Conditioning Pyramind

Conditioning Pyramid

In the mid-’90s, when Dr. Tim Maggs worked in the strength and conditioning department of the New York Giants under Coach Al Miller and consulted with the Chicago Bulls strength coach Al Vermeil, he became aware of the conditioning pyramid these two coaches developed for the athletes on their teams.

This pyramid (see Figure 1) shows a progressive program that will help each player reach his or her peak potential. The base of the pyramid, the work capacity category, has six components, each of which addresses a separate aspect of conditioning. All athletes who play on the Giants and Bulls must pass tests in all six categories before they can enter the weight room. These professional athletes are physically at the peak of their life, of course. Unlike most weekend warriors and younger athletes who are still in school, they’ve been taught how to lift and train properly.


But let’s consider the middle school and high school athlete, ages 12–18. These young boys and girls are still growing. They’re uneducated with regard to proper lifting and conditioning, and they’re often guided by too few coaches who have too little knowledge. They’re allowed to enter the weight rooms and begin lifting and training with no one testing them for their anaerobic capacity, body composition, joint mobility, strength endurance, core strength or aerobic capacity. The kids just start lifting without the correct knowledge to prevent injury.  This is what we are trying to prevent with CPOYA. 

The Current System

The trend in schools today is to produce bigger and better athletes, which is accomplished by adding strength training to the middle school and high school athletic agenda. Unfortunately for this generation, more trauma and injuries will occur and on a large scale, making the potential degeneration and disability much greater for much younger athletes.

And these kids don’t go to a doctor unless they’re injured. They don’t even go to the doctor when they’re injured. Any family that has been through it before with older children realizes that, in most cases, the ordinary medical doctor doesn’t know what to do with a pulled muscle, a sore back, a sprained knee, or plantar fasciitis. Even though our pediatricians and family physicians are not trained in sports injuries, they are still the go-to docs in this system. We have to live with the kind of care they give.

Without knowledge of the injuries that happen to young athletes, our doctors have narrowed their responses down to two possibilities: either take the athlete out of his sport for two weeks or refer him to the orthopedist. This suddenly makes a parent’s decision to see the family doctor a more costly decision.

With co-pays going up and insurance reimbursements going down, a visit to a doctor can end up costing parents $50 or more. An experienced parent or coach knows that no treatment—and maybe no accurate diagnosis, either—is going to result from this first visit to the general practitioner, only a two-week pink slip or a referral.

A referral to another doctor means more cost and more down time before any actual treatment can begin. And what does the orthopedist recommend?  Again, either two weeks off or another referral, this time to the physical therapist. Again, more money and more time. By the time the athlete gets to the physical therapist, it might be 10 days or more after the injury.

Treatment most likely will begin with the physical therapist and last until insurance coverage runs out. The major problem with this scenario, which plays out hundreds of times every day, is that no one ever looks at the complete bio-mechanical structure of the young athlete. No one looks at the athlete as a whole.

All individuals have unique bio-mechanics that are influenced by genetics and will affect the many different activities, sports, and traumas we endure. The imbalances originate in the feet. There follows a domino effect going up the structure of the human body and creating compensatory sites of increased mechanical loading (abnormal weight bearing), which will predictably cause involved joints, tendons and muscles to wear out prematurely.

These imbalances also increase the young athlete’s vulnerability for immediate injuries. Our goal should be to identify these sites sooner rather than later and to begin proactively to make adjustments and improvements to reduce the degree of breakdown over the course of a young athlete’s life. Although these sites do not have to be symptomatic, symptoms are often associated with these imbalances.