Military Fitness and Injury Risks

NSCA TSAC REPORT ISSUE 19
OCTOBER 2011
Military Fitness and Injury Risks

Guy Leahy, MEd, CSCS
The views expressed in this article are those of the author, and do not necessarily reflect the official policy or position of the Air Force, the Depart-
Contents
19.1 Military Fitness and Injury Risks 19.5 The Hallux and its Importance to Improving the Proficiency of Tactical Athletes 19.7 Managing Firefighter Fatigue 19.10 PT on the Firing Range 19.12 Utilizing the Naval Academy Martial Arts Curriculum as a Combat Conditioning Tool
ment of Defense, or the U.S. Government.
Military physical fitness (MPF) is broadly defined as the ability to physically accomplish all aspects of the mission while sustaining optimal health and remaining uninjured (14). This contrasts with the more traditional health-based physical training (HBPT), which focuses on reduction of cardiometabolic risk factors and containment of healthcare costs. A recognized weakness of the health-based focus is that while body composition and performance on health-based fitness tests (distance running/walking, push-ups/ sit-ups) correlates with cardiometabolic risk, such test results are poor predictors of MPF (18,22). An additional problem with HBPT is that its overemphasis on distance runs, push-ups, and sit-ups has led to high injury rates from overtraining, which negatively impacts mission readiness. Military task performance in deployed locations requires high levels of physical fitness with contributions from multiple energy systems. An optimal combination of strength, endurance, agility, speed, and flexibility is required to successfully accomplish such missions, which are frequently carried out under extreme environmental conditions. Nutritional/hydration requirements are substantial and MPF may be degraded by inadequate
calories or dehydration (19). In addition, these tasks frequently require carrying heavy external loads and/or wearing body armor, which can be physically taxing (13). Extended deployments may also reduce MPF if service members are unable to train for extended periods of time (10). Another goal of successful MPF is the ability to remain injury-free. Sports/ physical training-related injuries are the leading cause of nonbattle injuries (NBIs) in deployed locations. For example, during Operations Iraqi Freedom (Iraq) and Enduring Freedom (Afghanistan), 19 21% of all NBIs requiring medical evacuation to be treated were sports/physical training related (5). Over 2,700 service members from 2001 2008 were medically evacuated for a sport/physical training injury (4). The activities most commonly associated with injury in the study were basketball (26%), football (17%), physical training (16%), and weight lifting (14%). Leading injury types were fracture (28%), dislocation (18%), and disorders of muscle/tendon (15%). Leading anatomical sites for injury were the knee (26%), ankle/foot (17%), wrist/ hand (14%), and shoulder (12%). Activities related to injury varied by service. For example, 18.5% of all sportsrelated non-battle injuries (SRNBIs) for Army personnel were due to physical training, whereas physical training only constituted 4.1% of all Air Force SRNBIs. By contrast, the Air Force exhibited
page 19.1
National Strength and Conditioning Association www.nsca-lift.org/TSAC
OCTOBER 2011
Figure 1: Pull-Ups
the greatest percentage of SRNBIs from playing basketball (41.1%). Due to the negative effects of SRNBIs on lost duty time, mission readiness, and unit cohesion, it is imperative that physical training designed to improve MPF also minimize SRNBIs.
Figure 2: Squat Jumps

of body composition. Besides providing a potentially unfair promotion advantage to smaller service members, this bodymass bias makes it more difficult to accurately predict MPF in service members who are larger in terms of lean body mass (9). The Army Field Manual 2120, Physical Fitness Training, includes a very good description of the requirements of MPF, which is still relevant for todays service members (14). War places a great premium upon the strength, stamina, agility, and coordination of the soldier because victory and his life are so often dependent upon them. To march long distances with full pack, weapons, and ammunition through rugged country and to fight effectively upon arriving in the area of combat; to drive fast-moving tanks and motor vehicles through rough terrain; to make assaults and to run and crawl for long distances; to jump in and out of foxholes, craters, and trenches, and over obstacles; to lift and carry heavy objects; to keep going for many hours without sleep or restall of these activities of warfare and many others require superbly conditioned troops. Interestingly, the Army physical fitness test from World War II did not include an endurance run component (20). Four major components of MPF are endurance, mobility, strength, and flexibility (14). Endurance is needed to perform long marches/runs without fatigue. Elevated levels of aerobic fitness also contribute to rapid recovery from high-intensity intermittent exercise (21). Mobility is required when sprinting to engage an enemy, dodging enemy fire, or jumping from the top of a tank to the ground without injury. Strength is required when carrying ammunition, recovering casualties, and physically overpowering an opponent. Flexibility is needed as a part of optimizing the other three components, as well as an element of injury prevention. Several studies have tested various forms of physical training in order to improve MPF. Kraemer, et al. found periodized resistance training significantly improved occupational task performances (e.g., 1RM box lift, repetitive box lift, and 2 mi loaded run) relative to aerobic training alone (8). Williams, et al. concluded resistance training significantly improved performance on six material-handling tests, including maximal box lifts, repetitive carrying and lifting, and loaded marching (24). Marcinik, et al. found that circuit resistance training significantly improved manikin shoulder drag, opening/securing a water-tight door, and the paint bucket carry in Navy men (11). Harman, et al. compared a combined training protocol which included weightbased training, distance runs, interval training, agility training, and loaded backpack hikes with a similar protocol which included stretching, body weight resistance training, movement drills, sprint/shuttle running, and distance runs (3). Both groups significantly improved MPF, with no significant differences between groups. Hendrickson, et al. found that a training program which combined resistance and aerobic training improved MPF to a significantly greater degree than either resistance or aerobic training alone. This combined training did not produce an interference effect on strength development, which has been documented in other research (6,15). Both the U.S. Marine Corps and the U.S. Army have recently restructured their training and testing toward the goal of
page 19.2
Military Physical Fitness

Service members must possess high levels of MPF in order to successfully accomplish their missions. Combat analogies are frequently invoked to describe elements of athletic competitions, but the consequences of suboptimal physical performance are far greater for the service member than for any athlete. An athlete who performs poorly on the playing field may lose the game. A service member who performs poorly on the battlefield may lose their life, and may place other service members, as well as the success of the mission, at risk. The serious nature of military operations also provides a powerful argument for the need to have fitness tests which accurately predict MPF. Traditional fitness test batteries for all the military services focus almost exclusively on endurance components, and do not test for other important aspects of MPF, such as muscular strength, power, agility, speed, and load-carrying capacity. For example, 60% of the available points on the Air Force fitness test are derived from the run/walk component (1). An airman who scores well on the Air Force test may not possess other components of MPF critical to mission success, such as sprinting while wearing body armor exceeding a majority of the airmans own body mass. In addition, all of the traditional military fitness tests (distance running/walking, push-ups, sit-ups) impose a scoring penalty on larger service members relative to smaller service members independently
NSCA TSAC REPORT ISSUE 19 improving MPF. The Marine Corps now incorporates a Combat Fitness Test (CFT) designed to test MPF (23). The CFT consists of a series of combat-specific components which incorporate elements of endurance, mobility, and strength, which closely mimic real-world situations on the battlefield. The Army announced changes earlier this year for revamping the physical fitness test, incorporating strength, speed, agility, and coordination into the test battery (16). The Army also plans to add a new test similar to the CFT which would include components such as high crawling, carrying ammunition cans, and a simulated 180-lb casualty drag (17).
OCTOBER 2011 (2). Many of these non-recommended interventions, such as stretching muscles before and after exercise, prescribing running shoes according to foot shape, manipulating stride length, and warming up and cooling down before and after activity, are common components of military physical training programs. Of the six recommended interventions by the JSPTIPWG, only oneprevent overtrainingwas strongly recommended. The vast majority of military physical training injuries (MPTIs) are due to overtraining (14). Pollock, et al. found that running five days per week versus three days per week increased injury risk by 225% with no difference in VO2 max (12). Similarly, a running duration of 45 min versus 30 min three days a week increased injury risk by 125%, with no improvement in VO2 max. In fact, the only two interventions which have successfully reduced running injuries are reductions in mileage and frequency. This becomes all the more important in relation to the idea that a major cause of MPTIs results from an overreliance on endurance running in the militarys physical training programs, (14). Training programs recommended by the JSPTIPWG to improve cardiovascular fitness and reduce MPTIs include interval training and periodization training. Other training programs recommended by the JSPTIPWG for injury prevention are agility drills, core stability training, resistance training, plyometrics, and wobble-board training.
Injury Prevention
The Joint Services Physical Training Injury Prevention Working Group (JSPTIPWG) was created in 2004 to evaluate military physical training injury prevention programs, policies, and research for recommendations to reduce physical training-related injuries during and after initial military training within the four U.S. military services. The JSPTIPWG concluded that four critical components of a successful injury prevention program were: 1. Education of military leaders 2. Leadership support 3. Unit injury surveillance 4. Adequate resources for injury research and program evaluation In addition, the JSPTIPWG evaluated 31 potential intervention strategies for injury prevention. The JSPTIPWG found only six prevention strategies with enough evidence to recommend: 1. Prevent overtraining 2. Perform multiaxial, neuromuscular, proprioceptive, and agility training 3. Wear mouth guards during high-risk activities 4. Wear semirigid ankle braces for high-risk activities 5. Consume nutrients to restore energy balance within 1 hr following high-intensity activity 6. Wear synthetic-blend socks to prevent blisters The two interventions that were not recommended were the use of back braces and the pre-exercise administration of antiinflammatory medication. Regarding the other 23 interventions, due to lack of evidence, poor-quality studies, or a balance of conflicting evidence, they could not be recommended
Conclusions
To achieve military physical fitness, physical training must facilitate task-specific improvements in operational performance while simultaneously minimizing injury. Traditional military physical training has concentrated on health-related fitness components related to passing fitness tests, the results of which do not correlate well to MPF. An overemphasis on simply preparing to pass these health-related fitness tests, particularly distance-running tests, has produced high injury rates from overtraining. These high injury rates negatively impact mission success and military readiness. Research conducted over the last several years has demonstrated a variety of evidence-based alternative training strategies documented to improve MPF and reduce injury (7). The U.S. Marine Corps and the U.S. Army have made recent encouraging steps toward developing training and testing protocols incorporating MPF into their respective fitness cultures. Widespread implementation of these training methods would provide service members deployed to hostile locations an increased likelihood of mission success and avoidance of injury, as well as a safe return home to their families.
page 19.3
OCTOBER 2011
17. Schogol, J. Armys fitness testing plans include combat obstacle course. Stars and Stripes Online, Published March 1, 2011. Retrieved September 2011 from, http://www.stripes.com/ news/army-s-fitness-testing-plans-include-combat-obstaclecourse-1.136339. 18. Talbot, LA, Weinstein, AA, and Fleg, JL. Army physical fitness test scores predict coronary heart disease risk in Army National Guard soldiers. Mil Med 174(3): 245252, 2009. 19. Tharion, WJ, Lieberman, HR, Montain SJ, et al. Energy requirements of military personnel. Appetite 44(1): 4765, 2005. 20. Thomas, E. Are you fit to fight in World War II? NSCA TSAC Report 13: 59, 2010. 21. Tomlin, DL, and Wenger, HA. The relationship between aerobic fitness and recovery from high-intensity intermittent exercise. Sports Med 31(1): 111, 2001. 22. Vanderburgh, PM. Occupational relevance and body mass bias in military physical fitness tests. Med Sci Sports Exerc 40(8): 1538 1545, 2008. 23. White, J. The U.S. Marine Corps combat fitness test: What is driving the paradigm shift? NSCA TSAC Report 9: 12, 2009. 24. Williams, AG, Rayson, MP, and Jones, DA. Resistance training and the enhancement of the gains in material-handling ability and physical fitness of British Army recruits. Ergonomics 45(4): 267279, 2002.
References
1. 2. Air Force Instruction 362905, Fitness Program, 2010. Retrieved September 2011 from, www.e-publishing.af.mil/. Bullock, SH, Jones, BH, Gilchrist, J, and Marshall, SW. Prevention of physical training-related injuries: Recommendations for the military and other active populations based on expedited systematic reviews. Am J Prev Med 38(1S): 156181, 2010. Harman, EA, Gutekunst, DJ, Frykman, PN, et al. Effects of two different eight-week training programs on military physical performance. J Strength Cond Res 22(2): 524534, 2008. Hauret, KG, Campbell, K, Jones, BH, et al. Sports injuries in the U.S. Air Force, Marines, and Navy during deployments for Operation Iraqi Freedom (March 2003May 2008). Med Sci Sports Exerc 42(5): 473, 2010. Hauret, KG, Taylor, BJ, Clemmons, NS, et al. Frequency and causes of non-battle injuries air evacuated from Operations Iraqi Freedom and Enduring Freedom, U.S. Army, (20012006). Am J Prev Med 38(1S): S94S107, 2010. Hendrickson, NR, Sharp, MA, Alemany, JA, et al. Combined resistance and endurance training improves physical capacity and performance on tactical occupational tasks. Eur J Appl Physiol 109: 11971208, 2010. Knapik, JJ, Reiger, W, Paloska, F, et al. United States Army physical readiness training; rationale and evaluation of the physical training doctrine. J Strength Cond Res 23(4): 13531362, 2009. Kraemer, WJ, Mazzetti, SA, Nindl, B, et al. Effect of resistance training on womens strength/power and occupational performances. Med Sci Sports Exerc 33(6): 10111025, 2001. Leahy, GD. Body mass bias, allometric scaling and military fitness tests. NSCA TSAC Report, 18: 57, 2011. Lester, ME, Knapik, JJ, Catrambone, D, et al., Effect of a 13-month deployment to Iraq on physical fitness and body composition. Mil Med 175(6): 417423, 2010. Marcinik, EJ, Hodgdon, JA, Englund, CE, and OBrien, JJ. Changes in fitness and shipboard task performance following circuit weight training programs featuring continuous or interval running. Eur J Appl Physiol Occup Physiol 56 (2): 132137, 1987. Pollock, M, Gettman, L, Milesis, C, et al. Effects of frequency and duration of training on attrition and incidence of injury. Med Sci Sports 9(1): 3136, 1977. Ricciardi, R, Deuster, PA, and Talbot, LA. Metabolic demands of body armor on physical performance in simulated conditions. Mil Med 173(9): 817824, 2008. Roy, TC, Springer, BA, McNulty, V, and Butler, NL. Physical Fitness. Mil Med 175(8): 1420, 2010. Santtila, M, Kyrolainen, H, and Hakkinen, K. Changes in maximal and explosive strength, electromyography, and muscle thickness of lower and upper extremities induced by combined strength and endurance training in soldiers. J Strength Cond Res 23(4): 13001308, 2009. Schloesser, K, TRADOC revises Army physical fitness test. Retrieved February 28, 2011, from http://www.army.mil/article/52548/.
3.
4.
5.
6.
7.
8.
9. 10.
11.
12.
13.
14. 15.
16.
page 19.4
OCTOBER 2011
The Hallux and its Importance to Improving the Proficiency of Tactical Athletes
Rammell C. Nwaokai, CSCS, PES, CES It is generally accepted among rehabilitation and performance training professionals that repetitive faulty movements result in microtrauma to the tissue. If the root of the pain isnt viewable based on an assessment, then sometimes we should consider the toes; take off your socks. The importance of proper foot stability and ankle mobility cannot be neglected as an integral part of the kinetic chain. A sufficient way of addressing common foot-related injuries is to ask the tactical athlete to take off their socks. The hallux valgus (bunion) has a dynamic relationship with the kinetic chain and can be the cause of common ankle-related injuries and dysfunctions of the lumbopelvic-hip complex. The distal segment can affect the lumbopelvic-hip complex in several ways. Tactical athletes with hallux valgus and poor muscular integration can cause a dysfunction or impairment of the lumbopelvic-hip complex through movement compensation. Hallux valgus is a progressive lateral deviation of the big toe relative to the midline of the body (4). The bunion deformity is referred to as hallux abducto-valgus in order to account for the deviations in both horizontal and frontal planes (4). Due to the severity of the condition, most people seek surgery if the condition is painful, discomforting during walking or running and if it causes poor gait mechanics (1). Although the cause of hallux valgus is not totally clear, the asymmetry could be due to improper foot wear (too tight) and pronated feet, to name a few. Soldiers are required to ruck substantial distances with up to 80-lb loads, perform physical fitness tests, and accomplish occupational tasks with precision. However, a vital component to soldiers performance is often overlooked. Although foot care is observed routinely by combat medics and other military medical professionals, corrective exercise strategies for soldiers experiencing pain due to hallux valgus is often overlooked. If the range of motion and pain cannot be reduced, the soldier should be recommended to a military physical therapist who may then further recommend the soldier for surgery if the case is severe. Tactical athletes should be able to function without pain during routine activities. Compensation can be caused by repetitive activities from microscopic tears to the muscles, and deformities that hinder optimal movement. Looking at the big toe enables one to identify an apparent discomfort, because the central feature of the hallux valgus is to perform progressive lateral deviation of the big toe relative to the midline of the body (4). The progressive deviation creates a muscle imbalance in the forces that normally align the metatarsophalangeal joint. This abnormal muscle activation pattern (altered force-couple relationship) can cause weaker ipsilateral hip abduction strength and increased postural sway (5). Related studies show that subjects with increased postural sway experience seven times more ankle injuries, which lead to altered motor unit recruitment of the gluteal muscles to stabilize the lower leg (3). When the foot is induced into hyperpronation, symptoms
Figure 1. Example of hallux valgus on one foot
Figure 2. Example of hallux valgus on both feet
might appear at the hip due to excessive internal rotation (3). This denotes another indication of the hallux valgus to act as a vital proprioceptor in the foot and accept the load of the lower limb, or support foot supination. The fatigue in the lumbopelvic-hip complex is further aggravated by the postural sway, therefore causing the stabilizing muscles (gluteus medius) to compensate (4,5). Due to this compensation, the overstretched medial collateral ligament (that supports the metatarsophalangeal joint) and capsule may weaken or rupture, removing an important source of reinforcement to the medial side of the joint (4). The likelihood of injury will increase if the toe lacks dynamic stability in the sagittal plane due to joint arthrokinematics, which affects neuro-
page 19.5
NSCA TSAC REPORT ISSUE 19 muscular control and muscle activation (5). The predictable injuries due to the movement impairment include plantar fasciitis, posterior tibialis tendinitis (shin splints), anterior knee pain, and low back pain; all of which are along the kinetic chain (4,5). In addition, inadequate stability at the toe leads to pronation and over activity of the lateral gastrocnemius, which then causes the knee to adduct and the hip or gluteal muscles to become overworked at stabilizing the hip and knee. This compensation tends to lead to synergistic dominance, which occurs due to the inability of the prime mover to maintain force production. Furthermore, the tightness of the calf complex roots altered reciprocal inhibition altering the normal force-couple relationship, thus leading to synergistic dominance along the integrated muscular system that acts synergistically to perform optimally; this system is referred to as the kinetic chain. This information should encourage instructors, strength coaches and personal trainers dealing with tactical athletes to perform an observation of a soldiers feet which may lead to a valid indication of pain or discomfort. There is evidence that supports the existence of a kinematic chain in healthy subjects, where hyperpronation can lead to an immediate thigh internal rotation and change in pelvic position (2). To summarize, the big toe performs as an important proprioceptor, stabilizer and mobilizer to the kinetic chain, but hallux valgus limits its functionality. With this in mind, personal trainers, strength and conditioning professionals and athletic trainers are in the proper position to aid in pre-habilitation or recovery for our soldiers, and to maximize elite performance in our warriors.
OCTOBER 2011
References
1. Gilheany, M, Landorf, K, and Robinson, P. Hallux valgus and hallux rigidus: A comparison of impact on health-related quality of life in patients presenting to foot surgeons in Australia. Journal of Foot and Ankle Research 1(1): 16, 2008. Hollman, J. Correlations between hip strength and static foot and knee posture. Journal of Sports Rehab 15(1): 1223, 2006. Leighton, D. A functional model to describe the action of the adductor muscles at the hip in the transverse plane. 22, Portland: Physiotherapy Theory and Practice 1(5): 251262, 2006. Neumann, D. Kinesiology of the musculoskeletal system foundations for rehabilitation. (2nd. ed.) St. Louis, MO: Mosby, Elsevier; 2010. Reischl, S. Relationship between foot pronation on patellofemoral mechanics: A theoretical model. Foot Ankle Int 20(1): 513520, 1999.
2.
3.
4.
5.
page 19.6
OCTOBER 2011
Managing Firefighter Fatigue

Jorge Carvajal, CSCS, USAW Firefighters must constantly push their bodies and minds to their limits and be able to withstand the intense demands of the job. If a firefighter is unable to adapt to the physical and mental requirements of firefighting they become a liability to themselves and their crew. The unique combination of a highstress job and shift work makes for a fatigue-inducing combination. Firefighters deal with physically and mentally heavy loads during a shift. Many sleep little at night, responding to numerous fires or emergency medical services calls. As with all biological systems that need and run on energy, there is only so much available before the system is depleted of its energy stores. The system that is most affected by drained energy and fatigue in the human body is the central nervous system (CNS). The CNS acts as a governor of the body. In simple terms, it receives incoming sensory stimuli and sends out impulses, regulating bodily functions. Because of the high-intensity nature of firefighting, the CNS is a common site of fatigue. The CNS takes time to recover. Some studies show that exercise-induced muscle damage results in persistent force loss, a reduction in the range of joint motion, swelling, and delayedonset muscle soreness that peaks 24 48 hr after exercise. That means that it could take up to two days for muscles to get back to normal. Damaged muscle is responsible for shortages in energy production and is related to fatigue. A firefighters CNS is going to undergo further fatigue due to the added burdens common to the profession, such as lack of proper sleep and low energy stores due to poor nutrition, which render recovery of the CNS further delayed. It is important for firefighters to organize their training and activities to maximize the bodys capabilities and not put additional stress on the CNS. One the biggest problems confronted by those designing strength and conditioning programs for firefighters is the tendency to attempt to organize a training program around a seven-day cycle. Most programs in books and magazines are designed for people who work 9-to-5 jobs during the week with weekends off. The problem is that firefighters shift schedules do not adhere to the seven-day cycle or 9-to-5 hours, and neither does the human body. The traditional seven-day cycle leads to a classic density trap for most firefighters. Too much work is forced into a short period of time, thereby draining the CNS. In seven days there is often not enough time to do shift work, strength and energy systems work, flexibility and other specialized training, as well as handle normal life responsibilities. A nine-, ten-, or fourteen-day cycle is much more effective for firefighters. Even a 21-day cycle can be used with great success. Using a longer cycle allows better distribution of the work being done, makes recovery/regeneration easier, and helps better direct training focus. The best organization of training programs for firefighters uses a high/low approach in order to consolidate the most CNSintensive demands to the same training days, allowing for regeneration and recovery on off days. When following this approach, there should be a minimal recovery period of 48 72 hr between like CNS stressors. Therefore, in a weekly schedule, in order to minimize fatigue, one might have high-intensity strength work and interval training on some days and low-intensity tempo work (aerobic conditioning), mobility, corrective exercise on other days to assist and allow for recovery, thereby allowing the stress-response system to self-regulate. The following is a breakdown of the main training components relative to CNS impact and stress. High Stress CNS Activities Maximal effort weight training (+90% 1RM) Compound lifts, power cleans, deadlifts, weightlifting Maximum speed work (+95% effort) starts, accelerations, sprints High-intensity plyometric jumps, bounds, landings Sport implement throws (hammer, shot, discus) Dynamic effort weights
page 19.7
NSCA TSAC REPORT ISSUE 19 Mixed martial arts or boxing fighting, sparring, or heavy bag Medicine ball throws done explosively High-intensity interval training Low Stress CNS Activities Tempo runs/ drills (<75% intensity) Dynamic warm-ups/mobility work/corrective exercise Repetition method (modified) weights/calisthenics Submaximal speed work Aquatic drills Jumping rope Circuit weight training with sub-max loads Sled/weighted drags/pushes performed with moderate weight and sub-max efforts Tire flips performed with moderate to light weight Table 1. 24 hr on / 24 hr off for five days followed by three days off Monday
On Shift Off
OCTOBER 2011 Medicine ball throws performed with moderate-light weight with sub-max effort Here are some examples of how to use a high/low approach with different firefighter schedules and 9- or 10-day cycles to help manage fatigue associated with shift work. These are just some examples of how training can be structured. After a tough, busy shift, it is advisable to take the next day off or do a low-intensity recovery workout, get additional sleep, (the ultimate recovery tool) and save the max work for when the body has recovered. Firefighting is a physically and mentally demanding job. By organizing efforts toward strengthening and conditioning in a manner so as to not add to an already taxed central nervous system, firefighters have the best chance of developing the performance enhancement needed to adapt and overcome the stresses of the job and life.
Tuesday
Off Shift Low
Wednesday
On Shift Off
Thursday
Off Shift High
Friday
On Shift Off
Saturday
Off Shift Low
Sunday
Off Shift High
Monday
Off Shift Low
Tuesday
Off Shift High
Wednesday
On Shift Off
Table 2. 24 hr on / 48 hr off Monday

On Shift Off
Tuesday
Off Shift Low
Wednesday
Off Shift High
Thursday
On Shift Off
Friday
Off Shift Low
Saturday
Off Shift High
Sunday
On Shift Off
Monday
Off Shift Low
Tuesday
Off Shift High
Table 3. 24 hr on / 72 hr off Monday

On Shift Off
Tuesday
Off Shift Low
Wednesday
Off Shift High
Thursday
Off Shift Low
Friday
On Shift Off
Saturday
Off Shift Low
Sunday
Off Shift High
Monday
Off Shift Low
Tuesday
On Shift Off
Wednesday
Off Shift Low
page 19.8
NSCA TSAC REPORT ISSUE 19 Table 4. 48 hr on / 96 hr off Monday

On Shift Off
OCTOBER 2011
Tuesday
On Shift Off
Wednesday
Off Shift Low
Thursday
Off Shift High
Friday
Off Shift Low
Saturday
Off Shift High
Sunday
On Shift Off
Monday
On Shift Off
Tuesday
Off Shift Low
Wednesday
Off Shift High
Table 5. Two-day shifts, followed by two night shifts, followed by four days off Monday
AM Shift Off Sunday Off Shift Low
Tuesday
AM Shift Low/PM Monday Off Shift High
Wednesday
Off PM Shift Tuesday AM Shift Low/PM
Thursday
Low/AM PM Shift Wed AM Shift Off
Friday
Off Off
Saturday
High/AM Off
Table 6. Here is an example of a full nine-day cycle on a 24 hr on/ 48 hr off schedule Monday
On Shift Off
Tuesday
Off Shift Sled Drag
Wednesday
Off Shift Upper
Thursday
On Shift Off
Friday
Off Shift MB Drills w/ Light Tire Flips
Saturday
Off Shift Lower
Sunday
On Shift Off
Monday
Off Shift Jump Rope + Mobility Work
Tuesday
Off Shift Upper
page 19.9
OCTOBER 2011
PT on the Firing Range

Brian Jones, PhD, CSCS, USAW and Rodney Van Zant One of the challenges in tactical skills training and tactical fitness is to create realistic situations so that operators can develop the ability to perform under extreme stress. Scenario and force-on-force training allow for high levels of psychological stress and are invaluable. However, this training requires specialized equipment, role players, and resources that often make it cost prohibitive to perform on a regular basis. An inexpensive alternative is to induce a stress response similar to that of fight or flight through high-intensity exercise. This can be performed without training partners, with little or no equipment, and with greater frequency. Fatigue due to high-intensity exercise causes many of the same physiological responses as fight or flight, (1). These responses include a release of the stress hormones epinephrine and norepinephrine, a dramatic rise in heart rate and ventilation, and diminished fine motor control. Additionally, many deadly force encounters occur following a foot pursuit or require the operator to sprint to cover or from firing position to firing position. Marksmanship and critical shoot/ no shoot decisions must often be made under situations of extreme fatigue. The exercises listed provide examples of how fitness and conditioning work can be blended with firearms training. Each of these exercises can be done with live rounds, or with training devices such as air-soft or marker rounds. If shooting is not a possibility then dry fire work could be done using snap caps. In this situation, the emphasis would be on weapon deployment, target acquisition, decision making, sight picture, and trigger press under fatigue and stress. The main determinant of exercise modality is equipment and portability because gyms and shooting ranges are not often near each other. The following types of training are perfect because they either require no equipment or can be done using portable implements. moving someones body weight. Learning how to carry and drag a wounded or unconscious person is a standard job skill for those who go in harms way. Different variations of carries and drags with or without the aid of equipment, such as a litter, can also be used.
Sample drills and exercises

Set of 25 kettlebell swings followed by a draw and fire Burpees Complete a series of 50 burpees. Draw and fire immediately after five repetitions. Fire from behind cover, holster firearm, then drag or carry partner to the next station, deploy weapon, and fire. Wind sprint drill (40 100 yards) then fire a series of shots at a target. One partner does push-ups while the other partner fires a series of shots at a target. When one partner is finished firing they holster their firearm and begin performing pushups while the other partner begins firing at the target. This is alternated for a set number of repetitions.
Calisthenics
Standard body-weight exercises such as push-ups, sit-ups, squats/lunges, and burpees can be done without any equipment. They have the added benefit of being familiar to most active people, particularly those who have a military or law enforcement background.
Kettlebells
Kettlebells provide an easy way to perform loaded training using a variety of movements. A single 16 or 24 kg kettlebell is suitable for a wide variety of body sizes and strength levels by adjusting the number of repetitions. Some suitable kettlebell exercises include swings, snatches, cleans, jerks, presses, and squats.
Sandbags
Filled sandbags provide a way to work with an awkward, oddly shaped, and shifting load, replicating potential onduty tasks. A single sandbag of 50 75 lb can be used by trainees and may be lifted, carried, dragged, or loaded onto a high platform.
Safety Considerations
Live fire mistakes can be deadly and the likelihood of mistakes increases under stress and fatigue. When participating in fatigue-inducing drills on the shooting range it is imperative that all parties involved adhere to the cardinal rules of firearm safety: Treat all guns as if they are always loaded.
Partner drills
Using a training partner for resistance not only builds fitness but develops skill
page 19.10
OCTOBER 2011
Figure 1. Kettlebell Swings
Figure 2. Partner Trade-Offs
Figure 3. Precision Fire Under Stress
Figure 4. Running
Be sure of your target and what is beyond it. Keep your finger off the trigger until your sights are on target and you have decided to fire. Never point your muzzle at anything you are not willing to destroy. It is the responsibility of each trainee and tactical strength and conditioning professional to ensure that these rules are followed. Of these rules, the last two are most commonly violated during stress and fatigue drills. Fatigue is not, and cannot be, an excuse to be unsafe. If a trainee cannot maintain trigger finger and muzzle discipline then they must be pulled from the exercise session immediately.
References
1. Grossman, D, and Christensen, LW. On combat: The psychology and physiology of deadly conflict in war and in peace. PPCT Research Publications: 2004.
page 19.11
OCTOBER 2011
Utilizing the Naval Academy Martial Arts Curriculum as a Combat Conditioning Tool
Clifford S. Dooman, MS, CSCS At the United States Naval Academy, physical development is of utmost importance. All students must participate in some combination of varsity athletics, club sports, extracurricular activities, and physical education courses. In 2003 the Naval Academy Martial Arts Program (NAMAP) was created and implemented as part of the combative program offered by the department of physical education. The NAMAP is a direct descendent of the Marine Corps Martial Arts Program (MCMAP), which all students are required to complete. Through a two-semester curriculum, the NAMAP teaches many of the same skills as the MCMAP. The primary goal of the NAMAP is to build upon the skills all Naval Academy students acquire as plebes (freshmen) in their required boxing and wrestling courses and introduce them to more advanced fighting techniques. Because it is a required daily activity at the Naval Academy, many physical development opportunities are made available to the student body, including using the combative skills learned in the NAMAP as a physical training regimen. It is important to understand that this type of training is designed as a supplement to a well-thought-out, year-round strength and conditioning plan. Combative conditioning can take on many forms and is not limited to the topics discussed in this article. body for the physical stressors it is about to endure so as to decrease risk of injury and improve performance. The following combat conditioning program utilizes nontraditional warm-up methods not used in typical sport conditioning programs. The skills included in the warmup are prerequisites for the Naval Academy Martial Arts Program and dynamic enough in nature to provide appropriate preparation for a combat conditioning workout. other foot to resume the basic warrior stance.
Break falls
Break falls soften the impact of a fall and also utilize the falls momentum to maintain motion after hitting the ground. Break-fall training reduces the risk of injury and allows for a quick return to the standing position. Break falls can be executed from the basic warrior stance or a modified basic warrior stance, such as kneeling or crouching position, to shorten the fall. There are four types of break falls: front, back, side, and forward shoulder roll. Brief descriptions of each are outlined below. Front: The front break fall is executed by kneeling down. As you begin to fall forward, the elbows should be bent and open palms directed away from the body. As you contact the ground, your forearms and palms should contact the ground simultaneously. The fingers should be together and straight while the head is kept up to avoid hitting your chin on the ground. Side: The side break fall is executed from a squatting position. To execute a right-side break fall, the right arm comes across the body so the palm of the hand is facing the left shoulder. Next, the right foot slides to the left foot and you roll onto your right hip. The fall should be broken with the right arm slapping the ground. Contact should be distributed evenly from the shoulder down through the lower arm and hand. The arm should hit the ground at a 45 angle with respect to the body. The chin should remain tucked and the head off the ground. The lower body should contact the ground
page 19.12
Stance and motion

The first component of the warm-up is stance and motion. The stance, called the basic warrior stance is an athletic stance that provides the foundation for all movements involving close combat. Specific requirements include setting the feet at shoulder width with the left foot forward and right foot back. The hips and shoulders should be rotated approximately 45 to the right while the heads and eyes remain focused straight ahead. Body weight should be evenly distributed over both feet with both knees slightly bent. Hands should be at chin level and fists with thumbs facing each other. Elbows should be close to the body with the chin tucked. Motion from the basic warrior stance is executed at eight different angles. The goals of motion are to maintain the basic warrior stance and move without crossing the feet over or turning the body away from the target. The eight angles of movement are outlined in Figure 1. All movements should be completed by moving the lead foot in the direction of motion and then quickly moving the
The Warm-Up
Every type of training program and physical endeavor should start with some sort of warm-up session (Table 1). The main goal of this session is to prepare the
NSCA TSAC REPORT ISSUE 19 over the entire right leg, and the left leg should be bent with the foot contacting the ground. Back: The back break fall is executed from a squatting position. In a rolling motion, as you fall backward, tuck your chin and cross your arms in front of your chest with your hands open and palms facing you. As you contact the ground extend your arms in a slapping motion at a 45 angle with respect to your body. Contact with the ground should be evenly distributed throughout your torso, arms, and hands. Forward: The forward break fall is executed from a kneeling position by placing the right knee on the ground and the left leg bent with the foot flat on the ground. Reach the left arm down through the legs and tuck the chin into the chest. Lower your head and left shoulder to the ground. As you push off your feet you should roll onto your left shoulder, right hip, and then buttocks using your forward momentum to return back to your feet and into the basic warrior stance. side at the hips and strike the inside of your partners forearms along the inside or thumb side. Ulnar nerve strike (Figure 3): The ulnar nerve strike begins with the hands by the chin. Rotate from side to side at the hips and strike the inside of your partners forearms or little-finger side (ulnar nerve). Abdominal strike (Figure 4): Abdominal strikes begin by rotating from the hips and beginning with the left hand. Strike your partners stomach with a lead hand/ rear hand combination or 1-2 punch. Return to the basic warrior stance where your partner will mimic your initial movement. The stomach should be hit above the navel and below the xiphoid process with the first two knuckles of the fist. Femoral nerve strike (Figure 5): The femoral nerve strike begins by taking a basic warrior stance across from your partner, but with opposite feet forward (same-side foot forward). Begin by rotating from the hips with a round kicking motion of the back foot. The target consists of the medial thigh of your partners forward leg. Contact should be made with the lower portion of your shin. Peroneal nerve strike (Figure 6): The peroneal nerve strike begins with rotation from the hips using the back leg in a partial round kick motion. The lower shin or laces of your shoe should contact the outside thigh of your partners front leg.
OCTOBER 2011 Martial Arts Program (NAMAP), are modes of transportation and combative skills. While this type of program can incorporate various training methods such as body-weight exercises, free weights, medicine balls, kettlebells, sandbags, etc., the program in Table 2 is designed to be utilized anywhere, with only a partner and minimal equipment. Also, because nontraditional movements and techniques are utilized, this program can be used in conjunction with a traditional resistance training program.
Modes of transportation
Similar to techniques used in live combat, the first component of the program is modes of transportation. In combat, modes of transportation are often called maneuver under fire, movement to contact, or casualty recovery. These include covering a specific distance while running, jogging, or crawling. Some exercises include low crawl (Figure 7), bear crawl (Figure 8), or carrying another individual in more advanced movements such as firemans carry (Figure 9), buddy drag (Figure 10), belt drag (Figure 11), and piggyback (Figure 12). They can be performed over flat surfaces such as athletic fields, up hills, or over any type of uneven terrain, in straight lines or by implementing changes in direction. There are many other available methods not covered in this article as well.
Body hardening
Body hardening is designed to strengthen and protect areas of the body most often exposed to contact in close-quarters combat. The most common areas are the arms, torso, and legs; more specifically, the radial nerves, ulnar nerves, abdominals, femoral nerves, and peroneal nerve. These techniques all begin from the basic warrior stance with partners facing each other approximately 1 ft apart. All strikes should be executed in a firm but controlled rhythmic manner. Radial nerve strike (Figure 2): The radial nerve strike begins by dropping your arms to your side. Rotate from side to
Combative skills
Exercises using combative, hand-tohand skills can be extremely fatiguing as they often engage the whole body, activating large amounts of muscles. They can also be executed with a speed component, increasing the intensity of the activity. As the intensity of the activity increases, so does fatigue. In order to prevent injury, it is important to utilize proper technique.
page 19.13
Training Program Components

The two basic components of the training program provided in Table 2, which is modeled after the Naval Academy
OCTOBER 2011
Figure 1. Eight angles of movement
Figure 2. Radial nerve strike
Figure 3. Ulnar nerve strike
Figure 4. Abdominal strike
Striking
Skills such as striking with the upper and lower body, as well as grappling, generally require gross motor skills with larger muscle groups and may be more safely executed when under fatigue. More advanced skills such as joint locks, sweeps, and chokes requiring more precision, can be used as well, but with caution. Some common strikes consist of the lead-hand strike (Figure 13), rear-hand strike (Figure 14), horizontal elbow (Figure 15), front kick (Figure 16), round kick (Figure 17), and vertical knee (Figure 18).
nant position (e.g., the mount, side mount, rear mount, guard, etc.) Once a dominant position is established, the match is over and can be restarted. Alternately, partners can grapple for a specific timeframe, or until someone taps out. Multiple starting positions include knees (Figure 19), back-to-back (Figure 20), mount (Figure 21), and guard (Figure 22). These positions can be utilized for grappling exercises and should be executed under control at all times.
ercises, and combative skills. It requires groups of two people, or partners, and can be performed indoors or outdoors. The only necessary equipment is a strike pad/shield. It is important to remember to focus on technique. If executed properly, this workout will provide an opportunity to get in shape while practicing useful martial arts skills and adding some variety to your workout regimen.
Putting it All Together

A specific workout is listed in Table 2 and can be utilized at any time in conjunction with a traditional resistance training program. This workout includes a warm-up, modes of transportation ex-
Grappling
The primary goal of grappling is to achieve a dominant position over the opposition. One method is to grapple until one competitor achieves a domi-
page 19.14
OCTOBER 2011
Figure 5. Femoral nerve strike
Figure 6. Peroneal nerve strike
Figure 7. Low crawl
Figure 8. Bear crawl
Figure 9. Firemans carry
Figure 10. Buddy drag
Figure 11. Belt drag
page 19.15
OCTOBER 2011
Figure 12. Piggyback
Figure 13. Strikes lead hand
Figure 14. Strikes rear hand
Figure 15. Strikes horizontal elbow
Figure 16. Strikes front kick
Figure 17. Strikes round kick
Figure 18. Strikes vertical knee
Figure 19. Grapple knees
Figure 20. Grapple back-to-back
page 19.16
OCTOBER 2011
Figure 21. Grapple mount
Figure 22. Grapple guard
Table 1. Example Warm-Up Session Warm-Up

Component Stance And Motion Forward Back Forward Right Rear Left Forward Left Rear Right Left Right Breakfalls Front Breakfall Back Breakfall Left Side Breakfall Right Side Breakfall Forward Roll Body Hardening Radial Nerve Ulnar Nerve Abdomen Femoral Nerve Peroneal Nerve Exercise 1X3 5 Steps 1X3 5 Steps 1X3 5 Steps 1X3 5 Steps 1X3 5 Steps 1X3 5 Steps 1X3 5 Steps 1X3 5 Steps 1X3 5 Falls 1X3 5 Falls 1X3 5 Falls 1X3 5 Falls 1X3 5 Falls 1X10 Each Side 1X10 Each Side 1X10 1X10 Each Side 1X10 Each Side Sets/Reps
page 19.17
NSCA TSAC REPORT ISSUE 19 Table 2. Sample Program Training Program

Component Strike Lead Hand Lead Hand Firemans Carry Firemans Carry Front Kick Front Kick Knees Buddy Drag Buddy Drag Rear Hand Rear Hand Belt Drag Belt Drag Back To Back Round Kick Round Kick Piggy Back Piggy Back Horizontal Elbow Horizontal Elbow Mount Low Crawl Low Crawl Vertical Knee Vertical Knee Bear Crawl Bear Crawl Guard Exercise
OCTOBER 2011
Sets/Reps 1X10 (Partner 1) 1X10 (Partner 2) 1X20-50 Yards (Partner 1) 1X20-50 Yards (Partner 2) 1X10 (Partner 1) 1X10 (Partner 2) 1X1-3 Minutes 1X20-50 Yards (Partner 1) 1X20-50 Yards (Partner 2) 1X10 (Partner 1) 1X10 (Partner 2) 1X20-50 Yards (Partner 1) 1X20-50 Yards (Partner 2) 1X1-3 Minutes 1X10 (Partner 1) 1X10 (Partner 2) 1X20-50 Yards (Partner 1) 1X20-50 Yards (Partner 2) 1X10 (Partner 1) 1X10 (Partner 2) 1X1-3 Minutes 1X10-25 Yards Down And Back (Partner 1&2) 1X10 (Partner 1) 1X10 (Partner 2) 1X10-25 Yards Down And Back (Partner 1&2) 1X1-3 Minutes
Mode Of Transport
Strike Grapple Mode Of Transport
Strike
Mode Of Transport Grapple Strike
Mode Of Transport
Strike Grapple Mode Of Transport
Strike
Mode Of Transport Grapple
page 19.18
OCTOBER 2011
New Membership Opportunities on the Horizon for the NSCA

The National Strength and Conditioning Association (NSCA) is launching a new membership category created for exercise enthusiasts and individuals who are new to the strength and conditioning field. The goal of the Associate Membership is to expand the reach of the NSCAs mission, to support and disseminate research-based knowledge and its practical application, to improve athletic performance and fitness. This new channel gives individuals seeking more knowledge to improve job performance or those planning their professional development the fundamental resources and information on strength and conditioning. As part of the NSCAs commitment to provide Members with the latest in educational content, the Performance Training Journal (PTJ) and the TSAC Report will now become an exclusive benefit to NSCA Members. Professional Members who currently receive the Journal of Strength and Conditioning Research and the Strength and Conditioning Journal will receive this content at no additional cost. Associate Members will receive the PTJ and TSAC Report along with additional web-based content developed specifically to fit their needs. Individuals that do not wish to become NSCA Members but still want to receive free content from the NSCA can sign up for NSCA Connect, a new email alert. NSCA Connect will alert non-members to selected feature articles each month from every NSCA Publication. Visit http://nscalift.org/mainnews.shtml to sign up for this To continue receiving the PTJ and TSAC Report, the NSCA is offering current subscribers a limited-time, introductory annual rate of $19.95 for Associate Membership from November 1, 2011 through March 31, 2012. Qualifications apply for the Associate Membership level, so please visit the NSCA Website on November 1, 2011 for more details and take advantage of this special pricing. However, there are many new and exciting developments of member benefits on the horizon. Beginning in April 2012, the NSCA will be enhancing the way cutting-edge content is delivered to Members through innovative media and educational resources. feature, update your profile and receive NSCA Connect.
page 19.19
OCTOBER 2011 North Austin, Texas and is a member of the Texas National Guard. Nwaokai has a Bachelors degree from Northern Illinois University in Kinesiology Preventative and Rehabilitative Science and is a triathlon athlete. Brian Jones, PhD, CSCS, USAW Brian Jones is an assistant professor of Kinesiology and Health Science at Georgetown College. He has a PhD in Exercise Science and currently serves as the Kentucky State Director of the NSCA. Jones is a CSCS, USAW Sports Performance Coach, Crossfit Level 1 Coach, and World Kettlebell Club Instructor. In addition to teaching, he has extensive experience as a strength coach, personal trainer, and jiu-jitsu/defensive tactics instructor. He has worked as a coach and consultant for a number of law enforcement officers and agencies. Rodney D. Van Zant Rodney Van Zant is a Kentucky native and is currently an 11-year Laurel County KY Sheriff Department Sergeant and Range Master/Special Operations operator. He is a certified Department of Criminal Justice Training L.E. firearms, Concealed Carry, and less lethal weapons instructor. Van Zant is also an NRA L.E./Civilian firearms instructor and graduate of Government Training Institute and Alabama Defensive Pistol Academy, and is a certified police sniper. He owns www.ironsightdefense.com where he instructs civilian and law enforcement tactical firearms training.
Contributors
Jorge Carvajal, CSCS, USAW Jorge Carvajal is a performance enhancement specialist and Captain with Miami Dade Fire Rescue. He has a Bachelors degree in Exercise Science from the University of Florida, and is an instructor in the International Association of Firefighters/International Association of Fire Chiefs Wellness Fitness Initiative Peer Fitness Trainer Program. He has trained elite, college, amateur and Olympic athletes at such places as the U.S Olympic Training Center, the University of Florida and the University of Nebraska. Carvajal has been working with firefighters, military special operations, and special response teams for 22 years. 2LT Rammell C. Nwaokai, CSCS, PES, CES Rammell Nwaokai is currently an M.S. candidate in exercise science enrolled at California University of Pennsylvania within the exercise science department. Previous to that, Nwaokai was an undergraduate and graduate strength and conditioning coach at Northern Illinois University Sports Performance center assisting in the training of Division I athletes. As a member of the Reserve Officer Training Corp in undergrad, he oversaw the cadets physical readiness performance enhancement and injury prevention program as well. He enlisted in the Army in 2006, then commissioned from NIUs ROTC program in 2010 into the Illinois National Guard Medical Service Corp. He is a member of the ACSM (American College of Sports Medicine), MWACSM (Midwest American College of Sports Medicine), NASM (National Academy of Sports Medicine), ISSN (International Society of Sports Nutrition), and USA Triathlon association, and is CSCS certified. He is currently a personal trainer at Lifetime Fitness
NSCA Mission
As the worldwide authority on strength and conditioning, we support and disseminate researchbased knowledge and its practical application, to improve athletic performance and fitness.
TSAC Editorial Review

Mark Abel, PhD Raymond E. Bear, MS LTC Matthew Garber PT, DSc, OCS, FAAOMPT Kelly Kennedy, PhD, CSCS Doug Kleiner, PhD, ATC, CSCS,*D Joe Martin, DC Danny McMillian, PT, DSc, OCS, CSCS Katie Sell, PhD, CSCS Stew Smith, CSCS Mark Stephenson, MS, ATC, CSCS,*D
Staff
Editor T. Jeff Chandler, EdD, CSCS,*D, NSCA-CPT,*D, FNSCA Publisher Keith Cinea, MA, CSCS,*D, NSCA-CPT,*D Copy Editor Matthew Sandstead
Contact
NSCA TSAC 1885 Bob Johnson Drive Colorado Springs, CO 80906 phone: 800-815-6826 email: TSAC@nsca-lift.org
2011National Strength and Conditioning Association. Reproduction without permission is prohibited.
TSAC powered by
Contributors continued on next page
page 19.20
NSCA TSAC REPORT ISSUE 19 Clifford S. Dooman, MS, CSCS Cliff Dooman is the Director of Olympic Sports Performance and Assistant Professor of Physical Education at the United States Naval Academy in Annapolis, Maryland. Dooman received his Bachelors degree in Health Fitness from Springfield College and his Masters degree in Education/Exercise Science from the University of Dayton. Dooman is certified by the National Strength and Conditioning Association (NSCA) as a Certified Strength and Conditioning Specialist (CSCS) and USA Weightlifting as a Senior Coach. His students/ athletes include past, present, and future leaders of the United States Navy and Marine Corps. Guy D. Leahy, MEd, CSCS Guy Leahy is currently serving dual roles as the interim flight commander/ exercise physiologist at Davis-Monthan Air Force Base in Tucson, AZ. Leahy is a member of the ACSM (American College of Sports Medicine), NSCA (National Strength and Conditioning Association), and is CSCS certified. Leahy is the author/co-author of over 30 professional articles, including original research which has appeared in publications such as the Journal of Strength and Conditioning Research, TSAC Report, Medicine and Science in Sports and Exercise, Nature, Science and Scientific American. He has presented at several conferences, most recently at the 2011 NSCA Annual Meeting, where he was also an invited speaker at the TSAC Special Interest Group. Leahy holds a Master of Education degree from Western Washington University and a Bachelor of Science degree from the University of Oregon.
OCTOBER 2011
National Strength and Conditioning Association
TSAC CONFERENCE April 10 12, 2012 / Las Vegas / M Resort
www.nsca-lift.org/TSAC2012
National Strength and Conditioning Association www.nsca-lift.org/TSAC page 19.21

Military Fitness and Injury Risks

Diunggah oleh

Informasi Dokumen

Judul Asli

Hak Cipta

Format Tersedia

Bagikan dokumen Ini

Bagikan atau Tanam Dokumen

Opsi Berbagi

Apakah menurut Anda dokumen ini bermanfaat?

Apakah konten ini tidak pantas?

Hak Cipta:

Format Tersedia

Military Fitness and Injury Risks

Diunggah oleh

Hak Cipta:

Format Tersedia

NSCA TSAC REPORT ISSUE 19