Frozen Shoulder: Unravelling the Complexities and Providing Clarity

Written by Michael Crawley, BSc, BPT, CSCS

Nearly 100 years ago, Earnest Codman coined the term “frozen shoulder” and highlighted three clinical issues (Salamh et al. 2025):

• Difficult to define

• Difficult to treat

• Difficult pathology to explain to patients

Those three points still hold true today.

Multiple structures and pathological findings have been implicated in the development of frozen shoulder. This includes the accumulation of immune system mediators, thickening of ligaments, and altered collagen translation (Pandey and Madi 2021). Clinically, this presents as a shoulder with reduced range of motion in both active and passive flexion, abduction, and external rotation (as seen in the image below).

Figure 1: Reduced Shoulder range of motion (ROM) with frozen shoulder

The Real Impact of Frozen Shoulder

A scoping review examining how people experience and live with frozen shoulder demonstrates how debilitating and impactful the condition can be. King and Hebron (2023) identified five major themes:

1. “Dropping me to my knees, due to the pain”

2. Struggle for normality

3. Emotional change for self

4. Challenges through the healthcare journey

5. Coping & adapting

This highlights that frozen shoulder is not just a physical limitation. It can significantly alter how someone functions and experiences their daily life.

Unfortunately, frozen shoulder demonstrates a bias towards a particular demographic. Females in the 40–60 age category take the brunt of diagnoses. To rub salt in the wounds, females are more likely to experience a more prolonged and symptomatic course compared to male counterparts.

Types of Frozen Shoulder

Frozen shoulder can be broadly classified into two categories (Pandey and Madi 2021):

Primary:
A stiff shoulder developing with no known cause. However, there are commonly linked conditions, most notably diabetes mellitus and thyroid dysfunction. The incidence of frozen shoulder can reach as high as 30% in individuals with diabetes.

Secondary:
A stiff shoulder with an underlying cause such as direct trauma (e.g. a fall), infection, or inflammatory conditions.

The Three Stages of Frozen Shoulder

Frozen shoulder follows a series of stages, delineated by changing symptoms (Date and Rahman 2020). While approximate timelines are often attached, there is significant variability, and for some individuals, full resolution may not occur within 3–5 years.

Freezing Stage (Stage 1: 2–6 months)

• Predominantly characterised by moderate to severe pain and partial restriction of ROM

• Early stages may present with pain and only terminal loss of ROM

This stage can be confused with rotator cuff tendinopathy. However, ROM does not progressively worsen in tendinopathy, whereas it continues to worsen with each follow-up in frozen shoulder.

Frozen Stage (Stage 2: 4–12 months)

• Characterised by both pain and stiffness in varying proportions

• Early phase tends to be more pain-dominant

• Later phase becomes more stiffness-dominant

Thawing Stage (Stage 3: 6–26 months)

• Characterised by minimal pain

• Gradual resolution of stiffness

• Progressive return of movement

Pathologically, this reflects a gradual reduction in inflammation and restoration of movement.

Treatment and Management Across the Stages

What actually works, and when it matters

The research on the effectiveness of treatments for frozen shoulder remains conflicting. However, a conservative approach is typically recommended as the starting point (Date and Rahman 2020).

Common interventions include:

• Analgesics

• Physiotherapy

• Intra-articular injections

• Suprascapular nerve block

Early Stage: Movement Within Tolerance

In the early stage of frozen shoulder, gentle stretching and mobility exercises within a pain-free range are advised (Date and Rahman 2020).

Creativity can play a key role here, as Louis Gifford, the brilliant pain specialist, stresses. In his book Aches and Pains, he explains how adjusting body position can influence the amount of pain-free range available to a limb.

The videos below demonstrates this concept. The key idea is simple:

• The arm can move relative to the body

• Or the arm can stay fixed while the body moves around it

Shoulder Range of Motion Wall Drills:
https://youtu.be/9_GwO7r24hM

Passive and active-assisted exercises can also be incorporated. These reduce the working stress on affected structures, allowing the humerus to move through range without generating or exacerbating pain.

Active Assisted and Passive Shoulder:
https://youtu.be/072jZDVW-ac

As Pain Settles: Introducing Strength

As pain begins to reduce and become more manageable, strengthening exercises can be introduced.

Here, the principle that “the dose and position make the poison” becomes particularly relevant.

Using isometrics in varying positions and directions allows for global loading through the shoulder while staying within tolerable limits.

Entry Level Isometric:
https://youtu.be/mDzgyyKlzZo

Later Stages: What Are Mobilisations Actually Doing?

Mobilisations performed by a physiotherapist in the later stages have shown some utility. However, the mechanism behind their effectiveness is contested.

For many years, the prevailing thought was that inferior mobilisation directly impacted the shoulder joint capsule. However, Jeremy Lewis, a well-known Australian shoulder specialist, has pointed out that a physiotherapist would need to generate approximately 600kg of force to meaningfully affect the capsule.

I am not aware of many Canadians with a 600kg deadlift.

The best approach at this stage would be to continue to progress strength training through pain free range.

Injections and Medical Management: Timing Is Key

Outside of physiotherapy, injections and pharmacological treatments are often used.

Nonsteroidal anti-inflammatories have shown little impact in the case of frozen shoulder. Intra-articular steroid injections, however, have demonstrated positive effects, particularly when used at the right time.

Again, Jeremy Lewis stresses that these injections must be used in the early stages, when pain is highest. This reinforces the importance of early and accurate diagnosis.

A similar pattern is seen with suprascapular nerve blocks, which can also have a positive effect on pain relief when applied early (Date and Rahman 2020).

Surgical Options: Often Less Helpful Than Expected

Surgical options are available, but often yield little additional benefit.

Beard et al. (2018) found no clinically significant benefit of shoulder arthroscopy compared to sham surgery. This was further supported by the large UK FROST trial (Corbacho et al. 2021), which reported that early physiotherapy was more cost-effective and accessible compared to invasive and costly surgical approaches.

Interestingly, manipulation under anaesthetic, which previously had negative connotations, has shown some efficacy. This likely relates to the reduction of muscle guarding and tension that can develop with frozen shoulder. When under anaesthetic, this guarding effect is temporarily removed.

Looking Beyond the Shoulder

An important point that is often not expressed or evaluated in the research is that frozen shoulder may be a sign of broader health issues, stemming from multiple systems in the body.

In many cases, it can act as a wake-up call to incorporate strength and conditioning into your lifestyle and address other health metrics.

You may not be able to train the affected side in the same way, but there are still many full-body exercises that can be performed without exacerbating the shoulder:

• Towing a sled

• Belt squat

• Walking lunges

• Step-ups

Why This Matters

There are three key reasons why this approach is important:

1. Approximately 1 in 5 people go on to develop similar symptoms in the opposite shoulder (Pandey and Madi 2021)

2. Sedentary individuals are more likely to receive a frozen shoulder diagnosis

3. Well-designed strength and conditioning programs can positively influence the systems linked to frozen shoulder development, including endocrine, immune, and cardiovascular systems

Deeper Dive into Causation and Management

Recent research has continued to highlight the multi-faceted nature of frozen shoulder and the challenges associated with its management (Navarro-Ledesma 2025a).

This is not a condition driven by a single structure or isolated tissue. Instead, it reflects the interaction of multiple systems within the body.

The diagram below highlights this well. Rather than being caused by one specific issue, frozen shoulder appears to sit at the intersection of several physiological systems, all of which can influence one another.

Estrogen and Menopause

One of the more consistent patterns seen in the research is the increased prevalence of frozen shoulder in peri-menopausal women. This has led to estrogen being identified as a key player in its development (Wend et al. 2012).

As shown in figure below, estrogen has effects that extend well beyond the reproductive system. Its influence spans multiple systems that are directly relevant to frozen shoulder.

Neuroendocrine System

Declining estrogen levels can influence the nervous system through several mechanisms, impacting pain thresholds, resilience to stress, and central sensitisation.

A useful way to think about this is the “fire alarm” analogy.

You leave the bacon on the grill too long and the fire alarm goes off because of the smoke. There is no fire, but the system reacts as if there is.

With reduced estrogen levels, the threshold for triggering that “alarm” can become lower. The result is an amplified pain experience, even when the underlying tissue irritation may not fully justify it.

Metabolic System

Estrogen also plays a key role in fat metabolism, glucose regulation, and resistance to oxidative stress.

When these systems are disrupted, it can create an internal environment where tissue repair is compromised. This contributes to fibrosis, which is a hallmark of frozen shoulder.

Immune System

The same pattern continues within the immune system.

Declining estrogen levels tend to promote a more pro-inflammatory state. Immune system mediators accumulate within the tissues involved in frozen shoulder, and when combined with metabolic dysfunction, this can further drive the condition.

Targeting the System, Not Just the Shoulder

The research highlights how frozen shoulder is influenced by multiple systems, not just the shoulder itself. As a result, management is not limited to physiotherapy or surgical intervention alone.

There are a number of factors that could be explored here, but for the purpose of this piece, three of the more relevant and actionable areas will be discussed below.

Strength and Conditioning

Well-designed and properly implemented strength and conditioning programs have demonstrated positive impacts on estrogen levels, muscle mass, and fat mass in menopausal women (Razzak et al. 2019).

As mentioned previously, even with an impacted and painful shoulder, this does not mean avoiding training altogether or waiting for full resolution before doing anything.

The whole-body and multi-system benefits of strength training can influence long-term outcomes indirectly. While the shoulder itself may be limited, the broader physiological adaptations still matter.

Nutrition

Diet quality also plays a meaningful role.

A nutritional approach centred around higher-quality, minimally processed foods has been shown to impact symptom severity in individuals with frozen shoulder (Hamed-Hamed et al. 2026).

In practice, the decision to implement a structured strength training program often leads to improvements in other lifestyle behaviours, including dietary choices.

In the same way that hormonal, metabolic, and immune factors can drive the development of frozen shoulder, lifestyle decisions can push back against these drivers. This not only has the potential to improve current symptoms, but also to reduce the likelihood of future development.

Sleep and Circadian Rhythm

Circadian rhythm and sleep regulate inflammatory processes, hormonal release, and tissue repair (Navarro-Ledesma 2025a).

These are central to both general health and the development and recovery of frozen shoulder, as well as adaptation to strength training and exercise.

This is where the entanglement of systems becomes more apparent.

Bringing It Together

Sleep, exercise, and nutrition can be thought of as a three-legged stool. Each supports the others, and removing one weakens the entire system.

Addressing these factors will not provide an immediate solution to frozen shoulder. However, they can set the conditions for recovery and reduce the likelihood of recurrence, particularly when considering that approximately 20% of individuals will experience similar symptoms in the opposite shoulder.

Summary and Takeaways

Frozen shoulder is a systems issue, not just a joint problem

Frozen shoulder is not a local condition. It can have significant and long-term effects on both physical and psychological well-being.

In some cases, it can be so debilitating that it alters how an individual functions day to day. That may sound hyperbolic, but when revisiting the five themes outlined earlier, alongside the number of systems involved, it becomes more understandable.

Approaching treatment with a reductionist lens, relying solely on an injection or a home exercise program, is akin to using a hammer where a scalpel is required. This sentiment is supported in a recent review by Brindisino et al. (2026).

Effective management requires a more nuanced and personalised approach that considers the multiple drivers involved:

• Hormonal (endocrine)

• Immune system (autoimmune / inflammatory)

• Strength, mobility, and capacity

• Cardiovascular health

• Pain psychology (sensitisation and emotional drivers)

• Structural factors

• Circadian rhythm and sleep

Key Takeaways

• General strength training can still be completed and is beneficial with a frozen shoulder diagnosis

• Surgical interventions are often unwarranted and do not demonstrate superior outcomes

• Frozen shoulder is multi-factorial, and lifestyle factors such as exercise, nutrition, and sleep play a critical role in both management and risk reduction

References

Beard, D. J. et al. 2018. Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): a multicentre, pragmatic, parallel group, placebo-controlled, three-group, randomised surgical trial. The Lancet 391(10118), pp. 329-338. doi: 10.1016/S0140-6736(17)32457-1

Brindisino, F. et al. 2026. Beyond the capsule: an integrated perspective on the wide world of frozen shoulder. A collaborative viewpoint. Pain Management, pp. 1-20. doi: 10.1080/17581869.2026.2636725

Corbacho, B. et al. 2021. Cost-effectiveness of surgical treatments compared with early structured physiotherapy in secondary care for adults with primary frozen shoulder : an economic evaluation of the UK FROST trial. Bone Jt Open 2(8), pp. 685-695. doi: 10.1302/2633-1462.28.Bjo-2021-0075.R1

Date, A. and Rahman, L. 2020. Frozen shoulder: overview of clinical presentation and review of the current evidence base for management strategies. Future Sci OA 6(10), p. Fso647. doi: 10.2144/fsoa-2020-0145

Hamed-Hamed, D. et al. 2026. Impact of nutritional profile on pain and functionality in patients with frozen shoulder: a cross-sectional observational study. Frontiers in Medicine Volume 13 - 2026,  doi: 10.3389/fmed.2026.1785577

King, W. V. and Hebron, C. 2023. Frozen shoulder: living with uncertainty and being in “no-man’s land”. Physiotherapy Theory and Practice 39(5), pp. 979-993. doi: 10.1080/09593985.2022.2032512

Navarro-Ledesma, S. 2025a. Frozen Shoulder as a Systemic Immunometabolic Disorder: The Roles of Estrogen, Thyroid Dysfunction, Endothelial Health, Lifestyle, and Clinical Implications. J Clin Med 14(20),  doi: 10.3390/jcm14207315

Navarro-Ledesma, S. 2025b. Frozen Shoulder as a Systemic Immunometabolic Disorder: The Roles of Estrogen, Thyroid Dysfunction, Endothelial Health, Lifestyle, and Clinical Implications. Journal of Clinical Medicine 14(20), p. 7315. 

Pandey, V. and Madi, S. 2021. Clinical Guidelines in the Management of Frozen Shoulder: An Update! Indian J Orthop 55(2), pp. 299-309. doi: 10.1007/s43465-021-00351-3

Razzak, Z. A. et al. 2019. Effect of aerobic and anaerobic exercise on estrogen level, fat mass, and muscle mass among postmenopausal osteoporotic females. Int J Health Sci (Qassim) 13(4), pp. 10-16. 

Salamh, P. et al. 2025. An international consensus on the etiology, risk factors, diagnosis and Management for individuals with Frozen Shoulder: a Delphi study. J Man Manip Ther 33(4), pp. 309-320. doi: 10.1080/10669817.2025.2470461

Wend, K. et al. 2012. Tissue-Specific Effects of Loss of Estrogen during Menopause and Aging. Frontiers in Endocrinology Volume 3 - 2012,  doi: 10.3389/fendo.2012.00019

You Should Not Get Injured During a Training Session

Written by Evelyn Calado, MKin, CSCS, RKin

If you leave a training session injured, something has gone wrong.

That is not normal. It should not be expected. And it is not part of “training hard.”

I have been in this industry for over a decade, and I have seen far too many situations where clients get hurt in the weight room. Not because of bad luck, but because of poor decisions.

The Gym Should Be One of the Safest Places You Train

Think about it.

The weight room is a controlled environment.

• You control the load

• You control the movement

• You control the pace

• You control the rest

Compare that to sport, where there are opponents, unpredictable movements, and variables you cannot control.

In theory, your injury risk in the gym should be extremely low.

That does not mean training is easy. You should still be challenged. You should still push your limits.

But it should be done in a controlled and intentional way.

Where Things Go Wrong

Most training-related injuries are not random. They come from avoidable mistakes.

1. Ego-Based Training

This is one of the biggest issues.

A client walks in, maybe they look strong or athletic, and the session becomes about proving something. The load goes up too quickly, technique breaks down, and fatigue is ignored.

That is how people get hurt.

2. No Plan

This is more common than people think.

Clients come in and have no idea what they are doing that day. The trainer is choosing exercises on the spot with no structure, no progression, and no record of previous sessions.

Without a plan, there is no progression. Without progression, there is no direction. And without direction, you are just accumulating risk.

3. Poor Exercise Sequencing

Fatigue matters.

If someone is pushed to the point of exhaustion through their legs and core, and then asked to perform a heavy compound lift, that is a problem.

That is not “hard training.” That is poor decision-making.

4. Ignoring the Individual

Not every client should move the same way.

Mobility, injury history, movement patterns, and training experience all matter. If those are ignored, you are forcing someone into positions they are not prepared for.

That is where breakdown happens.

Soreness Is Not the Goal

Another misconception is that a good session should leave you unable to move.

If your trainer’s goal is to completely destroy you, that is a red flag.

• You should not struggle to sit at your desk

• You should not be unable to walk for days

• You should not feel worse instead of better

Anyone can make you tired.

It takes skill to build a program that challenges you, progresses you, and still allows you to function.

What Good Training Actually Looks Like

Good training is not random. It is structured.

• There is a clear plan

• There is progression over time

• Your loads and performance are tracked

• Exercises are selected for a reason

• Intensity is managed, not guessed

You are pushed, but within your capacity.

You improve, without being completely broken down in the process.

Playing the Long Game

At Avos Strength, the focus is simple:

Train. Play. Repeat.

The goal is not to win a single session. The goal is to keep you training consistently, improving over time, and continuing to do the things you enjoy.

That means:

• Checking your ego at the door

• Building progressively

• Respecting your current capacity

• Training with intention

The Bottom Line

The gym should not be where you get injured.

Can things happen occasionally? Yes. But injuries should be rare, not expected.

If you have worked with a trainer and felt unsafe, unsupported, or left sessions worse than when you walked in, that is not something you should accept.

You deserve better coaching than that.

ACL Injury Risk in Female and Youth Athletes: What Actually Matters (Part 2)

Written by Michael Crawley, BSc, BPT, CSCS

Anterior cruciate ligament injuries are a significant issue in sport, particularly among female and youth athletes. Female athletes have a significantly greater incidence of ACL injury compared to males, with research suggesting the risk may be between 2 and 8 times higher depending on the population studied (Herzberg et al. 2017).

A number of factors have been proposed to influence this increased risk. These include both extrinsic factors such as playing surface, and intrinsic factors such as biological, structural, and physical characteristics. This article focuses on the intrinsic side of the equation.

If you have not read Part 1, where we break down how ACL injuries occur and what influences risk more broadly, you can start here: ACL Injuries: How They Occur, Who Is at Risk, and Why Training Quality Matters

The key intrinsic factors that may influence ACL injury risk in the female athlete include:

• hormonal influences

• biomechanics and structural considerations

• strength and neuromuscular control

It is also important to recognize that surgery is not the only solution following an ACL injury. The appropriate approach depends on the athlete’s age, injury severity, and the presence of additional damage such as meniscal or cartilage involvement. Graft selection is also influenced by these factors and plays an important role in long-term outcomes.

Menstruation and Hormones

The menstrual cycle consists of three phases, each characterized by fluctuations in key hormones including estrogen, progesterone, and luteinizing hormone (Wojtys et al. 2002).

• Follicular phase: approximately 9 days

• Ovulatory phase: approximately 5 days, marked by peaks in estrogen and luteinizing hormone

• Luteal phase: approximately 14 to 15 days, with elevated progesterone

Research in this area remains mixed. However, several studies have reported a higher incidence of ACL injuries during the ovulatory phase compared to other phases (Wojtys et al. 2002; Herzberg et al. 2017).

Wojtys et al. (2002) demonstrated a higher number of ACL injuries, marked as X on the figure above, in a group of young female athletes during the ovulatory phase. The mechanisms behind this relationship are varied and often disputed. At the neurological level, Kumar et al. (2013) demonstrated reduced reaction time to visual and auditory stimulus between the follicular and luteal phases.

From a structural perspective, the ACL contains estrogen receptors, and cell culture research has demonstrated that estrogen can influence the ligament’s collagen composition. It is proposed that this may increase knee joint laxity. Maruyama et al. (2021) examined knee laxity across the menstrual cycle and found increased anterior knee laxity during the ovulatory phase.

However, this difference was only observed when participants were grouped into those with genu recurvatum and those without it, meaning athletes whose knees hyperextend 10 degrees or more versus those who do not. This adds another layer of complexity, as it suggests that biomechanical factors such as hyperextension may interact with hormonal factors such as higher estrogen levels rather than acting independently.

Relaxin is another important peptide hormone that has been specifically linked to injury risk in female athletes. It appears to work synergistically with estrogen, contributing to changes in ligament laxity (Berger et al. 2023; Parker et al. 2024).

Relaxin exerts its effects in two key ways:

• increases type 1 collagen degradation

• suppresses collagen synthesis

Given that ligaments are composed of approximately 40 to 50 percent type 1 collagen, this provides a plausible mechanism by which relaxin may influence ACL integrity. Alterations in the collagen structure of the ligament are one proposed explanation for increased laxity and injury risk.

Parker et al. (2024) also highlight a practical consideration. Relaxin levels tend to peak around days 21 to 24 of the menstrual cycle. In a coaching setting, this may present as an athlete reporting unexplained musculoskeletal discomfort around the knee without a clear training-related cause. This is not something to overreact to, but it can serve as a useful opportunity for education, monitoring, or short-term modification of training.

Across the cycle, these hormonal fluctuations may contribute to changes in reaction time, ligament laxity, and available joint range of motion. While some research has explored the use of oral contraceptives to regulate these hormonal variations and potentially reduce ACL injury risk (Herzberg et al. 2017), the quality of evidence remains low and is often confounded by multiple variables.

More importantly, as Parker et al. (2024) point out, oral contraceptives are not without trade-offs. While they may influence hormones such as relaxin and estrogen, there are more accessible and lower-risk interventions available. For most young female athletes, this is not where the focus should be.

Which leads into the next major factor: strength and neuromuscular training.

Strength and Neuromuscular Training

As female participation in sport has increased over the past few decades, there has been a corresponding increase in injury rates. At the same time, training age and exposure to structured strength and conditioning within a gym setting has generally lagged behind that of male athletes.

Well-rounded strength and conditioning is not only a tool to support and improve performance in sport. It can have a profound effect on robustness and coordinative qualities, helping to mitigate injury risk.

For a deeper look at how strength training should be structured for younger athletes, see: Building a Strong Foundation: The Crucial Role of Youth Strength and Conditioning

In young female athletes, several characteristics have been associated with increased ACL injury risk (Collings et al. 2022):

• lower strength ratios between hip adductors and abductors

• reduced trunk control

• higher countermovement peak force values

This highlights the importance of a complete strength and conditioning plan. As young athletes improve jumping ability and increase power output, the risk of ACL injury and other issues such as patellofemoral pain may also increase (Myer et al. 2015; Collings et al. 2022).

Training for these athletes must address several components:

• maximal strength and power

• jumping and landing mechanics and technique

• strength capacity

• energy system development

Sugimoto et al. (2016) demonstrated that neuromuscular programs that include a combination of strength training, jumping, trunk control, and coordination significantly reduce ACL injury risk in young female athletes.

Practical Exercise Examples

Below are five exercises that cover several key qualities related to performance and injury mitigation:

• Side lunge deceleration control

• Front squat

• Side plank hip abduction iso

• 1-2-1 broad jump

• Split stance press + hip hike

Adjusting variables such as volume, intensity, range of motion, and frequency can make exercises like these highly effective across a range of sports and athlete levels.

Adherence, Enjoyment, and the Training Environment

Several factors can impact adherence in young female athletes:

• time

• enjoyment

• coaching expertise

• equipment access

Research suggests that even two 30-minute sessions per week in-season can meaningfully reduce ACL injury risk, provided a more comprehensive program is completed in the off-season (Sugimoto et al. 2016).

Enjoyment and coaching quality are closely linked. Engagement in the gym setting can be a challenge, particularly for younger athletes. Incorporating competition, variability, and game-based elements can improve buy-in and training consistency.

Reaction, Coordination, and Game-Based Training

The following examples can be used to improve reaction time, coordination, and strength:

• Tennis ball reaction game

• Walking lunge with figure 8 pass

These drills can be implemented in pairs, relay formats, or with sport-specific variations. They also expose athletes to a broader range of movement patterns.

This ties closely into long-term athlete development principles, which are outlined further here:
Build the Athlete First: Why Youth Athletes Need Physical Literacy Before Sport Specialization

An additional benefit of implementing games with different constraints and equipment is the development of energy systems and exposure to a wider range of motor patterns. The importance of this is two-fold.

1. Fatigue has been shown to impact landing control and hip-to-ankle force dissipation in female athletes (Mancino et al. 2024). Improving overall capacity can enhance an athlete’s ability to maintain reaction time and landing mechanics over longer periods.

2. Game and exercise constraints can also help offset the repetitive, high-volume actions seen in many sports. This becomes even more relevant in athletes who specialize early in a single sport.

Luo et al. (2025) found that early sport specialization increases injury risk, reduces long-term performance, and negatively impacts psychological outcomes. With a creative and experienced coach, the gym setting can serve as a valuable environment to address these gaps.

That said, even with a well-informed and diligent athlete who engages in strength training and participates in multiple sports, ACL injuries can still occur.

Surgical Route and Graft Selection

When a discussion has been made and surgery is deemed the best option, the next decision is graft selection. The importance of this choice lies in the fact that it is one of the few modifiable factors (Duchman et al. 2017). For the young female athlete, variables such as sex, age, and sporting demands cannot be changed.

The main graft options include:

• Autograft: tissue harvested from the athlete’s own body. Common options include hamstring tendon (HT), bone-patellar tendon-bone (BPTB), and quadriceps tendon (QT)

• Allograft: donor tissue. Options can include tibialis anterior, Achilles tendon, hamstring, or patellar grafts (Duchman et al. 2017)

Pinheiro et al. (2022) conducted a large analysis in female athletes and found that bone-patellar tendon-bone grafts had a lower incidence of graft failure compared to hamstring grafts. This becomes more nuanced when age is considered.

Mancino et al. (2024) reported that BPTB grafts had lower re-rupture rates in females aged 15 to 20 compared to hamstring autografts. However, in athletes aged 21 and older, outcomes between BPTB and hamstring grafts were similar.

Graft revision risk is also an important consideration. Pinheiro et al. (2022) found that revision rates were 1.8 times higher in hamstring grafts compared to BPTB, increasing to 2.8 times in females under 18. This is particularly relevant, as revision surgeries tend to produce poorer outcomes compared to primary ACL reconstruction (Meena et al. 2024).

More recent evidence suggests that quadriceps tendon grafts produce comparable outcomes in terms of knee stability, functional performance, and re-tear risk (Meena et al. 2024).

Previous injury history should also influence graft selection. Lazarides et al. (2018) reported that a history of moderate to severe patellar tendinopathy was associated with increased graft failure when using BPTB grafts.

Similarly, hamstring autografts may contribute to post-surgical return-to-sport challenges (Bouzekraoui Alaoui et al. 2025), including:

• persistent strength deficits compared to the uninvolved side

• reduced maximum effective angle, a proxy for hamstring function and potential injury risk

In athletes with a history of recurrent hamstring strains or existing strength deficits, harvesting a hamstring graft from the involved side should be carefully considered. This may further complicate the already challenging process of restoring hamstring strength and function during rehabilitation.

Additional Surgical Consideration: LET

Another surgical consideration is the lateral extra-articular tenodesis (LET), which may provide additional protection against re-injury. Recent research has identified specific factors where LET can help reduce risk and may be used as an added layer of structural support (Meena et al. 2024).

These factors include:

• increased general knee ligament laxity

• high tibial slope and increased knee hyperextension

• return to high-demand sport

• younger age

These considerations are particularly relevant for the young female athlete. As discussed throughout this article, hormonal influences on ligament laxity, along with structural characteristics such as knee hyperextension, are commonly observed in this population.

Using appropriate graft selection alongside LET where indicated provides an additional layer of structural support and may improve long-term outcomes in higher-risk athletes.

Summary

There is a complex interplay between hormonal, structural, and neuromuscular factors that may increase ACL injury risk in young female athletes. While many aspects of the research still require further clarity, it is clear that both modifiable and non-modifiable factors are at play.

There are several practical approaches that can help mitigate risk while also improving performance. As participation in female sport continues to grow, appropriate exposure to education, training, and support systems is no longer optional. It is essential.

Actionable Takeaways

• Pre-season screening and strength testing, alongside ongoing in-season monitoring, can help identify and manage risk

• Strength and neuromuscular training should be prioritized, including development of landing mechanics and force absorption

• Coaches can use warm-ups and training creatively to expose athletes to a wider range of movement patterns, which can improve engagement and reduce repetitive strain

• Avoiding early sport specialization where possible can support long-term performance and reduce injury risk

• Graft selection should consider individual factors such as age and injury history, with input from both the physio and orthopaedic surgeon

• Discussing additional surgical options, such as LET where appropriate, may improve outcomes in higher-risk athletes

• Education for both athletes and parents is key. Increasing awareness and training age can have a meaningful impact on long-term development and injury mitigation

For athletes or parents looking for more structured support, this is where individualized assessment and programming can make a meaningful difference: Book an Initial Assessment

Is Two Days per Week of Strength Training Enough for Longevity?

Written by Evelyn Calado, MKin, CSCS, RKin

If you look at most public health guidelines, the answer seems straightforward. Adults are advised to perform muscle-strengthening activities at least two days per week. This recommendation appears in Canadian, American, and international guidelines and applies to both adults and older adults.

But this raises an important question.

Is two days per week simply the minimum needed to check a health box, or is it actually enough to support long-term health, independence, and longevity?

The short answer is that two days per week can be enough, but only under specific conditions. Frequency alone does not determine whether strength training meaningfully impacts longevity. The quality and intensity of the stimulus matter far more than the number of days on a calendar.

What the Guidelines Actually Mean

Public health recommendations are designed for populations, not individuals. Their goal is to identify the lowest effective dose of activity that meaningfully reduces disease risk at a broad scale.

When guidelines recommend strength training twice per week, they are not suggesting that this is optimal for strength, muscle mass, or performance. They are identifying a threshold below which health risks increase, particularly as we age.

In other words, two days per week is a floor, not a ceiling.

Strength Training and Longevity: What the Research Actually Shows

Research consistently shows that resistance training is associated with lower all-cause mortality, reduced cardiovascular disease risk, and improved long-term health outcomes. From a public health perspective, even relatively small amounts of strength training appear to provide meaningful benefit.

However, it is important to be precise about what these findings actually represent.

Most large-scale longevity studies are designed to identify the minimum effective dose of strength training required to reduce population-level risk. They are not designed to define what is optimal for building strength, preserving muscle mass, or maximizing physical capacity across the lifespan.

In this context, it is true that one to two well-performed strength training sessions per week capture a substantial portion of the longevity benefit observed in epidemiological research. Beyond that point, additional sessions do not appear to reduce mortality risk in a simple, linear fashion.

This does not mean that training more is unnecessary, nor does it suggest that strength beyond a certain point stops being valuable. It simply reflects how longevity is measured in large populations.

For individuals interested in aging well, remaining strong, and protecting themselves against injury, disability, and loss of independence, the goal should not be to meet the minimum dose, but to build and maintain as much usable strength as possible over time.

Longevity vs Capacity: Two Different Goals

It is worth separating two concepts that are often conflated.

Training for longevity focuses on reducing disease risk and maintaining basic function. Training for capacity focuses on building strength, muscle mass, power, and resilience.

While two strength sessions per week may be sufficient to support longevity-related outcomes and can improve strength and muscle mass, they are often not the most effective approach for maximizing those qualities long term, particularly in trained individuals or as we age.

From a coaching perspective, the objective is not to do the least amount of work required to stay alive. The objective is to build a body that remains capable, robust, and adaptable for decades.

That typically requires more than the minimum.

Grip Strength, Brain Health, and Why Strength Is More Than Muscle

One of the most compelling demonstrations of strength’s relationship to long-term health comes from research on grip strength.

A large prospective study using data from nearly 500,000 adults in the UK Biobank examined the association between hand grip strength and dementia incidence. Grip strength, often used as a proxy for overall muscular strength, was found to be strongly and inversely associated with dementia risk.

Individuals in the lowest quartile of grip strength had a 72 percent higher incidence of dementia compared to those in the highest quartile.

This finding is important for two reasons.

First, it reinforces that muscular strength is closely tied to neurological and cognitive health, not just physical capability.

Second, it highlights that simple, measurable indicators of strength can reflect deeper systemic health. This is one reason grip strength is included in assessments such as the Avos Performance Battery. It provides insight into overall robustness, not just hand function.

Strength training, when performed with sufficient intensity, appears to play a meaningful role in preserving mobility, independence, and long-term brain health.

Strength Still Matters Even When Cardio Is “Good Enough”

Another frequently overlooked point is that strength contributes to longevity independently of cardiovascular fitness.

A long-term study following approximately 1,500 men over the age of 40 with hypertension for nearly 18 years examined the relationship between muscular strength, cardiorespiratory fitness, and mortality risk.

The findings were striking.

Even among men who were only in the bottom half of cardiorespiratory fitness, those in the top third for muscular strength had an almost 48 percent lower risk of all-cause mortality compared to those in the lowest strength group.

In other words, being strong mattered, even when aerobic fitness was not exceptional.

The lowest mortality risk was observed in individuals who were both strong and aerobically fit, but strength alone still provided a substantial protective effect. This reinforces the idea that resistance training is not optional if longevity is the goal.

Is Two Days per Week Enough in Practice?

This is where nuance matters.

For many adults, particularly those with limited time, two well-designed strength training sessions per week can meaningfully support long-term health. When performed with sufficient intensity and progression, this approach can maintain and often improve key outcomes such as:

• Muscular strength

• Muscle mass (particularly in untrained individuals or those returning to training)

• Bone health

• Joint capacity and tissue tolerance

• Metabolic health

• Overall function and independence as you age

However, outcomes depend on the goal, training history, and how the sessions are structured.

If an individual’s goal includes maximizing lean muscle mass, strength, power, or creating a larger buffer against age-related decline, training more than twice per week is often useful. This is not because two days “doesn’t work,” but because additional sessions often make it easier to accumulate more high-quality weekly training volume, practice key movement patterns, and progress without excessively long sessions.

Frequency alone does not determine effectiveness. What matters is whether training provides enough mechanical tension, effort, and progression to challenge the tissues that decline most rapidly with age.

Using five-pound dumbbells indefinitely, avoiding effort, or treating strength training as light activity rather than progressive overload is unlikely to produce meaningful adaptation.

Two high-quality sessions can outperform several low-effort ones. But for many people seeking to age strong, three to four sessions per week can be a practical way to accumulate more total weekly work and drive continued progress, especially once the “beginner gains” phase has passed.

Aging Changes the Equation

As we age, muscle protein synthesis becomes less responsive, strength declines faster than endurance, and power loss accelerates. This means that intensity and intent become increasingly important over time.

For older adults, two days per week may still be sufficient, but only if:

• Exercises are appropriately loaded

• Movements challenge balance and coordination

• Strength is trained through meaningful ranges of motion

• Progression is maintained where possible

Training “often enough” is not the same as training “effectively.”

ACL Injuries: How They Occur, Who Is at Risk, and Why Training Quality Matters (Part 1)

Written by Michael Crawley, BSc, BPT, CSCS

BACKGROUND

Anterior cruciate ligament injuries (ACLI) are often viewed as sudden, unavoidable events that are “fixed” through surgery. In reality, both injury risk and long-term outcomes are strongly influenced by training quality, rehabilitation approach, and the decisions made before and after injury.

This article highlights the complexity of ACL injuries, explains how and why they occur, and outlines key training and rehabilitation considerations that influence risk and return to sport outcomes. While ACL injuries are often discussed in isolation, they are rarely simple knee injuries, and successful outcomes require a broader, long-term view.

The information presented is intended to provide practical, actionable insight for a range of athletes and stakeholders, including:

• Youth multi-sport athletes and their parents

• High-level collegiate and professional athletes

• Competitive recreational athletes of all ages

ACLI have increasingly been described as an epidemic across both amateur and professional sport. Several studies report that ACL injuries account for approximately 50 percent of knee injuries. Over the past 10 to 20 years, female and youth athletes have experienced the largest increase in incidence. Childers et al. (2025) identified female adolescent athletes as the highest-risk group, with a 1.5-fold increased risk compared to their male counterparts.

Importantly, ACL injuries often occur alongside meniscal and cartilage damage. These associated injuries substantially increase the risk of long-term joint degeneration, including osteoarthritis and the need for total knee replacement (Petushek et al. 2019). This added complexity also plays a significant role in surgical decision-making and long-term outcomes.

HOW DOES THIS HAPPEN

ACL injuries generally fall into two categories:

1. Contact injuries

2. Non-contact injuries, which account for nearly 80 percent of all ACL ruptures (Beaulieu et al. 2023)

Most non-contact injuries occur during high-speed or high-load movements such as single-leg landings, rapid deceleration, or sharp changes of direction. These movement patterns are common across many sports and can occur both during high-intensity competition and through repeated lower-intensity exposures over time.

Sports such as basketball, soccer, netball, and rugby place consistent demands on these movement patterns, emphasizing the importance of preparing athletes not only for isolated high-risk moments, but also for cumulative loading over a season.

RISK FACTORS AND TRAINING IMPLICATIONS

ACL injury risk is influenced by a combination of anatomical, biomechanical, and training-related factors. While some risk factors cannot be changed, many can be meaningfully influenced through education and training.

Female Athlete Considerations

In female athletes, structural features of the tibia, such as posterior tibial slope, along with hormonal influences on ligament laxity, contribute to an increased risk of ACL injury (Kikuchi et al. 2022; Beaulieu et al. 2023).

While these factors cannot be modified, they highlight the importance of early education for young female athletes and their coaches. Building awareness around neuromuscular control, strength development, and movement quality is a critical component of risk reduction.

Playing Surface

Research examining the influence of playing surface has produced mixed findings. However, some studies report higher ACL injury rates in NFL athletes competing on artificial surfaces compared to natural grass (Hershman et al. 2012).

Although athletes cannot always control the surface they compete on, training exposure can be diversified. Incorporating training on a variety of surfaces may help improve adaptability and tolerance to different loading conditions prior to competition.

Fatigue and Repetitive Loading

Emerging evidence suggests that ACL rupture does not always result from a single traumatic event. Fatigue and repetitive sub-maximal loading may contribute to progressive ligament failure over time (Wojtys et al. 2016).

From a training perspective, building tissue capacity in key muscle groups such as the hamstrings, quadriceps, calves, and adductors may increase tolerance to repeated stress and reduce injury risk.

Whole-Body Strength and Neuromuscular Control

Although ACL injuries occur at the knee, load can be transmitted from both the top down and bottom up through the kinetic chain. Poor three-dimensional strength across the trunk, hip, knee, and ankle can increase stress on different portions of the ACL (Beaulieu et al. 2023).

Training that develops strength in multiple planes of motion, both in isolated exercises and integrated movement patterns, helps improve robustness and neuromuscular control.

For example, multi-directional jumping exercises can target trunk, hip, knee, and ankle coordination simultaneously:

• Jumping exercise example: https://youtu.be/foi2J2Tpks8

WHAT IS CONSIDERED SUCCESSFUL ACL REHABILITATION AND HOW IS IT ACHIEVED

Over the past decade, the definition of successful return to sport (RTS) following ACL injury has evolved. A well-regarded Canadian kinesiologist, Carmen Bott, emphasizes that simply returning to sport is not the same as returning successfully.

Long-term data highlight the difficulty of maintaining sport participation following ACL injury. Pinheiro et al. (2022) reported that among elite athletes followed over five years, participation at the same competitive level declined from 75 percent in year one to just 20 percent by year five.

Outcomes are even less favorable in competitive amateur athletes. Approximately 65 percent return to pre-injury level, with overall return to competitive sport roughly 10 percent lower (Nwachukwu et al. 2019).

Following a well-structured, progressively loaded strength and conditioning program can enhance both physical capacity and confidence during rehabilitation. A simplified progression may include:

• Heel slide + straight leg raise (early post-surgery): https://youtube.com/shorts/MyEWyGisbug

• Wall squat (introducing controlled strength): https://youtube.com/shorts/M2ZhZGdo11Q

• Drop squats (early preparation for landing mechanics): https://youtube.com/shorts/MW-KZrf18RU

• Nordic hamstring exercise (high-level strength development): https://youtube.com/shorts/4YNp9C0PQ_4

• Full-range jumping progressions: https://youtube.com/shorts/lDO7zvvshUo

This progression represents only a snapshot of a rehabilitation process that commonly spans 9 to 12 months. Progression should be goal-oriented rather than time-driven, with athletes meeting clearly defined prerequisites before advancing.

TO CUT OR NOT (NOT MEDICAL ADVICE)

When an athlete is diagnosed with an ACL injury, the immediate assumption is often that surgery is required. Indeed, 98 percent of orthopaedic surgeons recommend ACL reconstruction for athletes aiming to return to sports involving running, cutting, and jumping (Weiler et al. 2015).

However, surgery is not always the appropriate choice. Non-operative management may be suitable depending on several factors (Komnos et al. 2024), including:

• Individual expectations and current sport level

• Presence of concomitant injuries such as meniscal or cartilage damage

• Degree of knee laxity and perceived instability

Fitzgerald et al. (2000) classified individuals into three groups:

1. Copers: return to pre-injury level of sport

2. Adapters: return to a reduced level to avoid instability

3. Non-copers: unable to return due to persistent instability

A notable example is a Premier League footballer who returned to play eight weeks after a complete ACL rupture without surgery (Weiler et al. 2015). While this represents a single case, it highlights the importance of individualized decision-making.

What Does This Mean for Non-Professional Athletes?

Athletes outside professional systems should:

• Ask detailed questions about the structures involved in their injury (ACL only vs associated damage)

• Communicate subjective symptoms such as instability, confidence, or locking

• Clarify long-term goals, whether returning to competition or maintaining an active lifestyle

• Consider an initial period of structured rehabilitation before committing to surgery, particularly when instability is not present

In the Premier League case study, the athlete consulted three surgeons, two of whom recommended surgery, while one supported a conservative rehabilitation-first approach. This underscores the value of informed discussion and shared decision-making.

SUMMARY AND KEY TAKEAWAYS

• ACL injuries are complex and influenced by multiple interacting factors including age, sex, sport demands, training exposure, and movement quality.

  • Educating female athletes about menstrual cycle considerations and ligament laxity may be beneficial.

  • Monitoring training load during high knee-stress activities is important.

  • Developing tissue capacity through comprehensive strength training can enhance tolerance to stress.

• Returning to previous levels of sport remains challenging, particularly for non-professional athletes.

  • Rehabilitation should be thorough and guided by experienced practitioners.

  • Successful return to play depends on strength, neuromuscular control, and power that match sport-specific demands.

• Surgery is not the only option.

  • Decisions should be made collaboratively between the athlete, physiotherapist, and surgeon.

  • Clear communication around injury extent and long-term goals leads to better outcomes.

Looking for Individualized Support?

If you’re currently dealing with an ACL injury, returning from surgery, or unsure how to safely progress your training, working with an experienced coach can make a meaningful difference.

Michael works closely with athletes across all levels and has extensive experience supporting ACL rehabilitation and return-to-sport training in collaboration with physiotherapists and medical professionals.

If you’d like to explore whether coaching support is right for you, you can book an initial assessment here.

PART 2: WHAT TO EXPECT

The next article will focus specifically on female and youth athletes and will explore:

• Graft selection considerations when surgery is required

• The role of prehabilitation in improving long-term outcomes

References

Beaulieu, M. L., Lamontagne, M., Xu, L., & Li, G. (2023). Loading mechanisms of the anterior cruciate ligament. Sports Biomechanics, 22(1), 1–29. https://doi.org/10.1080/14763141.2021.1916578

Childers, J. D., Weiss, L. J., Pennington, Z. T., Nwachukwu, B. U., & Allen, A. A. (2025). Reported anterior cruciate ligament injury incidence in adolescent athletes is greatest in female soccer players and athletes participating in club sports: A systematic review and meta-analysis. Arthroscopy, 41(3), 774–784.e772. https://doi.org/10.1016/j.arthro.2024.03.050

Fitzgerald, G. K., Axe, M. J., & Snyder-Mackler, L. (2000). A decision-making scheme for returning patients to high-level activity with nonoperative treatment after anterior cruciate ligament rupture. Knee Surgery, Sports Traumatology, Arthroscopy, 8(2), 76–82. https://doi.org/10.1007/s001670050190

Hershman, E. B., Anderson, R., Bergfeld, J. A., Bradley, J. P., Shelbourne, K. D., Sills, A., & McGuire, K. J. (2012). An analysis of specific lower extremity injury rates on grass and FieldTurf playing surfaces in National Football League games: 2000–2009 seasons. The American Journal of Sports Medicine, 40(10), 2200–2205. https://doi.org/10.1177/0363546512458888

Kikuchi, N., Hara, R., Hiranuma, K., Nakazawa, R., & Fukubayashi, T. (2022). Relationship between posterior tibial slope and lower extremity biomechanics during a single-leg drop landing combined with a cognitive task in athletes after ACL reconstruction. Orthopaedic Journal of Sports Medicine, 10(7), 23259671221107931. https://doi.org/10.1177/23259671221107931

Komnos, G. A., Kotsifaki, A., Dingenen, B., & Gokeler, A. (2024). Anterior cruciate ligament tear: Individualized indications for non-operative management. Journal of Clinical Medicine, 13(20), Article 6233. https://doi.org/10.3390/jcm13206233

Nwachukwu, B. U., Chang, B., Voleti, P. B., Berkanish, P., Cohn, M. R., & Allen, A. A. (2019). How much do psychological factors affect lack of return to play after anterior cruciate ligament reconstruction? A systematic review. Orthopaedic Journal of Sports Medicine, 7(5), 2325967119845313. https://doi.org/10.1177/2325967119845313

Petushek, E. J., Sugimoto, D., Stoolmiller, M., Smith, G., & Myer, G. D. (2019). Evidence-based best-practice guidelines for preventing anterior cruciate ligament injuries in young female athletes: A systematic review and meta-analysis. The American Journal of Sports Medicine, 47(7), 1744–1753. https://doi.org/10.1177/0363546518782460

Pinheiro, V. H., Mascarenhas, R., Saltzman, B. M., & Nwachukwu, B. U. (2022). Rates and levels of elite sport participation at 5 years after revision ACL reconstruction. The American Journal of Sports Medicine, 50(14), 3762–3769. https://doi.org/10.1177/03635465221127297

Weiler, R., Monte-Colombo, M., Mitchell, A., & Haddad, F. (2015). Non-operative management of a complete anterior cruciate ligament injury in an English Premier League football player with return to play in less than 8 weeks: Applying common sense in the absence of evidence. BMJ Case Reports, 2015, bcr2014208012. https://doi.org/10.1136/bcr-2014-208012

Wojtys, E. M., Beaulieu, M. L., Ashton-Miller, J. A., & Newcomb, W. (2016). New perspectives on ACL injury: On the role of repetitive sub-maximal knee loading in causing ACL fatigue failure. Journal of Orthopaedic Research, 34(12), 2059–2068. https://doi.org/10.1002/jor.23441

Build the Athlete First: Why Youth Athletes Need Physical Literacy Before Sport Specialization

Written by Evelyn Calado, MKin, CSCS, RKin

Every parent wants the best for their child.

A chance to make the top team.
A scholarship.
A future in sport.

And because of that hope, many families fall into the same trap: more camps, more private sessions, more tournaments, more exposure. Summer schedules become nonstop. Kids bounce from training block to training block with no real break.

But more sport is not the same as better development.

Kids are not mini professionals. They are growing humans. And when young athletes are pushed into year-round specialization without a physical foundation, the outcomes are predictable: burnout, recurring injuries, stalled progress, and a quiet loss of joy for the game.

The goal of youth sport is not to peak at 12 or 13.
The goal is to build a base that allows athletes to keep improving at 16, 18, and beyond.

That is where long-term athlete development matters.

What long-term athlete development actually means

In Canada, Sport for Life’s Long-Term Development framework is very clear: athletes need to do the right things at the right time.

Early stages such as Active Start, FUNdamentals, and Learn to Train focus on physical literacy before puberty. Physical literacy includes fundamental movement skills like running, jumping, landing, throwing, catching, climbing, rotating, balancing, and reacting.

This physical foundation is what allows athletes to specialize later if they choose. It is not a delay. It is preparation.

When kids skip these stages and jump straight into high volumes of sport-specific training, they often get good at the sport temporarily, until their body becomes the limiting factor.

The real cost of early sport specialization

Early sport specialization is heavily marketed. Parents are told that year-round commitment and early focus are the path to success.

Research and real-world coaching experience tell a different story.

Early specialization and high training volume are associated with:

• Higher rates of overuse injuries

• Increased burnout and mental fatigue

• Decreased long-term participation in sport

• Recurrent pain that becomes “normal” far too early

If a child is always sore, always tight, or always tired, that is not a badge of dedication. That is a signal.

We are now seeing stress fractures, chronic tendon pain, and ACL injuries in middle school athletes. That should concern everyone involved in youth sport.

Kids should still be kids (and this matters for performance)

One of the most overlooked pieces of youth development is unstructured movement.

Kids need time to:

• Run fast without a stopwatch

• Jump and land naturally

• Skip, hop, and change direction

• Throw and catch objects of different shapes and weights

• Wrestle, climb, crawl, and play games

• Solve movement problems without constant instruction

This type of movement exposure builds coordination, adaptability, and resilience. It also builds better athletes later.

The best long-term performers are rarely the ones who only did one sport year-round from childhood. They are often the kids who played multiple sports, played outside, and developed broad athletic skills early.

Strength training is not the problem. It is part of the solution.

One of the most persistent myths in youth sport is that strength training is dangerous for kids.

When strength training is age appropriate, coached properly, and focused on movement quality, it is not only safe, it is one of the most effective tools we have.

For youth athletes, strength training helps:

• Improve sprinting and jumping ability

• Build tendon and joint resilience

• Improve posture and body control

• Reduce injury risk

• Build confidence and competence in movement

Strength training does not mean maximal lifting or adult programs scaled down. It means learning how to move well under load, progressing gradually, and respecting growth and recovery.

The issue is not strength training.
The issue is poor coaching and poor programming.

Youth training guidelines

When parents ask what a balanced approach actually looks like, I lean on five clear guidelines from the Australian Institute of Sport. These guidelines help protect young athletes while still allowing them to develop.

1. Two days off structured sport per week

Young athletes should have two days off organized sport each week.
This does not mean inactivity. It means a break from formal practices, games, and competitions.

No more than three structured training days in a row is a good rule of thumb.

Days off are used for recovery, light movement, and general athletic development, not more sport volume.

2. Minimum 24 hours between intense sessions

Intense sessions include impact, contact, sprints, and jumps.

If today is a hard practice or game, tomorrow should not be another high-intensity day whenever possible. Tissues and the nervous system need time to recover.

3. Fatigue reduction matters

If a kid is constantly sore, tired, or emotionally flat, something needs to change.

Priorities include:

• Adequate nutrition

• Sleep, often 9 or more hours for youth

• Monitoring total load, including practices, games, extra training, camps, and school stress

Fatigue is not always physical. Academic and emotional stress count too.

4. Strength training 2 to 3 times per week

Strength training should be a consistent part of youth development.

This builds the foundation for speed, power, tissue resilience, and confidence. The focus should always be on quality movement, not chasing numbers.

5. Adjust training during stressful life periods

During exams, growth spurts, poor sleep, emotional stress, or unusually busy weeks, training volume should be reduced.

Pulling back is not falling behind. It is smart coaching.

What a balanced training week can look like

This will vary based on age, maturity, sport, and season, but a general structure might look like:

• Two days off structured sport

• Two to three sport practices or games

• Two strength training sessions

• Intense days separated by at least 24 hours

• Strength sessions adjusted in volume during heavy competition weeks

This approach supports development without constantly pushing kids into a recovery deficit.

What parents should look for in youth training

Youth physical development is largely unregulated, which makes it hard for parents to know what to look for.

At minimum, a coach working with youth should have:

• Education in kinesiology, exercise science, or a related field

• Training in growth, motor development, and youth exercise prescription

• A clear philosophy aligned with long-term athlete development

• Safe Sport or ethics training

• Insurance and proper business practices

• The ability to adjust training when a child is tired, sore, or growing rapidly

Being a former high-level athlete does not automatically make someone qualified to guide youth physical development.

Good intentions are not enough.

The long-term goal is bigger than sport

There will be a last game every athlete plays.

Sport is finite. Strength, movement skill, and confidence in the body are not.

When kids learn to move well, build strength, recover properly, and respect their body, they carry those habits into adulthood. Whether they pursue elite sport or not, they win.

The goal is not to create robots who grind year-round.
The goal is to build adaptable, resilient humans who can handle sport, stress, and life.

That starts by building the athlete first.

How We Support Youth Athletes

If you are a parent in Vancouver and want a smarter approach that supports your child’s sport without piling on more volume, Avos Strength works with youth athletes using a long-term development model that prioritizes health, performance, and longevity.

Book a youth athlete consult

References

Australian Institute of Sport. (n.d.). Youth and junior athlete development principles. Australian Sports Commission.
https://www.ais.gov.au

Balyi, I., Way, R., & Higgs, C. (2013). Long-term athlete development. Human Kinetics.

Faigenbaum, A. D., Kraemer, W. J., Blimkie, C. J. R., Jeffreys, I., Micheli, L. J., Nitka, M., & Rowland, T. W. (2009). Youth resistance training: Updated position statement from the National Strength and Conditioning Association. Journal of Strength and Conditioning Research, 23(Suppl 5), S60–S79.
https://doi.org/10.1519/JSC.0b013e31819df407

International Olympic Committee. (2015). Youth athletic development: IOC consensus statement. British Journal of Sports Medicine, 49(13), 843–851.
https://doi.org/10.1136/bjsports-2015-094962

Jayanthi, N. A., LaPrade, R. F., Meeuwisse, W. H., Oberlander, T. F., & Patel, D. R. (2015). Sports-specialized intensive training and the risk of injury in young athletes: A clinical case-control study. American Journal of Sports Medicine, 43(4), 794–801.
https://doi.org/10.1177/0363546514567292

LaPrade, R. F., Agel, J., Baker, J., Brenner, J. S., Cordasco, F. A., Côté, J., Engebretsen, L., Feeley, B. T., Gould, D., Hainline, B., Hewett, T. E., Jayanthi, N., Kocher, M. S., Myer, G. D., Nissen, C. W., Philippon, M. J., Provencher, M. T., & Sanchez, G. (2016). AOSSM early sport specialization consensus statement. Orthopaedic Journal of Sports Medicine, 4(4).
https://doi.org/10.1177/2325967116644241

Lubans, D. R., Morgan, P. J., Cliff, D. P., Barnett, L. M., & Okely, A. D. (2010). Fundamental movement skills in children and adolescents: Review of associated health benefits. Sports Medicine, 40(12), 1019–1035.
https://doi.org/10.2165/11536850-000000000-00000

O’Kane, J. W., Neradilek, M., Polissar, N., Sabado, L., Tencer, A., & Schiff, M. A. (2017). Risk factors for lower extremity overuse injuries in female youth soccer players. Orthopaedic Journal of Sports Medicine, 5(10).
https://doi.org/10.1177/2325967117733963

Sport for Life. (n.d.). Long-term development framework.
https://sportforlife.ca