Adolescent Athletic Development

Growing Shouldn’t Hurt

By Angus McDowell

The physical stress put on a young body during periods of rapid growth and also high levels of sport can be immense. It is not uncommon for children to be participating in up to 4 different sports at the same time and having multiple training sessions per day, often back-to-back. This stress is then amplified by adolescent rapid growth and hormonal changes that often coincide with a high sporting load. The result of this cumulative stress can result in vulnerability for young bodies. It is paramount that at this time they remain protected from overload and non-contact traumatic injury but also from growth associated issues such as Osgood-Schlatters, Severs Disease, and Patello-femoral Joint overload.

The area of “athletic development” has undergone dramatic expansion over the last few years with a much greater focus being put on guiding and nurturing adolescent athletes. The “Long Term Athletic Development” model suggests a time line for both timing and focus of athletic development and acts as a guide to when, during a child’s growth, that they develop different sporting characteristics (e.g Speed, Agility, Power, Sports Specific Skills and muscle development). This timeline can then be used to structure periods during which protection is the focus and periods where development is the focus, and even timeframes where adolescents should focus on specific sports and activities.

The development process that an adolescent goes through has the potential to dictate a large quantity of their physical characteristics and sports specific characteristics for the future, as an adult. From a sporting perspective, this can have a dramatic effect not only on their athletic careers but also on their injury prevention and long-term health. It is important to consider the future when deciding on sport participation and training to maintain the highest level of physical protection and promote proper development in adolescent athletes.

If you would like us to develop a personalised development timeline for your sporting son or daughter to protect them and allow them to flourish, please contact Reception 9596 9110 to book an appointment with Angus McDowell or John Contreras or book online at

Blood Flow Restriction Training

By Georgia Koutrouvelis

Patellofemoral (knee cap) pain is a very common injury which we see in both males and females, and  adolescents and adults.

The effectiveness of increasing quadriceps strength to reduce patellofemoral (knee cap) pain has been well established in the literature.  In order to achieve true strength changes, the use of high intensity training at a load greater than 70% of one-repetition maximum is required.  This high resistance not only loads up the quadriceps, but also the patellofemoral joint.

The people who would mostly benefit from quadriceps strengthening are those with kneecap pain, but unfortunately, they can experience a flare up of their discomfort during high load strengthening exercises.  We also know that quadriceps activity is reduced in the presence of knee cap pain, so the notion of exercising into pain thresholds is not recommended.

So, this raises the following questions:


How do we increase quadriceps strength, in the presence of patellofemoral pain?

A recently researched option is Blood Flow Restriction Training (BFRT).


What is Blood Flow Restriction Training? 

Research on BFRT was first published in Japan as Kaatsu training in 2000.  The aim is to increase both muscle strength and size through by exercising under reduced blood flow conditions to and from the muscles.  A sphygmomanometer (blood pressure cuff) is used to apply the pressure restriction at a desired measurement.


Does it work?

Yes.  In 2012, a meta-analysis of all the literature illustrated the effectiveness of using BFRT as a method of increasing both muscle strength and size.  These changes were achieved by using only 30% of one- repetition maximum (as compared to the 70% required with traditional strength training).


Is it safe?

A review of the literature in 2011 showed that BFRT appears to be as safe as traditional strength training methods.  Although this is quite a safe intervention, any potential participants will still undergo a medical screening questionnaire to assess their relative risk.


How does it work?

The physiological mechanisms behind BFRT training aren’t very well understood, however we do know that there is a build-up of metabolic waste product within the muscle, an increase of growth hormone factor greater than traditional strength training, and reduced oxygen to the muscle.


Will it change my patellofemoral pain?

A published studied in 2016 compared an eight-week traditional strength training program with and eight week BFRT program, to assess whether there was a significant change in pain, function, quadriceps strength and size in patients experiencing patellofemoral joint pain.  I assisted in this study by being a facilitator of the intervention.  The intervention compared eight-week training program, 3 times a week, of knee extension and leg press exercises. One group performed the program under traditional strength training, methods (70% one-repetition maximum) and the other under BFRT conditions (with partial occlusion via a blood pressure cuff, at a resistance of 30% one-repetition maximum).  The patients who demonstrated significant changes in daily levels of pain were those with knee cap pain on resisted knee extension and runners.


Who should I consider BFRT?

  • If you have patellofemoral pain and traditional quadriceps strength training is too painful
  • If you would like to increase quadriceps strength but high levels of load on the knee is not appropriate in the short term or longer term. For example, post-operative patients, those with patellofemoral osteoarthritis

For more information or to book an appointment with Georgia Koutrouvelis, please contact Reception 9596 9110.