NSCA Strength and Conditioning Professional …...NSCA Strength and Conditioning Professional Standards and Guidelines ABSTRACT THIS IS THE UPDATED VERSION OF THE NSCA STRENGTH AND

NSCA Strength andConditioningProfessional Standardsand Guidelines

A B S T R A C T

THIS IS THE UPDATED VERSION OF

THE NSCA STRENGTH AND CON-

DITIONING PROFESSIONAL

STANDARDS AND GUIDELINES.

THE LAST UPDATE WAS PER-

FORMED IN 2009.

The Strength and Conditioningprofession involves the com-bined competencies of sport/

exercise science, administration, man-agement, teaching, and coaching.Practitioners must also comply withvarious laws and regulations while re-sponding to instances of potentialinjury and related claims and suits.This creates remarkable challengesand requires substantial experience,expertise, and other resources to effec-tively address them, especially in mul-tisport (e.g., collegiate and scholastic)settings.

Ample resources are available in someof these settings but in many others,however, they are not. Budgets, equip-ment, facilities, and staff are often lim-ited (or lacking altogether), witha resulting mismatch between the par-ticipants’ demand for safe and effectiveprograms and services, and the institu-tion’s provision of them. It is importantfor Strength and Conditioning practi-tioners and their employers to

understand that this standard of careis a shared duty; the institution andindividual are thus jointly responsiblefor fulfilling it. Collectively, these issuesare the driving forces behind thisproject.

The purpose of the NSCA Strengthand Conditioning ProfessionalStandards and Guidelines documentis to help identify areas of liabilityexposure, increase safety, anddecrease the likelihood of injuriesthat might lead to legal claims andsuits, and ultimately improve thestandard of care being offered. Thisdocument is intended to be neitherrigid nor static and will be updatedperiodically to reflect the industry’sbest practices. It is hoped thatStrength and Conditioning practi-tioners and the institutions employ-ing them will mutually benefit fromapplying this information, and in turnsignificantly enhance the quality ofservices and programs provided totheir participants.

NOTICE

This document is intended to pro-vide relevant practice parametersfor Strength and Conditioning pro-fessionals to use when carrying outtheir responsibilities in providingservices to athletes or other partici-pants. The standards and guidelinespresented here are based onpublished scientific studies, pertinentstatements from other associations,

analysis of claims and litigation,and a consensus of expert views.However, this information is nota substitute for individualized judg-ment or independent professionaladvice.

Neither the NSCA nor the contribu-tors to this project assume any dutyowed to third parties by those read-ing, interpreting, or implementingthis information. When renderingservices to third parties, these stand-ards and guidelines cannot be adop-ted for use with all participantswithout exercising independent judg-ment and decision-making based onthe Strength and Conditioning pro-fessional’s individual training, educa-tion, and experience. Furthermore,Strength and Conditioning practi-tioners must stay abreast of newdevelopments in the profession sothat these standards and guidelinesmay evolve to meet particular serviceneeds.

Neither the NSCA nor the contribu-tors to this project, by reason ofauthorship or publication of this doc-ument, shall be deemed to be engagedin practice of any branch of profes-sional discipline (e.g., medicine, phys-ical therapy, law) reserved for thoselicensed under state law. Strengthand Conditioning practitioners using

Address correspondence to the NSCANational Office at [email protected].

KEY WORDS :

principles of practice

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Copyright ª National Strength and Conditioning Association. Unauthorized reproduction of this article is prohibited.


this information are encouraged toseek and obtain such advice, if neededor desired, from those licensedprofessionals.

INTRODUCTION

SCOPE OF PRACTICE

The legal responsibilities and profes-sional scope of practice for Strengthand Conditioning professionals canbe subdivided into 2 domains: (42)“Scientific Foundations” and “Practi-cal/Applied”. Each of these involvescorresponding activities, responsibil-ities, and knowledge requirements(refer to Appendices 1 and 2):

Scientific foundations.� Exercise Sciences (e.g., Anatomy,Exercise Physiology, Biomechanics,Sport Psychology)

� Nutrition

Practical/Applied.� Exercise Technique� Program Design� Organization and Administration� Testing and Evaluation

LEGAL DUTIES AND CONCEPTS

Strength and Conditioning practi-tioners have legal duties to providean appropriate level of supervisionand instruction to meet a reasonablestandard of care and to provide andmaintain a safe environment for theparticipants under their supervision.These duties also involve informingusers of risks inherent in and relatedto their activities, and preventingunreasonable risk or harm resultingfrom “negligent instruction or supervi-sion (16,17,21).” Statler and Brown (56)summarize the following key liabilityconcepts for the Strength and Condi-tioning professional:� Assumption of risk: voluntary partic-ipation in activity with knowledge ofthe inherent risk(s). Athletic activi-ties, including strength and condi-tioning, involve certain risks.Participants must be thoroughlyinformed of the risks of activity,and required to sign a statement tothat effect.

� Liability: a legal responsibility, duty,or obligation. Strength and Condi-tioning professionals have a duty tothe participants they serve to takereasonable steps to prevent injuryand to act prudently when an injuryoccurs (5).

� Negligence: failure to act as a reason-able and prudent person wouldunder similar circumstances. Four el-ements must exist for a Strength andConditioning professional to befound liable for negligence: duty,breach of duty, proximate cause,and damages (47). Simply stated,a Strength and Conditioning profes-sional is negligent if he/she is provento have a duty to act and to havefailed to act with the appropriatestandard of care, proximately caus-ing injury or damages to anotherperson.

� Standard of care: what a prudent andreasonable person would do undersimilar circumstances. A Strengthand Conditioning professional is ex-pected to act according to his/hereducation, training, and certificationstatus (e.g., CSCS, NSCA-CPT,EMT, cardiopulmonary resuscita-tion [CPR], automated external defi-brillator [AED], First Aid).

Standards versus guidelines. It isimportant to distinguish between“standards” and “guidelines” becauseeach term has different legal implica-tions (9,60):� Standard: a required procedure thatprobably reflects a legal duty or obli-gation for standard of care (note thatthe standard statements in this doc-ument use the word “must”). Thestandards set forth in this documentmay ultimately be recognized asa legal standard of care to be imple-mented into the daily operations ofstrength and conditioning programsand facilities.

� Guideline: a recommended operat-ing procedure formulated and devel-oped to further enhance the qualityof services provided (note that theguideline statements in this docu-ment use the word “should”). Guide-lines are not intended to be

standards of practice or to give riseto legally defined duties of care, butin certain circumstances they couldassist in evaluating and improvingservices rendered.

While the publication of this docu-ment does not amount to a judicialdetermination of the standard of careto be applied in a particular case, it ispresumed that the standards statedherein will likely be given authoritativeweight in actual litigations.

Published standards of practice 5potential legal duties. Proof of dutyor standard of care in a negligence casecan be determined in various ways,one of which is from standards of prac-tice published by professional associa-tions and organizations. In actuallitigation, published standards of prac-tice can be introduced through experttestimony or in the discovery phase ofpretrial to help determine whethera defendant was negligent in carryingout his/her legal duties (9). The currenttrend in most jurisdictions is to allowsuch standards as admissible evidence,where they are generally recognized asbeing indicative of widely acceptedpractices. Furthermore, courts examin-ing these issues in negligence caseshave ruled that violations of such pro-fessional standards often constitutea breach of duty.

If properly adopted and applied, pub-lished standards of practicecan minimize liability exposures asso-ciated with negligence, and therebyserve as a potential shield for thosewho comply with them. They can alsobe used as a sword against those whodo not comply, potentially increasingliability risks associated with negli-gence (9). The key issue in this regardseems to be the practitioner’s consis-tent application of established stand-ards of practice in the provision ofdaily service. For example, if his/herconduct is proven to be consistent withaccepted standard(s), it will be difficultto show breach of duty, thereby pro-viding protection against negligence. Ifhis/her conduct is not proven to beconsistent with accepted standard(s),

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however, it may be easier for theinjured party to show breach of dutydue to failure to follow such standards,which can lead to a ruling ofnegligence.

TYPES OF STANDARDS

In addition to standards for desired oper-ational practices published by profes-sional organizations such as the NSCA,there are also standards for technical/physical specifications published byindependent organizations such as theAmerican Society for Testing and Mate-rials (ASTM) or U.S. Consumer ProductSafety Commission (CPSC). These arebriefly described below:

Operational practices. In a negligencelawsuit, established standards of carecan be used to gauge a practitioner’sprofessional competence by compar-ing his/her actual conduct with writtenbenchmarks of expected behavior. Inaddition to the standards and guide-lines from allied professional organiza-tions such as the American College ofSports Medicine (ACSM) (3,12,60),American Heart Association (AHA)(3,35,36), and National Athletic Train-ers’ Association (NATA) (39) refer-enced in this document, the followingassociations have also published stand-ards of practice:� Aerobics and Fitness Association ofAmerica. Exercise Standards andGuidelines (4th ed). Ventura, CA:AFAA, 2002.

� American Academy of Pediatrics.Strength training by children andadolescents. Pediatrics 121: 835–840,2008. Available at: http://pediatrics.aappublications.org/content/121/4/835. Accessed 11/5/2017.

� American Physical Therapy Associ-ation. Guide to Physical TherapistPractice (2nd ed). Alexandria, VA:APTA, 2003.

� National Association for Sport andPhysical Education. Moving Intothe Future: National Standards forPhysical Education (2nd edition).Reston, VA: NASPE, 2004.

� National Athletic Trainers’ Associa-tion Board of Certification. Standardsof Professional Practice. Dallas,

TX: NATA, 2016. Availableat: http://www.bocatc.org/public-protection#standards-discipline Ac-cessed 11/5/2017.

� President’s Council on Fitness,Sports and Nutrition. The Role ofResistance Training for Childrenand Adolescents. Available at:http://www.fitness.gov/blog-posts/role_resistance_training.html. Accessed11/5/2017.

� Society of Health and Physical Edu-cators. Quality Coaches, QualitySports: National Standards for SportCoaches (2nd ed). Champaign, IL:Human Kinetics, 2006.

� US Center for SafeSport. Availableat: https://safesport.org/ Accessed11/5/2017.

Technical and physical specifications.Technical and physical specificationsof equipment and facilities relevant tothe Strength and Conditioning profes-sion have been published by theASTM and CPSC. The CPSC also op-erates the National Electronic InjurySurveillance System (NEISS), a surveil-lance and follow-back system thatgathers data from hospital emergencydepartments to provide timely infor-mation on consumer injuries associ-ated with certain products oractivities. Some of these data havebeen used to research weight traininginjuries, as will be addressed in theInjury Trends, Litigations, and Stan-dard of Care Load section.

STANDARDS OF PRACTICE ASTHEY APPLY TO RISKMANAGEMENT

Risk management is a proactive admin-istrative process that helps minimizelegal liability, as well as decrease the fre-quency and severity of injuries and sub-sequent claims and lawsuits (8). It maynot be possible to eliminate all risks ofinjury and liability exposure in strengthand conditioning settings; however, itcan be effectively minimized and miti-gated by implementing sound risk man-agement strategies. The Strength andConditioning practitioner is ultimatelyresponsible for risk management, butall facility staff should be involved in

the various aspects of the process.Eickhoff-Shemek (10) proposes a 4-stepprocedure for applying standards of prac-tice to the risk management process:1. Identify and select standards of practice,

as well as all applicable laws. Becauseso many standards of practice arepublished by various organizations,it is challenging for the Strength andConditioning professional to beaware of all of them, and determinewhich ones are appropriate whenimplementing the risk managementplan. In terms of participant safety,the most conservative or stringentstandards in a given industry shouldgenerally be used.

2. Develop risk management strategies re-flecting standards of practice and allapplicable laws. This step involveswriting procedures describing spe-cific responsibilities and/or dutiesthat staff would carry out in partic-ular situations. The proceduresshould be written clearly, succinctly,and without excessive detail (toomuch detail may not allow the flex-ibility practitioners need in particu-lar situations and makeimplementation of those strategiesdifficult or impractical). Once thewritten procedures are finalized,they should be included in the staffpolicies and procedures manual.

3. Implement the risk management plan.Implementation of the risk manage-ment plan primarily involves stafftraining to ensure that the practi-tioner’s daily conduct will be consis-tent with written policies andprocedures and selected laws andstandards of practice. The policiesand proceduresmanual should be usedin conjunction with the initial trainingof new employees, as well as duringregular in-service training, where allemployees practice a particular (e.g.,emergency) procedure. From a legalperspective, it is also important toexplain to staff why it is essential tocarry out such duties appropriately.

4. Evaluate the risk management plan.Like the law, standards of practiceare not static and need to be up-dated periodically to reflect change.The risk management plan should

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be formally evaluated at least annu-ally, as well as after each incidenceof accident or injury to determinewhether emergency procedureswere performed correctly and whatcould be done to prevent a similarincident in the future.

LIABILITY EXPOSURE IN THESTRENGTH AND CONDITIONINGPROFESSION

While each strength and conditioningprogram and facility is unique, theNSCA Professional Standards andGuidelines Task Force has identified9 areas of potential liability exposure,as delineated below. It is important tonote that they are interrelated. Forexample, proper instruction and super-vision is associated with personnelqualifications, as well as facility layoutand scheduling issues. Noncompliancein any area can therefore affect others,and in turn compound the risk of lia-bility exposure and potential litigation.Furthermore, the Strength and Condi-tioning practitioner and his/heremployer share the corresponding du-ties and responsibilities.

Collectively within these liability expo-sure areas, 11 standards and 14 guide-lines for Strength and Conditioningpractitioners have further been identi-fied (these are presented in the nextsection of this document). Thesestandards and guidelines are intendedto serve as an authoritative and unbi-ased source for professional guidance.The rationale for each is summa-rized below.

Preparticipation screening and clear-ance. A physical examination is imper-ative for all participants beforeparticipating in a strength and condi-tioning program and should be per-formed by a properly qualified healthcare provider with the requisite train-ing, medical skills, and background toreliably perform a physical examina-tion. This should include a comprehen-sive health and immunization history(as defined by current guidelines fromthe Centers for Disease Control andPrevention (CDC)), as well as a rele-vant physical examination, part of

which includes an orthopedic evalua-tion. Some type of cardiovascularscreening, as discussed below, is alsorecommended. The Strength and Con-ditioning staff should receive docu-mentation about any condition thatwould potentially require special train-ing considerations (e.g., sickle-cell dis-ease), even if the participant has beengiven medical clearance to participate.Participants who are returning from aninjury or illness must also be requiredto provide documentation of medicalclearance before returning to a strengthand conditioning program. Therefore,communication between the SportsMedicine/Athletic Training staff andthe Strength and Conditioning staffmust be clear and timely.

Currently, there are no universallyaccepted standards for screening par-ticipants nor are there approved certi-fication procedures for health careprofessionals who perform such ex-aminations. However, a joint Pre-Participation Physical Evaluation TaskForce of 6 organizations (AmericanAcademy of Family Physicians, Amer-ican Academy of Pediatrics, AmericanCollege of Sports Medicine, AmericanMedical Society for Sports Medicine,American Orthopaedic Society forSports Medicine, and American Oste-opathic Academy of Sports Medicine)has published a widely acceptedmonograph including detailed instruc-tions on performing a preparticipationhistory and physical examination,determining clearance for participa-tion, and a medical evaluation formto copy and use for each examination(46). In addition, the American HeartAssociation and American College ofSports Medicine have published state-ments on preparticipation screeningfor those involved in fitness-relatedactivities (3,35,36). Relevant pointsare summarized as follows:� Educational institutions have an ethi-cal, medical, and possible legal obliga-tion to implement cost-efficientpreparticipation screening strategies(including a complete medical historyand physical examination), and therebyensure that high school and college

athletes are not subject to unacceptablerisks. Support for such efforts, espe-cially in large athletic populations, ismitigated by cost-efficiency consid-erations, practical limitations, and anawareness that it is not possible toachieve zero risk in competitivesports.

� Preparticipation athletic screeningshould be performed by a properly qual-ified health care provider with the req-uisite training, medical skills, andbackground to reliably perform a physi-cal examination, obtain a detailed car-diovascular history, and recognize heartdisease. A licensed physician is pre-ferred, but an appropriately trainedregistered nurse or physician assis-tant may be acceptable under certaincircumstances in states where non-physician health care workers arepermitted to perform preparticipa-tion screening. In the latter situation,however, a formal certification pro-cess should be established to demon-strate expertise in performingcardiovascular examinations.

� A complete and careful personal andfamily medical history and physicalexamination designed to identify (orraise suspicion of ) cardiovascular riskfactors known to cause sudden deathor disease progression is the best avail-able and most practical approach toscreening populations of competitivesports participants. Such screening isan obtainable objective, and shouldbe mandatory for all participants. Ini-tially a complete medical history andphysical examination should be per-formed before participation in orga-nized high school athletics (grades9–12). An interim history should beobtained in intervening years. Forcollegiate athletes, a comprehensivepersonal/family history and physicalexamination should be performed bya qualified examiner initially onentering the institution, beforebeginning training and competition.Screening should be repeated every2 years thereafter unless more fre-quent examinations are indicated;and an interim history and bloodpressure measurement should be ob-tained each subsequent year to





determine whether another physicalexamination, and possible furthertesting, is required (e.g., due toabnormalities or changes in medicalstatus).

� Health appraisal questionnaires shouldbe used before exercise testing and/ortraining to initially classify participantsby risk for triage and preliminary deci-sion-making. After the initial healthappraisal (and medical consultationand/or supervised exercise test, ifindicated), participants can be fur-ther classified for exercise trainingon the basis of individual character-istics. When a medical evaluation/recommendation is advised orrequired, written and active commu-nication between facility staff and theparticipant’s personal physician orhealth care provider is strongly rec-ommended. Furthermore, partici-pants should be educated about theimportance of obtaining a prepartici-pation health appraisal and medicalevaluation/recommendation (if indi-cated), as well as the potential risksincurred without obtaining them.

Personnel qualifications. Qualifiedand knowledgeable personnel mustbe hired to properly supervise andinstruct participants using Strengthand Conditioning facilities and equip-ment. A three-pronged approach isrecommended.

First, the Strength and Conditioningpractitioner should acquire expertise,and have a degree from an accreditedcollege/university in one or more ofthe topics comprising the “ScientificFoundations” domain identified in theCertified Strength and ConditioningSpecialist (CSCS) Examination Con-tent Description (42) (i.e., anatomy,exercise/sport physiology, biomechan-ics, sport psychology, nutrition; seeAppendix 1), or in a related subject(e.g., exercise/sport pedagogy, psy-chology, motor learning, trainingmethodology, kinesiology). Note thatthe NSCA’s Education RecognitionProgram (ERP) has been developedto recognize institutions of higherlearning that meet such requirements,

and also helps to identify an educa-tional career path for the Strengthand Conditioning profession. Likewise,practitioners should make an ongoingeffort to acquire knowledge and com-petence in the content areas outsidetheir primary area of expertise. In2004, the Commission on Accredita-tion of Allied Health Education Pro-grams (CAAHEP) began accreditingprograms in exercise science and exer-cise physiology (https://www.caahep.org/ Accessed 11/5/2017), so if thepractitioner is unable to attend anNSCA-ERP institution, training in anaccredited program in exercise scienceor exercise physiology will ensure thatthe “Scientific Foundations” are thor-oughly covered.

High school settings are unique inthat most teaching positions requirea teacher certification from an ac-credited program, typically in Physi-cal Education, for an individual whowill be working with students in anathletic setting. The Society of Healthand Physical Educators (SHAPE),formerly known as AAHPERD, hasalso created national standards andguidelines for physical educationteacher education that address theunique issues pertinent to exerciseand sport in the high school environ-ment (https://www.shapeamerica.org/ Accessed 11/5/2017).

Second, accredited certifications offeredthrough professional organizations withcontinuing education requirements anda code of ethics (e.g., the CSCS creden-tial; see Appendix 2) are available toStrength and Conditioning practitionersinterested in acquiring the necessarycompetencies. Depending on the prac-titioner’s specific duties, responsibilities,and interests, relevant certificationsoffered by other governing bodiesmay also be appropriate, dependingon the requirements for obtaining andmaintaining certification.

Third, a Strength and Conditioningpractitioner’s knowledge and skilldevelopment can be enhanced byapplying the “performance team” con-cept (i.e., aligning a staff comprised of

qualified professionals with interde-pendent expertise and shared leader-ship roles; see Appendix 3) (27,28).The scope of practice for the Strengthand Conditioning profession hasexpanded and diversified to the pointwhere it is very challenging, and oftenunrealistic, for each individual toacquire proficiency in all areas. There-fore, specific roles and responsibilitiesmust be outlined and understood by allmembers of the Strength and Condi-tioning staff and matched with eachperson’s training and experience. Theproductivity of a hierarchical (single-leader) work group can be significantlyimproved by applying the team modelto staffing; the same team dynamicsthat augment the group’s effectivenessalso tend to enhance individual mem-bers’ learning and skill acquisition (27).

Program supervision and instruction.Although serious accidents are rare insupervised exercise programs, the lia-bility costs associated with inadequateor lax supervision are very expensive,and the plaintiff’s recovery rate in suchnegligence lawsuits can be high. Themain causes of these incidents are poorfacility maintenance, defective equip-ment, and inadequate instruction orsupervision. The importance of staffingis readily apparent in each circum-stance. For example, Rabinoff (48) re-viewed 32 litigations arising fromnegligent weight training supervisionand found that 3 issues were raisedby the plaintiff’s attorneys in each case:poor instruction (or instructor qualifi-cations); lax/poor supervision; and fail-ure to warn of inherent dangers (in theequipment, facility, or exercise). Thestandard of care used in each casewas based on statements establishedby the NSCA, ACSM, or SHAPE. Aprevalent trend in such litigations is theissue of “professional instructor qualifi-cations,” such as appropriate degrees,recognized certifications, training,experience, and continuing education(refer to guideline 2, and Appendices1 and 2).

Participants in a Strength and Condi-tioning facility must be properly




supervised and instructed at all timesto ensure maximum safety, especiallybecause of the athletic, skillful natureof many activities implemented instrength and conditioning programs,in accordance with the dynamic corre-spondence (54) and practice specificity(49,50) principles. Bucher and Krotee(5) recommend the following cardinalprinciples of supervision:� Always be there (mentally andphysically).

� Be active and hands-on.� Be prudent, careful, and prepared(e.g., knowledgeable of proper tech-nique/spotting, program design).

� Be qualified (e.g., accredited degree,CSCS/NSCA-CPT, CPR/AED,First Aid).

� Be vigilant.� Inform participants of safety andemergency procedures.

� Know participants’ health status.� Monitor and enforce rules andregulations.

� Monitor and scrutinize theenvironment.

In addition to the physical and mentalpresence of qualified professionalsduring strength and conditioningactivities, effective instruction and super-vision involves a range of practical con-siderations (2,4,19,21,23,56,59):� A clear view of all areas of the facil-ity, or at least the zone being super-vised by each practitioner and theparticipants in it. This issue is relatedto facility design and layout, encom-passing equipment placement withrespect to visibility, versatility, andaccessibility. (refer to standard 4)

� The practitioner’s proximity to thegroup of participants under his/hersupervision. This includes the abilityto see and communicate clearly withone another, and quick access to par-ticipants in need of immediate assis-tance or spotting.

� The number and grouping of partic-ipants to make optimal use of avail-able equipment, space, and time.

� The participants’ age(s), experiencelevel(s), and need(s).

� The type of program being con-ducted (e.g., skillful/explosive free-weight movements versus machine

or guided-resistance exercises) andthe corresponding need for coachingand spotting.

In an ideal world, strength and condi-tioning activities should be scheduledto distribute activity throughout theday, and thereby promote an optimaltraining environment (refer to Appen-dix 4 for basic guidelines on calculatingspace needs). Even with careful plan-ning, however, most facilities havetimes of peak usage (e.g., as a resultof team practices and participants’ classschedules). Beyond a certain point, it isimpractical to simply spread strengthand conditioning activities over a widerrange of times to maintain an accept-able professional-to-participant ratio.The central issue is to accommodatepeak usage times by providing ade-quate facilities and qualified staff, suchthat all participants are properly in-structed and supervised (refer to guide-line 2) (23,31,60). Furthermore, propertechniques, movement mechanics, andsafety should be emphasizedto minimize injury risk and liabilityexposure (7,14,25) (also see the NSCAposition statements summarized inAppendix 5). Likewise, instructionalmethods, procedures, and progressionsthat are consistent with accepted pro-fessional practices should be used(45,49,50,54,57,58).

While reasonable steps should be takento make optimal use of the Strengthand Conditioning facility and staff,a potential mismatch between availableresources and demand for programsand services exists in many institutionsduring times of peak usage. As ex-plained below in the Injury Trends, Lit-igations, and Standard of Care Loadsection, the combined effects of expo-nential growth in collegiate/scholasticathlete participation, corresponding lia-bility exposures, and equal opportu-nity/access laws create a remarkablestandard of care load and liability chal-lenge for Strength and Conditioningpractitioners and their employers. A2-pronged approach can thus berecommended.

First, strength and conditioning activi-ties should be planned, and the

required number of qualified staffshould be present, such that recom-mended guidelines for minimum aver-age floor space allowance perparticipant (100 ft2), minimumprofessional-to-participant ratios (1:10junior high school, 1:15 high school,1:20 college), and number of partici-pants per barbell or training station(up to 3) are applied during peak usagetimes (2,23,56). In general circumstan-ces, this corresponds to 1 Strength andConditioning practitioner per 3–4training stations and/or 1,000 ft2 area(junior high school); 5 training stationsand/or 1,500 ft2 area (high school); or6–7 training stations and/or 2,000 ft2

area (college), respectively. It isextremely important to note that theseratios do not take into account the useof complex lifts such as the weightlift-ing movements and their derivations,or the use of the primary structural(multijoint) free-weight exercises.Therefore, a much smaller supervisionratio is warranted in these circumstan-ces (e.g., 1:12 instead of 1:20 forcollege-level). In addition, there areno data regarding how the ratiosshould differ with training status.Therefore, professional discretionshould be used to adjust these guide-lines with respect to the practical con-siderations discussed above.

Second, Strength and Conditioningpractitioners and their employersshould work together toward a long-term (e.g., 3–5 years) goal of matchingthe professional-to-participant ratio inthe Strength and Conditioning facilityto each sport’s respective coach-to-athlete ratio. This is relatively straight-forward in collegiate settings where theNCAA limits the number of coachesper sport in Division I (NCAA DivisionI Manual, Bylaw 11.7; updated annu-ally) and also provides sports participa-tion data (refer to Appendix 6; notethat coach-to-athlete ratios forindividual-event sports are lower thanthose for team sports) (40). In theabsence of similar information in other(e.g., scholastic) settings, such determi-nations can be made on an individualinstitution basis; or possibly according





to trends within a district, division,or state.

Facility and equipment set-up, inspec-tion, maintenance, repair, and sign-age. In some cases, Strength andConditioning professionals areinvolved in all phases of facility designand layout. Perhaps more commonly,however, they assume responsibilityfor an existing facility, in which casethe opportunities to plan or modify itmay be limited. In either case, theStrength and Conditioning practi-tioner and his/her employer are jointlyresponsible for maximizing the safety,effectiveness, and efficiency of thefacility, such that the allotted spaceand time can be put to optimal use(24) (also see Appendix 4).

The Strength and Conditioning profes-sional should establish written policiesand procedures for equipment/facilityselection, purchase, installation, set-up,inspection, cleaning, maintenance, andrepair. Safety audits and periodic in-spections of equipment, maintenance,repair, and status reports should all beincluded. Manufacturer-provided usermanuals, warranties, and operatingguides, and other relevant records(e.g., pertaining to equipment selection,purchase, installation, set-up, inspec-tion, cleaning, maintenance and repair;refer to guideline 6), should be kept onfile and followed regarding equipmentoperation and maintenance (5).

The Strength and Conditioning pro-fessional should understand the con-cept of “product liability,” whichrefers to the legal responsibilities ofa product manufacturer and/or vendorif a person sustains injury or damagedue primarily to a defect or deficiencyin design or manufacturing (56). Whilethis issue applies to manufacturers andvendors, there are actions and/or be-haviors that can increase the Strengthand Conditioning professional’sresponsibility, consequently puttinghim/her at risk for claims or suits(16). The following steps should betaken to minimize liability exposurescaused by strength and conditioningequipment (5,11,30):

� Buy the equipment exclusively fromreputable manufacturers, and be cer-tain that it meets existing standardsand guidelines for professional/com-mercial (not home) use.

� Use the equipment only for the pur-pose intended by the manufacturer;do not modify it from the conditionin which it was originally sold unlesssuch adaptations are clearly desig-nated and instructions for doing soare included in the productinformation.

� Post any signage provided by themanufacturer on (or in close proxim-ity to) the equipment.

� Do not allow unsupervised partici-pants to use the equipment.

� Regularly inspect the equipment fordamage and wear that may placeparticipants at risk for injury.

Emergency planning and response.An emergency response plan is a writ-ten document that details the properprocedures for caring for participantswho incur injuries during activity aswell as lightning safety (refer to Appen-dix 7 for sample guidelines). While allStrength and Conditioning facilitiesshould have such a document, it isimportant to appreciate that the docu-ment itself does not save lives. Indeed,it may offer a false sense of security if itis not backed up with appropriatetraining and preparedness by qualified,professional staff. Therefore, all person-nel in Strength and Conditioning facil-ities must:� Know the emergency response planand the proper procedures for deal-ing with an emergency (e.g., locationof phones, activating emergencymedical services, designated person-nel to care for injured participants,ambulance access, and location ofemergency supplies).

� Review and practice emergency pol-icies and procedures regularly (e.g.,at least quarterly).

� Maintain current certification inguidelines for cardiopulmonaryresuscitation and automated externaldefibrillators (CPR-AED) as estab-lished by the American Heart

Association and International Liai-son Committee on Resuscitation(1). Several organizations, such asthe American Heart Association,Red Cross, National Safety Council,and St. John Ambulance, offeracceptable certifications. First Aidtraining and certification may alsobe necessary if Sports Medicine per-sonnel such as an MD, PA, or ATCare not immediately available.

� Adhere to universal precautions forpreventing exposure to and trans-mission of bloodborne pathogens,as established by the CDC (51),Occupational Safety and HealthAdministration (OSHA) (43), andthe NCAA Sports Medicine Hand-book (44). Bloodborne and AirbornePathogens Training by the NationalSafety Council may be necessary ifpersonnel are not immediately avail-able to properly respond to exposureto blood or other potentially infec-tious materials.

Records and record keeping. Docu-mentation is fundamental to the man-agement of strength and conditioningprograms and facilities. In addition todeveloping and maintaining a policiesand procedures manual (56), a varietyof records should be kept on file (5):� Personnel credentials� Professional standards and guidelines� Policies and procedures for opera-tion and safety, including a writtenemergency response plan (refer tostandard 5; Appendix 7)

� Manufacturer-provided user’s man-uals, warranties, and operatingguides; and equipment selection,purchase, installation, set-up, inspec-tion, cleaning, maintenance, andrepair records

� Injury/incident reports, prepartici-pation medical clearance, and re-turn to participation clearancedocuments (after the occurrence ofan injury, illness, change in healthstatus or an extended period ofabsence) for each participant undertheir supervision

� In collegiate and scholastic settings,athletes are required to sign




protective legal documents (e.g.,informed consent, agreement to par-ticipate, waiver, personal contract;refer to Appendix 8) covering all ath-letically related activities, includingstrength and conditioning; however,in other settings, the Strength andConditioning professional shouldconsider having participants signsuch legal documents

� Training logs, progress entries and/or activity instruction/supervi-sion notes

Legal and medical records should bekept on file as long as possible in theevent of an injury claim or suit. Stat-utes of limitations (i.e., the time inwhich individuals may file a lawsuit)vary from state to state, so it is goodpractice to maintain files indefinitely orconsult with a legal authority (22). Allrecords should be kept as securely aspossible, with limited access by anyonenot on staff. Examples of securing re-cords include locked filing cabinets andpassword-protected computers andcomputer files. As is the case withother organizational and administra-tive tasks, it is necessary to have ade-quately and appropriately trained staffto properly keep and maintain suchrecords.

Equal opportunity and access. Fed-eral, state, and possibly local laws andregulations prohibit discrimination orunequal treatment (e.g., according torace, color, national origin, religion,sex, gender identity and expression,political affiliation, age, disability, vet-eran status, genetic information, orsexual orientation or other such legalclassifications) in most organizations,institutions, and professions. For exam-ple, practitioners employed in federallyfunded educational (i.e., collegiate orscholastic) settings must comply withcivil rights statutes including Title IXof the Education Amendments of1972, which mandates gender equityin providing opportunity and accessto athletic facilities, programs, andservices. The Strength and Condition-ing professional must obey the letterand spirit of these laws when workingwith participants as well as with staff. If

a Strength and Conditioning profes-sional witnesses any discriminatory orunequal treatment of individuals orteams while performing duties in thescope of employment, the illegal con-duct must be immediately reported toa supervisor, compliance department,and/or the general counsel for theemployment entity. To protect theinterests of the Strength and Condi-tioning professional, it is also recom-mended to consult with a privatelegal entity when the foregoing situa-tion is encountered.

Participation in strength and condi-tioning activities by children. Resis-tance training can be an importantcomponent of youth fitness, healthpromotion, and injury prevention.Such programs are safe when properlydesigned and supervised, and canincrease children’s strength, motor fit-ness skills, sports performance, psycho-social well-being, and overall health(12,32,33). Indeed, many of the benefitsassociated with adult strength and con-ditioning activities are attainable byprepubescent and adolescent partici-pants who participate in age-specifictraining (12,32,33). However, it isimportant for the Strength and Condi-tioning practitioner to take certain pre-cautions with children (13).

In a 20-year retrospective review ofweight training injuries that wereevaluated and/or treated in U.S. hos-pital emergency departments (basedon NEISS data), Jones (26) found analarming incidence of injuries toyoung children. Children ,7 yearsof age are almost 6 times more likelyto be injured than those .15 years ofage, with the majority (80%) resultingfrom playing with or around weighttraining equipment in the home. TheCPSC estimated in 2015 that approx-imately 8,850 children younger than 5years are injured each year with exer-cise equipment (e.g., include station-ary bicycles, treadmills, and stairclimbers), with an additional 45,725injuries per year to children 5–14 yearsof age (https://origin.prod.cpsc.gov/s3fs-public/2015%20Neiss%20data%

20highlights.pdf Accessed 11/5/2017). This has clear implicationsregarding the importance of supervis-ing children in these age groups, andtheir exposure to such equipment orfacilities. In support of this, Malina(34) reported that estimated injuryrates in resistance training programswere 0.176, 0.053, and 0.055 per 100participant-hours in pre- and early-pubertal youth, respectively, in theprograms examined. Twenty-twostudies were examined and all usedhigh levels of supervision and lowinstructor to participant ratios, whichwas believed to be the reason for theextremely low injury rates.

Another area of potential injury con-cern for children and pubescents/ado-lescents is the use of maximum (max)testing (one repitition maximum[1RM]). While Faigenbaum and others(12,13,32,33) have shown max testingto be safe in these age groups, it isemphasized that maintaining propertechnique is critical. As an alternative,simple field-based measures such asvertical jump, long jump, and handgripstrength, which have been correlatedto 1RM strength may be used (32).Attention to NSCA-prescribed guide-lines (7,14,25) for lifting techniqueshould always be followed.

Supplements, ergogenic aids anddrugs. The issue of using ergogenic aids,including nutritional supplements anddrugs, is complicated by several factors.First, dietary supplements are regulatedas foods rather than drugs according tothe Dietary Supplement Health andEducation Act of 1994. Consequently,concerns exist regarding quality con-trol/assurance and possible consequen-ces for consumers can exist. Strengthand Conditioning practitioners are oftenapproached for advice on nutrition andsupplementation but may be limitedthrough state laws in what advice canbe administered. Spano (55) outlinesthe roles and responsibilities of the SportNutritionist and other professionals whomay give nutrition advice. However, theStrength and Conditioning practitionershould be aware of the following:





� The Federal Trade Commission hasprimary responsibility for advertisingclaims. Simply stated, advertising forany product, including dietary sup-plements, must be truthful, substan-tiated, and not misleading.

� The U.S. Food and Drug Adminis-tration has primary responsibility forproduct labeling claims. The legisla-tion enforced by this agency includescurrent good manufacturing practiceregulations and selected portions ofthe Federal Food, Drug and Cos-metic Act related to dietary supple-ments. Note that the U.S.Pharmacopeia and National Formu-lary, which establishes manufactur-ing practices for nutritionalsupplements (i.e., standards for iden-tity, strength, quality, purity, packag-ing, labeling, and storage), is cited asa primary resource in this legislation.

A second complicating factor is that theboundaries between dietary supple-ments, drugs, and conventional foodsare unclear. This is especially problem-atic for competitive athletes and coaches,because such products may contain sub-stances that are banned by 1 or moresport governing bodies despite the man-ufacturer’s or vendor’s use of terms suchas “herbal”, “legal”, “natural”, “organic”,“safe and effective”, etc. Furthermore,supplementmanufacturers are constantlydeveloping new products with differentcombinations of ingredients, making itmore challenging to identify those thatmay be problematic.

A third factor is that banned substancepolicies and procedures, testing proto-cols, and related rules and regulationsdiffer among sport governing bodies atall levels (e.g., USOC, MLB, NBA,NFL, NHL, NCAA, NAIA, NFHS).Therefore, a compound that is permis-sible according to 1 governing bodymay be impermissible according toanother. The US Anti-Doping Agency(USADA; https://www.usada.org/about/ Accessed 11/5/2017) andthe World Anti-Doping Agency (WA-DA; https://www.wada-ama.org/ Ac-cessed 11/5/2017) have manyresources including lists, handbooks,overviews, guides, and FAQ web pages

to assist coaches and athletes in ensur-ing they are avoiding all banned sub-stances, in addition to those providedby a specific sport governing body.

The National Federation of State HighSchool Associations’ Sports MedicineAdvisory Committee is opposed to theuse of dietary supplements to obtaina competitive advantage and has createda position statement to that effect(http://www.nfhs.org/media/1015652/dietary-supplements-position-statement-2015.pdf Accessed 11/5/2017). Further-more, Strength and Conditioningpractitioners at NCAA member institu-tions need to be aware of NCAA Divi-sion I Bylaw 16.5.2.g: “An institutionmay provide permissible nutritional sup-plements to a student-athlete for the pur-pose of providing additional calories andelectrolytes. Permissible nutritional sup-plements do not contain any NCAAbanned substances and are identified ac-cording to the following classes: carbo-hydrate/electrolyte drinks, energy bars,carbohydrate boosters, and vitaminsand minerals.” The NCAA Committeeon Competitive Safeguards and MedicalAspects of Sports has subsequentlydeveloped lists of permissible versus non-permissible nutritional supplements,although these will probably change asthe market continues to evolve and newproducts are evaluated.

INJURY TRENDS, LITIGATIONS,AND STANDARD OF CARE LOAD:EFFECTS OF RISING ATHLETICPARTICIPATION

The lack of qualified instruction andsupervision can be identified, eitherdirectly or indirectly, as a causative fac-tor in the available information on in-juries and litigations associated withweight training. In some cases, this isclearly documented (26,29), while inothers it can be inferred. For example,the relatively high coach-to-athleteratio (and corresponding standard ofcare) in Olympic-style weightlifting isa likely reason for the low incidence ofinjury in this sport despite its technicaland athletic nature (18,29). Based onthe collective information summa-rized below, it is difficult to overem-phasize the fundamental importance

of qualified staffing in fulfilling the in-stitution’s and Strength and Condi-tioning professional’s shared legalduties for safety, supervision, and stan-dard of care.

Collegiate settings. Year-roundstrength and conditioning activitiesare now the rule rather than the excep-tion in collegiate athletic programs.According to NCAA data onstudent-athlete participation (40), theoverall number of participantsincreased 108% (from 231,445 to482,533) between 1981–82 and 2014–15. Of special interest are the changesin female participation during thisperiod. The increase in women’s par-ticipation was 186% (from 74,239 to212,474) as compared with 63% formen (from 169,800 to 276,599).

The total number of, and time of par-ticipation in, athletically related activi-ties has also expanded accordingly.While desirable in terms of prepara-tion, the allowance of nontraditionalseasons, off-season skill instruction,and year-round strength and condi-tioning activities increases each stu-dent-athlete’s potential for injury andliability exposure, as well as the corre-sponding standard of care load placedon support staff. The NATA recentlypublished a detailed overview of injuryincidence in collegiate athletics, andfound that it has risen sharply and con-sistently with the increase in partici-pants and exposures (39). Thepotential liability issues for Strengthand Conditioning professionals andtheir employers are further com-pounded by the exponential rise infemale participation and laws mandat-ing equal opportunity and access toathletic programs, services, and facili-ties (refer to standard 7).

Scholastic settings. The sheer numberof high school athletes, and growingemphasis on year-round strength andconditioning activities in scholastic set-tings, presents a tremendous challengein terms of demand for standard ofcare, and accompanying liability expo-sure. Student-athlete participation in




organized high school sports increased100% (from approximately 4 million toapproximately 8 million) between 1971and 2016 (41). Of special interest arethe changes in female participationduring this period. The relativeincrease in girls’ participation was1,000% (from about 0.3 million to 3.3million) as compared with 24% forboys (from approximately 3.7 millionto 4.5 million).

As is the case in collegiate settings, thecombination of increasing participa-tion in athletic activities, a correspond-ing rise in liability exposures, and lawsmandating equal opportunity andaccess creates a remarkable standardof care load and challenge in terms oflegal duties for Strength and Condi-tioning practitioners and their employ-ers (refer to standard 7).

Other populations. Studies examiningthe incidence and types of weighttraining injury report varying injuryrates, but similar distributions of injurytypes. Weight training injuries seem tobe associated with various trainingmethods (e.g., bodybuilding, powerlift-ing, Olympic-style weightlifting, fit-ness/recreational weight training) andequipment (e.g., free weights, ma-chines). Of these, explosive types oftraining and free-weight apparatus areoften incorrectly believed to be inher-ently more dangerous than othermethods. In some of the earliest inves-tigations, Hamill (18) conducted a sur-vey of sport injury rates in 13–16-year-old school children and foundthat the injury rate in Olympic-styleweightlifting (0.0017 per 100 hours) iseven lower than that for weight train-ing (0.0035 per 100 hours) and thateach of these injury rates were muchlower than those observed for other,more popular sports (e.g., basketball0.03; football 0.10; gymnastics 0.044;athletics 0.57). Calhoon and Fry (6)analyzed weightlifting injury reportsat the U.S. Olympic Training Centersover a 6-year period and found thatelite weightlifters’ injuries were strains,tendinitis, or sprains typical of acute(59.6%) or chronic (30.4%) overuse or

inflammation. Injury rates were calcu-lated to be 0.33 per 100 hours ofweightlifting exposure, and the recom-mended number of training daysmissed for most (90.5%) injuries was1 day. These authors concluded thatweightlifting injury patterns and ratesare similar to those reported for othersports and activities. More recently,Keogh and Winwood (29) compileddata from several investigations andfound that bodybuilding had the low-est injury rates (0.024 injuries per 100hours), with strongman (0.53 injuriesper 100 hours) and Highland Games(0.75 injuries per 100 hours) reportingthe highest rates. The shoulder, lowerback, knee, elbow, and wrist/handwere generally the most commonlyinjured anatomical locations; strains,tendinitis, and sprains were the mostcommon injury type (29,38). Very fewsignificant differences in any of theinjury outcomes were observed asa function of age, sex, competitive stan-dard, or bodyweight class, althoughMyer (38) found a higher incidenceof “accidental” injuries in youth versusadults.

Although risk-factor studies of acuteweight training injuries are lacking,recognized contributing factorsinclude poor technique, lack of super-vision, skeletal immaturity, and steroidabuse (37). Some of these factors areconfirmed in the NSCA (33) andACSM (12) published statements onyouth resistance training. Chronicweight training injuries, however, havebeen attributed to excessive weighttraining and improper training techni-ques (52,53,61). Each of these factorscan be positively influenced with qual-ified instruction and supervision.

PREPARTICIPATION SCREENINGAND CLEARANCE

STANDARD 1.1

Strength and Conditioning professio-nals can only work with participantswho have undergone health careprovider screening and clearance be-fore participation, in accordancewith instructions specified by theAAFP-AAP-ACSM-AMSSM-AOSSM-

AOASM Pre-participation PhysicalEvaluation Task Force (46), the AHAand ACSM (3,35,36), as well as relevantgoverning bodies and/or their constitu-ent members (e.g., NCAA/NAIA (44)for collegiate athletes; state legislatures,or individual state high school athleticassociations/districts for scholastic ath-letes). In the collegiate athletics environ-ment, the Athletic Training staff isinvolved in this process in accordancewith NATA guidelines. In recreationalactivity programs, Strength and Condi-tioning professionals must require partic-ipants to undergo preparticipationscreening and clearance in accordancewith AHA and ACSM recommenda-tions (3,35,36). For children, the clear-ance decision must includea determination or certification thanthe child has reached a level of maturityallowing participation in such activitiesas addressed in the “Participation inStrength and Conditioning Activitiesby Children” standards statement (referto guideline 8).

GUIDELINE 1.1

Strength and Conditioning professio-nals should cooperate and communi-cate with each of a trainingparticipant’s health care providersand provide service in the participant’sbest interest according to instructionsspecified by such providers.

PERSONNEL QUALIFICATIONS

GUIDELINE 2.1

The Strength and Conditioning practi-tioner should acquire a minimum ofa bachelor’s or master’s degree froman accredited college or university (ver-ification by transcript or degree copy)in one or more of the topics comprisingthe “Scientific Foundations” domainidentified in the Certified Strengthand Conditioning Specialist (CSCS)Examination Content Description(42) (see Appendix 1), or in a relatedsubject area. An ongoing effort shouldalso be made to acquire knowledge andskills in the other content areas.

GUIDELINE 2.2

The Strength and Conditioning practi-tioner should achieve and maintain





professional certification(s) with con-tinuing education requirements anda code of ethics, such as the CSCScredential offered through the NSCA(see Appendix 2). Depending on thepractitioner’s scope of activities,responsibilities, and knowledge re-quirements, related certificationsoffered by other governing bodiesmay also be appropriate.

GUIDELINE 2.3

The productivity of a Strength andConditioning staff member, as well aslearning and skill development of indi-vidual members, should be enhancedby aligning a performance team com-posed of qualified practitioners withinterdependent expertise and sharedleadership roles (see Appendix 3).Once the team is assembled, respectiveactivities and responsibilities from thedomains identified in the CertifiedStrength and Conditioning Specialist(CSCS) Examination Content Descrip-tion (42) (see Appendix 1), as well asappropriate liaison assignments, shouldbe delegated according to each mem-ber’s particular expertise.

PROGRAM SUPERVISION ANDINSTRUCTION

STANDARD 3.1

Strength and conditioning programsmust provide adequate and appropri-ate supervision by well-qualified andtrained personnel, especially duringpeak usage times. To ensure maximumhealth, safety, and instruction, Strengthand Conditioning professionals mustbe physically and mentally presentduring strength and conditioningactivities, have a clear view of theentire facility (or at least the zonebeing supervised by each practitioner)and the participants in it, be physicallyclose enough to the participants undertheir supervision to be able to see andclearly communicate with them, andhave quick access to those in need ofspotting or assistance.

STANDARD 3.2

In conjunction with appropriate safetyequipment (e.g., power racks), atten-tive spotting must be provided for

participants performing activities inwhich free weights are supported onthe trunk or moved over the head/face(7,14).

GUIDELINE 3.1

Strength and conditioning activitiesshould be planned, and the requisitenumber of qualified staff (refer toguideline 2) should be available suchthat recommended guidelinesfor minimum average floor spaceallowance per participant (100ft2), minimum professional-to-participant ratios (1:10 or lowerjunior high school, 1:15 or lowerhigh school, 1:20 or lower college),and number of participants per bar-bell or training station (3) areachieved during peak usage times(23,56). Younger participants, novi-ces, special populations, or partici-pants engaged in complex-movement strength and conditioningactivities should be provided withgreater supervision (e.g., 1:12 insteadof 1:20; refer to guideline 8). Strengthand Conditioning practitioners andtheir employers should worktogether toward a long-term goalof matching the professional-to-participant ratio in the Strength andConditioning facility to each sport’srespective coach-to-athlete ratio(refer to Appendix 6).

FACILITY AND EQUIPMENT SET-UP, INSPECTION, MAINTENANCE,REPAIR AND SIGNAGE

STANDARD 4.1

Exercise devices, machines, and equip-ment, including free weights, must beassembled, set up, and placed in activ-ity areas in full accordance with man-ufacturer’s instructions, tolerances, andrecommendations and with accompa-nying safety signage, instruction plac-ards, notices, and warnings posted orplaced according to ASTM standardsso as to be noticed by users before use.In the absence of such information,professionals must complete thesetasks in accordance with authoritativeinformation available from othersources.

STANDARD 4.2

Before being put into service, all exer-cise devices, machines, and freeweights must be thoroughly inspectedand tested by Strength and Condition-ing professionals to ensure they areworking and performing properly andas intended by the manufacturer.

STANDARD 4.3

Exercise machines, equipment, andfree weights must be inspected andmaintained at intervals specified bymanufacturers. In the absence of suchspecifications, these items must be reg-ularly inspected and maintained ac-cording to a schedule determined bythe Strength and Conditioning practi-tioner based on their knowledge andexperience.

STANDARD 4.4

Exercise devices, machines, equip-ment, and free weights that are in needof repair, as determined by regularinspection or as reported by users,must be immediately removed fromuse until serviced and repaired and bere-inspected and tested to ensure thatthey are working properly before beingreturned to service. If such devices areinvolved in incidents of injury, legaladvisors or risk managers must be con-sulted for advice before service/repairor destruction.

GUIDELINE 4.1

Strength and Conditioning professio-nals and their employers should ensurethat facilities are appropriate forstrength and conditioning activities.Factors to be reviewed and approvedbefore activity include, but are not lim-ited to, floor surface, lighting, roomtemperature and air exchange (24).

GUIDELINE 4.2

Manufacturer-provided user’s manuals,warranties, and operating guidesshould be preserved and followed(refer to guideline 6).

GUIDELINE 4.3

All equipment, including free weights,should be cleaned and/or disinfectedas recommended by the manufacturerand/or OSHA. Users should be




directed to wipe down skin-contactsurfaces after each use.

EMERGENCY PLANNING ANDRESPONSE

STANDARD 5.1

Strength and Conditioning professio-nals must be trained and certified incurrent guidelines for CPR establishedby AHA/ILCOR (1). Training in uni-versal precautions for preventing dis-ease transmission established by theCDC (51) and OSHA (43) is requiredif personnel are not immediately avail-able to properly respond to exposure toblood or other potentially infectiousmaterials. First Aid training/certifica-tion is also necessary if Sports Medi-cine personnel (e.g., MD or ATC) arenot immediately available duringstrength and conditioning activities.New staff engaged in strength and con-ditioning activities must comply withthis standard within 6 months ofemployment.

STANDARD 5.2

Strength and Conditioning professio-nals must develop a written, venue-specific emergency response plan todeal with incidents such as injuries,lightning strikes, and reasonably fore-seeable untoward events within eachfacility. The plan must be posted atstrategic areas within each facilityand practiced at least quarterly. Theemergency response plan must be ini-tially evaluated (e.g., by facility riskmanagers, legal advisors, medical pro-viders, and/or off-premise emergencyresponse agencies) and modified asnecessary at regular intervals. As partof the plan, a readily accessible andworking telephone must be immedi-ately available to summon on-premiseand/or off-premise emergencyresponse resources.

GUIDELINE 5.1

The components of a written andposted emergency response planshould include access to a physicianand/or emergency medical facilitywhen warranted; communication andtransportation between the venue andthe medical facility; appropriate and

necessary emergency care equipmenton-site that is quickly accessible; anda thorough understanding of the per-sonnel and procedures associated withthe plan by all individuals (refer toAppendix 7).

RECORDS AND RECORD KEEPING

GUIDELINE 6.1

In conjunction with written policiesand procedures, Strength and Condi-tioning professionals should developand maintain various records includingmanufacturer-provided user’s manuals,warranties, and operating guides;equipment selection, purchase, installa-tion, set-up, inspection, cleaning, main-tenance, and repair records; personnelcredentials; professional standards andguidelines; safety policies and proce-dures, including a written emergencyresponse plan (refer to standard 5);training logs, progress entries, and/oractivity instruction/supervision notes;and injury/incident reports, prepartici-pation medical clearance, and return toparticipation clearance documents. Allrecords should be kept as securely aspossible, with limited access by anyonenot on staff. Examples of securing re-cords include locked filing cabinets andpassword-protected computers andcomputer files. In settings where par-ticipants are not otherwise required tosign protective legal documents (e.g.,informed consent, agreement to partic-ipate, waiver; refer to Appendix 8) cov-ering all athletically related activities,the Strength and Conditioning profes-sional should have such legal docu-ments prepared by an appropriateprofessional, for participants underhis/her supervision. These recordsshould be preserved and maintainedfor a period determined by the institu-tion where the facility is housed or pro-fessional legal advice and consultation.

EQUAL OPPORTUNITY ANDACCESS

STANDARD 7.1

Strength and Conditioning professio-nals and their employers must pro-vide facilities, training, programs,services, and related opportunities

in accordance with all laws, regula-tions, and requirements, mandatingequal opportunity, access, and non-discrimination. Such federal, state,and possibly local laws and regula-tions apply to most organizations, in-stitutions, and professionals.Discrimination or unequal treatmentbased on race, color, national origin,religion, sex, gender identity andexpression, political affiliation, age,disability, veteran status, geneticinformation or sexual orientation, orother such legal classifications is gen-erally prohibited.

GUIDELINE 7.1

If a Strength and Conditioning profes-sional witnesses any discriminatory orunequal treatment of individuals whileperforming duties in the scope ofemployment, the illegal conduct mustbe immediately reported to a supervi-sor, compliance department, and/orthe general counsel for the employ-ment entity. To protect the interestsof the Strength and Conditioning pro-fessional, it is also recommended toconsult with a private legal counselwhen the foregoing situation isencountered.

PARTICIPATION IN STRENGTHANDCONDITIONING ACTIVITIES BYCHILDREN

GUIDELINE 8.1

Children younger than 7 years shouldnot be permitted to engage in strengthand conditioning activities with freeweights or exercise devices/machinesin facilities designed for use by adultsand adolescents and should be deniedaccess to such training areas. Otherforms of strength and conditioningactivities may be beneficial for suchchildren, and should be recommendedaccording to the established guidelines(12,32,33), and with a greater degree ofinstruction and supervision than thatsupplied to adolescents and adults.Children participating in such activitiesshould be cleared as specified in theNSCA’s “Standard for Pre-participation Screening and Clearance”(refer to standard 1).





GUIDELINE 8.2

Children between 7 and 14 years ofage who have reached a level of physi-cal, emotional, and intellectual maturityallowing participation in specifiedstrength and conditioning activities, asdetermined and certified by their medi-cal care provider (or by the Strength andConditioning professional acting in con-cert with a child’s medical care provider),and after clearance for participation asspecified in the NSCA’s “Standard forPre-participation Screening and Clear-ance” (refer to standard 1), should beindividually assessed by the Strengthand Conditioning professional in con-junction with the child’s parent(s)/guardian(s)/custodian(s) to determinewhether such children may engage insuch activities in areas containing freeweights and exercise devices/machinesgenerally used by adults and older chil-dren. If so permitted, such activitiesshould be developed and implementedaccording to established guidelines(12,32,33) and with a greater degree ofinstruction and supervision than thatsupplied to adolescents and adults.

GUIDELINE 8.3

Children who are 14 years of age andolder, according to the Strength andConditioning practitioner’s profes-sional judgment, have reached a levelof physical, emotional, and intellectualmaturity, allowing them to engage inspecified Strength and Conditioningactivities (provided they have beengranted parental consent and beencleared for participation as specifiedin the NSCA’s “Standard for Pre-participation Screening and Clear-ance”; refer to standard 1), may engagein such activities in areas containingfree weights and exercise devices/ma-chines generally used by adults andwith a greater degree of instructionand supervision than that supplied toadult populations while training.

SUPPLEMENTS, ERGOGENIC AIDS,AND DRUGS

STANDARD 9.1

Strength and Conditioning professionalsmust not prescribe, recommend, orprovide drugs, controlled substances or

supplements that are illegal, pro-hibited, or harmful to participantsfor any purpose including enhancingathletic performance, conditioning, orphysique. Only those substances thatare lawful (via third-party testing) andhave been scientifically proven to bebeneficial, or at least not harmful, maybe recommended to participants byStrength and Conditioning professio-nals, and only to individuals age 18 orabove and not in an individualizedmanner.

APPENDIX 1. STRENGTH ANDCONDITIONING PRACTITIONERDEFINITION

In 1996, 2004, and again in 2012,the NSCA Certification Commission(changed to Certification Committee in2008) and its examination service con-ducted a Job Analysis study with the pur-pose of surveying the activities,responsibilities, and knowledge require-ments of a Certified Strength and Condi-tioning Specialist (CSCS). The resultswere used to describe the job activitiesof the CSCS in sufficient detail to providea basis for the development of a profes-sional, job-related certification examinationthat will certify strength and conditioningspecialists as competent professionals.An early step in the process was to createa “practitioner” definition. Essentially, thisdefinition is a job description that estab-lishes the legal and professional scope ofpractice of the appropriate activities ofa CSCS (refer to Appendix 2):

Certified Strength and Condi-tioning Specialists are professionalswho apply foundational knowledge ina practical setting to assess, moti-vate, educate, and train athletes forthe primary goal of improving sportperformance. They conduct generalphysical and sport-specific testingsessions, design and implement safeand effective strength training andconditioning programs, and provideguidance for athletes in nutrition andinjury prevention. Recognizing theirarea of expertise is separate and dis-tinct from the medical, dietetic, ath-letic training, and sport coachingfields; Certified Strength and Condi-tioning Specialists consult with andrefer athletes to these professionalswhen appropriate.

The 1996 CSCS Job Analysisstudy evaluated the results of a ques-tionnaire sent to randomly selectedNSCA members who were CSCS-certified as of October 1996. Respond-ents were asked to assign an impor-tance to 112 tasks that a CSCStypically performs on the job. Fromthese data, the NSCA CertificationCommission’s CSCS Job AnalysisCommittee determined the inclusioncriteria of the tasks (5 of the original112 were excluded), the distributionof tasks within each CSCS examinationdomain and its subcategories, as wellas distribution of the examination ques-tion type (i.e., recall, application, andanalysis) within each domain and itssubcategories. The document result-ing from the CSCS Job Analysis studyis the “CSCS Examination ContentOutline,” which forms the basis forthe Certified Strength and Condition-ing Specialist (CSCS) ExaminationContent Description (42), an examina-tion preparation resource availablethrough the NSCA. The 2004 ques-tionnaire was sent to certified individ-uals and the new results were used tochange the format of the examination,with more emphasis placed on thepractical/applied section. In 2012, sur-vey data results were reviewed by theCSCS Job Analysis Committee anddecision rules were established. Theserules were used to determine whichtasks were appropriate for assessmentand inclusion in the final test contentoutline.

CSCS EXAMINATION CONTENTOUTLINE

Adapted from: Certified Strengthand Conditioning Specialist (CSCS)Examination Content Description (42)

Scientific foundations

I. Exercise Sciences (59 questions)A. Apply knowledge of muscle

anatomy and physiology.B. Apply knowledge of neuromus-

cular anatomy and physiology.C. Apply knowledge of basic prin-

ciples of biomechanics regardingexercise selection, execution, andsport performance.




D. Apply knowledge of bone andconnective tissue (tendons andligaments) anatomy andphysiology.

E. Apply knowledge of bioenerget-ics and metabolism.

F. Apply knowledge of neuroendo-crine physiology.

G. Apply knowledge of cardiopulmo-nary anatomy and physiology.

H. Apply knowledge of physiologi-cal adaptations to exercise andtraining.

I. Apply knowledge of the anatom-ical, physiological, and biome-chanical differences of athletes(e.g., age, sex, training status, spe-cific sport or activity).

J. Apply knowledge of psychologi-cal techniques used to enhancethe training and performance.

II. Nutrition (21 questions)A. Apply basic knowledge of nutri-

tional factors affecting healthand performance.

B. Apply basic strategies for manipu-lating food choices and trainingmethods tomaximize performance.

C. Recognize signs, symptoms, andbehaviors associated with eatingdisorders and altered eating habits.

D. Apply basic knowledge of the ef-fects, risks, and alternatives ofcommon performance-enhancingsubstances and methods.

III. New “untried” questions (15 non-scored questions)

Practical/applied

I. Exercise Technique (38 questions)A. Teach and evaluate resistance

training exercise technique.B. Teach and evaluate plyometric

exercise technique.C. Teach and evaluate speed/sprint

technique (e.g., resisted and assis-ted sprinting, speed-strength).

D. Teach and evaluate agility tech-nique (e.g., forward, backward,and lateral movements; turn, tran-sition, acceleration, and decelera-tion maneuvers).

E. Teach and evaluate metabolic con-ditioning/energy systemsdevelopment.

F. Teach and evaluate flexibilityexercise technique.

G. Teach spotting procedures andtechniques.

II. Program Design (39 questions)Based on an athlete’s health sta-

tus, training age, capabilities, and train-ing goals, design training programs thatmaximize performance and minimizeinjury potential by

A. Incorporating various trainingmethods and modes.

B. Selecting exercises.C. Applying the principles of exer-

cise order.D. Determining and assigning exer-

cise intensities (e.g., load, resis-tance, heart rate).

E. Determining and assigning trainingvolumes (defined as sets 3 reps).

F. Determining and assigning work/rest periods, recovery and un-loading, and training.

G. Determining and assigning exer-cise progression (e.g., mode,intensity, duration, frequency).

H. Applying the principles ofperiodization.

I. Designing programs for an injuredathlete during the reconditioning period(e.g., assigning exercises for a giveninjury or condition in collaboration withsport medicine professionals).III. Organization and Administration(13 questions)

A. Determine the design, layout, andorganization of the strength andconditioning facility (e.g., flooring,ceiling height, mirror placement,ventilation, lighting, characteristicsof the equipment) based on ath-letic needs and industry standards.

B. Determine the primary duties andresponsibilities of the members ofthe strength and conditioning staff.

C. Determine the policies and pro-cedures associated with theoperation of the strength andconditioning facility (e.g., facil-ity/equipment cleaning andmaintenance, rules, scheduling,emergency procedures).

D. Create a safe training environ-ment within the strength andconditioning facility.

IV. Testing and Evaluation (20 questions)

A. Select and administer tests tomaximize test reliability andvalidity.

B. Administer test protocols and pro-cedures to ensure reliable datacollection.

C. Evaluate and interpret test results.V. New “untried” questions (15 non-

scored questions)

APPENDIX 2. CERTIFIEDSTRENGTH AND CONDITIONINGSPECIALIST (CSCS) PROGRAM

The CSCS program was initi-ated in 1985 to identify individualswho possess the knowledge and skillsto design and implement safe andeffective strength and conditioningprograms. This certification programencourages a higher level of compe-tence among practitioners, which ulti-mately raises the quality of strengthtraining and conditioning programsfor athletes by those who are CSCS-certified.

A CSCS educates and trainsprimarily athletes in proper strengthtraining and conditioning practices.Strength and Conditioning CSCS pro-fessionals work in a variety of environ-ments, including high school, college,university, and professional institu-tions, sports medicine clinics, health,and fitness clubs, corporate wellnesscenters, and in professional sports.Competencies assessed in the CSCSexamination are determined througha Job Analysis conducted by an inde-pendent professional examination ser-vice based on input from currentStrength and Conditioning professio-nals. Every step in the process leadingto the development of valid certifica-tion examinations meets the stringentguidelines of the National Commissionfor Certifying Agencies (NCCA). Pass/fail rates and reliability statistics arepublished annually.

Writers of the examinations includerenowned practitioners, researchers, edu-cators, and psychometricians. Althoughthere are many certification programsassociated with physical training, theCSCS certification examination programis 1 of only 2 that have been specificallydesigned to assess the competencies ofthose who strength train and conditionathletes.





ACCREDITATION

In 1993 the NSCA CertificationCommission certification programbecame the first fitness-related certifi-cation accredited by the esteemedNCCA*. The rigorous CSCS andNSCA-Certified Personal Trainer(NSCA-CPT) examinations are amongthe most challenging in the industry.

*Note: The NCCA is the accredita-tion body of the Institute for CredentialingExcellence, a nonprofit nongovernmentagency that promotes excellence in com-petency assurance for practitioners in alloccupations and professions. The NCCAmeasures the ability of certifying organi-zations in any industry to accuratelydiscriminate between qualified andunqualified professionals. To earn NCCArecognition, a credentialing body mustdemonstrate an ability to develop andadminister psychometrically sound exami-nations that effectively differentiate quali-fication level through a series of criteria,including:� The certifying organization is respon-sible for all decisions pertaining to cer-tification and recertification (including,but not limited to, examination con-tent, eligibility requirements, grievanceand disciplinary policies, setting fees,programoperation, etc.) without beingsubject to approval by any other body.

� The examination is developed froma Job Analysis study.

� Pass/fail rates and reliability statisticsare a matter of public record.

� Examination development involvesqualified professionals, such as contentexperts and psychometricians withexpertise in examination development.

Accreditation for professional orpersonnel certification programs pro-vides impartial, third-party validationthat the program has met recognizednational and international credentialingindustry standards for development,implementation, and maintenance ofcertification programs.

CSCS EXAMINATION FORMAT

To earn the CSCS credential, can-didates must pass a rigorous examinationthat consists of 2 sections. A candidatemust pass both sections to be CSCS-certified (and may retake any section notpassed). The first section, called “Scientific

Foundations”, consists of 80 scoredmultiple-choice questions in the areas of:� Exercise Sciences (Anatomy, Exer-cise Physiology, Biomechanics,Sport Psychology)

� NutritionThe second section, “Practical/

Applied”, consists of 110 scoredmultiple-choice questions, 30–40 ofwhich contain video and/or images thatassess competencies in exercise techni-ques, functional anatomy, and testingprocedures with the exercises, muscles,and/or joints shown. The areas coveredinclude:� Exercise Technique� Program Design� Organization and Administration� Testing and Evaluation

CONTINUING EDUCATIONPROGRAM

The purpose of having continuingeducation as part of a certification pro-gram is to encourage certificants to stayabreast of evolving knowledge and skillsin the profession, and, in doing so, topromote the ongoing competency ofthose who are certified. The NSCA re-quires each certificant to do the follow-ing to remain certified:� Complete 6 continuing educationunits (CEUs) or a prorated amountof CEUs if certified within the 3-yearreporting period.

� Maintain current CPR certification.� Submit a completed CEU ReportingForm and recertification fee.

� Maintain documentation of activitieslisted on the CEU Reporting Form.

The NSCA is committed to certi-fying individuals who demonstrate theknowledge and skills necessary todesign and implement safe and effectivestrength training and conditioning andpersonal training practices. With thecredibility possessed by the CSCSand NSCA-CPT examinations comesthe responsibility to ensure the integrityof the credentials awarded. This philos-ophy implies that the responsibility of itscertificants is not limited to the well-being of the athletes and/or clients,and the reputation of others in their field;with the overall goal being an improve-ment of health and well-being for all.

The NSCA is dedicated to main-taining a high standard for its membersand certificants. The following Code ofEthics assures that CSCS and NSCA-CPT certificants are aware of the stand-ards of ethical behavior that should befollowed in the practice of theirprofession.Principle 1: Certificants shall respectthe rights, welfare, and dignity of allindividuals.

1.1. Certificants shall not discrimi-nate on the basis of race, color,national origin, religion, sex,gender identity and expression,political affiliation, age, disabil-ity, veteran status, genetic infor-mation or sexual orientation, orother such legal classifications.

1.2. Certificants shall provide com-petent, fair, and equal treatmentto all individuals.

1.3. Certificants shall preserve theconfidentiality of personal andprivileged information of theathlete, client, or the NSCA.

1.4. Certificants shall not release anyinformation to a third party notinvolved with the athlete’s orclient’s care without a writtenrelease unless required by law.

Principle 2: Certificants shall complywith all applicable state, local and fed-eral laws, and NSCA Bylaws, policies,and procedures.

2.1. Certificants shall comply withall institutional guidelines.

2.2. Certificants shall comply withall copyright laws.

2.3. Certificants shall be familiarwith and follow the NSCA By-laws and all applicable policies,procedures, rules, standardsand guidelines.

2.4. Certificants shall not condoneor engage in any illegal orunethical behavior.

Principle 3: Certificants shall maintainand promote high standards.

3.1. Certificants shall not misrepre-sent, either directly or indi-rectly, their skills, training,professional credentials, iden-tity, or services.

3.2. Certificants shall only provideservices they are qualified to




provide through education orexperience and which are al-lowed by practice acts andother pertinent regulations.

3.3. Certificants shall refer athlete orclient to more qualified fitness,medical, or health care profes-sional when appropriate.

3.4. Certificants who are researchersor educators shall maintainand promote ethical conductin research and educationalactivities.

3.5. Certificants should strive to con-tinuously improve knowledge,skills, and techniques to protectthe athlete or client from injury.

Principle 4: Certificants shall not engagein any behavior or form of conduct thatadversely reflects on the NSCA.

4.1. Certificants should conductthemselves personally andprofessionally in a manner thatdoes not compromise theirprofessional responsibility.

4.2. Certificants shall not placefinancial gain above the wel-fare of the NCSA, athlete’s orclient’s and shall not in anyarrangement exploit theNSCA, athlete or client.

4.3. Certificants shall avoid sub-stance abuse and, if necessary,

seek rehabilitation for chemi-cal dependency.

Certificants should also strive to safe-guard the public by reporting viola-tions of this Code of Ethics.

APPENDIX 3. STRENGTH ANDCONDITIONING PERFORMANCETEAM DEVELOPMENT

Teams are preferable to single-leader groups when there is a need forcollective work products (i.e., multipleskills, judgments, and experiences) bymembers working together in real time,shifting leadership roles, and mutual aswell as individual accountability (27,28).By contrast, single-leader/hierarchicalwork groups are appropriate when thesum of independent workers’ contributionsis adequate, singular rather than sharedleadership is effective, task(s) and corre-sponding solution(s) are familiar, workers’skills can be applied productively withoutinteraction (other than sharing information),and speed and efficiency have priority overextra performance results (27,28).

Extraordinarily demanding chal-lenges are the driving forces behindhigh-performance teams. Common fea-tures of such teams include (27,28):� Members are committed to a clear mis-sion, common approach, collaboration,and mutual accountability andresponsibility.

� Expectations and goals are high butachievable, and performance evalua-tion is based on results.

� Roles are interdependent; leadership isshared; abilities, experiences, expertise,knowledge, skills, and talents are com-plementary; contribution, participa-tion, and influence are balanced.

� Effective task performance is facili-tated by encouraging and rewardingcreativity, innovation, and risk taking

in all decision making or problemsolving activities.

The strength and conditioning staffcan be aligned through hiring of practi-tioners with formal education and special-ization in specific scientific foundations(e.g., anatomy, exercise physiology, bio-mechanics, sport psychology) (42). Anassembled team allows for cooperativeexpertise by practitioners with comple-mentary skills and provides an educationalopportunity for staff members to gainknowledge outside their specialization byworking with outside liaisons. The tablebelow provides a practical example ofa strength and conditioning performanceteam. The director of strength and condi-tioning is responsible for delineating theappropriate duties and responsibilities tothe rest of the strength and conditioningstaff for program design, exercise tech-nique, organization and administration,and testing and evaluation (56).

Scientific foundations education/Expertise Practical and applied activities/Responsibilities Liaison assignment(s)

Exercise/sport anatomy; biomechanics Exercise technique; testing and evaluation;rehabilitation and reconditioning

Exercise/sport scientist; teamcoaches; sports medicine team

Exercise/sport physiology Program design; testing and evaluation Exercise/sport scientist; teamcoaches

Exercise/sport nutrition Nutrition Exercise/sport scientist; sportnutritionist/dietitian

Exercise/sport pedagogy Program design; exercise technique;organization and administration

Exercise/sport scientist; teamcoaches; athleticadministration

Exercise/sport psychology; motor learning Exercise technique; rehabilitation andreconditioning

Exercise/scientist; sportsmedicine team; team coaches

Training methodology Program design; organization andadministration

Exercise/sport scientist; teamcoaches; athleticadministration

Kinesiology; physiotherapy; sportsmedicine

Rehabilitation and reconditioning Sports medicine team





APPENDIX 4. STRENGTH ANDCONDITIONING FACILITYSCHEDULING

TABLE D1. CALCULATIONS FORSPACE NEEDS (24)

Note: Many facilities use combina-tion platforms and racks (multi-purposetraining stations) as a way to savespace and allow participants to com-plete several exercises in 1 location.Accordingly, the standing rack andOlympic lifting area calculations aboveshould be combined.

APPENDIX 5. STRENGTH ANDCONDITIONING TRAINING PLANDEVELOPMENT

A detailed discussion of devel-oping a Strength and Conditioningtraining plan is beyond the scope ofthis project. For more specific informa-tion on program design, the Strengthand Conditioning practitioner shouldrefer to Chapters 17–21 of Essentialsof Strength Training and Conditioning,4th edition (15) as well as the NSCAposition statements listed below.

NSCA Position Statements(https://www.nsca.com/nsca-tools-and-resources/); PDF files (Accessed 11/5/2017).Long-Term Athletic Development—2016

Androgen and Human Growth Hor-mone Use—2009Youth Resistance Training—2009

APPENDIX 6. NCAA DIVISION IATHLETE-TO-COACH RATIOS

TABLE F1: NCAA DIVISION IOVERALL CHAMPIONSHIPSPORTS PARTICIPATION (2014–15)AND RESULTING ATHLETE-TO-COACH RATIOS, AS THE ONLYDIVISION WITH LIMITATIONS ONNUMBER OF COACHES (NCAADIVISION I MANUAL, BYLAW 11.7)(40)

TABLE F2: NCAA DIVISION I MEN’SCHAMPIONSHIP SPORTSPARTICIPATION (2014–15) ANDRESULTING ATHLETE-TO-COACHRATIOS, BY SPORT (40)

TABLE F3: NCAA DIVISION IWOMEN’S CHAMPIONSHIPSPORTS PARTICIPATION (2014–15) AND RESULTING ATHLETE-TO-COACH RATIOS, BY SPORT (40)

APPENDIX 7. EMERGENCY CAREAND PLANNING

Source: NCAA Sports MedicineHandbook (44)

EMERGENCY CARE ANDCOVERAGE

Reasonable attention to all possi-ble preventive measures will not elimi-nate sports injuries. Each scheduledpractice or contest of an institution-sponsored intercollegiate athleticsevent, as well as out-of-season practi-ces and skills sessions, should includean emergency plan. Like student-athletewelfare in general, a plan is a sharedresponsibility of the athletics depart-ment; administrators, coaches; andmedical personnel should all play a rolein the establishment of the plan, pro-curement of resources; and understand-ing by all parties. Components of sucha plan should include1. The presence of a person qualified

and delegated to render emergencycare to a stricken participant;

2. The presence or planned access toa physician for prompt medical eval-uation of the situation, whenwarranted;

3. Planned access to early defibrillation;4. Planned access to a medical facility,

including a plan for communicationand transportation between the ath-letics site and the medical facility forprompt medical services, when war-ranted. Access to a working telephone

Area Examples Formula

Prone and supineexercises

Bench press; lyingtriceps extension

Actual weight bench length (6–8 ft) + safety space cushion of 3 ft multiplied bysuggested user space for weight bench width of 7 ft + safety space cushion of 3 ft.Example: If using a 6 ft long weight bench for the bench press exercise (6 ft + 3 ft)3 (7 ft + 3 ft) 5 90 ft (2)

Standingexercises

Biceps curl; uprightrow

Actual bar length (4–7 ft) + double-wide safety space cushion of 6 ft multiplied bysuggested user space for standing exercise width of 4 ft. Example: If using a 4 ftcurl bar for the biceps curl exercise (4 ft + 6 ft) 3 (4 ft) 5 40 ft (2)

Standingexercises ina rack

Back squat; shoulderpress

Actual bar length (5–7 ft) + double-wide safety space cushion of 6 ft multiplied bysuggested user space for standing exercise in a rack width of 8–10 ft. Example: Ifusing a 7 ft. Olympic bar for the back squat exercise (7 ft + 6 ft)3 (10 ft)5 130 ft (2)

Olympic liftingarea

Power clean Lifting platform length (typically 8 ft) + perimeter walkway safety space cushion of 4ft multiplied by lifting platform width (typically 8 ft) + perimeter walkway safetyspace cushion of 4 ft. Example: (8 ft + 4 ft) 3 (8 ft + 4 ft) 5 144 ft (2)

Sport Teams Athletes Average squad size Limit on no. of coaches Athletes per coach

Total (men + women) 6,475 175,952 112

Average (39 sports) 27.2 2.9 9.5




or other telecommunications device,whether fixed or mobile, should beassured;

5. All necessary emergency equipmentshould be at the site or quicklyaccessible. Equipment should be ingood operating condition, and per-sonnel must be trained in advance touse it properly. This equipmentshould include but is not limitedto, an AED, a bag-valve mask,advanced airway tools, a spineboard, and other stabilization sup-plies for the head and neck, splints,and bleeding control materials, suchas a tourniquet and large sterile dress-ings. Sports medicine providers shouldbe trained to use emergency equip-ment before deployment. In addition,emergency information about thestudent-athlete should be available

both on campus and while travelingfor use by medical personnel;

6. An inclement weather policy thatincludes provisions for decisionmaking and evacuation plans (SeeNCAA Guideline 1E);

7. A thorough understanding by all par-ties, including the leadership of visit-ing teams, of the personnel andprocedures associated with the emer-gency care plan;

8. Certification in CPR techniques,first aid, and prevention of diseasetransmission (as outlined by OSHAguidelines) should be required forall athletics personnel associatedwith practices, competitions, skillinstruction, and strength and con-ditioning. New staff engaged inthese activities should complywith these rules within 6 monthsof employment;

9. A member of the institution’s sportsmedicine staff should be empoweredto have the unchallengeable authorityto cancel or modify a workout forhealth and safety (i.e., environmentalchanges), as he or she deemsappropriate;

10. Institutions should ensure that theemergency action plan incorpo-rates roles and responsibilities ofcoaching staff, medical staff, spec-tators, and others during injuryevaluation/response on the field,to ensure appropriate first responseand medical evaluation. The emer-gency action plan should providethat appropriate medical staff haveaccess to the injured athlete with-out interference; and

11. Institutions should have on file andannually update an emergencyaction plan for each athletics venue


Baseball 295 10,396 35.2 3 11.8

Basketball 345 5,432 15.7 4 3.9

Cross country 311 4,845 15.6 2 7.8

Fencing 20 383 19.2 2 9.6

Football 250 27,873 111.5 11 10.1

Golf 297 2,947 9.9 2 5.0

Gymnastics 15 304 20.3 3 6.8

Ice hockey 59 1,638 27.8 3 9.3

Lacrosse 68 3,109 45.7 3 15.2

Rifle 17 131 7.7 2 3.9

Skiing 11 155 14.1 2 7.0

Soccer 200 5,738 28.7 3 9.6

Swimming/diving 134 3,839 28.6 3 9.5

Tennis 258 2,678 10.4 2 5.2

Track (indoor) 257 10,174 39.6 3 13.2

Track (outdoor) 278 11,067 39.8 3 13.3

Volleyball 21 405 19.3 3 6.4

Water polo 22 566 25.7 2 12.9

Wrestling 76 2,520 33.2 3 11.1

Total 2,934 94,200 59

Average (19 sports) 32.1 3.1 10.4





to respond to student-athlete cata-strophic injuries and illnesses, includ-ing but not limited to, concussions,heat illness, spine injury, cardiacarrest respiratory distress (e.g.,asthma), bleeding and sickle-cell traitcollapses. All athletics health careproviders and coaches, includingstrength and conditioning coaches,sport coaches and all athletics per-sonnel conducting activities withstudent-athletes, should review andpractice the plan at least annually.

LIGHTNING SAFETY

Lightning is the most consistentand significant weather hazard thatmay affect intercollegiate athletics.Within the United States, the National

Oceanic and Atmospheric Administra-tion (NOOA) estimates that 40 fatalitiesand about 10 times that many injuriesoccur from lightning strikes every year.NOAA estimates that as many as 62percent of lightning strike fatalities occurduring outdoor organized sport activi-ties. Although the probability of beingstruck by lightning is low, the odds aresignificantly greater when a storm is inthe area and proper safety precautionsare not followed.

Education and prevention are thekeys to lightning safety. Preventionshould begin long before any intercolle-giate athletics event or practice occursby being proactive and having a lightningsafety plan in place. The following stepsare recommended to mitigate the light-ning hazard:

A. Develop a lightning safety plan foreach outdoor venue. At a minimum,the plan should include the following:

1. The use of lightning safety slo-gans to simplify and summarizeessential information and knowl-edge. For example, the followingslogan from the National Light-ning Safety Institute is an effec-tive guide: “If you see it, flee it; ifyou can hear it, clear it.” Thisslogan reflects the fact that onthe first sound of thunder, light-ning is likely within 8 to 10 milesand capable of striking your loca-tion. No punishment or retribu-tion should be applied tosomeone who chooses to evacu-ate if perceiving that his or her


Basketball 343 4,984 14.5 4 3.6

Bowling 34 299 8.8 2 4.4

Cross country 342 6,031 17.6 2 8.8

Fencing 24 397 16.5 2 8.3

Field hockey 77 1,732 22.5 3 7.5

Golf 259 2,170 8.4 2 4.2

Gymnastics 61 1,085 17.8 3 5.9

Ice hockey 35 846 24.2 3 8.4

Lacrosse 106 3,172 29.9 3 10.0

Rifle 24 151 6.3 2 3.2

Rowing 88 5,668 64.4 3 21.5

Skiing 12 175 14.6 2 7.3

Soccer 326 8,963 27.5 3 9.2

Softball 289 6,044 20.9 3 7.0

Swimming/diving 195 5,393 27.7 3 9.2

Tennis 318 2,912 9.2 2 4.6

Track (indoor) 319 12,816 40.2 3 13.4

Track (outdoor) 329 13,075 39.7 3 13.2

Volleyball 328 5,165 15.7 3 5.2

Water polo 32 674 21.1 2 10.5

TOTAL 3,541 81,752 53

Average (20 sports) 23.1 2.7 8.7




life is in danger because of severeweather.

2. Designation of a person tomonitor threatening weatherand to notify the chain of com-mand who can make the deci-sion to remove a team, gamepersonnel, television crews,and spectators from an athlet-ics site or event. That personmust have recognized andunchallengeable authority tosuspend activity.

3. Planned instructions/announce-ments for participants and spec-tators, designation of warningand all clear signals, proper sign-age, and designation of safer pla-ces from the lightning hazard.

4. Daily monitoring of local weatherreports before any practice orevent, and a reliable and accuratesource of information aboutsevere weather that may formduring scheduled intercollegiateathletics events or practices. Ofspecial note should be NationalWeather Service-issued thunder-storm “watches” or “warnings”and the warning signs of develop-ing thunderstorms in the area,such as high winds or darkeningskies. A “watch” means that con-ditions are favorable for severeweather to develop in an area;a “warning” means that severeweather has been reported in anarea and for everyone to take theproper precautions. It should benoted that neither watches norwarnings are issued for lightning.An NOAA weather radio is par-ticularly helpful in providing thisinformation.

5. Identification of, and amechanismfor ensuring access to, the closestsafer buildings, vehicles, and loca-tions to the field or playing area,and an estimate of how long ittakes to evacuate to that locationfor all personnel at the event. Asafer building or location isdefined as:a. Any fully enclosedbuilding normally occupied orfrequently used by people, withplumbing and/or electrical wiring

that acts to electrically ground thestructure. Avoid using the shower,plumbing facilities, and electricalappliances, and stay away fromopen windows and doorwaysduring a thunderstorm.b. In theabsence of a sturdy, frequently in-habited building, any vehicle witha hard metal roof (neither a con-vertible nor a golf cart) with thewindows shut provides a measureof safety. The hard metal frameand roof, not the rubber tires,are what protects occupants bydissipating lightning currentaround the vehicle and notthrough the occupants. It isimportant not to touch the metalframework of the vehicle. Someathletics events rent school busesas safer locations to place aroundopen courses or fields.

B. For large-scale events, continuousmonitoring of the weather shouldoccur from the time pre-event activitiesbegin throughout the event.C. Venue-specific activity-suspension,venue evacuation, and activity-resumption plans:

1. On the first sound of thunder,lightning is likely within 8 to 10miles and capable of strikingyour location. Please note thatthunder may be hard to hear ifthere is an athletics event goingon, particularly in stadia withlarge crowds. Lightning canstrike from blue sky and in theabsence of rain. At least 10 per-cent of lightning occurs whenthere is no rainfall and when bluesky is often visible somewhere inthe sky, especially with summerthunderstorms. Lightning can,and does, strike 10 (or more)miles away from the rain shaft.Be aware of local weather pat-terns and review local weatherforecasts before an outdoor prac-tice or event.

2. Ensure a safe and orderly evacu-ation from the venue with an-nouncements, signage, safetyinformation in programs, and en-trances that can also serve asmass exits. Planning should

account for the time it takes tomove a team and crowd to theirdesignated safer locations. Indi-viduals should not be allowed toenter the outdoor venue andshould be directed to the saferlocation.

3. Avoid using landline telephonesexcept in emergency situations.People have been killed whileusing a landline telephone duringa thunderstorm. Cellular or cord-less phones are safe alternativesto a landline phone, particularly ifthe person and the antenna arelocated within a safer structure orlocation, and if all other precau-tions are followed.

4. To resume athletics activities,lightning safety experts recom-mend waiting 30 minutes afterboth the last sound of thunderand last flash of lightning. A use-ful slogan is “half an hour sincethunder roars, now it’s safe to gooutdoors.” At night, be awarethat lightning can be visible ata much greater distance thanduring the day as clouds arebeing lit from the inside by light-ning. This greater distance maymean that the lightning is nolonger a significant threat. Atnight, use both the sound ofthunder and seeing the lightningchannel itself to decide on re-setting the 30-minute “return-to-play” clock before resumingoutdoor athletics activities.

D. Emergency care protocols: Peoplewho have been struck by lightning donot carry an electrical charge. There-fore, CPR is safe for the responder. Ifpossible, an injured person should bemoved to a safer location before start-ing CPR. Lightning-strike victims whoshow signs of cardiac or respiratoryarrest need prompt emergency help.If you are in a 911 community, callfor help. Prompt, aggressive CPR hasbeen highly effective for the survival ofvictims of lightning strike. Automaticexternal defibrillators are a safe andeffective means of reviving persons incardiac arrest. Planned access to earlydefibrillation should be part of your





emergency plan. However, CPRshould never be delayed while search-ing for an AED.

Note: Weather watchers, real-timeweather forecasts and commercialweather-warning, and lightning monitoringdevices or services are all tools that canbe used to aid in the monitoring, notifica-tion, and decision-making regarding stop-page of play, evacuation, and return to play.

APPENDIX 8. PROTECTIVE LEGALDOCUMENTS

Notes: This appendix provides gen-eral legal information. Protective legaldocuments should not be adopted orused in any context without individualizedlegal advice. The information in this appen-dix has been adapted with permissionfrom an article by JoAnn Eickhoff-Shemek, entitled “Distinguishing Protec-tive Legal Documents”, published in theACSM’s Journal of Health and Fitness (8).

TYPES OF PROTECTIVE LEGALDOCUMENTS

Institutions such as universities/colleges and high schools often requireathletes to read and comprehend, andsign some type of protective legal doc-ument(s) before participation in athleti-cally related activities, includingstrength and conditioning. These docu-ments can help protect the institutionand its employees from potentially costlylegal claims and lawsuits. The law involv-ing protective legal documents is quitecomplex, and understanding their func-tion and the specific legal protectionthey provide is often confusing.

Several types of protective legaldocuments exist. Three that are com-monly used in the health/fitness fieldmay be applicable in Strength and Con-ditioning settings: informed consent,agreement to participate, and waiver.Each provides protection from lawsuitsarising from certain types of injuries thatcan occur while participating in activi-ties, as explained below.

CAUSES OF INJURY ASSOCIATEDWITH PHYSICAL ACTIVITY

There are 3 causes of injury asso-ciated with physical activity: inherentrisks, negligence, and extreme forms ofconduct (10).

Inherent risks

As the term implies, these risksare inherent in the activity. Generally, in-juries caused by inherent risks are acci-dental in nature, not preventable, and noone’s fault. The informed consent andagreement to participate documentsprovide the best legal protection for law-suits arising from such injuries. Althoughactual sections and content of protectivedocuments vary (and depend upon statelaw), the following are generally includedin informed consent and agreement toparticipate documents:

Informed consent.� Purpose of the activity� Risks of the activity*� Benefits of the activity� Confidentiality� Inquiries� Signatures

Agreement to participate.� Nature of the activity� Possible consequences of injury*� Behavioral expectations of theparticipant

� Condition of the participant� Concluding statement� Signatures

*Note: “assumption of risk”language.

A section within each of thesedocuments is devoted to informing theparticipant of the potential risks, includ-ing those inherent in the activity. It isimportant that this section carefully de-scribes these risks (e.g., types of acci-dents that might occur and theconsequences of these accidents),and that the language used is under-standable to the person who will besigning it. This provides an “assumptionof risk” defense, meaning the partici-pant knew and fully understood therisks, appreciated the risks, and volun-tarily assumed them. In general, the lawdoes not allow individuals to recovercompensation for injuries resulting fromassumed risks.

NegligenceInjuries can be caused by negli-

gence, which is a failure to act as a reason-able and prudent professional would actunder the circumstances. Participants can

be injured by negligent acts of theStrength and Conditioning staff (e.g., fail-ure to inspect/maintain exercise equip-ment, failure to provide CPR or First Aidwhen needed). A waiver document, alsocalled a prospective release, provides thebest legal protection for lawsuits arisingfrom injuries caused by negligence. Onceagain, while the actual sections and con-tent of such documents vary dependingon state law, waiver documents generallyinclude exculpatory clause; description ofrisks (“assumption of risk” language);indemnification language (may not bevalid); severability clause; affirmation oflegal capacity; and signatures.

The “exculpatory clause” is a keysection within the waiver explicitly stat-ing that the participant releases theStrength and Conditioning facility forany liability associated with negligenceby the facility or its employees. Thisclause, which must be written very care-fully to be enforceable, provides evi-dence that the participant gave up(waived) his/her right to file a negligencelawsuit against the facility. However, theexculpatory clause does not provide pro-tection from lawsuits arising from injuriesbecause of inherent risks, and an“assumption of risk” section is oftenadded to the waiver for this purpose.

Extreme forms of conduct

Injuries can also be caused byextreme forms of conduct (often calledgross negligence, willful and wanton con-duct, or reckless conduct). For example, ifthe Strength and Conditioning staff hadprevious knowledge of an existing dangeror risk but took no corrective action to helpprevent resulting injuries, this failure to actwould most likely constitute an extremeform of conduct. Generally, no documentscan provide legal protection for grosslynegligent or reckless conduct. A few statesmay allow the use of a waiver to protectfrom such conduct, but most do not (11).

MAKING PROTECTIVE LEGALDOCUMENTS ENFORCEABLE

Protective legal documents,signed by participants before their par-ticipation in strength and conditioningprograms and services, can providea good defense for the Strength andConditioning facility after an injured par-ticipant files a claim or lawsuit. A variety




of factors should be considered forthese forms to be legally enforce-able (8,20):� A lawyer who is knowledgeableabout the law regarding protectivedocuments must review your protec-tive legal documents to help ensurethey are written properly and reflectthe law in your state.

� Informed consent and waiver docu-ments are contracts, and can only besigned by adults because minors can-not enter into a contract. “Agree-ment to participate” documents arenot contracts, and therefore can besigned by adults as well as minors.

� The exculpatory clause used ina waiver is not allowed in aninformed consent or agreement toparticipate. If an exculpatory clauseis added to an agreement to partic-ipate for adults, it then becomesa waiver.

� The exculpatory clause used ina waiver is not enforceable in med-ical or research settings, or in cer-tain states where they are againstpublic policy. In educational set-tings such as a college/university,the general rule is that waivers areagainst public policy for requiredactivities but may be enforceablefor voluntary activities.

� Informed consent documents usedin medical settings must be pro-vided before a patient has any kindof medical procedure. If theinformed consent is not written oradministered properly, the healthcare provider (and medical facility)could be found negligent for notinforming the patient of particularrisks. This also applies in researchsettings because subjects must beproperly informed of risks throughinformed consent (note that thispoint is applicable in Strength andConditioning settings, where ath-letes participate as human subjectsin research studies).

� All documents must be administeredproperly. For example, participantsshould have ample time to readthem and a well-trained employeeshould verbally explain the docu-ment to each participant.

� Protective documents must bestored in a secure place for theamount of time consistent with thestatute of limitations, which may beup to 4 years in some states.

The choice of document or com-bination of documents to use is a veryimportant decision. In situations wherestrength and conditioning activities arenot covered in the employing institu-tion’s legal documentation, Strengthand Conditioning professionals shouldconsult with a qualified lawyer to assistwith these decisions and to review orwrite the documents before implementa-tion. Because legal advice and consulta-tion can be quite expensive, Strengthand Conditioning professionals mayreduce costs by “drafting” their ownlegal documents using information fromapplicable resources (e.g., most univer-sity research protection offices have ex-amples of agreement to participate andwaiver documents, and examples ofinformed consent documents). These re-sources should be shared with your law-yer when he/she reviews the drafts andmakes the final document revisions.

Written protective documentsprovide important evidence when a law-suit occurs. For example, if a Strengthand Conditioning facility is sued for neg-ligence, but has evidence that theinjured party signed a properly writtenand administered waiver, this documentprovides the evidence needed to seeksummary judgment (i.e., a pretrial motionin which the judge can dismiss the casebecause, as a matter of law, there is noissue to be tried in a court of law). In thissituation, the legal document protectsthe facility from a potentially costly neg-ligence lawsuit.

APPENDIX 9. NSCAPROFESSIONAL STANDARDS ANDGUIDELINES TASK FORCECONTRIBUTORS

N. Travis Triplett, PhD, CSCS*D,FNSCA (Chair); Vic Brown, MS, CSCS,RSCC*D, ATC; Scott Caulfield, MA,CSCS*D, RSCC*D; Michael Doscher,MS, MSCC, SCCC, CSCS, RSCC*D;Patrick McHenry, MA, CSCS*D, RSCC;Traci Statler, PhD, CC-AASP, CSCS;Reed Wainwright, JD, CSCS, RSCC*D.

Reviewers: Bob Alejo, CSCS, RSCC*E;Brian Gearity, PhD, CSCS, RSCC,FNSCA, ATC; Jon Jost, CSCS,RSCC*E; Teena Murray, MS, RSCC*D,MSCC; and Mike Nitka, MS, CSCS*D,RSCC*E, FNSCA. 2009 version: N.Travis Triplett, PhD, CSCS*D, FNSCA(Chair); Michael Doscher, MS, CSCS*D,CP; Patrick McHenry, MS, CSCS*D,CP; Mack Rubley, PhD, CSCS*D; andChat Williams, MS, CSCS*D, NSCA-CPT*D. 2001 version: Steven Plisk,MS, CSCS (Chair); Mike Brass, MS,CSCS; JoAnn Eickhoff-Shemek, PhD;Boyd Epley, MEd, CSCS, FNSCA;David Herbert, JD; Joe Owens, MS,CSCS*D; David Pearson, PhD,CSCS*D; and Dan Wathen, MS, ATC,CSCS*D, NSCACPT*D.

This document was reviewed andapproved by the National Strength andConditioning Association Board ofDirectors.

Conflicts of Interest and Source of Funding:The authors report no conflicts of interestand no source of funding.

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