Returning to Sports Post-COVID: Where Public Health and Strength & Conditioning Meet
/BREAKING NEWS: USA, Spring 2020. March Madness, The Masters, and every Major League, minor league, high school, and youth sports league - shut down. All due to a pandemic caused by a 125 nanometer virus called COVID-19.
As people say these days, we live in unprecedented and uncertain times.
Through it all, sports appear to still be a vital thread to the fabric of American culture. For many youth and high schoolers, sport is the major outlet for physical activity providing physical, mental and social benefits. For many adults, it provides a livelihood.
But, as we re-open America and return to what we have started to call “the new normal,” how do we go from at-home body weight workouts and driveway hoops (perhaps inspired by The Last Dance) to assembling with our team to practice, train, compete, and offer friendship? Or, for the opportunity to be a spectator or a sports parent and experience the joy of sports?
This question is definitely the hot topic and being asked not only in the sports arena but everywhere else–restaurants, the entertainment industry, schools, the workplace…everywhere.
A List of Current Recommendations and Guidelines
In an effort to begin answering this question, several organizations have assembled advisory committees and working groups to come up with a set of recommendations and guidelines for returning to sport.
Here, we merely provide links to a collection of resources from some of these major organizations including the Centers for Disease Control and Prevention (the CDC) along with several national sports organizations.
Centers for Disease Control and Prevention (CDC)
National Federation of State High School Associations (NFHS)
NCAA – Sport Science Institute
United States Olympic & Paralympic Committee
American College of Sports Medicine (ACSM)
American College of Cardiology’s Sports & Exercise Cardiology Council
National Strength and Conditioning Association
Project Play
Note: Given the changing environment, recommendations and guidelines may change at any time.
“Check with state and local officials”
A common theme that continues throughout the sporting ecosystem is that the guidelines can be vague (i.e. use of the word ‘encourage’) and, like many aspects of the American democracy, get passed from the federal level to the states and onto local institutions or municipalities. Thus, there are federal or national guidelines from the CDC, the American College of Sports Medicine, the National Strength and Conditioning Association, and the National High School Federation that are recommended but then because of state-to-state differences in COVID cases, state policies, etc. there becomes another 50 variations.
It is also possible that even regional or local differences (“hotspots”) exist within a state. Thus, there are local groups like the team of medical experts in St. Louis who are collaborating on recommendations for safely resuming youth and high school sports.
Most national organizations including the CDC and NFHS have a statement such as the following: “It is important to check with state and local health officials to determine the most appropriate actions while adjusting to meet the unique needs and circumstances of the local community.”
Return to Sport: Beyond Public Health Policies
Besides the public health policies around infectious disease mitigation of risks, there are also specific return to sport guidelines pertaining to training and conditioning. As outlined in the NSCA 10 pillars of long-term athletic development, health and well-being of the athlete should be central. Some, and even many, of these athletes have been relatively inactive compared to the typical weekly training and competition schedule, or even a typical off-season or pre-season program.
Last year, the NSCA and the Collegiate Strength and Conditioning Coaches Association (CSCCa) published guidelines for Safe Return to Training Following Inactivity that may occur during transition periods (i.e., after a vacation between or during academic terms). Part of this was prompted by an increased incidence of catastrophic or severe medical emergencies such as sudden cardiac death, exertional heat stroke, and exertional rhabdomyolysis, but moreso due to an increase in soft tissue injuries like pulled hamstring or ACL tear when athletes return to training after a period of inactivity. As stated in the paper, “the risk of non-contact (soft tissue) injury is significantly greater after periods of inactivity if training workloads and/or recovery strategies are not adjusted to reflect athletes' reduced level of fitness.”
Furthermore, “almost 60% of non-contact injuries occur during these periods in which the athlete is transitioning back into training following a period of inactivity. This increase in non-contact injuries suggests that athletes are being exposed to excessive workloads in the period immediately after their return to campus, and/or their training workload is being increased at a faster rate than is appropriate.”
A Simple Case of Progressive Overload
The joint consensus paper from the NSCA and CSCCa details the recommendations and best practice guidelines pertaining to the retraining of college athletes during transition periods but many of the principles can be applied to younger (middle school and high school) athletes as well. More specifically, is the consideration and application of one of the fundamental principles of exercise prescription–progressive overload.
Progressive overload is the continual and gradual increase in the total workload during training sessions to stimulate physiological adaptations while also allowing for adequate recovery. The opposite of progressive overload is the sedentary person (or the athlete who has been inactive for a prolonged period) who goes from zero to high training frequency and high training loads in the first week or two and has excessive soreness and fatigue. Instead, the workouts should be phased in gradually and progressively up to full intensity and higher volumes to encourage proper acclimatization and to minimize the risk of adverse effects on health and injury. With this in mind, training sessions and actually all regular practice sessions must be appropriately designed and implemented to reflect the individual athletes' current levels of fitness and fatigue, so as to not induce excessive exertion and increased risk of injury.
The 50/30/20/10 Rule and FIT for Strength Training
The general approach to re-conditioning following a layoff like COVID should follow the 50/30/20/10 rule outlined in the NSCA-CSCCa guidelines. The 50/30/20/10 rule reflects the percentage weekly reduction of volumes and/or workloads for conditioning and testing in the first 2–4 weeks of return to training based on the uppermost volume of the conditioning program. Thus, it is ideal to understand the game demands (yardage covered, number of sprints, average %heart rate max, etc.) of the sport.
It was suggested that the application of this rule be based off three scenarios of the athlete profile.
Athlete type 1: Returning athletes who have experienced a 2-week break or longer or for student-athletes who are beginning under a new head sport coach. A 2-week build-up of 50% and 30% weekly reduction from max conditioning volume over the two weeks.
Athlete type 2: New athletes that are coming off a period of inactivity, or all student-athletes who are beginning under a new head strength and conditioning coach. A 4-week build-up of weekly reductions of 50/30/20/10% from max conditioning volume over the four weeks.
Athlete type 3: Athletes returning to training after an incident of exertional rhabdomyolysis or exertional heat illness, or perhaps a prolonged period of inactivity. A 4-week build-up of weekly reductions of 50/30/20/10% from max conditioning volume over the four weeks. This may include an additional rehabilitation program as well.
In the case of return to sport post-COVID, it could be perhaps be recommended that the conservative approach be to program for the athlete who is not physiologically prepared for the demands of training and/or returning from prolonged inactivity (athlete 2 or 3). But of course, this will vary according to what has occurred during the last few months of quarantine and some coaches, athletes and programs have been quite consistent in communication and training.
The strength training program should consider the introduction or re-introduction of loading in the weight room using the FIT principle. Remember, some of these athletes have been doing body weight or light kettlebell strength training sessions, if at all. Depending on the strength training activity of the athletes during COVID, the frequency in the first few weeks may be 1-3 times per week and then increased to 2-4 times in weeks 3 and 4. The intensity should take into account the sets, repetitions and the percent of the 1 rep max (%1RM). In general, 1-3 sets of 12 reps at 65% 1RM would be acceptable. Rest intervals should be 1:4 work-to-rest in week one and 1:3 in week two. Plyometric exercises should not exceed 70 foot contacts in week one and 100 foot contacts in week two in average-sized athletes, and progress from low to high intensity. However, strength and conditioning coaches should use their own professional judgment regarding limitations on the return to strength training program, especially if working with younger, less experienced athletes. Again, think progressive overload and know your athletes.
Should a conditioning test be conducted upon return?
Another aspect of the return to sport process that has raised some debate centers around testing. Should a conditioning test be conducted upon return? The NSCA-CSCCa recommends that an appropriate conditioning test (i.e. repeat sprint test for intermittent field sports, Yo-Yo test, etc.) can be conducted at 50% reduction in testing volume in athletes who have not trained recently. For example, in the traditional 110-yard shuttle test commonly used in American football, the test would be cut down to 8 reps instead of 16 reps while maintaining intensity and rest time between reps. Ideally, you would be able to compare a conditioning test to past results. Alternatively, you could conduct typical conditioning in line with the 50/30/20/10 rule at a prescribed submaximal intensity and measure the heart rate response. Here, the conditioning becomes ‘the test’. For example, for the Yo-Yo test commonly used in soccer, if the athlete achieved a level 16 previously, they would work up to a level 8 (50% reduction) the first week, level 11 the 2nd week (30% reduction), level 12+ the third week (20% reduction), and level 14 the 4th week (10%).
However, there are others who are opposed to conditioning or fitness testing upon return from COVID. They are being cautious, and in doing so will use the principle of progressive overload to slowly and gradually return the athletes to a state of fitness that will prepare them to meet the demands of their sport. In tests of all-out sprint effort (repeat sprint tests), this becomes relevant to avoid soft-tissue injury. Again, the strength and conditioning coach and others involved in the health and safety of the young athlete should use their professional judgment and knowledge of the athlete’s training and conditioning regimen in the past few months to safety return them to sport.
Consider the Total Workload: The Whole is Greater than the Sum of its Parts
A final, but very important point: The total training volume should be taken into account. This would include what happens in the sport-specific practice, conditioning, and strength training. The body does not know if the workload is coming from practice or conditioning or the weight room–it just knows that it is demanding effort and energy. In what may be a very truncated pre-season for some sports, coaches may be rushed to install offensive and defensive strategies but it should be also be considered that “conditioning” can be effectively and efficiently incorporated into a well-designed practice session. In some cases, there will need to be communication between the sports coach(es) and strength and conditioning coach.
Warning: Do NOT Perform Physically Exhausting Conditioning to Develop “Mental Toughness’
Oh one last thing, do NOT perform physically exhausting conditioning drills for the purpose of developing “mental toughness!’ This is not just a post-COVID thing, it’s an all the time thing.
First, there are better ways to develop mental skills. Second, there are way too many mental toughness conditioning stories that result in news headlines, hospitalizations, and even death!
Health and Well-Being is Central to Return to Sport Post-COVID
Let’s admit it–we all want to get back to sports, and reap the myriad of benefits it brings–physically, mentally, and socially. Given the increased risk of COVID infection, it’s clear that we need to practice good hygiene based on public health recommendations to mitigate the risk of this infectious disease. In addition, it is important to communicate with clinicians when athletes and coaches who have been infected with COVID-19 and recovered are cleared to return to sport. The logistics behind the implementation of these public health recommendations will be challenging, but once in place we also need to implement best practices in training and conditioning to also ensure the health and safety of athletes.
Finally, let’s not forget the power that sports brings through inter-personal relationships, including those interactions that can nurture mental health and social well-being during this period of uncertainty.
Join over 1 million coaches and athletes using Volt's AI-powered training system. For more information, click here.
Learn more about Dr. Eisenmann | @Joe_Eisenmann
