intervention program in professional football players. Scandinavian Journal of Medicine and Science in Sports 21: 287-292, 2011.

14. Kotter, JP. Leading Change: Why Transformation Efforts Fail. Harvard Business Review: Harvard Business Publishing; 2007.

15. Minick, KI, Kiesel, KB, Burton, L, Taylor, A, Plisky, P, and Butler, RJ. Interrater reliability of the functional movement screen. The Journal of Strength and Conditioning Research 24(2): 479-486, 2010.

16. Morreale, MG. Combine Test Could Provide Red Flag for Injuries. NHL.com. Published May 26, 2013.

17. O’Connor, FG, Deuster, P, Davis, J, Pappas, CG, and Knapik, JJ. Functional movement screening: Predicting injuries in officer candidates. Medicine and Science in Sports and Exercise 43(12): 2224-2230, 2011.

18. Ozanian, M. The Most Valuable NFL Teams. Forbes.com. Published August 14, 2013.

19. Peate, WF, Bates, G, Lunda, K, Francis, S, and Bellamy, K. Core strength: A new model for injury prediction and prevention. Journal of Occupational Medicine and Toxicology 2:3, April 2007.

20. Teyhen, DS, Shaffer, SW, Lorenson, CL, Halfpap, JP, Donofry, DF, Walker, MJ, Dugan, JL, and Childs, JD. The functional movement screen: A reliability study. Journal of Orthopedic and Sports Physical Therapy 42(6): 530-540, 2012.

ABOUT THE AUTHORMatt Zummo is currently the Executive Officer for 2d Tank Battalion, 2d Marine Division. He has over 15 years of experience as an active duty Marine Corps officer with multiple combat deployments. Having served as a platoon commander, company commander, battalion operations officer, and at the Marine Corps Recruit Depot San Diego and Officer Candidate School, he has trained thousands of Marines in various environments to include during austere combat deployments. He has a Bachelor of Science degree in Business Administration from the University of Colorado, a Master’s degree in Military Studies from the Marine Corps University, and is a Level 1 Functional Movement Systems (FMS), Level 1 United States of America Weightlifting (USAW) Sport Performance Coach, and CrossFit Level 1 coach.


DEVELOP THE BASIC MOVEMENT PATTERNS BEFORE TRAINING FOR SPECIFICITY

ROBB ROGERS, MED

Specificity of training is important for all populations of the performance enhancement industry. However, in the tactical population, specificity of training is often placed ahead of many of the basic building blocks of human performance. Many of the people that come to tactical careers are not athletes and may not have ever performed cariocas, shuffles, agility drills, formal sport practices, or warm-ups of any kind. Additionally, they may have never been instructed on the proper mechanics of a squat, lunge, step-up, or hip hinge movement pattern. Incorrect movement patterns can lead to various problems for tactical athletes including potential injury. Instead of focusing on training programs that address specific aspects of the demands of tactical athletes initially, it could be beneficial for tactical facilitators to emphasize proper movement patterns as a foundation for all tactical athletes before progressing.

In the tactical population, it is not uncommon to find individuals who cannot perform a squat movement with proper form and without restrictions. For example, in some tactical athletes, the knee flexors may compromise the pelvic girdle or lumbar spine, resulting in poor lower back mechanics during squat movements. Alternatively, squats may be performed incorrectly due to a lack of core stability or hip mobility, for example, which does not allow tactical athletes to hinge their hips properly.

The ability of a tactical athlete to overhead squat can also be dysfunctional due to many factors including the shoulder girdle. Shoulder girdle mechanics can sometimes be compromised if the individual is restricted due to the biomechanical demands of the job or training program (e.g., compromised posture during computer work, rucking, push-ups for testing, etc.). Dysfunctions such as the examples provided can lead many tactical athletes to be predisposed to injury under loads, and the ravages of time.

DYNAMIC WARM-UP One possible remedy that tactical facilitators can easily implement is to mandate group dynamic warm-up routines that include corrective exercises and injury prevention movements. This may prove to be vital to improving proper movement. The sample exercise list is split into dynamic exercises and dynamic warm-up movements.

SAMPLE DYNAMIC WARM-UP PROTOCOL Shoulder Girdle - Exercises

Stick Drill (Figures 1 and 2)

Corner Stretch (Figure 3)

Door/Rack Lat Stretch (Figure 4)

Hip Girdle - Exercises

Kneeling Hip Flexor Stretch

Scorpion Hip Flexor Stretch

Ankle Grab Cradle (Figure 5)

Cradle (Figure 6)

Reverse Cradle (Figure 7)

Table Cradle Stretch (Figure 8)

Squat Pattern - Movements

Squat and Alternate Reach

Lateral Squat

Drop Step Lunge

Hip Hinge Pattern - Movements

Single-Leg Reach Back Good Morning

Single-Leg Reach Back Good Morning— Opposite or Same Arm Reach

Single-Leg Reach Back Good Morning — Opposite or Same Arm Reach with Band

Overhead Pattern - Movements

Overhead Stick Squat

TRX Overhead Sit – Back Squat

Super Band Overhead Pull-Apart Squat



After these exercises are incorporated into a workout routine on a weekly basis, the tactical athletes and facilitators can decide which warm-up exercises and movements appear to have the most benefit. These are usually the exercises that are the most difficult to perform, which warrant further focus in follow-up sessions. In addition, if a tactical athlete is in need of reconditioning, these exercises can be the foundation of a corrective exercise program.

To summarize, the basic movement patterns can be easily incorporated into the training program of tactical athletes in their warm-up routine. In addition, the movement patterns can be used as the foundation for the exercises incorporated into circuit training in order to reinforce the optimal movement patterns. Through reinforcement and correct repetition, the optimal movement patterns of bend, rotate, flex, and extend may become normalized and lead to an increased ability to move and train well.

If poor movement patterns are performed with an increased resistance, increased volume, or sustained for a chronic period of time, then the tactical athlete risks feeling discomfort, pain, and injury; this does not have to be the norm. It is important that the tactical facilitator teaches the basics first to establish a foundation, then the remedial interventions can be added as needed. After that is accounted for, the tactical athletes can move on to more specific exercises in their training. Always remember that the program should start from the foundation up, rather than the specific training first.

ABOUT THE AUTHORRobb Rogers was recently named the Head Strength and Conditioning Coach at Texas A&M University – Kingsville. Prior to that, he has worked as a strength coach for Liberty High School in Colorado Springs, CO; a contractor training Special Forces personnel for the military; the Performance Center/TSAC Director at the National Strength and Conditioning Association (NSCA) Worldwide Headquarters; a performance coach for St. Vincent Sports Performance; a strength coach for Middle Tennessee State University; a strength and conditioning coordinator for the St. Louis Blues National Hockey League (NHL) team; the Strength and Conditioning Director at Baylor University; the Head Strength Coach at the University of Southern California; and an assistant strength coach at the University of Missouri. Rogers has been published in numerous journals and magazines and is a member of the Perform Better Seminar Team. Rogers has been a national/international lecturer since 1985, teaching and consulting with coaches, law enforcement, trainers, and therapists around the world. He earned his Bachelor’s degree in Physical Education from Southwest Missouri State University and his Master’s degree in Human Performance and Sports Psychology from the University of Missouri.


ROBB ROGERS, MED

FIGURE 1. STICK DRILL FIGURE 2. STICK DRILL

FIGURE 3. CORNER STRETCH

FIGURE 5. ANKLE GRAB CRADLE FIGURE 6. CRADLE

FIGURE 4. KNEELING HIP FLEXOR STRETCH



FIGURE 7. REVERSE CRADLE FIGURE 8. TABLE CRADLE STRETCH

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