Saturday, January 1, 2000

Pro Locker Room Conditioning For Kids Chiropractic's Integral Role

by Dr. Tim Maggs and Coach Al Miller © 2000

(This is the third in a series of articles co-authored by Dr. Tim Maggs and Coach Al Miller, Head Strength and Conditioning Coach for the Atlanta Falcons.)

The most underserved segment of our athletic population in this country has to be kids, age 6-14. This group of young athletes are conditioned and coached primarily by well intentioned dads. If there happens to be any type of pre-season examination, it will typically be done by the family doctor, whose exam might rule out anything from allergies to childhood diabetes, but will most likely never look at the biomechanics of this young athlete.

For many reasons, this gross oversight needs to be addressed. A young athlete's psyche, conditioning, understanding of physical injuries and prevention of sport related injuries can only improve if our current system demands better biomechanical awareness for our youths. Dads make sure there are no deaths during a game, but it's time we provide more sophistication, education and information to all of those involved. Once these kids reach high school, there is still a gross deficit in biomechanical and conditioning awareness, but if kids in elementary and junior high school can be introduced at a young age to the A, B, C's of physical wellness, then the program should carry over into later years.

Although there are many similarities between assessment and conditioning for both youths and adults, likewise, there are many differences. These differences need to be highlighted to those professionals who have the opportunity to work with this age group and promote the importance of improved knowledge, awareness and conditioning of the neuromusculoskeletal and biomechanical system. In short, each child entering the sports arena needs to be fully evaluated, informed of the structural corrections that need to be made, and managed through those corrections. An awareness of psychological influences will help any professional working with kids. As critical psychological and physical improvements are made, a more intense introductory conditioning program can be implemented.

Athletic Jacket

Every pro athlete has their own jacket. This jacket is a detailed diary of all injuries, treatments and improvements made during their pro career. This jacket follows an athlete wherever they go. If drafted, they have it with them. If taken in free agency, they have it with them. Simply put, it is their life history as an athlete, and that information is valuable to many people for many reasons.

Knowing the importance of this jacket, all athletes, including our kids, should start immediately tracking all of this valuable information. Having the ability to track biomechanical and psychological information becomes invaluable in many situations. Knowing what conditioning was done prior to certain injuries provides any coach or consultant with tremendous information. This seems only logical, as record keeping for all pertinent information can only help. It would contain each year's exam findings, subjective findings, illnesses, injuries, surgeries, medications, food supplements, etc. It would also document, as detailed as anyone would like, work-out programs done throughout the year. This would basically be a blue print of each child's athletic life, based around each year's biomechanical evaluations.

Once these evaluations are done, the findings must be interpreted properly and corrective treatments, therapies and exercises need to be employed. These treatments and modalities can and should extend into the season, in an effort to both improve any distortions found on the initial exam, as well as prevent any mid-season blow-out that might be avoidable with proper recommendations. And we should never lose sight of the bigger picture here; we want to help these young athletes develop into sound adults without the ramifications of burn-out and long term athletic abuse that so many retired athletes experience today.

The Tripod Evaluation

The overall fitness of youths in this country has greatly declined over the past 40 years. It should become everyone's responsibility to help seek improvement. Sports is one of the viable avenues to begin to make changes, as exercise and conditioning is an automatic component of any sports program. All this can begin with a sportsmedicine system willing to evaluate kids for more than classic medical conditions. A tripod program, consisting of 1) an understanding of the psychological profile, 2) a full biomechanical evaluation and 3) a logical fitness/conditioning program based on the sport of interest or fitness level of the child.

It is important to establish a communication and rapport with all kids you work with. If working with a group, it's easy to hide behind a group presentation and never really have to look each and every child in the eye, but individual success goes way up if each and every child is looked at and communicated to independently. Remember, each child/athlete is moved by reasons totally unique and different from the child next to them, and these uniquities must be found and tapped into.

Psychological Profile

The psyche of each child is an often overlooked component of this complete evaluation. We tend to think either the parents fully control what a child does or the child is a mere clone of what all kids should be like and will respond robotically to whatever we ask for. Somewhere along the way, this whole idea has to make sense to the child or the spirit behind the program will never become lit. Without a true spirit on behalf of the child, no program will reach full potential. It's far more logical to determine the formula needed to light the fire in this child before going on to the next phase of the program. A built-in motivation, to some degree, is mandatory and should be sought for the success of a program.

Some kids become motivated immediately when you inform them that this is exactly what Jason Williams, Mark McGwire, Peyton Manning, or whoever they may be able to relate to, had to do when they were kids to become the stars they've become. Sacrifice and discipline led them to success.

Other kids aren't moved by that type of motivation, so it's important to attempt to find something that will fuel their fire. For example, a child may have a weight problem, and that can become the source of motivation. Or, the child may already have some back pain, knee pain, neck pain, etc., and that can become the source for motivation. But, something has to fuel each and every kid, as hard as it may be to find the exact motivator. And the motivation should never be only because the parent wants the child to do it. Someone needs to find out what will make the child motivated, as the parent/child source for motivation will hit a dead-end at some point. If a motivational source can't be found, the long term success of any fitness program goes down.

Biomechanical Exam

Once a dialogue has been reached, a biomechanical evaluation (see side bar) should be done. Scoliosis screenings are today's version of a biomechanical exam. These screenings, many of which are performed by unskilled people, in no way locate the many specific biomechanical imbalances, fixations, irritations and defects that all kids are forced to cope with. Each child's structure is like their fingerprint, totally unique, and locating their imbalances, anomalies, areas of increased stress and sites of potential injuries is paramount in removing the artificial ceiling of physical capacity when starting this program.

Treatment Recommendations

When thinking in terms kids and athletics, we tend to not think of any treatments unless there is some associated pain and/or disability. This thinking needs to be revised, as every child has some degree of structural imbalance, areas of vulnerability and decreased performance potential. A short leg, rotated pelvis, increased sacral base angle, hypolordosis of the lumbar spine or a myriad of other potential faults will hamper progress. The solution consists of corrective structural treatment, restoring motion, alignment and curvature to all areas of the spine, improved flexibility, understanding of proper physical habits, improved diet and specific exercise based on the interests of the child. In order to reach maximum potential for each child, we must accept that there is no shortcut to getting there. It's a tedious process, but the outcome is well worth the cost. We no longer can sit and wait for acute low back pain, a symptomatic Osgood-Schlatter's or frequent headaches before we begin treatment or changes, despite the fact that most health insurances suggest and encourage just that.

Fitness/Conditioning For Kids

When thinking in terms of fitness and conditioning for this age group, it's important to introduce first things first, as a "rush to glory", such as time trials in running or maximum weight lifting will typically produce injury. Also, without the full educational phase for conditioning, the body will never acquire the necessary "memory" needed for maximum potential. It's critical to remember when thinking in terms of conditioning for kids, their nervous system needs to go through a thorough education process. If this phase is cut short, the nervous system responsible for reflexes, quickness, coordination and speed will never fully develop. The nervous system, in kids under the age of 15, also learns at a rate possibly 5 times quicker than older kids and adults. We notice this phenomenon when teaching kids computers, skiing, tying shoes or other multi-faceted tasks. This window of time makes it even more important to invest whatever is needed to enhance this period for conditioning.

Secondly, due to the influence of end zone dances, high fives and MTV celebrations seen on TV, many kids have a hard time learning to walk before they run. If the preliminary parts of a conditioning program are eliminated or cut short, the ultimate potential will be compromised.

Regardless of what sport a child is preparing for, basic conditioning will be mostly the same for all kids. Running, jumping, skipping, jump roping and jumping jacks are some of the simple drills kids automatically perform. Skipping, for example, has a plyometric component to it, a rhythm and timing component as well as a benefit for overall coordination. For young basketball players, skipping simulates the difficult mechanics needed to take a lay-up. Kids can use their arms in a lay-up fashion as they do their skipping drills. With many of the more sophisticated exercises or sport-specific exercises, all kids should be able to perform these 5 basic movements and be in reasonable shape, both physically as well as cardio-vascularly, before beginning them.

Second-level exercises can consist of carioca, a foot-work drill performed over a certain distance, that helps to build coordination and foot speed. Also, step-ups, such as on a stool or even a step, will help to build muscles, strength and coordination. Step-overs involve an athlete either performing the drill head-on or sideways. One version is to step over something like a broomhandle, with a 1-2-3 pattern and then step back with the same 1-2-3 pattern. This can be done 25-50 times for quickness and coordination. Step drills, going up a flight of stairs, where the child has to lead with the right and follow with the left, and then lead with the left and follow with the right, will help to improve focus and coordination.

When working in a gym or on a field, you can set up point-to-point runs of approximately 10-20 meters. Kids can run to the designated point in a frontword run, side-slide back (without crossing feet), run backwards back to the same point, and skip back. These types of drills can be done using forward runs, backward runs, skipping, carioca, side-slides and a host of other varying exercises. But, the important aspect of this drill is that it forces a young athlete to have to concentrate on what is next. This focus helps greatly and the diversification keeps the enthusiasm there. This drill also provides the stopping and starting forces the body must learn to handle, as this is needed in almost all sports.

Jumping drills are another important set of exercises. The use of a jump rope, repetitive jumps at a spot on the wall, volleyball type games, hurdling exercises, short-run jumps, long-jump drills or many others help to develop sprinting techniques with low-grade bounding. The drills can also be split into one-footed hopping as well as two-footed hopping.

Actual running drills are important, and kids should be able to run from the acceleration phase to the top end phase. You must be careful as ossification of the bones has not occurred yet. Emphasis should be placed on general improvements of time over specific distances. Even if improvements in times aren't immediately noticed, ultimate improvements will be recognized.

Weighted exercises should only be done on a very cautious and limited basis. Light barbells and light medicine balls are usually the weights of choice when introducing a young athlete to a weighted exercise. If a child cannot perform the movement drills outlined above, they should never be allowed to add weight to their program. With the lighter weights, squatting exercices, step-up exercises, abdominal exercises and some motion exercises are a relatively safe way to begin. If any strains or limitations are noticed, it may become necessary to progress slower.


Most young athletes in this country today are chosen on their immediate qualities, not their long term potential qualities. Most of our conditioning and sport selection works on the hurry up approach. Overall, we're not doing a very good job of physical preparation. Farm life is gone, most kids live in air-conditioned homes, computers and play-station reduce physical activities and the work ethic has become much softer. It's hard to ask our kids to step up and perform when we, as adults, fail to do so. Secondly, the field of biomechanics has grown considerably in the past decade, and it's importance in sports is becoming more recognizable everyday.

The hard reality is that kids need to be introduced to this more disciplined, sophisticated, organized and sensible physical preparation program at an earlier age in an effort to have a program they can build on in years to come. This program should provide maximum benefits with minimum potential for injury. With commitment and perseverance by the teachers in today's sports, athletics in this country can grow in many diverse and beneficial ways.


Biomechanical Exam

Visual Exam (For symmetry, heights and balance)

-Posterior View--ears, scapulae, waist folds, hips, gluteal crease, popliteal space, medial malleoli, heels.

-Lateral View--posture, cervical lordosis, thoacic kyphosis, lumbar lordosis, pelvic angle.

-Anterior View--head (occiput) alignment with body, shoulders, hips, arm lengths, knees, feet.

Range of Motions

-cervical, thoracic, lumbo-sacral, hips, knees, ankles, toes, shoulders, elbows, wrists, fingers.

Muscle Tests

-abdominals, obliques, low back extensors, adductors, abductors, quads, sartorius, hamstrings, hip flexors, calves, plantar flexors, dorsi-flexors, biceps, triceps, deltoids, rhomboids, latissimus dorsi's, traps, wrist flexors, wrist extensors, brachioradialis, pec majors, SCM's, cervical flexors, cervical extensors, cervical lateral flexors.

Deep Tendon Reflexes

Sensory Tests


-leg lengths, arm lengths, thighs, calves, bicep/tricep, forearms, neck, chest (full inhalation/exhalation), waist, hips, height and weight, foot sizes.


Toe-In Check

Lateral Arches

-loss of arch, increased arch, same or different, right vs. left.

Orthopedic Tests

-Straight Leg Raise, Bilateral Leg Raise, Patrick-Fabere's, Gaenslen's, L-S Compression, Thoracic Compression, Cervical Compression and Distraction, Adson's, Allen's, Deerfield Test.

Trigger Points

-sub-occipital, cervical paraspinal, traps, rhomboids, deltoids, tricep tendon, biceps tendon, wrist extensors, SCM's, quadratus lumborum, gluteus medius, piriformis, L-S paraspinal, S-I muscles, hamstrings, ilio-tibial band, calves, adductors, abductors, quads, plantar fascia, lateral shin muscles, medial shin muscles.


-(2) view cervical, (2) view lumbo-sacral views.

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