Pendekatan Shadaow Vs Pendekatan Bermain

EFEKTIVITAS MODEL PEMBELAJARAN DENGAN PENDEKATAN SHADOW DAN PENDEKATAN BERMAIN TERHADAP PERKEMBANGAN KETERAMPILAN DASAR BULUTANGKIS SISWA DI SEKOLAH DASAR
TAHUN 2004

Research Report from LAPTUNILAPP / 2006-10-02 14:17:59
Oleh : Herman T, Fakultas Ilmu Sosial dan Ilmu Politik
Dibuat : 2006-10-02, dengan 1 file


ABSTRAK

Efektivitas Model Pembelajaran dengan Pendekatan Shadow dan Pendekatan Bermain terhadap perkembangan Keterampilan Dasar Bulutangkis Siswa di Sekolah Dasar Tabun 2004. Penelitian ini bertujuan untuk memperoleh informasi, mengenai pengembangan keterampilan dasar bulutangkis siswa sekolah dasar melalui model pendekatan shadow dan model pendekatan bermain.

Metode yang digunakan dalam penelitian ini adalah metode eksperimen dengan desain "pre-test – post test". Sampel yang digunakan siswa Sekolah Dasar Negeri 1 Untoro, Kecamatan Trimurjo, Kabupaten l.ampung Tengah. Sampel berjumlah 45 orang siswa yang dibagi dalam tiga kelompok, yaitu kelompok shadow berjumlah 15 orang, kelompok bermain berjumlah 15 orang dan kelompok kontrol berjumlah 15 orang. Pengumpulan data dilakukan dengan tes keterampilan dasar konsep Tes MFS.

Hipotesis yang diajukan adalah:

1. Ada perbedaan yang signifikan dalam perkembangan keterampilan dasar bulutangkis melalui pendekatan shadow;
2. Ada perbedaan yang signifikan dalam perkembangan keterampilan dasar bulutangkis melalui pendekatan bermain;
3. Secara keseluruhan pendekatan shadow lama efektifnya dengan pendekatan bermain dalam meningkatkan keterampilan dasar bulutangkis untuk siswa sekolah dasar.

Teknik analisis: pengujian hipotesis dilakukan dengan t-test, dan U-test Mann Whitney.

Hasil analisis data:

Berdasarkan basil uji t-tes untuk keterampilan dasar bulutangkis `kelompok shadow' diperoleh nilai t hitung sebesar 8,05 yang lebih besar dari t tabel (1,75). Hal ini berarti keterampilan dasar bulutangkis siswa sekolah dasar `kelompok shadow' berkembang setelah mengikuti pembelajaran bulutangkis dengan pendekatan shadow. Pada `kelompok bermain' diperoleh t hitung sebesar 5,34 yang lebih besar dari t tabel (1,75). Hal ini berarti keterampilan dasar bulutangkis siswa sekolah dasar 'kelompok bermain' berkembang setelah mengikuti pembelajaran bulutangkis dengan pendekatan bermain.

Pada `kelompok kontrol' diperoleh t hitung sebesar 1,04 yang lebih kecil dart t tabel (1,75). Hal ini berarti keterampilan dasar bulutangkis siswa sekolah dasar `kelompok kontrol' tidak ada perkembangan.

Hasil uji perbandingan dengan Mann-Whitney menunjukkan bahwa kelompok shadow diperoleh nilai U hitung sebesar 45 yang lebih kecil daripada U tabel (127). Sedangkan pada kelompok bermain diperoleh U hitung sebesar 194,50 yang lebih besar daripada U tabel (127). Dengan demikian dapat disimpulkan bahwa pendekatan shadow lebih baik daripada pendekatan bermain.

Hasil uji perbandingan dengan Mann-Whitney menunjukkan bahwa kelompok bermain diperoleh nilai U hitting sebesar 29 yang lebih kecil daripada U tabel (127). Sedangkan pada kelompok kontrol diperoleh U hitung sebesar 236 yang lebih besar daripada U tabel (127). Dengan demikian dapat disimpulkan bahwa pendekatan bermain lebih baik daripada kelompok kontrol.

PPLP Hanya Jalan Pintas

Oleh: Yunas Santhani Azis
Kompas, 26 Juli 2005


Pusat Pendidikan dan Latihan Pelajar merupakan jalan pintas untuk memperoleh atlet berprestasi yang dirancang dalam keadaan darurat. Bila ini diteruskan tanpa perbaikan sistem pendidikan jasmani secara keseluruhan, program PPLP tersebut ujung-ujungnya hanya menjadi proyek tanpa ujung.

Itulah kritik pedas yang dilontarkan Ketua Lembaga Penelitian Fakultas Ilmu Olahraga, Universitas Negeri Jakarta, Syarifudin dalam sebuah perbincangan pada Jumat pekan lalu.

Keras atau lunak, sembarangan atau santun, yang jelas apa yang disampaikan Syarifudin langsung menusuk persoalan inti upaya Indonesia menuju prestasi olahraga puncak—yang sayang, tidak kunjung sampai.

Persoalan pokok tersebut sesungguhnya dapat disimak dari pernyataan Deputi Pemberdayaan Olahraga Menteri Negara Pemuda dan Olahraga Djohar Arifin Husin tentang Pusat Pendidikan dan Latihan Pelajar (PPLP). ”Filosofi PPLP harus dikembalikan pada semangat awal Ragunan. Filosofi dasarnya adalah atlet potensial yang disekolahkan,” katanya (Kompas, 18/7).

Atlet (anak, pelajar) potensial dimasukkan dalam PPLP! Pertanyaannya, siapa dan bagaimana menentukan si anak itu berpotensi menjadi atlet berprestasi tinggi, yang bahasa kerennya high performance athlete? Jawabnya, tentu saja guru-guru dan pelajaran pendidikan jasmani sekolah.

Orientasi pendidikan jasmani (PJ) adalah perkembangan fisik, motorik, psikis, dan sikap anak. Kalau dilakukan dengan benar, anak akan mempunyai tingkat keterampilan gerak yang baik, ujar Syarifudin. Dengan orientasi seperti itu, gurulah agen yang dapat melihat apakah seorang anak berbakat atau tidak untuk mencapai jenjang prestasi tinggi.

Syarifudin mengingatkan, pengamatan terhadap bakat seseorang adalah sebuah proses berkelanjutan yang tak mungkin dilakukan sepotong-sepotong. Pakar ilmu olahraga modern, Tudor Bompa, yang buah pikirannya luas diterapkan, juga tidak menjamin seorang anak yang menjuarai sebuah pertandingan adalah seorang yang berbakat.

Olahraga Jerman

Satu setengah tahun sebelumnya, pakar olahraga Jerman, Hans-Peter Thumm, sudah menegaskan hal senada. Dari empat tujuan pendidikan jasmani yang disampaikannya, butir terakhir adalah sebagai identifikasi fondasi bakat-bakat berbagai cabang olahraga (Tabel 1).

Mengutip teori, Thumm yang selama empat bulan di medio akhir 2003 mengamati pelaksanaan pendidikan jasmani di sekolah dasar dan menengah Indonesia, maksimum cuma tiga sampai lima persen dari populasi anak sekolah yang mempunyai potensi motorik yang memenuhi syarat untuk masuk dalam olahraga prestasi (high performance sport) dewasa ini.

Begitu kecilnya sehingga hanya sekolah yang punya kualitas pendidikan jasmani harian bagus yang dapat memberi guru dan pemandu bakat kesempatan untuk mengidentifikasi potensi motorik sesungguhnya. Menurut Thumm pula, banyak penelitian membuktikan secara luas hubungan yang erat antara standar prestasi olahraga sebuah negara dan tingkat pendidikan jasmaninya (Tabel 2).

Kurikulum baru

Sejak tahun 2000, Indonesia sudah memperkenalkan kurikulum pendidikan jasmani yang baru. Kurikulum itu tidak lagi menekankan pada kecabangan olahraga, tetapi pada pengajaran gerak dasar yang mengacu pada pendekatan jangka panjang. Tahap pengajaran keterampilan gerak disesuaikan dengan masa pertumbuhan dan perkembangan fisik dan psikologis seorang anak (Tabel 3).

Kurikulum seperti itu sesungguhnya sejalan dengan pikiran Thumm yang melihat pendidikan jasmani sekolah haruslah berkonsentrasi pada kebugaran secara keseluruhan. Itu karena 95 persen anak didik yang merupakan mayoritas bukanlah individu yang punya potensi motorik cemerlang untuk menuju olahraga prestasi tinggi.

Pendidikan jasmani haruslah berorientasi pada terbentuknya dengan baik perkembangan fisik, motorik, menjadikan olahraga sebagai sarana pembelajaran sosial amat penting dalam membentuk manusia yang paham, taat aturan, bertanggung jawab, membentuk karakter yang kuat, dan menghargai serta menerima perbedaan (Tabel 4).

Hanya dengan pelaksanaan pendidikan jasmani yang benar pula tercipta motivasi berolahraga terus-menerus, baik untuk prestasi ataupun gaya hidup. Dalam bahasa Nugroho, pengajar Fakultas Ilmu Olahraga Universitas Negeri Yogyakarta, pelaksanaan pendidikan jasmani yang bagus melahirkan minat tinggi sekaligus memunculkan para siswa yang memang berbakat pada cabang-cabang tertentu.

Siapa peduli?

Beres? Tidak! Justru di sini kelemahan Indonesia. Menurut Syarifudin, begitu bertumpuk persoalan dihadapi guru dan program pendidikan jasmani sekolah yang membuat tidak tercapainya orientasi ideal pendidikan jasmani.

Persoalan pertama adalah kompetensi guru-guru jasmani sekolah. Dalam seminar badmini Mei lalu, Syarifudin menjelaskan sulitnya para guru mengimplementasikan kurikulum pendidikan jasmani tahun 2000 lebih jauh.

Di tingkat sekolah dasar, hampir semua guru olahraga adalah guru kelas yang hanya memperoleh kursus pendidikan jasmani selama enam bulan. Beban yang dihadapi berbanding terbalik dengan apa yang disiapkan pada mereka: murid berumur 7 sampai 10 tahun adalah usia-usia kritis dalam perkembangan gerak.

Latar belakang mereka bahkan ada yang dari PGA (Pendidikan Guru Agama). Di tingkat yang lebih tinggi (guru SMP dan SMA), guru dihadapkan pada persoalan-persoalan kesejahteraan diri dan keluarga, kata Syarifudin.

Persoalan kedua adalah cerita klasik lainnya, fasilitas pendidikan jasmani yang minim. Ketiga, kepedulian yang kecil terhadap pendidikan jasmani baik dari birokrat, kepala sekolah, maupun guru-guru itu sendiri.

Sudahkah pemerintah dan birokrasi peduli bila mengingat pendidikan jasmani di sekolah hanya diajarkan selama dua jam pelajaran setiap minggunya? Padahal, jelas Syarifudin, seperenam dari 24 jam waktu yang dimiliki oleh manusia yang ada dalam masa pertumbuhan haruslah untuk pengayaan proses belajar. Adakah yang peduli dengan guru-guru pendidikan jasmani kita? Apa ada institusi yang mengurusi mereka? Tidak ada, kata Syarifudin.

Kesimpulannya, membangun olahraga Indonesia yang kuat tidak bisa terlaksana tanpa pembenahan tiga hal tersebut, kompetensi guru-guru pendidikan jasmani harus dibangun dan ditingkatkan dengan serius, fasilitas pendidikan jasmani dan kepedulian terhadap pendidikan jasmani juga merupakan syarat yang tak dapat ditawar.

A Talk with Tudor Bompa

by Mike Mahler
www.t-nation.com


Tudor Bompa is known to many as the man who single-handedly revolutionized Western training methods. After more than forty years of work in the arena of international sports, he's widely considered one of the world's leading specialists when it comes to periodization, planning, peaking, and strength and power training. Name your favorite strength coach and very likely he's been strongly influenced by the work of Tudor Bompa.

Like many top coaches, Bompa began as an athlete himself and competed as a rower in the 1956 Olympic Games. As a coach (if one can even use that limiting term to describe him), Bompa has worked with athletes in eleven Olympic Games and World Championships, and has helped create four gold medals and 22 national champions. He's presented his training theories is over 30 countries.

In other words, this guy knows his stuff!

Currently, Bompa is a full-time professor at York University in Toronto Ontario. Luckily, he took the time to sit down to an interview with T-mag.


Testosterone: How did you first get interested in strength training?

Tudor Bompa: My athletic background is in track and field, and later on I got into rowing and cross country skiing. I was amongst the first athletes to incorporate a great deal of strength training into training for skiing. That was back in the early 1960's! My improvements were so visible that many other competitors were aghast. Because of my gains in upper and lower-body strength, I was able to use the skating technique for many parts of the race. Equally important was the use of my superior force in the arms.

T: How did you first begin coaching the things you learned as an athlete?

TB: The most critical innovations in the approach to strength training came in 1963 when I was asked to train a nationally ranked javelin thrower. Her coach had moved to another city and I was the only person who could train her. I have to mention that at that time, as is the case today in many sports, athletes were training year-round only for power, using some free weights but also a great deal of medicine ball training. Before I started to train this athlete in early 1963, I'd logically concluded that power is a function of maximum strength [he highest force one can display in one attempt or 1RM], as well as speed and quickness of action. While speed has more genetic limitations than strength, I had decided to look for improved power by increasing maximum strength to the highest possible levels.

As I continued to train this thrower, I also continuously monitored and tested both speed and quickness and maximum strength. After a year and a half of training her, I found out that gains in power come 95% from gains in maximum strength, and only 5% from speed. That year represented the year when I created periodization of strength. Using this strength training strategy, my javelin thrower improved by 15 meters within a year and a half. She became the Olympic champion in 1964 and set a new world record as well.

T: You've written a great deal about periodization and its application in strength training. In your terms, what exactly is periodization?

TB: In the case of training, periodization has two elements. First, periodization of the annual plan, or how this type of plan is divided into specific phases of training. Therefore we have the preparatory, competitive, and transition phase. These phases are further subdivided into macrocycles and microcycles.

Second, periodization of motor abilities — strength, speed, and endurance. In order to maximize the development of these abilities, another kind of "periodization" exists, with specific training phases and training objectives. In case of periodization of strength, the sequence of these phases are: Anatomical Adaptation (AA phase), Maximum Strength Phase, and conversion (transformation) of such gains into power.

Periodization represents a clear structure to follow and is thus the most effective way to improve athletic performance.

T: What are some of the most common mistakes that athletes make with regard to training?

TB: This question is really big! I'll try to provide a brief answer. The first problem is the influence of bodybuilding on strength training for sports. Many people believe that strength is proportional to size.

T: Not true?

TB: Completely incorrect! Hypertrophy is necessary only in very few sports, such as linebackers in football, shot putters in track and field, the super heavy-weight category in wrestling, or if an individual is far too slim. In such a case, the periodization of strength has to include three to six, or even nine weeks of training for hypertrophy. For any other athletes, bodybuilding methods are completely useless!

Sports do not require mass! Sports require power, quickness, and fast application of force. Bodybuilding methods do not result in increasing power. On the contrary, bodybuilding methods make the athletes much slower. And this is a no-no in most of the sports that require quickness and acceleration in force application.

T: Okay, what's another major mistake you see?

TB: The fallacy of Olympic weightlifting exercises! There are several strength coaches with Olympic lifting backgrounds. Unfortunately for them, they can't adjust their knowledge to the needs of strength training for sports. Strength training programs for sports must recognize that almost each sport involves different and specific muscle groups. These muscles are called "prime movers" or the muscles performing the actual technical moves. Therefore, strength training exercises have to target the prime movers. The Olympic lifting exercises are rigidly targeting only certain muscle groups, often not very important for many sports.

T: Give us an example of what you mean.

TB: Take judo for instance. Once I listened to a presentation regarding strength training for judo. The speaker was your typical Olympic lifting coach. He went over snatches and the clean and jerk! When the organizers asked my opinion, I simply said that the whole idea is wrong because judo involves primarily the flexor muscles of the hips, abdominals, and trunk, not the extensors normally targeted by Olympic lifting moves. The lifting coach became very upset when he heard me say this and left the room!

The exact same thing happened with swimming. An Olympic lifting coach once again suggested (what else?) the clean and jerk and the snatch. I pointed out that he was really missing the actual prime movers used in swimming, the arms flexors. The coach's exercises were targeting exactly the opposite group of muscles, the extensors. How difficult is to understand such a basic concept in sports training? Personally I'd use power cleans only for few sports such as linebackers in football and Greco-roman wrestling. I'd use clean and jerks for basketball players, performed with a medicine ball or a power ball.

This leads to another problem. The Olympic lifting coaches are using their own periodization, specific to Olympic lifting. Well, how much common sense does one need to have in order to understand that the Olympic lifting coaches have to adapt their training methodology to the periodization of that particular sport and not the other way around?

T: Good point. Any other mistakes you see that drive you nuts?

TB: Many athletes and coaches use the same type of strength training, irrespective of the physiological requirements their respective sports require. Each sport has its specific physiological profile. The sports where the alactic energy system is dominant are basically sports where speed and power are necessary to achieve high results [jumping and throwing events in track and field, linebackers, baseball, sprinting, etc.]

For sports where the alactic-acid system has a high percentage of ergogenesis, or breakdown in percentage of the three energy systems, it's required that power-endurance and muscle-endurance [30-50 reps per set] be trained. Finally, for endurance-dominant sports, one needs to develop muscle-endurance [tens and even hundreds of reps]. If this isn't achieved, a good adaptation to such training won't occur.

What we see here is a very important training principle — strength training has to play a physiological role; it has to tap the same energy system to add to the specific adaptation to the physiological requirements of a given sport. If one doesn't follow the above principle, he or she is entirely missing the point in strength training. I can strongly state that in athletics there is no strength for strength's sake, but rather just strength training with a specific purpose: maximum adaptation for performance improvement.

T: Are there any strength-training exercises that all athletes should be doing?

TB: Certainly, especially as they target the ankle, knee, and hip muscles. Most sports performed on the ground [all team sports, track, martial arts, etc.] use knee extensors and flexors, and gastrocnemius and soleus for the ankle actions. Therefore squats, leg curls, and toe raises are very popular with most sports.

Although many coaches do use squats and leg curls, toe raises aren't utilized as much as the other two exercises. Somehow they miss the fact that ankles play a very important role in any type of sprinting, quick changes of direction, and any agility actions. In many cases, the gastrocnemius and soleus are stronger than the quadriceps! This is why improvements in quickness and agility will come faster after these two muscles get stronger.

T: How about abs?

TB: Yes, this is equally true with regard to abdominal muscles. Abdominal curls with all variations and rotations are very necessary for all sports. A strong back is also crucial in many sports. Therefore, back extensions should be considered.

As for the arms and shoulders, there are more sports-specific variations than for the lower body. Look at the technical moves to figure out the prime movers in that sport. In sports training, it's more important to think about training movements and not muscles since exercises that mimic a technical move are better for targeting the prime movers.

I also believe that training has to be simplified. Especially nowadays, when there are so many gimmicks being introduced on the market and some individuals come up with all kinds of "novelties"! If you were to listen to each individual promoting a novelty [i.e. overspeed training, balance-training, etc.], you'll never have the time to actually train the athlete to reach the optimal adaptation level. Remember that high levels of specific adaptation results in athletic improvements!

T: What are some of the techniques you've used to blast through training plateaus?

TB: An athlete doesn't reach a plateau very quickly. It takes time — several years of training at a high level — before something like that can even be considered. In my career of many years I've rarely seen athletes reaching a plateau in strength training. This situation is mostly discussed in bodybuilding and at times in football. Nevertheless, let's try to discuss some possibilities for breaking through training plateaus. Here are five:

1. Use a maximum strength phase to stimulate higher percentage of fast twitch muscles into action. In many sports, strength training is poorly designed — lifting weights for strength's sake. There's no plan, no periodization. Athletes and bodybuilders that use periodization very rarely reach a plateau, in my experience.
2. Design a good periodization program with phases of maximum strength and phases of power training, where the objective is to increase the firing rate of fast-twitch muscles. In my strength training book, Periodization of Training for Sports, I discuss that in detail.
3. If one has a longer preparatory (pre-season) phase, several phases of maximum strength and power could be alternated. This alternation of maximum strength with power would certainly have the probability of breaking the plateau.
4. Under normal conditions I wouldn't suggest a maximum-strength phase for longer than six weeks. It's quite stressful to cope with. However, if an athlete has reached a plateau, I'd use a nine-week long maximum strength phase. Under these conditions, the muscles are stimulated at much higher levels than before.
5. Use more eccentric (negative) contraction techniques. Eccentric contractions require a much higher tension in the fast twitch muscles. Eccentric training shouldn't be used before the athletes have a better background. Unfortunately, many coaches can hardly wait to use everything they know; in this way they themselves are contributing to reaching a plateau.

T: So training and performance plateaus are often the coach's fault?

TB: Often a plateau is reached because of a coach's ignorance. Poor selection of training methods and their logical sequence also contribute. Similarly, the lack of patience in applying the right method at the right time also contributes to a psychological plateau, meaning that the coach thinks "I have used everything I know!" What's next then? Don't rush to throw everything you know at your athlete!

Organize a longer-term sequence of training methods. Plan everything you do well. Be more methodical in what you use in training. Allow the necessary time for the athlete to grow, to get ready for the next method, load increment, or alternation of types of strength. Remember that you can help a great deal, but you may also do quite a bit of damage. The coach has to wisely use maximum stimulation, high recruitment of fast-twitch muscles, and alternate with power training, where the firing rate of the same muscles are trained.

T: What about altering tempo? For example, taking more time in the concentric and eccentric ranges?

TB: Altering tempo is mostly a bodybuilding concept, though some people promote it as a sort of strength-training novelty, good for everything and everybody. The scope of altering the tempo of a lift is to create the highest tension in a muscle for the longest period of time, using both concentric and eccentric contraction.

Here's the main difference between bodybuilding and strength training for sports. For bodybuilding, the scope of increased tension is designed to induce hypertrophy. In strength training for sports, using heavy loads [> 85-90% of 1 RM] the scope is not to increase the duration of tension, but rather to apply the force against resistance as quickly and dynamically as possible so that the highest number of fast-twitch muscle fibers are recruited in the action.

Therefore, a major reason we use heavy loads in training athletes in different sports is to stimulate the recruitment of fast-twitch muscle fibers, and as a result, to use them during the performance of athletic action. The more fast twitch muscle fibers are used during the performance of a technical skill, the higher the application of force and the benefit for an increased performance.

The use of eccentric contraction in strength training for sports isn't as popular as concentric contraction. However, in some sports like throwing events in track and field and linebackers in football, it's used both to increase maximum strength and hypertrophy.

T: What role does nutrition play in recovery and do you provide nutrition and supplementation advice for athletes?

TB: The efficiency of an athlete's performance depends on his or her quality of training and nutrition. The energy used by the body strictly depends on the nutrition, diet, and training supplements one uses. But nutrition has to also be periodized according to the periodization of strength and endurance training. One can't just talk about nutrition in disregard of training.

For instance, diet has to be different for an individual working to improve hypertrophy, doing maximum speed training, or working on long-distance aerobic endurance. All these examples refer to completely different types of training which require a very specific type of nutrition. Unfortunately, most nutritionists haven't grasped this very important concept yet. They've never heard about periodization of training and the specific needs of nutrition as per a training program planned for given days. They're still talking about nutrition in general.

Two years ago, I specified such a concept to a small group of nutritionists. Most of them wanted more information about it. I suggested they look into my book, Periodization: Theory and Methodology of Training, where integrated periodization is discussed.

T: Fair enough. I've read that in Bulgaria, Olympic athletes train five times a day, seven times a week and that Russian powerlifters bench press up to 21 times a week. What do you think of this training frequency and would these types of programs be beneficial to a natural trainer?

TB: I just wish that people wouldn't compare apples to oranges. In order to discuss this we have to better qualify what Bulgarians and Russian Olympic weightlifters were doing in the time of the communist system. Yes, the Bulgarian Olympic lifters were training from 9:00 AM to 5:00 or 6:00 PM, 45 minutes on and 30 minutes off, except for the lunch break of some two hours. The Russians weren't powerlifters. They were Olympic lifters and what they were doing is something they've adapted to progressively over several years. Most of these athletes had a background of eight to ten years before they were doing that kind of training.

Also, remember that their training regimen was done in national training camps, where training, sleeping, and food ingestion were the only things they were doing. In addition, they weren't working on anything else, just lifting the bloody barbells! I'm not as impressed — exaggerations and myths aside — as many seem to be, simply because I have a similar background, where my athletes were training two to four times per day with a total of five to eight hours of training!

Now let's examine what pro-athletes are doing in the US. They train technically, tactically, speed, agility and strength/power several times per week, some up to three times per day. Is anybody suggesting that these athletes have to bench press 21 times per week? Team sports, however, aren't the best examples regarding training. Many amateur athletes train much more than pro-players. Also, the quality of coaching in many team sports, especially with regard to strength and conditioning, is quite pathetic. Similarly, some of the professional coaches — in fact, the majority — have a very poor understanding of training theory.

What do I think about the programs you mentioned? Who cares? Would I like to duplicate in this continent what my athletes have done in training camps in Romania? Not at all! Different societies, different times and mentality! Yet several of the athletes trained or consulted by myself in this continent have won against the East Europeans several times with just half of the amount of training time!

One of the key elements in training is to have high training knowledge and excellent methodology in applying it. Being equipped with such knowledge can do miracles. Forget about the "locker room gossip" regarding Russians and Bulgarians.

T: What books do you recommend on strength training — besides yours, of course? Who are the best strength training coaches out there?

TB: This is a very difficult question to answer, the reason being that I don't feel comfortable discussing the books written by other authors. However, I'll try to be as frank as I can. To be honest, I'm really dissatisfied with the level of strength training books available on the market. It seems to me that there's a great mess regarding this important area.

One of the greatest frustrations I have is that to some authors, there's no clear distinction between the objectives of strength training for sports, bodybuilding, and Olympic weightlifting. Authors with a football background expect everyone to do what a linebacker is doing. The same thing is valid for those who have a bodybuilding background. They discuss split routines, supersets, etc. This is totally inadequate for strength training for sports.

To me, a strength training book must serve the needs of a given audience. Use the best sports science information possible and most importantly, be practical. Just going through the process of reviewing the literature (as many do) isn't serving anybody's purpose.

T: Do you feel that some or most strength coaches have a tendency to make their programs too general at times and too complicated at other times?

TB: Yes, you're perfectly right. Let me try to explain what happens. There are several situations that are necessary to examine. Hopefully, from this analysis, some strength and conditioning coaches may start reflecting on their own situation.

First, both the technical coach (head coach) and the strength and conditioning coach are attempting to do their best to improve their athlete's performance. Each of these two coaches is trying to prove to themselves what they know and what they can do. Unfortunately, these two individuals don't cooperate well together to create programs specific to the needs of their athletes.

The head coach, not knowing much about strength and conditioning, doesn't take a leadership role regarding how much training to do, in which areas, what to stress in order to make the athletes better, etc. The result of this lack of cooperation is a high level of fatigue. When the athletes are reporting to the coach, each coach considers them rested, which is hardly the case. Fatigue is a cumulative outcome of training. If improperly monitored, fatigue will affect an athletes potential, their focusing potential, their accuracy of passing and shooting, and their performance.

Another problem is the "cocktail" strength and conditioning coach. Often, training programs are very general, a sort of "cocktail," doing all sorts of things for every athlete in the group. There isn't specificity regarding the needs of the sport, position played, or to relate the program to the dominant energy system in that particular sport. Knowing the proportions of energy systems in that sport dictates the type of training one must do.

T: Give us an example of that please.

TB: In sports where the anaerobic alactic system is clearly dominant — baseball, linebackers in football, jumping and throwing events in track and field — training should be focused on maximum strength, power, and maximum speed. In other words, they're focused on training elements which are tapping this energy system.

What business does a linebacker have running three miles? During the game he performs like a bulldozer, demolishing the opposition, but only for a two to four-second duration. To have such an athlete run three miles is a blasphemy! I wouldn't call this "general training," but a high degree of ignorance!

T: A "cocktail" strength and conditioning coach, huh? Interesting term. Any other categories of coaches you notice?

TB: Yes, the "busy-bee" type of strength and conditioning coach who wants to do too much in a very short period of time. Let's face it, a strength and conditioning coach has two to three hours per week to work with team sports athletes. Depending on the phase of the annual plan, a strength and conditioning coach has to do specific work according to the periodization of a given motor ability. The closer to the competitive phase, the more specific and simplified training should be.

And yet many coaches are doing everything under the sun: lifting weights, power training, using medicine balls, working to improve maximum speed, etc. The uninitiated "greenhorn" coach, the one with a shallow level of knowledge in sports science, will easily bite into the gimmicks of the day, such as overspeed, balance training, rotation training, and functional training.

In addition to the fact that some of these training ideas don't work at all, attempting to use them in training creates a crisis! A time crisis! If one has two to three hours to work with the athletes, when do they have the time to use all these novelties? Simplify your training! To be effective, training must be simplified.

To create an efficient program, one has to be very selective in what he does in training. Never forget that your training must result in a very specific adaptation. When superior adaptation occurs, performance will be superior. If one is using too many training elements, it's almost impossible to have a good adaptation. Just think about that! If you do, you'll see that you don't have time and room for totally unproven gimmicks.

This is my case for position-specific training programs. In team sports, almost each position requires different qualities and taps specific proportions of the three energy systems. Take for instance a mid-fielder in soccer vs. a sweeper, or a linebacker versus a wide receiver in football. These positions are so different from each other that a "cocktail" training program impedes the improvement of these athletes. Therefore a strength and conditioning training program has to be specific, to train the necessary qualities for that position.

T: That makes total sense. By the way, do you have any new projects in the works?

TB: The newest book that will be launched is the second edition of Serious Strength Training. I'll have a new co-author, Dr. Mauro DiPasquale. This new edition will be published by Human Kinetics in August, 2002.

Another project I hope to start very soon will refer to endurance sports. I do believe, together that we'll bring several training novelties for endurance sports. Then, in the fall, I'd like to start to update my strength training for sports book, Periodization of Training for Sports, where the title has to be corrected to incorporate the term "strength." My intent is to make this book the most popular training book [it already is really, since it sold more copies than any other books.] The book will have many additions regarding sports science and practical application.

I'll also refer to several fallacies used in training, from balance training to others. In my opinion, sports scientists have to take a strong and critical stance regarding the newest gimmicks invading and polluting the market.

T: Thanks for taking the time to chat with us, Tudor.

TB: My pleasure.


For more information on Tudor Bompa, go to TudorBompa.com.


Mike Mahler is a certified kettlebell instructor and has been a strength athlete for over ten years. Mike is available for phone consultations and personal training in the Washington DC area. If you'd like more information on a personalized strength training and nutrition program to address your needs or to set up a phone consultation, please e-mail Mike at mahler25@yahoo.com or call him at 703-848-8979.

Kelemahan Olahraga Kita

Oleh Agus Mahendra
Kompas, 19 Oktober 2000


OLIMPIADE telah membuka babak kesadaran baru, bahwa untuk selanjutnya kita tidak perlu terlalu tergantung dari bulu tangkis saja. Angkat besi secara mengejutkan mampu menyumbangkan medali. Pertanyaannya, benarkah Indonesia boleh berharap banyak dari cabang-cabang lainnya untuk olimpiade selanjutnya?

Kita bisa mengelompokkan potensi cabang dari kompleksitas teknis serta persyaratan mekanika yang terlibat di dalamnya. Ada cabang yang persyaratan teknik dan mekanikanya rendah, seperti angkat besi, panahan, atau beberapa nomor atletik seperti lari jarak menengah hingga jarak jauh. Ada pula cabang yang menuntut persyaratan teknik dan mekanika yang sangat kompleks, seperti senam, tenis, tenis meja, beberapa nomor atletik, dan banyak lagi.

Untuk cabang-cabang yang masuk dalam kelompok pertama, Indonesia memiliki peluang besar karena tidak memerlukan penguasaan teknik yang memakan waktu lama, dan tidak terlalu banyak membutuhkan campur tangan pelatih untuk menganalisis tekniknya. Kondisi yang harus dipenuhi, kita tidak boleh kalah dalam hal kekerapan, kekerasan, dan kebermaknaan latihan-bahkan kalau perlu dalam hal kedinian latihan. Konkretnya, mulailah latihan di cabang-cabang ini sedini mungkin, dengan dosis, intensitas, frekuensi, serta densitas latihan yang paling tinggi takarannya sehingga tidak kalah dari negara lain.

Contohnya, prestasi para pelari Kenya dan Ethiopia di jarak menengah dan jauh. Penelitian yang dilakukan para pakar dari Korsel terhadap keunggulan fenomenal para pelari kedua negara tersebut menunjukkan, rumus keberhasilan mereka ternyata bukanlah kondisi geografis yang tipis oksigen, bukan pula pola makan. Tetapi, yang lebih menentukan adalah efisiensi gerakan sebagai hasil latihan dan pola kehidupan sehari-hari.

Ini bisa dijelaskan baik dari segi motorik maupun fisiologis. Dengan pola kebiasaan dari kegiatan sehari-hari yang umumnya berisi kegiatan berlari, telah terjadi mekanisme adaptasi tubuh yang luar biasa di dalam pemrograman gerak dan metabolisme pengolahan energinya, sehingga tercapai efisiensi gerak yang sangat tinggi. Perubahan itu hanya bisa terjadi dari kegiatan yang sangat intensif, yang dilakukan sejak atlet masih kanak-kanak.

Lingkungan alam dan kebiasaan makan hanyalah penunjang, dan pada satu segi malah dapat menghambat. Hambatan inilah yang tidak disadari para pelatih kita, sehingga bibit-bibit atlet yang telah terbina alam-misalnya di bumi padang rumput Sumbawa, atau pegunungan Irian-malah hancur oleh perubahan lingkungan yang terjadi sangat tiba-tiba, ketika para atlet diboyong ke pelatnas di Jakarta. Jelas saja, para atlet mengalami kejut budaya dan pola hidup, karena tercerabut dari lingkungan hidupnya sehari-hari.

Sampai beberapa dekade ke depan, atau malah sampai kapan pun, atlet-atlet Indonesia tidak akan mampu menembus barikade keunggulan teknis atlet-atlet kelas dunia. Alasannya, atlet kita lebih sering memelihara kelemahan mendasar dalam penguasaan teknik. Ketika harus bertarung dengan atlet lain yang tekniknya sempurna, serta merta kita langsung kalah.

Mengapa atlet kita tidak bisa menguasai teknik yang sempurna? Barangkali kita harus merunut ke belakang sistem keolahragaan kita yang belum memungkinkan semua insan olahraga maju bersama-sama. Kita belum memiliki sistem keolahragaan yang jelas, baik sistem secara umum untuk seluruh cabang, maupun sistem khusus yang berlaku bagi satu cabang. Implikasinya, atlet kita lebih sering maju sendirian ke tingkat yang lebih tinggi, tetapi pelatihnya ketinggalan di belakang. Artinya, banyak atlet Indonesia yang potensial tidak mampu berkembang lagi karena keterbatasan kemampuan pelatih. Akibat lanjutannya, kematangan atau kesempurnaan teknik atlet kita selalu kalah kualitas dibandingkan lawan.

***

KUALITAS pelatih kita tidak pernah maju karena ketiadaan sistem keolahragaan di Indonesia telah menyebabkan belum terpetakannya secara jelas profil kemampuan pelatih beserta jenjang kariernya. Ketika seorang pelatih dipilih, tidak ada kriteria yang jelas tentang tingkat dan kemampuan apa yang bisa dijadikan sebagai tolok ukur. Tidak jelas pula jalur karier seorang pelatih yang ingin meningkatkan tingkat kualifikasi atau kemampuannya. Jika bukan karena kegigihannya sendiri, kemampuan pelatih kita lebih sering mentok di satu tingkat saja.

Oleh sebab itu, kemampuan pelatih kita tidak pernah terasah dalam memadukan prinsip biomekanika yang melandasi pelaksanaan teknik gerakan dalam tataran praktiknya. Padahal, pemahaman yang baik pada prinsip mekanik serta hukum-hukum alam yang mempengaruhi gerak, merupakan syarat utama bagi kesempurnaan teknik. Kelemahan dalam hal satu ini bukan saja terlihat pada saat menangani tim elite nasional kita, melainkan terjadi pula pada pembinaan di tingkat pemula.

Komentar pelatih asing pada penampilan atlet kita selalu sama dari waktu ke waktu, yaitu penerapan teknik dasarnya (basic technique) salah sehingga memerlukan banyak waktu untuk mengoreksinya. Kelemahan lain pelatih ialah dalam memahami prinsip-prinsip pelatihan dan mengutak-atik metode serta teknik yang ada. Mereka tidak kreatif mencari cara baru. Mereka tak memiliki kemampuan produksi, lebih suka mereproduksi atau meniru sesuatu yang memang sudah ada.

Mungkin asumsi ini bisa dipatahkan dengan mengajukan kasus bulu tangkis yang berhasil dalam tiga olimpiade, padahal bulu tangkis berada dalam kelompok cabang yang tidak sederhana. Ini juga tidak benar, karena bulu tangkis posisinya berada di antara kedua kelompok yang disebut di atas. Dalam arti itu, kita dapat mengatakan kompleksitas teknik bulu tangkis tidak serumit cabang permainan lain, misalnya tenis atau sepak bola.

Selain itu, satu hal yang paling menentukan keunggulan bulu tangkis kita adalah fanatisme masyarakat terhadap permainan itu sendiri. Bulu tangkis seolah-olah sudah menjadi permainan milik kita sendiri sehingga sama dengan budaya kita. Kepekatan nuansa budaya ini yang telah membuat para pemain Indonesia mencapai efisiensi gerak dan gaya yang khas Indonesia, sehingga unggul dari lawan.

Kasus kita di bulu tangkis sama seperti Pakistan di cabang hoki, Korsel di taekwondo, atau Rumania dan Rusia di senam. Bedanya, cabang favorit di negara-negara lain terus digali secara ilmiah dan kultural, serta dana yang memadai. Sementara, pembinaan bulu tangkis di Indonesia berkembang lebih secara alamiah. Oleh karena itu, kita boleh ragu bahwa pada olimpiade mendatang, bulu tangkis masih bisa diandalkan untuk menyumbang emas. Di Sydney, hanya satu dari lima emas yang diperoleh.

Kelemahan paling mendasar keolahragaan kita adalah iklim kompetisi yang tidak terarah dan tidak teratur. Dari segi ini, kita bisa mendeteksi betapa tidak seimbangnya kemampuan atlet kita dalam hal teknik dibandingkan kemampuan mentalnya. Atlet kita sering sudah menyerah sebelum berlaga, mencerminkan kelemahan mental bertanding yang memang tidak terasah secara terarah, baik saat latihan maupun saat pertandingan.

Tentu masih banyak kelemahan keolahragaan kita, tetapi yang mencolok adalah mental para pengurus Orde Baru. Budaya instant adalah yang paling mendesak untuk dikikis, sehingga pengurus sadar tidak ada gunanya bergulat dengan program-program instant untuk meraih medali atau juara umum, hanya karena ingin dianggap berjasa.

Yang terlebih penting adalah mendorong dan kalau perlu mendanai, upaya penciptaan sistem dari setiap cabang olahraga, walaupun hasilnya baru bisa terlihat satu generasi mendatang. Inilah yang sekarang mulai disadari Malaysia yang mensponsori penciptaan sistem bagi beberapa cabang strategis.

* Agus Mahendra MA, dosen FPOK-UPI

Belajar dari Yayuk Basuki

Atlet Kita harus Sinergikan Pengalaman dengan Iptek
Bali Post, 17 Desember 2006



Pada 1-15 Desember lalu telah berlangsung Asian Games XV di Doha, Qatar. Pada ajang olah raga itu, Indonesia juga ikut berpartisipasi karena masih punya sejumlah atlet yang baik. Namun, yang akan dibahas di sini adalah atlet yang baik barangkali kurang diimbangi oleh pembinaan yang sepadan. Guna membicarakan itu, tamu kita kali ini adalah Yayuk Basuki. Bagi dunia, ia salah seorang bintang. Sedangkan bagi Indonesia, ia petenis terbesar yang pernah dimiliki dengan pernah mencapai peringkat 20 besar di dunia dan berprestasi besar di Wimbledon.

Di event Asian Games, Yayuk Basuki sudah mendapatkan empat medali emas yang diraih dalam rentang waktu yang sangat lebar. Pertama kali mendapatkan medali emas pada 1986 yaitu di ganda putri bersama Susanna Anggarkusuma dan terakhir kali emas tunggal putri pada 1998. Ini satu rekor tersendiri. Kini, pemerintah -- dalam hal ini Menteri Pemuda dan Olah Raga -- telah menunjuk Yayuk menjadi salah seorang anggota tim untuk memantau olah raga. Berikut wawancara dengan Yayuk Basuki.

--------------

APA tugas yang diberikan pemerintah kepada Anda sekarang?

Saya sekarang masuk dalam tim monitoring yang berada di Kantor Kementerian Negara Pemuda dan Olah Raga. Tim ini dibentuk oleh Menteri Pemuda dan Olah Raga (Menpora) karena melihat kegagalan kontingen Indonesia di ajang SEA Games di Filipina pada 2005. Setelah mengevaluasi kinerja tim Indonesia, Menpora menilai perlu membentuk suatu badan yang akhirnya dinamakan tim monitoring. Tugas kita adalah memonitor dan mengawasi seluruh pelaksanaan program maupun pembinaan khususnya pemusatan latihan di Tanah Air. Kita juga sudah memprediksi seberapa besar peluang kita di Asian Games 2006 ataupun di SEA Games 2007. Sebenarnya banyak tugas kita termasuk mengefisiensikan anggaran dan memonitor penggunaan anggaran supaya tepat guna dan pembinaannya berlanjut.


Tugas tim monitoring ini begitu banyak. Khusus di cabang olah raga tenis, sering ada gejala secara individu, yaitu banyak atlet yang berprestasi tapi kalau sudah terjun ke gelanggang multi-event atau yang besar tidak berprestasi?

Kalau saya perhatikan dan ini juga saya lihat setelah saya mendunia atau masuk profesional, atlet-atlet kita memiliki perbedaan dengan atlet negara lain. Perbedaan yang mencolok yaitu faktor mental. Faktor mental ini benar-benar harus diperbaiki oleh seluruh atlet di Indonesia. Dampak faktor mental ini sangat luas. Contoh kecilnya seperti saat bertanding biasa di dalam negeri mencatat hasil bagus. Misalnya, seorang pelari mencatat waktu yang bagus. Tapi setelah diadakan uji tanding di luar negeri, mungkin catatan waktunya akan berubah.


Maksudnya, prestasi atlet kita tidak stabil?

Kadang-kadang mereka juga akhirnya tidak konsisten. Misalnya, seorang karateka bernama Umar Syarif pernah juara dunia junior di Denmark. Dia salah satu karateka terbaik di dunia saat ini. Walaupun kini sedang mengalami cedera, tapi saya dengar Umar sudah siap kembali lagi. Saya ingat sekali saat terjun di Asian Games 1998, tangan Umar Syarif berkeringat dingin. Jadi dari sisi pribadinya sendiri ada keraguan, mentalnya ternyata belum terasah.


Artinya, sewaktu menjadi juara dunia mentalnya kuat, tapi di tempat lain seperti Asian Games bisa lemah?

Ya. Ini karena Asian Games adalah multi-event di mana kita membawa nama negara. Kalau kejuaraan dunia mungkin masih membawa nama individu. Itu perbedaannya. Kedua, di sisi lain kurangnya pertandingan. Barangkali untuk satu-dua kali pertandingan oke, tapi itu belum mencukupi. Atlet-atlet kita seharusnya banyak mengikuti uji tanding. Jadi setiap bulan mereka harus ada uji tanding supaya prestasi mereka bisa konsisten. Kalau kita lihat, saat ini masih naik-turun gelombang prestasinya.


Kalau Anda, saat bertanding di Wimbledon sebagai individu dan bertanding di Asian Games atau SEA Games yang membawa nama negara, mana paling berat tekanannya?

Terjun di arena Asian Games itu lebih stres karena tanggung jawab kita kepada negara. Saya tidak bertanggung jawab terhadap pribadi, tetapi pada negara. Tapi di situ seninya buat saya, walaupun saya sampai dikatakan aneh. Saya benar-benar mencintai tantangan.


Beban karena stres membela negara, tapi ada dukungan dari negara juga. Ini berarti saling mengimbangi. Kalau di Wimbledon, kadang-kadang saat latihan tidak ada yang tahu, tidak ada dukungan juga?

Iya, benar. Seperti saat kita berangkat, maka berangkat sendiri. Kalau multi-event itu, seluruh mata masyarakat olah raga tertuju ke kita dan kita juga menjadi tumpuan untuk mengharumkan nama negara. Tapi di situ timbul suatu semangat buat saya karena satu motivasi saya adalah mengharumkan nama bangsa. Jadi berbuat yang terbaik. Bagi saya, terjun di arena Asian Games betul lebih stres karena dibutuhkan konsentrasi ekstra.


Jadi, di situ ada faktor masing-masing individu, ada yang senang tantangan dan ada yang menjadi goyah. Pasti selalu ada variasi antar-individu terhadap hal itu. Apa yang bisa dilakukan oleh organisasi olah raga untuk membantu atlet yang beragam itu?

Kita mendidik dari awal. Jadi betul-betul kita menciptakan suatu sistem organisasi secara lebih sistematis di mana sekarang ini sudah banyak penyandangnya, salah satunya termasuk ilmu pengetahuan dan teknologi (Iptek). Kita harus mengkombinasikan itu semua dengan perkembangan Iptek sekarang yang luar biasa. Kita tidak bisa seperti dulu tergantung berdasarkan pengalaman saja. Untuk sekarang, itu tidak akan mampu bertahan lama. Pengalaman itu harus kita sinergikan dengan Iptek. Itu saya rasa akan lebih baik. Hanya saja cara kerjanya memang harus sistematis. Kadang-kadang organisasi kita maunya tetap instan. Dari langkah pertama maunya langsung ke langkah kelima tanpa ke langkah kedua, ketiga, dan keempat dulu. Saya lihat beberapa organisasi masih seperti itu sistem kerjanya. Bagi saya, perlu kita revitalisasi supaya pada masa depan pembinaan menjadi lebih langgeng, lebih panjang, dan atlet pun akan berprestasi lebih lama.


Di beberapa organisasi ada psikolognya. Apakah memang jawabannya ada di situ atau dalam aura organisasi yang lebih luas?

Psikolog adalah salah satu penyandang juga. Sebetulnya ada beberapa tenaga ahli yang kita perlukan, salah satunya Iptek tadi. Tapi di sisi lain kita juga sudah pasti membutuhkan seorang psikolog. Walaupun tidak semua cabang olah raga percaya akan fungsi psikolog, saya pribadi sangat menyetujui dan psikolog ini adalah yang kita butuhkan. Saya lihat di nasional belum banyak organisasi yang memanfaatkan psikolog.


Apakah atlet pada umumnya punya sistem "support" sendiri secara mental seperti orangtuanya, temannya atau lainnya?

Saya rasa tidak. Seharusnya orang yang paling dekat dengan atlet adalah pelatih. Pelatih ini akhirnya yang akan memberikan masukan. Pelatih adalah panutan atlet. Pelatih membuat laporan ke organisasi atau manajer. Pelatih ini yang paling tahu kondisi dan kebutuhan atlet. Maaf, pelatih kita belum banyak yang tahu teknologi keolahragaan. Jadi semua memang rata-rata masih berdasarkan pengalaman. Contohnya, mereka yang dari mantan atlet jika tidak mengikuti Iptek olah raga maka belum tentu akan menjadi pelatih yang baik.


Ada yang mengatakan kalau olah raga beregu kita lemah tapi olah raga perorangan kita kuat seperti terlihat dalam tenis, badminton, tenis meja. Apakah itu betul? Apa bedanya beregu dan individu dalam konteks kelemahan mental atlet?

Sebetulnya kalau itu dianggap perbedaan tidak juga. Belakangan ini memang cabang-cabang olah raga tadi secara individual yang kelihatan lebih menonjol seperti badminton dan juga catur. Tapi kita juga mesti berterus terang bahwa cabang-cabang strategis kita saat ini baru mengalami kemerosotan yang sangat di bawah sekali. Itu mungkin benar-benar tanpa terprediksi sebelumnya termasuk cabang strategis seperti renang, atletik, dan senam.


Kita biasanya berharap atletik bisa menyumbangkan 8-17 medali emas di SEA Games. Tapi dalam SEA Games lalu atletik hanya bisa meyumbangkan satu medali emas. Sangat jauh kemerosotannya. Renang juga sama. Dari sekitar 50 medali emas yang diperebutkan, renang hanya menyumbang 1-2 medali emas. Juga merosot, karena biasanya renang menyumbangkan puluhan medali emas sejak zaman Lukman Niode sampai Elfira Rosa Nasution. Bagaimana ini?

Kita memang harus mengatasi hal ini, mencari tahu mengapa cabang olah raga itu sangat merosot. Saya katakan lagi, perlu ada revitalisasi dari sisi pembinaan karena cabang-cabang olah raga ini sekarang rata-rata tidak berbasis pada Iptek. Karena itu kita coba memasukkan agar basis utama setiap cabang olah raga dari Iptek dulu. Contoh kecil, di bidang olah raga saya yaitu tenis. Di tenis kita juga mesti paham mengenai bio mechanic.


Bisa dicontohkan diri Anda misalnya?

Misalnya, saya yang bertubuh kecil tapi bisa melakukan serv dan forehand keras. Dari mana saya bisa melakukan itu, bisa diteliti. Barangkali dari rotasi tubuh dan itu bisa dilakukan penelitian dari body rotation. Anak-anak sekarang berpikir, agar pukulan keras maka pukul dengan keras sehingga mengakibatkan tangan bisa cedera. Kalau dulu, bagaimana cara meminimalisasikan cedera ini, tapi sekarang kok malah lebih banyak cedera. Itu dianggap karena turnamennya lebih banyak. Padahal sebetulnya kerawanan cedera ini bisa kita sedikit redam. Itu memang bisa dari tubuh si anak, bisa juga dari over training, atau seorang pelatih yang tidak begitu memahami.


Dibanding dulu, sekarang banyak turnamen setiap minggu dan orang bisa melihat secara detail dan "close up". Orang awam saja bisa mendapatkan informasi itu. Apakah atlet sekarang tidak lebih cenderung ke Iptek dengan mengamati perkembangan tenis dunia?

Atlet kita kadang-kadang tahunya "pokoknya saya masuk lapangan dan latihan".


Mereka kurang memperhatikan yang di luar lapangan?

Iya, saya perhatikan ada beberapa atlet di luar waktu latihan malah tidur. Padahal waktu kosong itu mungkin bisa kita isi dengan aktivitas lain seperti kursus satu mata pelajaran atau bahasa atau belajar komputer. Sebetulnya sisi otak atlet ini juga perlu kita asah supaya mereka tetap aktif. Sekarang, atlet setelah capek latihan maka istirahat tidur saja dan tidak ada aktivitas lain. Padahal mereka juga dituntut untuk mengetahui perkembangan Iptek. Maaf, saya bukan menghakimi, tapi saya rasa ini yang perlu kita selamatkan dan perlu kita programkan untuk ke depan. Ini supaya atlet-atlet kita saat menghadapi lawan bukan hanya kondisi tubuhnya segar dan tidak hanya bermodal power saja, tapi juga bermodalkan skill dan isi kepalanya.


Kondisi Indonesia berubah-ubah seperti mengalami krisis moneter, susah, bahkan sekarang susah minyak segala. Sebetulnya, apakah ada pengaruh ekonomi terhadap prestasi atlet?

Saat ini sangat berpengaruh karena atlet sekarang beda dengan dulu. Kalau dulu, atlet kita benar-benar mau maju demi Indonesia, sedangkan atlet sekarang kalau tidak ada biaya maka tidak mau maju. Jadi terus terang saja, perbedaannya di situ.


Dalam kondisinya yang sudah berbeda, bagaimana menggabungkan motif pribadi dengan kebesaran negaranya, apakah prestasi atlet kita akan naik?

Terus terang saja dan ini bukan karena saya pesimis, tapi memang peluang atlet kita -- contohnya di Asian Games XV ini -- sangat berat. Salah satunya karena Cina menurunkan seluruh atlet juara dunia. (*)

If You Coach Children

you have to take particular care to avoid repetitive stress
by: Raphael Brandon


By definition, coaches should be able to help athletes avoid injury. Part of a coach's job description should be to incorporate suitable injury prevention work into each training programme - for example, maintaining the correct levels of flexibility and working on core stability.

Coaches should also concentrate on making sure that injuries don't occur during the workouts themselves. This is especially important if you coach children, because young athletes are particularly prone to developing injuries since their bodies are still maturing and bones and muscles are growing. This is especially true of chronic 'overuse' injuries. An overuse injury happens when an athlete performs one particular movement repeatedly and the body cannot cope with the repetitive stress associated with that movement. For example, runner's knee is related to the repeated knee flexion as the foot strikes the ground many times during a run. The knee joint, possibly because of knee-joint mechanics, cannot cope with this repetitive stress. Young athletes commonly suffer this type of injury. For instance, 'Little Leaguer's elbow' is famous in America where young baseball pitchers suffer a very high incidence of elbow tendinitis caused by repeated pitching at 80 mph at the age of 10. In the UK, shoulder injuries in young swimmers and tennis players are common (front-crawl and serving related injuries) as is knee pain.

The way to reduce the risk of children suffering injuries like this is to identify the movements or exercises which involve high forces or high repetitions and monitor the amount that these are performed. As the child develops and continues to train on a regular basis, you can gradually increase the amount that these demanding movements or exercises are carried out. It is also wise when training young athletes to allow for generous rest periods and to focus on quality, not quantity.

Take the case of Tim

The following case study is a classic example of a young athlete who suffered from an overuse injury and the rehabilitation process he had to go through to ensure the injury didn't return. Tim is a 10-year-old tennis player of national standard. He plays between 4-8 hours a week plus one hour of fitness training. Last December he suffered a wrist injury, where the circum-stances that led to the injury were entirely related to its cause.

Tim had spent over two hours in the afternoon playing points against a friend. He then went into a one-hour tennis lesson with his coach. In the lesson, the coach concentrated on top-spin serves. The top-spin requires an extra 'whip' of the wrist through the ball to achieve the extra spin, and is a demanding movement. By the end of the lesson Tim's wrist was painful and the damage had been done. Basically, his wrist joint was not strong enough to withstand two hours of friendly competition (if such a thing is possible with young athletes!) followed by a lesson which focused on one particularly demanding movement. As a result, Tim suffered an overuse wrist tendinitis injury.

The clear lesson here is that demanding movements should be concentrated into smaller coaching segments or only worked on when the athlete is completely fresh. Tim's injury obviously wasn't caused intentionally, but at the same time it can be considered to be the result of a 'training error'. A training error occurs when you perform 'too much, too soon' or 'too much, too tired'. Young athletes are much more sensitive to training errors, and as coaches we must therefore be as vigilant as we can.

The difficulty arises in trying to quantify what comprises a suitable training dose without falling into what could be considered as a training error. Sometimes it can be confusing trying to balance the act between not pushing young athletes too hard and treating them as though they were wrapped in cotton wool. However, it is possible to take a measured approach to training doses by thinking about how many repetitions of the movement should take place in the training session.

When we train in the gym with weights, we naturally set limits to the number of repetitions performed. We don't allow our athletes to do bench presses for a whole workout; instead, they are unlikely to perform more than 30 reps of bench presses split up into 3-4 sets with rest periods. The same is true of a plyometric training workout. We don't have athletes hopping around for a whole hour. Instead, they will perform something in the region of 100 foot contacts in a 45-minute workout, split up into many sets with rest periods in between.

How this applies to Tim

The answer to the problem of calculating suitable training doses is to apply the same planning to all coaching sessions that you apply to strength or power workouts. When you are coaching a movement that involves high forces, or when you are teaching a new exercise - this is demanding simply because it is unfamiliar - you need to plan in advance a fixed limit of repetitions. If Tim had hit 20 top-spin serves and then gone on to another activity, he probably wouldn't have been injured. The next training session he could have hit 40 serves and progressed methodically from this gentle starting point. I believe that if you take this kind of measured approach you are less likely to injure your athletes during training.

To recap what I've been saying, to avoid injuries you need to identify the movements in your sport that involve high forces or large numbers of repetitions. Then, having identified these, you need to plan appropriate training doses based on how new the movement is and how well-conditioned the athlete is. From this starting point, you can progress the intensity or volume of training in a sensible manner. Remember, with children, if you always give them exercise in short bursts and small doses with rest intervals in between, they will probably cope very well. If you think about children's natural activity patterns, everything they do is in short bursts of high intensity. They climb, sprint, jump, throw, and play games involving twisting and turning - all demanding movements, but performed in short bursts. Whereas adults, when they want a leisure activity are more likely to go for a five-mile continuous run, children will perform multiple sprints with rest periods over the course of an afternoon's play. You don't need to be frightened of teaching children demanding tasks or movements - just don't give them too many, and always allow generous rest periods. This way you will reduce most injury risks.

Rehabilitating Tim

Having analysed the causes of Tim's injury and the implications of training errors, a synopsis of Tim's rehabilitation period is also a very good example of what can happen when trying to recover from an injury.

After his injury occurred, Tim rested from tennis for a few days. When he tried to play again, the pain returned. He then rested again and then played again, with the same result.

At this point he visited a physiotherapist for treatment. By then Tim's parents were increasingly concerned about the persistent recurrence of pain and accepted my recom-mendation that Tim should rest completely from tennis and simply do general PE at school and fitness training until his wrist was 100% perfect. Sometimes it is very difficult to persuade young athletes to take a proper rest from their sport, but it is essential to give the developing body a proper chance to heal completely. For Tim, since it was his dominant hand, the healing process was probably slowed down by the fact that he couldn't avoid using his wrist in daily life, which meant he had to be extra patient.

As for rehabilitation exercises, Tim performed regular stretching exercises for the wrist and forearm muscles, and after a three-week complete rest when the pain had gone I gave Tim a wrist-extension exercise to perform each day at home. This was done with a 1 kg dumbbell with the aim of building the strength in his wrist. After a further, precautionary fortnight, Tim played tennis for the first time, but only for five minutes. There was no adverse reaction to this session so he repeated the five-minute hit three times during that first week. The following week he played tennis three times for 10 minutes each session, and the next week he played three times for 20 minutes. During this week the wrist began to bother him again, and I asked whether he had kept up the wrist-strength exercises and he said he hadn't. He reintroduced the exercises and the wrist has been fine ever since. After another week, Tim was able to complete an hour of normal tennis lessons.

The whole process took about two months before Tim could compete again. This involved some tough decisions on his part, to be patient and not to play again for what must at his age have seemed an eternity. In addition, further patience was needed in order to progress back into tennis very slowly. I often see young athletes taking only the minimum rest until the pain subsides before resuming a full training schedule, with the frequent result - a recurrence of the injury.

Overuse Injuries in Children and Adolescents

John P. DiFiori, MD
THE PHYSICIAN AND SPORTSMEDICINE - VOL 27 - NO. 1 - JANUARY 1999


In Brief: With the growth of youth sports programs, overuse injuries in young people have become common. Making the diagnosis can be challenging, but often the real hurdles are in identifying the causes of injury. Growth-related factors require special considerations in injury management. A directed history assessing these and other causative factors and a systematic exam help formulate a comprehensive rehabilitation program. Recommendations for a successful return to activity and prevention of reinjury include avoiding heavy training loads and early sport-specific training, taking adequate rest periods, and ensuring proper supervision.

The benefits of regular exercise are not limited to adults. Youth athletic programs provide opportunities to improve self-esteem, acquire leadership skills and self-discipline, and develop general fitness and motor skills. Peer socialization is another important, though sometimes overlooked, benefit. Participation, however, is not without injury risk. While acute trauma and rare catastrophic injuries draw much attention, overuse injuries are increasingly common.

Diagnostic and treatment efforts should focus on how the injury developed and consider issues that are unique to growing athletes. An understanding of these concepts provides the basis for making specific injury-prevention recommendations.


Kids' Activities Intensify

The true magnitude of youth sport participation in the United States is difficult to measure. Approximately 35 million children and young adults between ages 6 and 21 participate in sports, including 6 to 8 million in school programs (1,2). Over the last three decades participation among young women has increased dramatically (2). Involvement in nonscholastic clubs, in sports such as volleyball, basketball, softball, and gymnastics, also appears to be increasing. Furthermore, parents are hiring "personal" coaches and trainers to furnish specialized training beyond that provided by schools or clubs (3). Between school and club programs, private instruction, and popular summer sports camps, many youngsters are training and competing year-round. Though it is uncertain if more children and young adults are involved in sports, it seems clear that those who participate are doing so in a more extensive way.

Because training has become more sport-specific and nearly continuous, overuse injuries are now common among young athletes (table 1: not shown). Recent data indicate that
30% to 50% of all pediatric sports injuries are due to overuse (4-6). In a study (4) of children (aged 5 to 17) who presented to a sports injury clinic, 49.5% of 394 sports injuries were classified as overuse, with boys and girls displaying a similar frequency. The relative percentage of overuse injuries varies by sport, however. In a 2-year study (5) of 453 young elite athletes, 60% of swimmers' injuries were due to overuse, compared to 15% of soccer players' injuries. Athletes who had overuse injuries lost 54% more time from training and competition than those who had acute injuries.


How Overuse Occurs

Overuse injuries occur when a tissue is injured due to repetitive submaximal loading. The process starts when repetitive activity fatigues a specific structure such as tendon or bone. With sufficient recovery, the tissue adapts to the demand and is able to undergo further loading without injury. Without adequate recovery, microtrauma develops and stimulates the body's inflammatory response, causing the release of vasoactive substances, inflammatory cells, and enzymes that damage local tissue (7). Cumulative microtrauma from further repetitive activity ultimately causes clinical injury. In chronic or recurrent cases, continued loading produces degenerative changes leading to weakness, loss of flexibility, and chronic pain (8). Thus, in overuse injuries the problem is often not acute tissue inflammation, but chronic degeneration (ie, tendinosis instead of tendinitis).


Contributing Factors

An understanding of the risk factors contributing to overuse injuries is the cornerstone of prevention. These risk factors have typically been classified as intrinsic or extrinsic. In children, issues specific to the immature musculoskeletal system deserve special consideration (table 2). (See "Case Report: Knee Pain in a New Runner," below.)

Table 2. Factors Contributing to Overuse Injury

Intrinsic Factors

• Growth (susceptibility of growth cartilage to repetitive stress,
• inflexibility, muscle imbalance)
• Prior injury
• Inadequate conditioning
• Anatomic malalignment
• Menstrual dysfunction
• Psychological factors (maturity level, self-esteem)

Extrinsic Factors

• Too-rapid training progression and/or inadequate rest
• Inappropriateequipment/footwear
• Incorrect sport technique
• Uneven or hard surfaces
• Adult or peer pressure

Growth-related factors. Two factors related to growth are particularly important. First is the susceptibility of growth cartilage to repetitive stress. In children, growth cartilage is present at the articular surface, physes, and apophyses (9).

The articular cartilage appears most vulnerable to injury at the ankle, knee, and elbow. The development of osteochondritis dissecans at these sites is poorly understood and is possibly related to repetitive microtrauma (10).

Apophyseal injuries, including tibial tubercle apophysitis (Osgood-Schlatter disease) and calcaneal apophysitis (Sever's disease), are commonly attributed to overuse (11). They result from traction-induced microtrauma at the tendon-bone attachment. Contributing factors include the weakness of the growth cartilage relative to the tendon, and poor flexibility and increased traction during the adolescent growth spurt.

Physeal injuries may also be caused by repetitive loading. Growth plate injuries have been reported in the proximal humerus in throwers (12) and a badminton player (13) and in the proximal tibia of a runner (14). In gymnastics, repetitive loading of the wrists can injure the distal radial growth plate (15). It appears that metaphyseal ischemia inhibits mineralization within the zone of provisional calcification, prolonging chondrocyte life. This, together with continued division of chondrocytes in the proliferative zone, results in widening of the growth plate (16). Physeal injuries may produce partial or complete growth arrest (17).

The second growth-related factor that contributes to injuries is the rapid change in the relative lengths of the long bones and their adjacent muscle-tendon attachments. Joint tightness can develop when bones lengthen faster than muscle-tendon units, producing inflexibility and dynamic muscle imbalances. The discrepancy may also increase traction on the apophyses and stress at the joint surface (eg, patellofemoral joint).

Other intrinsic risk factors. Patients who have overuse injuries often have a history of previous injury, which may signal repeated errors in training or technique, an inadequately rehabilitated injury, or an unaddressed cause of the original injury. Menstrual dysfunction, often associated with a decrease in bone mineral density, appears to increase the risk of stress fractures in some athletes (18,19).

Alignment abnormalities have been associated with overuse injuries; these include pes planus, pes cavus, hyperpronation, tibial torsion, patellofemoral malalignment, femoral anteversion, and leg-length discrepancy. Although difficult to quantify, excessive ligamentous laxity also may predispose patients to overuse injury. Examples include anterior knee pain in a runner with a hypermobile patella or shoulder pain in a swimmer with glenohumeral instability. Laxity measurements are relatively static and may not accurately represent the dynamic situation (eg, velocity of pronation in a runner). The contributions of alignment problems and joint laxity to overuse injuries remain unclear because prospective studies are few (20). These limitations should be kept in mind when addressing anatomic alignment and joint laxity in individual rehabilitation programs.

The child's level of conditioning is another important consideration. Youngsters will likely benefit from developing general strength and endurance before participating in a training program. Unfit children may lack the proprioceptive skills, and weak and/or inflexible musculoskeletal structures may be unable to withstand the forces of training. Proper preparation and age-appropriate activities may help reduce injury.

Psychological factors should also be considered. Pressures from peers and adults often play a role (see below), but it is important to recognize that the child's level of maturity and self-esteem will influence motivation and the ability to focus on conditioning and safety.

Extrinsic risk factors. Changes in the components of the training program are frequently associated with overuse injury. Though variations in the frequency, intensity, and duration of training are necessary to improve performance, another important training element is often overlooked: rest. Gradual training progression accompanied by scheduled recovery periods is often well tolerated by young athletes. Abrupt increases in any facet of training and/or inadequate rest intervals often lead to overuse injury. An example is a young tennis player who enters a summer camp to work on his serve. Accustomed to practicing 2 hours per day, 5 days per week with the high school team, the athlete now spends 4 to 6 hours each day emphasizing the serve and quickly develops a rotator cuff tendinopathy. Parents and coaches should be aware that training programs designed for adults are not appropriate for young athletes. In fact, because of the great variation in physical and emotional maturity among children and adolescents, individualization of training schedules is encouraged.

Faulty equipment is another risk factor. Footwear should be well-fitted and suited to the demands of the activity. Running shoes should be replaced at regular intervals because they can lose more than 40% of their shock-absorbing capacity after 250 to 500 miles (21). Other examples include the grip size and string tension of a tennis racquet and the fit of a bicycle. Equipment changes may also result in injury. A well-conditioned track athlete who switches from training flats to spikes for interval workouts may develop lower-extremity problems from changes in running mechanics.

Poor technique can also produce injury. In tennis, for example, flexing the wrist at ball impact during the backhand stroke commonly causes lateral epicondylitis. Instruction in proper technique helps treat and prevent overuse injury. Finally, changes in training surfaces may lead to injury. Rapidly introducing hill running, running on a beach or other tilted surface, and running on uneven or hard surfaces can trigger injury.

Pressure from others--especially adults--may play a role in the development of overuse injury. Parents and coaches who promote excessive intensity or who encourage a "no pain, no gain" or win-at-all-costs attitude may well contribute to injury. Assessing a
child's motivation can be helpful: Is he or she genuinely interested in playing, or doing so only because of others' expectations? Children who have uncharacteristic symptoms or fail to progress as expected with treatment may be expressing their lack of interest in the sport.


Clinical Evaluation

History. A thorough history cannot be overemphasized. A detective-like approach will not only help establish the diagnosis, but will also suggest the severity of the injury and reveal many potential predisposing factors. Have patients describe when they first recognized the injury. Once this is determined, ask detailed questions about training in the several weeks before the first signs of injury:

• Was there a change in training intensity, frequency, or duration?
• Was a new technique or piece of equipment introduced?
• Is the athlete involved in other activities such as resistance training or physical education classes that could have contributed to the injury?
• When was the last athletic shoe purchase?
• Has there been a similar injury in the past, and does the patient have a history of other overuse injuries?
• How were past injuries treated?

In adolescent girls, document age of menarche and whether cycles are regular or irregular. Menstrual dysfunction should be evaluated concurrently.

Recording a patient's age and reviewing the growth curve can determine if he or she is in a rapid growth period. The mean onset of the adolescent growth spurt is approximately 10 years for girls and 12 years for boys. Peak height velocity is reached, on average, at age 12 for girls and age 14 for boys. Injuries that occur without obvious training changes or contributing factors may simply be related to the musculoskeletal changes associated with accelerated growth.

Next, have the patient describe the location and quality of the pain and when it occurs during activity. Pain that occurs at the end of an activity and resolves before the next training session signals a relatively mild injury; pain during activity that impairs performance is more severe. One must always consider the possibility of occult tumors or rheumatologic conditions in young athletes who have chronic pain symptoms.

Observe patient-parent interaction in the exam room:

• Do the parents attempt to control the physician's encounter with the child?
• Does the child seem enthusiastic about the sport?
• Do parents place an inappropriate emphasis on competition?
• What are the athlete's and parents' hopes regarding future participation? Are there aspirations for national-level competition or college scholarships?

Identify how the athlete, parents, or coaches have attempted to treat the injury. Those who have been to several physicians may have unrealistic expectations that should be addressed.

Physical examination. The examiner should localize the complaint, identify injured tissue, and assess all structures that dissipate force in the involved extremity. For a patient who has anterior knee pain, for example, the exam should proceed from the ground up, beginning with foot and ankle alignment and continuing proximally. This method can identify underlying malalignment, inflexibility, muscle imbalance, joint laxity, or restriction of motion. The examiner also should compare flexor-extensor muscle groups and the injured extremity to the uninjured.
Careful palpation of the painful area will often reveal the exact injury site. Recreating the loading pattern can help reproduce symptoms. Simple methods include having the patient run or hop in place or applying pressure over a musculotendinous structure while applying resistance at various joint angles. When provocative maneuvers are unsuccessful, examining the child immediately after the sports activity may be useful.

Occasionally, symptoms are difficult to localize. Poorly localized symptoms are not unusual for some overuse injuries, such as back pain in a dancer who has a stress reaction of the pars interarticularis. In other situations, the sport may be unmasking an underlying problem. Vague knee pain, for example, may be the presenting complaint of a patient who has osteochondritis dissecans, a hip disorder, or an osteosarcoma.

Imaging studies may be helpful in some situations. Radiographs can identify osteochondral lesions (figure 1), stress fractures, tumors, and growth-plate widening. Additional studies, such as bone scans or magnetic resonance imaging, may be useful if plain radiographs are unrevealing (figure 2). The specifics of each case guide the decision to obtain radiologic studies, and which to choose.


Treatment

The fundamental goal of treatment is to develop strong, flexible tissue that absorbs the forces of the sport. The principal measures: [Figure 2]

Relative rest. The initial phase of treatment involves protecting the injured site from a level of impact loading that perpetuates overuse by reducing training volume and using alternative activities to maintain aerobic conditioning and morale. The patient's clinical history provides a guide to the amount of rest needed from sport-specific training (table 3: not shown). Less severe injuries such as mild patellofemoral pain warrant a 25% to 75% decrease in training load; a more severe injury, such as a stress fracture, initially requires complete rest from the offending activity. Examples of alternate activities include pool running with or without a flotation vest, bicycling, rowing, and swimming. Patients may continue sports activities that do not stress the injured area.

Ice. Ice, an effective modality that should be used throughout treatment, reduces swelling and pain by causing vasoconstriction, slowing nerve conduction, and reducing cellular metabolism (22). It should be applied lightly over a cloth or bandage for 10 to 20 minutes several times a day for the first 48 to 72 hours and after rehabilitation exercises. Ice massage, rubbing the ice in a circular motion over the injury, is another option.

Other modalities. Topical heat (ie, moist heat packs) may help increase collagen extensibility and reduce stiffness. Other modalities such as ultrasound, iontophoresis, and electrical stimulation may be useful adjuncts. The clinical benefits of nonsteroidal anti-inflammatory drugs (NSAIDs) have not been clearly demonstrated (23). When rest and ice have not relieved patients' pain, a short NSAID course may reduce pain and allow rehabilitation to proceed.

Rehabilitation. Once pain has been controlled, supervised rehabilitation can begin. The objectives of rehabilitation are to restore range of motion, strength, flexibility, and
proprioception. Returning to the sport before reaching these endpoints increases the risk of reinjury.

As range of motion is restored, pain-free resistance exercises are begun. Isometrics and limited isotonics are often part of this stage; these activities should be supervised to guard against improper technique and equipment misuse. Soft-tissue techniques can be used to reduce adhesions and loosen tight structures.

Gentle flexibility exercises are added when strength and range of motion improve. Overstretching should be avoided. Strengthening and flexibility exercises should also address adjacent uninjured structures. Aerobic conditioning is also initiated to prepare patients for their return to sport. The level of pain during activity and symptoms and findings the following day guide the progression. Significant improvement signals the time to add eccentric and isokinetic exercises, which require close supervision to ensure correct technique. Simultaneous increases in exercise resistance and velocity should be avoided.

After range of motion, strength, and flexibility improve, gradually adding sport-specific activities allows patients to regain proprioception and reacquaint themselves with the biomechanics of the sport. Patients can resume training and competition when they have recovered their muscular and aerobic endurance and can perform sport-specific activities without pain.


Avoiding Reinjury

Athletes who complete a thorough rehabilitation may suffer reinjury if the risk factors that led to the problem are not addressed. Athletes, parents, and coaches should be educated about training errors that may have occurred, the importance of scheduled rest periods, and the need to avoid excessive training volumes, especially during the adolescent growth spurt. To correct poor technique, the coach or trainer often must instruct athletes and provide reminders about possible relapses.

Patients may benefit from advice on appropriate footwear and equipment. Over-the-counter shoe inserts can help modify biomechanical malalignment. In some situations, such as marked pes planus in a patient who has refractory plantar fasciitis, custom orthoses may be needed.


Preventing Overuse

The American College of Sports Medicine estimates that 50% of overuse injuries in children and adolescents are preventable (24). Preparticipation screening, required by most schools, should be encouraged for all children involved in organized athletics. This is an excellent opportunity to identify sport-specific injury risk factors and to assess young people's maturity, skill level, and motivation for the sport. Parents should ensure that their children will receive proper supervision and coaching. They can lobby local organizations to sponsor coaches' attendance at coaching and safety seminars.

Training programs should accentuate general fitness and avoid excessive volume. All programs for youngsters should include conditioning and flexibility. Early sport specialization should be eschewed. Adults may seize on an example of a child who began exclusive training for a sport and became a local or national success, but the daily repetition required to perfect sport-specific skills too often leads to injuries. Experimentation with different sports allows children to develop fitness and motor skills, enjoy the social aspects of sport, and choose the sports they prefer. Parents can be reassured that there are many examples of outstanding athletes who did not become involved in their sports until a relatively late age. Bill Rodgers, four-time winner of the Boston and New York marathons, started running cross-country at age 15. After Phoebe Mills won a bronze medal in gymnastics in the 1988 Olympics, she took up diving and competed in national competitions from 1990 to 1994. Michael Jordan didn't make his high school's varsity team until he was in 11th grade.

Because children rarely suffer overuse injuries when they control the intensity level, coaches and other adults should avoid setting rigid expectations about training intensity. Despite scarce data about training progression and injury, gradual progression should be stressed. A general guide is the "10% rule": Total training (intensity, frequency, duration, or any combination of these) should increase no more than 10% at a time (6,24). Thus, a young runner who runs 20 miles per week would run 22 miles the next week, without changing pace. The rule is a useful starting point, but must be adjusted for each athlete.

Periodization may also help to reduce overuse injuries and prevent overtraining. This technique involves the systematic cycling of training loads over set periods of time with well-defined rest periods. Finally, training should be carefully monitored during the adolescent growth spurt. Because growth-related factors can predispose patients to injury, it may be appropriate to temporarily modify training during this period.


Return to Safe Play

A diligent search for contributing factors and an understanding of the issues that are unique to children are essential to injury management. Incorporating these elements into a comprehensive rehabilitation program usually results in a successful return to participation. Attention to preventive measures such as training progression and appropriate supervision will allow youngsters to continue to enjoy the many benefits of organized play.


References

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Case Report: Knee Pain in a New Runner

A 13-year-old girl presented with a 2-week history of left anterior knee pain. She was a swimmer, but she had begun training with the school's track program 3 weeks earlier, and running was a new sport for her. She had been running 8 to 10 miles per week (up to 2 miles per session) and said pain onset was gradual. At presentation, she reported pain with initiation of running such that she could no longer complete 1 mile. The patient said her pain was more noticeable when she walked up and down stairs and that her knee felt a bit stiff when she was sitting in class.

History. The patient did not recall any prior knee injury, and there was no history of locking, catching, swelling, or instability. She reported no other sports-related injuries and had not been strength training. The majority of the running was done on either the road or a dirt track. She had iced the knee the first few days she had pain, but had not done so recently. Instead, she purchased a neoprene knee sleeve, which did not provide much relief. She denied any pain when sleeping at night, and had no other joint complaints. Her medical and surgical histories were otherwise unremarkable. She had not yet begun menses.

The patient was accompanied by her mother. The interaction between mother and child appeared appropriate. The patient provided most information without prompting or much qualification from her mother. She stated that her participation in track stemmed from her own interest.

Physical examination. Height and weight were in the 35th and 20th percentiles for her age respectively. Her growth history was not available for review. Examination of the lower extremities revealed normal-appearing arch heights and mild genu valgum. Tubercle sulcus angles (seated Q angles) were slightly increased bilaterally. No pelvic obliquity was observed. No knee effusion was noted, and the patient demonstrated full pain-free range of motion without crepitus. Patellar inhibition testing was positive on the left, but negative on the right. Patellar tilting and medial glide were normal. The medial and lateral facets were nontender, and a nontender medial plica was noted. Hamstring flexibility was decreased bilaterally. Quadriceps tone was poor. The ligaments were stable. The patient's running shoes were moderately worn cross-trainers.

Diagnosis. A working diagnosis of patellofemoral pain syndrome was established.
Treatment. The patient's running was reduced to one quarter mile every other day, preferably on grass. Ice massage was recommended three to four times daily, and swimming was selected as an alternative activity for conditioning. She was instructed to begin daily isometric (open- and closed-chain) exercises for the quadriceps, hamstrings, and gastroc-soleus complex with an emphasis on the vastus medialis obliquus. A lower-extremity flexibility program was also started, focusing on the hamstrings. Proper running shoes were recommended. If symptoms were improving, she was allowed to run 1 1/2 miles total the second week and 2 miles the third week.

By the time of her follow-up visit 3 weeks later, the pain had resolved, and she was running 1/2 mile four times per week. Isotonic strengthening was begun to build lower-extremity strength. Running mileage was slowly increased.

At her final visit, 6 weeks after follow-up, she had been running with her team without limitation for 1 week. The patellar inhibition test was negative and knee flexibility and muscle tone had improved. She was advised to maintain strength and flexibility exercises and avoid rapid training changes.

Discussion. The patient's pain was clearly related to the onset of her running program along with several other contributors. Intrinsic factors were growth, poor hamstring flexibility, inadequate conditioning, and anatomic malalignment (mild genu valgum and increased tubercle-sulcus angles). Extrinsic factors were rapid training progression, inappropriate footwear, and hard running surface (road).


Dr DiFiori is an assistant professor in the Department of Family Medicine Division of Sports Medicine and assistant team physician in the Department of Intercollegiate Athletics at the University of California, Los Angeles. Address correspondence to John P. DiFiori, MD, UCLA Department of Family Medicine, 200 UCLA Medical Plaza Building, Suite 220, Los Angeles, CA 90095; e-mail to jdifiori@ucla.edu