Kids

ECross project is not only a simple gymnastic course to be proposed as alternatives to others activities, but it is a real model of general physical education which aim to improve kid’s health and physical condition.

This is the reason why we believe it is essential:

• To introduce the project to paediatricians by referring to the available materials on the website reserved area
• To introduce the project to schools with free and short projects (e.g. 3 lessons for each class). Even in this case it is important to refer to the available material on the website
• To contact local sport societies to propose personalized lessons over the period in which the sport activity is suspended. For example, youth football society suspends the activities in winter. In this case, we can organize team lessons in which working on multilateral exercises and other exercises for the general athletic preparation (specific preparation is not the best way for kids).
• To organize original birthday parties in which proposing funny exercises that usually are closer to coordination skills, such es e-board, e-line, games, robe climb, jump rope. Then, it is possible to include a healthy snack instead of the typical junk food. It is great opportunity to publicise the program, to make kids try it, and to transmit to parents a clear message about what really is ECross Program.
• To organise thematic lessons for anyone. Halloween, Carnival and Christmas are the best occasion to organise lessons funny and thematic that do not forget the main aim: training kids! It is possible to

organize also inciting and useful parent-son lessons in which there is the possibility to develop both Kids and Adults program

• To organise the Christmas dinner and the end-of-course dinner: parents involved, local close to the gym; dinners has three main benefits:
  • To make kids socialize out of the lesson;
  • To make parents socialize to enforce the group;
  • The trainer can socialize with parents who over the year cannot talking with him;
• To organize outdoor events, such as summer camping, trip to the seaside or mountains, with the aim of make kids trying new sports and enforcing the group.

All these initiatives aim to the method and mark spread. Thanks to teamwork, as well as favouring the spread of your business at local level, these initiatives will help you, in the short and long term, to increase the member’s number attending to your courses.

English has been already recognised as the universal language. Our project has the objective of favouring the diffusion of that language through: English lessons applied to the physical activity, use of correct terminology of human body and exercises, useful games to learn the language. See the specific section and the attachments on our website to always be up to date.

The physical condition pass through a correct nutrition. This is the reason why, ECross program wants to spread the health nutrition culture, taking into account the fact that kids often tend to pay more attention to their trainer than to their parents. We strongly believe that trainer must be informed and must know the nutrition basic principle in order to pass down to young people a positive culture about nutrition.

Even in this case, we recommend you to see the specific section of the website to download updated contents.

As the coordination and conditional skills, even English and nutrition must be inserted in the course planning.

Recognising promptly the gravity of a possible trauma/disease

When a kid attending the gym has a sudden illness or is the victim of an accident, the trainer must keep calm and try to understand what happened, in order to call emergency service, the parents, or to wait parent’s arrival.

Most of all, try to calm and comfort the kid, identify the problem and, if possible, give the first aid, calling the emergency system if necessary or call the parents.

According to the gravity of the accident and of kid’s general condition, ask for help in the gym if there are medical personnel, when needed, procure the A.E.D (automated external defibrillator) or the first aid kit. Furthermore, if you are giving first aid to the injured kid, you have to assure that another trainer or a member of the staff is controlling the rest of the group. Do not leave kids alone!

A B C

General evaluation of kid’s condition. Ask yourself these fundamental questions:

• Is he conscious?
• Is he breathing?
• Verify circulation evidence (movements, breath, cough)

How to evaluate consciousness: if the kid seems fainted or dormant, kneel down near his head and call out loud his name in both ears, pinch the trapezium with the two longer fingers; the trapezium is the muscle between the shoulder and the neck.

So, If the kid is conscious, he should open his eyes, follow objects with the gaze, talk; instead, if he does not answer he is unconscious. In this case, call immediately the emergency number, check if there are efficient respiratory acts and circulation signs. Then, put the kid on his back on a rigid plan and with limbs aligned.

Discover kid’s thorax and count for 10 effective seconds while observing is there are circulation signs such as movements, cough or breath. If there are not circulation signs and you are able to do it, start to implement the AED; instead, if there are circulation signs, control again the consciousness calling and

pinching the trapezium; if in the meantime, the consciousness has appeared, stay with the kid, ask him how he feels and help him to assume a comfortable position if he did not suffer a severe trauma. On the contrary, if the kid is still unconscious and did not suffer severe trauma, keep the air tract free so that the tongue does not obstruct the air flow. Put a hand on kid’s front and the other hand under the chin, slightly flex his head backward until the jaw remains perpendicular to the rigid plan. In this position, wait the rescue and check every minute the presence or absence of circulation signs.

Efficient call to the emergency number

When necessary, call the emergency number or type the same number through “FlagMii”, a free app usable for now only in Piedmont and Aosta Valley regions. (Italy)

The application, once installed on the phone and activated, allows you to easier communicate with emergency services, allows the localization of the phone from which you are calling and so, rescues are facilitated, especially if you are in unknown places or you do not know a precise address.

Once chosen the method through which call the rescues, you have to know how to communicate with emergences and what to say.

• Type the emergency number
• Introduce yourself (name, surname of the one who is calling, eventual profession or relationship)
• Explain what happened (indicate what type of aid are requested, dynamic and gravity of the accident) and who is the injured (name surname age)
• Provide information about the actions before the call and about a precise address or reference points
• Do not close the call (wait that the operator guides you or says you to end the call)
• Maintain the phone on and usable 
• Id you are in an isolated or hard to reach area, send someone on the street to wait rescues.

Example.

“Hello I am Marco Rossi, a trainer at “Tribu in movimento” gym, in Tarantasca. I am calling for a medical emergency: a kid, who attend the gym, fell down the stairs, and now is complaining about a pain at the right leg, he cannot move it. He did not hit his head, is conscious, does not bleed. I immobilised the limb and applied ice. The kid is Luca Verdi and is 5. I need an ambulance. The gym is “tribu in movimento”, in Tarantasca, along the strada statale Laghi d’avigliana n° 100, in the big shed on right, at the end of San Chiaffredo, in direction to Cuneo. In the same shed there is also the pub “Munchen”. I have already sent an associate of mine on the street to help the ambulance to find us”

It is very important to inform the parents about what happened. Kids are minors and parents take the decisions on their health. If the situation is bad, it is better to call the emergences and then the parents; on

the contrary, if the situation is not so bad, it is better to call the parents and then decide with them what to do.

psychological aid

The psychological support that we must provide to the injured should not be underestimated. You have too stay near the kid, provide him attentions, entertainment and pain containment. The psychological aid can be made by everyone, even by another kid or trainer.

It is a matter of dialogue with the injured kid; you have to ask him how he feels, where he has pain, what happened, if an analogue episode had happened before, if he had been sick in those days, if he takes medicines and which (maybe write the names); furthermore, you have to reassure him about the prompt arrive of rescues or parents and entertain him with some stories.

Most frequent problems

Traumatic brain injury

It can be more or less bad depending on: trauma entity, dynamic, place where it happened, height of the fall, kid’s age, if he vomited more than once, unconsciousness, seizures, anisocoric pupils, otorrhea, bad headache, balance loss and disorders, irritability, unjustified somnolence.

Most of all, you have to understand the trauma entity and dynamic: evaluate the consciousness. If the kid is conscious but the trauma is important or there are signs of major head trauma, it is better to call emergences. In the meantime, try to immobilise his head and eventually cover him.

If the trauma is minor, and the kid is conscious, there are no signs about head trauma, the dynamic is not important, you can evaluate if call the parents, apply ice on eventual tumefaction, put the in a comfortable position and make him rest. You have to observe him, and in case of head trauma signs, call the emergency.

If the trauma involved the spine (e.g. fall from the stairs, fall from more than 1 metres height etc), it is important to explain to the operator of the emergency number what happened, and to wait he says you what to do; in any case, do not move the kid and immobilise the head.

Sprain

It is the solicitation of a joint over the normal limit which provokes an excessive stretch and a consequent partial or total damage of capsule, ligaments, tendons, interarticular menisci.  Very often it appears after trauma in the sport practice: this trauma can be represented by a collision with an adversary or by a failure of the articulation due to a rough terrain or an inadequate athletic preparation or equipment.

The typical localizations of this type of injury are knees and ankles; then, wrist, elbow and fingers.
solicitations to joints can be also due to accidental falls or various accidents. The hit joint generally appears swollen, painful, hot and in more serious cases also with a haemorrhage. The patient complains pains and in case of inferior limb sprain, he cannot deambulate.

What to do in case of sprain. The prevention is essential. The joint stability depends on the capsular ligamentous structures and on the muscle: the latter is the essential sustain of a joint and it has to be efficient. We recommend to avoid muscle fatigue and this is possible by learning their limits.

In sport, equipment and playground are very important. Tools must be appropriate and high-quality. Articulations which already suffered a sprain are subject to relapse and so they need to be protected. In sport practise, it is possible to use the “taping”, an elastic compression bandage that allow movements but partially limits their realization

It is recommended the immediate therapeutic measure called R.I.C.E (rest, ice, compression, elevation):

• Put the articulation at rest and do not load it
• Appling ice immediately and in the following days, 30 minutes every 2/3 hours
• Compressing the articulation with a rigid bandage
• Lifting the limb to reduce the oedema

Dislocation

It is an anatomic alteration which determines the loss of contact between the joint heads of an articulation. It can be complete, when the loss is total, or incomplete, when there is a partial contact. According to the nature we talk about congenital (present from birth), pathological (after a disease, such as the arthritis) or traumatic dislocation. The latter appears after a trauma that provokes the shift of bone heads. The most frequent interest shoulder, knee and kneecap, hip and elbow.

The causes of the luxation can be found in a traumatic event, which is often characterized by a certain gravity, because joint ligaments are robust and it is necessary a significant impact to make the loss of articular relationship happens. Sometimes, it is accompanied by lacerations and stretches. Occasionally, even nervous and vascular structure may be damaged. Many traumatic dislocations occur because of the practise of some dangerous sport such as, football, basketball, skiing, rugby or other sports requiring a big physical commitment.

Dislocation symptoms, especially in traumatic cases, are represented by a sudden pain, which become acute over palp, a swollen with abrasions and ecchymosis, joint numbness, deformation, and impossibility to do adequate movements.

It often occurs that the deformation is visible, palpable, and the numbness interests the anatomic area below. Treatments for dislocation consist of preparing first actions which involves holding up and immobilizing the joint; it is necessary to provide a rigid bandage and to apply compresses.

Fracture

It is an interruption in bone continuity. It can be caused, in paediatric age, by a trauma which surpasses the resistance strength of a healthy bone. The fracture originates swollen and acute pain.

Knowing the risk factors that can bring to a fracture means to reduce their incidence. Vertebral fractures are often spontaneous or due to the effort in lifting a weight. Fractures of femur, humerus and wrist are due to a fall. Risk factors can be distinguished in:

• Environmental: slippery or wet floor, carpet with raised edges or non-adherent to the floor, too high mobiles that implies the need to use a chair, stairs without handrail, simple fall, road accidents. It is recommended to use soft shoes with slip-resistant sole.
• Symptoms: swollen, acute pain, pain that occurs even after many hours from trauma and increases over time; the affected part, especially if it away from the heart (such as, a finger), seems bluish at the tip; pain at the slightest pressure and movement

In case of suspected fracture, control kid’s general conditions; if he is in state of shock, does not move, has difficulty in breathing, his limb appears deformed or lacerated, alert immediately the emergency, wash the wound with water or sodium chloride solution, immobilize the limb, apply ice and cover the kid.

Types of fractures:

• Compound: two or more bone fragments remains in the anatomic position at the level of the interruption
• Non-compound: when stumps or fragments are shifted from their anatomic position (usually, a bone deformation is visible)
• Exposed: when the cute has been lacerated and the fracture is exposed at the air, with infections risks.

Ocular trauma

This injury mainly affects males between 20 and 40-year-old. Naturally, there is a risk for kids under 14 over the game activity. The majority of ocular trauma occurs outside (workplace, sport practise, gardening, etc; instead, potentially most dangerous the place for females is the home environment.

According to the entity of the trauma and to the affected parts of the eyeball, consequences can be really bad. It is essential to assure that kids do not come into contact with springs and sharpened games or

equipment that are not adapt to their age, and whose incorrect use could bring to possible risks.
In the practise of sport in which there are actions of contacts with other players (e.g. karate) or objects (e.g. balls, tennis).

In case of eye trauma, especially when violent, or in case of suspected corneal trauma (abrasions or scratches), if the kid is conscious, breaths and has normal circulation signs, you can advise his parents or bring him to the hospital. If eyes have been in contact with toxic substances, it is necessary to immediately wash the part with abundant fresh water and rinse well in order to remove eventual remaining of the substance. If, after any ocular trauma, even in absence of visible important injuries, you notice a qualitative or quantitative alteration of vision, it is better not to underestimate the problem. Kids need more attentions: especially with younger children, we have to control that they do not have access to blunt objects (scissors, knives etc). the supervision of an adult is always essential. Furthermore, it is necessary to assure that caustic products (soda and similar) are not accessible to kids.

Very often kids are not able to describe their disorder precisely, or, if they are scared, they continue to complain even when there is not a real problem. In case of ocular trauma, it is important to establish the violence of impact. i.e. an ocular trauma that does not cause problems occurs if the impact with the edge has been mild, without a corneal involvement, there is only a mild swelling or redness of the periocular region, the vision is normal and the pain is limited. On the contrary, it is better to go to the hospital when the impact has been violet, the pain is acute (possible headache) and he vision is blurred. It is better to go to the hospital even when eyes are been in contact with chemical substances.

Attentions is needed in highlighting the eventual presence of a foreign body in the eyes, whatever is its dimension. If there is a splinter and the pain is acute, we have to cover both eyes with wet handkerchiefs and to advise parents. Instead, if there is a big object stuck in the eyes, we must immobilize the affected eye, bandage also the other eye and call the emergency. We must not extract the object.

Dental trauma

Dentoalveolar injuries are very frequent: 3 subjects every 10 suffer an oral trauma, and at least one in one case, the cause is a sport activity. The preadolescence age (8-12 -year-old) is the most exposed to this risk and there are the aggravating circumstances that there may be difficult results, there is low possibility of restitutio ad integrum and the social restoration costs are very high. Literature reveals that, in paediatric age, oral facial trauma interests the 15/30% of kids and, with caries, represents the most common cause of recourse to dental treatment. Even if the oral region represents the 1% of the body, it has been shown that the 5% of all accidents affect it; instead, in kids which has been already traumatized in preschool age, the oral region is involved in 17% of cases.

Types: Avulsion (the tooth leak the cavity), dislocation (tooth transfer respect to its natural position), the movement can be: inward (intrusion), outward (extrusion), toward the side (lateral); milk teeth trauma.

In case of avulsion the tooth must not be cleaned but preserved in saliva, milk or sodium chloride solution. You have to advise parents.

In case of important oral trauma, you should wash the mouth with water, make kids spit the blood, apply ide and call parents.

Exercise-induced asthma

It corresponds to a form of bronchial asthma which presents itself through asthmatic crisis that are characterised by cough, respiratory whistle, respiratory difficulties and tightness of chest. Generally, it appears at the end of effort or physical exercises which involves an important increase of lung ventilation (increase of frequency and breath largeness), which last at least some minutes (at least 7/8 minutes)

The responsible of asthmatic symptoms is the bronchospasm, that is a condition characterised by bronchial walls muscle contraction that, by reducing calibre of them, creates all the symptoms through a real obstruction of the air flow. This condition, which tends to solve spontaneously during a variable period from 30 minutes to 2 hours, occurs in subjects who present a nonspecific bronchial hyperreactivity and not only in subjects that already have asthma (40/90% of subjects); it occurs also in other subjects, who are not affected by bronchial asthma, but present a genetic predisposition to allergies which is called atopy, or who are atopic people’s sons. 

In these patients, asthma attacks tend to appear exclusively over the physical activity. The current hypothesis is that, at the basis of Exercise-induced asthma attack, there is the rapid cooling of the airways due to the increased bronchial ventilation over the workout and to the related evaporation. This is the reason why, running seems to be the main responsible for this type of asthma attack: running represent the optimal prototype of a situation in which the described above cooling and the relative events occur. Instead, the asthma is not cause by other sports, such as cycling and athletics, because of their lower speed in brachial cooling.

What should we do when a kid suffers from exercise-induced asthma? Interrupt the physical activity, put the kid seated and help him to breath normally. If the kid has the inhaling medicine, you can give it to the kid and advise parents. If the asthma attack is protracted and do not answer to the inhaling medicine, the skin colour appears cyanotic or pale, or his condition worsen, it is better to call the emergency number. The psychological aid is always important, even in this phase.

Foreign body inhalation

It corresponds to the situation by which a body is ingested (food or objects accidentally put in mouth) but it does not go down through the digestive tract, but it obstructs the airways and make the air flow really difficult. Possible consequences of the obstruction (partial or total) vary according to the foreign body dimension and the point in which he has stopped.

In case of partial obstruction, the body actives the self-defence mechanisms of cough, through which it tries to expel the foreign body. Coughing alternate to the difficulty respiration. The victim is alert.
In case of total obstruction, the victim cannot breathe, does not cough and tend to become cyanotic.

In the first case, the victim must keep calm and be encouraged to cough, so that the situation can be solved easily. In the second case, it is important to intervene promptly.

First of all, you must call the emergency number and while they arrive, you must apply the Heimlich manoeuvre: it is a manoeuvre that everyone should be able to do because it can save lives. It cannot be applied to infants under 1-year-old. It is important to observe with attention and to apply the indications of the health operators. Patting on the back in case of foreign body inhalation does not solve the situation, and, on the contrary, risks to make it worse.

Even attempts to extract the body with the fingers, unless it is fully visible and easy to catch, may worsen the situation because the risk is that of pushing the body even more down. It is important to recognise this situation and intervene promptly because the total obstruction may have serious consequences, even lethal given that it causes suffocation.  If the obstruction is partial and the subject cough and breathe, the trainer can encourage him to cough and to keep cam. The situation should disappear by itself; if it persists or becomes complete, it is important to call the emergency service and to start with the Heimlich manoeuvre.

How to intervene on adults and kids (from 1-year-old). The Heimlich manoeuvre is not a difficult procedure but it is important to do it precisely to avoid further risks. Positioning behind the victim; hug him by bringing your hands and his belly; close your hands in punch, put one hand between the belly button and the thorax, and the other under the first. Push forcefully the punch on the indicated zone, by directing the movement in depth and upward. Continue until the victim breathe again.

Syncope

This term is used in medicine to describe a temporary loss of consciousness due to a sudden decrease of the blood flow directed to the brain. It is also known as faint or loss of consciousness. When you are going to faint, you feel your head spinning and you have dizziness, nausea and suddenly the view become black and white. Skin can become cold and moist and, if there is no one to support you, you fall to the floor. After the syncope you can remain unconsciousness for one or two minutes; then, you recover and slowly return to normality. It may occur also in perfectly heath patients. There are several types of syncope:

• Vasovagal syncope: its trigger event is well-identifiable: emotional stress, trauma, pathology, sight of blood, staying for long time in standing position.
• Carotid sinus syncope: it is caused by a constriction of the carotid artery and it may occur when you turn your hand to one side, when you shave or when you wear a collar;

• Situational syncope occurs when urinating, defecating or coughing; it also occurs as a result of a gastrointestinal stimulation

The syncope can be also the symptoms of a cardiac pathology or anomalies which makes the heart rate irregular or temporary alternate the blood volume and its distribution in the body. From a general point of view the syncope is cause by a temporary reduction of blood flow to the brain and this may occur for several different reasons, and so, it is not always possible to individuate the right cause. The trigging event can be: something really unpleasant (sight of blood), intense heat, sudden pain, cough, sneezes, laughs, change of position (e.g. stand up quickly, it is the cause of postural tachycardia syndrome)

When coughing, urinating or making efforts, the blood flow directed to the brain can be altered and so, the syncope takes place. If the syncope is caused by turning your hand to one side, maybe the reason is that neck bones pinch one blood vessel directed to the brain. You can also faint because of the suddenly decrease of the glycaemia (e.g. for who suffers from diabetes or who is fasting for too long). The worst and worrying faints are the ones due to convulsions, cardiac disorders or problems of blood vessels directed to the brain.

Even the presence of heart disease can cause an interruption of the blood flow to brain (cardiac syncope). The risk increases with: age (with age, the possibilities of syncope increase), coronary disease, chest pain (angina), previous heart attack, ventricular disfunction, cardiomyopathy, abnormal electrocardiogram (test by which you can verify the presence of anomalies in heart rate), repeated and sudden syncope 

If the child quickly return to normality, is alert and remember what happened, you need to call his parents. Instead, if the child has a slow recovery, does not remember what happened, got his head hurt while falling, appears confused and disoriented, it is necessary to call the emergency service. While waiting rescues, if the child has not trauma, he can lie down and lift the legs, and then, he can assume a comfortable position, drink a bit of water and sugar and suspend the physical activity.

Thorax pain

According to the place in which the pain originates, the thorax pain can be:

• Cardiac: arrhythmia, acquired cardiac pathologies (pericarditis, vasculitis, cardiomyopathy), congenital cardiac pathologies, especially after a surgery.
• Respiratory: infection, pleural pathologies, asthma, foreign body inhalation, pneumothorax or pneumomediastinum, inhalation irritations, dysfunctional breath, such as hyperventilation, thorax neoplasia
• Gastrointestinal: gastroesophageal reflux, oesophagitis, gastritis, oesophageal spasms, achalasia, oesophageal foreign body, pancreatitis, diaphragmatic hernia ascites

• Muscular skeletal: painful syndromes of ribs and articulation (Tietze syndrome, costochondritis, trauma, slipping rib syndrome); of the sternum; of thoracic and intercostal; of the spine (trauma, cancer, infections etc.)
• Psychogenic: dysfunctional breath
• Miscellaneous: pain due to mammary development. From herpes zoster. “Precordial catch”: well-localized and short pain that affects kids especially between 6 and 12-year-old, and derives from the parietal pleura or from a muscle spasm; usually, it does not radiate and worsen with deep inspiration. Stitch, it is a pain localized in the inferior part of the thorax, or on the side, when you do a physical exercise after a meal or fluid intake.

The cardiac thorax pain has frequent particular characteristics that makes it recognizable:

• It often appears under effort
• It does not spread but is affected by the position
• It is related to diaphoresis, nausea, dyspnoea and syncope
• Palpitations /tachyarrhythmia rapidly arise

Fortunately, the myocardial infarction is uncommon in paediatric age. You should interrupt the physical exercise, put the kid in the most comfortable position, calm the kid and help him to breathe regularly. If the kid has a known cardiac pathology, if the pain continues, or even if the general conditions get worst, you must call the rescues; otherwise, contact parents.  

Haemorrhages

Haemorrhages consist of the sudden and intense loss of blood. If the quantity of escaped blood surpasses the litre, there can be a state of shock (serious emergency). Symptoms depends on the place of the haemorrhage; usually we have accelerated heart rate, thirst, nausea, vomit, vertigo, blurred vision, cold and clammy skin.

First, you have to tampon the wound with sterile material, and to compress. Then, we have to maintain the affected zone up and put the wounded supine. After first aid actions, the wounded must be transferred to the nearest hospital. Nosebleed, loss of blood from the nose, depends on several causes: vasodilatation, high pressure, trauma; in kids another cause can be swollen and tortuous vessels (because they are not perfectly formed). In this case you should apply on the nose an ice bag or a wet cloth and compress naris with decision for at least 10 minutes. Wounded’s head must be flexed forward to avoid the blood swallowing. Then, it is recommended to apply normal cotton wool into the naris.

A haemorrhage is a blood leak from vessels. We can distinguish internal haemorrhage and external haemorrhage: the first occurs when the blood spill inward, while the second when the blood spill outward. Furthermore, there are venous, arterial and capillary haemorrhages according to the interested vessels.
Venous haemorrhages are recognizable because of the blood dark colour and of the slow, continue and

uniform blood leak. Arterial haemorrhages are characterized by a bright red and a splashing leak (in synchrony with the heart rate).

Capillary haemorrhages interest the subcutaneous and superficial vessels: in this case the reddish blood leak in drops all around the wound. If there is not a laceration of the skin a hematoma appears (blood collected under the skin) while on the skin you can see an ecchymosis (initially, it is a red stain but with time it becomes violet, yellowish and then disappears).  Venous haemorrhages, after being disinfected, can be contained by putting a sterile gauze or a clean handkerchief on the wound and by tamponing. Even a bandage can be useful, but it must not be too strict in order to allow the circulation.

Even in this case, if the affected part is a limb, you can lift it up to reduce the blood flow. In case of arterial haemorrhages, it is necessary to intervene promptly because usually, the escaped blood quantity is very high compared to venous haemorrhages. If the haemorrhage is not abundant, after disinfecting the area, you can simply tampon it with a sterile gauze or a clean handkerchief. Instead, if the haemorrhage affects big vessels, it is necessary to compress on it in order to reduce the leak. The tourniquet must be used only in the most serious cases.

In case of external haemorrhage, you should lie down the wounded and lift up the blooding zone (unless there is a suspected fracture); if the wound is big you have to join the its margins by pressing with the fingertips for about 10 minutes; then you have to press on the wound with a tampon or a gauze, and stop it with a well-adherent bandage.

Internal haemorrhages are less evident than external ones because blood coming out from the vessels pours inside the body. So, the haemorrhage is not visible and symptoms are: pallor, cold and violet extremities, anxiety, rapid but weak heart rate (sometimes it is quite imperceptible), rapid ad superficial respiration, blurred view, violent thirst, tinnitus in the ears. First, you must call the emergency number and give to health operator detailed information. So, put the wounded in anti-shock position (lied down with legs up to favours the blood flow to brain) and cover him with a blanket until the rescue arrival. It is important to provide psychological support all the time.

Nose haemorrhage

The epistaxis, or nose haemorrhage, is the blood loss from the nose after the breakage of one blood vessel of the nasal septum. It can be spontaneous, without a precise cause, or can be caused by several factors, often banal, such as excessive sun exposure or little trauma.

However, epistaxis is not worrying and can appear at any age and in any situation. First, you should sit the wounded down with the back upright; the head must be flexed forward to avoid the blood swallowing. He has to press his naris with fingers.

It is also recommended to slacken eventual strict clothes. Haemorrhage can be controlled by compressing the naris from which the blood comes out for about 5/10 minutes; the head must always be flexed forward. If this does not work, you can try block the blood by inserting small tampons in the naris. It is important to spit the blood and not to swallow it.

If the epistaxis stops, you should advise parents; otherwise, if kid’s general condition worsen, you should call emergency service.

Abdominal pain

This pain arises suddenly, within a few hours. Characteristics to be detected are intensity level and place.

Intensity:

• Modest pain
• Intense pain
• Continue or intermittent pain

Place:

• Entire abdomen
• Around the bellybutton
• Around the right iliac fossa (right side down)
• Around the left iliac fossa (left side down)
• Around the suprapubic region (in the middle and down)

Painful menstrual cycle, also called dysmenorrhea, is characterized by abdominal pain, backache, headache, nausea, diarrhoea. Menstrual pains are related to both physical and mental factors, such as stress and anxiety.

So, we should remember that for our girls do not know how to face those menstrual and new pains. However, the majority of women suffers from pains localized in the inferior part of the abdomen and in the pelvic area (in correspondence to the pelvis, under the abdomen). Abdominal and pelvic pains are due to a series of cramps determined by the uterine and ovarian activity; in fact, over menstruation, the muscles of this region contract to expel cells of the uterine mucosa in flaking phase.

If the pain is very high, you should stop the physical activity and make the kid assume his favourite position. It is important not to give food or beverage to the kid; if the pain get worst, you must call the emergency number. Otherwise, it is sufficient to call the parents.

Pneumothorax

Pneumothorax is the consequence to the air accumulation in the pleural cavity, i.e. inside the outer membrane of the lung. The lung collapses and it cannot expand because of the air or undesirable gas. The trapped air can come from the outside or from the lung. The pneumothorax can be unilateral or bilateral. The spontaneous pneumothorax, or pneumothorax due to open trauma, occurs when there is rib cage injury which creates a continue air exchange between the pleural space and the outside. The closed pneumothorax occurs when air enters the pleural cavity but there is not air exchange outside.

The causes can be violent trauma such as a gunshot, an accident, a contusion which provokes ribs facture, etc. Symptoms depends on the trapped air quantity out of the lung; they can be:

• Thorax pain: serious pain which provokes a sensation similar to a stab
• Respiratory problems: breathlessness,
• the skin become bluish because of the oxygen lack
• low blood pressure
• stress, anxiety, cough, tiredness, air hunger.

If the kid has one of these symptoms, you should advise the emergency and parents, make the kid assume the seated or standing position, untie eventual strict clothes, help the kid to breathe regularly and provide him psychological support.

Seizures

They are also called “little evil”. This is a nervous system disorders in which seizures are due to temporary communication problems among neurons. It is a form of epilepsy which consists of short and generalised seizures, in kids from 3 to 12-year-old. It is characterized by moments of unconsciousness and motor arrest. The kid present eyes wide open, rarely with eyes rolling and may realize gesture or say meaningless phases. After the episode it is possible that he does not remember anything. There are two types of seizures: the first is the generalized seizure while the second is the partial seizure which affects only a part of the brain. Obviously, they worry very much parents whose task is keeping sake their son, by protecting his head and positioning him laterally.  The little evil seizures last from 5 to 15 seconds, after which the kid does not remember the accident; often, they repeat several times every day. There are also the febrile seizures: they are accompanied by fever, eye rolling, pallor, cyanosis and foaming at the mouth.

In case of seizures, you should hold kid’s head, turn the kid on one side, so that if he vomits, there is no risk of inhaling it and obstructing the air flow. You must advise the emergency and parents.

Seizures always make people worry and so, It is necessary to keep calm. 

TO SUM UP:

• In case of illness or trauma, the trainer must be aware of the gravity by conducting the evaluation ABC. Control of consciousness, breath and circulation signs
• the emergency call must be clear and precise; the trainer must provide all the necessary information for a promptly rescue.
• The psychological support is very important, especially with children. It is essential to stay with the kid to provide safety, attention and pain containment.

PARAMORFISMS

Paramorphisms are the object of the corrective gymnastics and represents posture flaws and attitudes which have been vitiated by muscle hypotonia and joint rigidity. So, they differ from dysmorphisms which are caused by bone alterations. 

A paramorphism is reversible thanks to a proper gymnastic which tends to restore the disturbed muscle balance which alters the normal form of muscle groups. Often, this type of alteration is not visible, such as many cases of muscle-joint rigidity that impedes a functional movement extent; other times, the form is altered only in determined situations, such as, for example, the flat feet under load due to a ligamentous laxity reversible with an appropriate gymnastics.

It is important to distinguish paramorphisms and dysmorphisms: the latter type represent a true irreversible situation and given that the causes are multiple (genetic, viral, traumatic, etc), they need a real medical or surgical therapy. So, it is fundamental a correct differential diagnosis through which establish the nature of alterations. This diagnosis must be done by a specialist. A dysmorphism in its early stages can appear as a paramorphisms, but it cannot be prevented by gymnastics.

In order to stabilise a paramorphism, it must be adequately treated until the subject is able to assume a normal position and to maintain it without efforts.

The procedure passes through three common points to all corrective treatments:

•  awareness
• Unlocking through mobility exercises and stretching
• muscle tone building

the main paramorphisms are:

relaxed posture or asthenic habit: it is the relaxed posture that the body assume when he opposes wrongly to the gravity action: lop-shouldered, spinal kyphosis and muscle hypotonia. This posture is favoured by psychological disorders such as an excessive timidity, feeling of inferiority, lack of confidence also due to physiological disorders such as food shortages, frequent diseases or respiratory insufficiency. What is important is to define the causes because, once removed them, this paramorphism can be easily and definitively solved.

Winged scapulae: they are determined by scapulae lack of contact to the dorsal plan. It is a paramorphism if their position stabilises through arm abduction, and it is possible to usefully intervene with corrective gymnastics only in this case. Scapula may appear protruding also due to rib cage structural anomalies. In this case, it is not sufficient to tone fixator muscles, but it is necessary to act on the primary cause.

Glenohumeral rigidity: when it is bilateral, it depends on a low articular activity, with a consequent shorten of the shoulder anterior muscle, and a reduction of capsule joint functionalities. When a subject is in prone position, with arms extended up and hands together, if it is a paramorphisms, he should be able to maintain the arms lifted up from the floor for a few seconds. On the contrary, it is a dysmorphism. It is recommended to consult a specialist to avoid dysmorphism suspicion. Consequences on the structure of the spine are understandable; by failing to lift the arms up, the glenohumeral joint heart will move to the lumbar zone by accentuating the lordotic curvature.

Flat feet. This paramorphism arises from 3-year-old and can be easily solved from the age of 7. If this does not occur, it is a dysmorphism due to an excessive load which has deepened the situation, to knee or ankle valgus. The principal cause is the ligamentous laxity which is resolvable through an appropriate sequence of frequent and protracted exercises which aim to strengthen ligaments. Walking barefoot possibly on the sand, articular exercises and awareness are the principal solution. So, it is necessary to wear rigid shoes that block the articulation and inhibit the sural triceps action.

Paramorphic pelvis unbalance: the pelvis, by laying on the femoral heads which are articulated in the acetabular cavities, assumes a balanced position that is determined by the action of several muscles: iliopsoas, tensor fasciae latae muscle, gluteus, abdominal muscle, etc.
Unless there are pathological processes at the expense of bones and joints, the pelvis balance can be modified by acting on one of this muscles. However, everything would appear vain without an appropriate unblocking, a correct sensibilization and the awareness of the pelvis position and of its movements. This awareness difficulty is demonstrated by the difficulty to learn the neutral position to assume in lifting any one object, even with a modest weight, off the ground.

 Curved back: this paramorphism can be corrected through an appropriate gymnastics only when the dorsal hyperkyphosis disappear by intentionally assuming determined forced attitudes. It can be cause by timidity, lack of self-confidence, inability to establish himself, dorsal muscle hypotonia or respiratory insufficiency. The awareness is really important and it can be reached through the help of mirrors, the joint unblocking which aim to localize movements, the dorsal and abdominal muscle tone building, a regular respiratory gymnastics, and the practise of sport and team games to improve interpersonal skills.

Lumbar hyperlordosis: it is paramorphic if the excessive lumbar curvature disappear by assuming particular attitudes, such as the bust flexion forward with legs extended. In the corrective gymnastics, it is necessary not to assume a body positions which tend to accentuate the lumbar curvature.

Scoliosis attitude. It is a curvature of the spine on the frontal plan. It is very important to do a correct differential diagnosis to understand is it is a paramorphism or a dysmorphism. The causes of the real scoliosis are multiple, and in many cases the corrective gymnastics must be done by specialists. The gymnastics corrects the paramorphisms thanks to respiratory exercises, coordination exercises, joint unblocking exercises, muscle tone building exercises and symmetrically exercises on all four.

Through observation and thanks to mirrors divided into squares, it is possible to evaluate kids’ posture and signal to their parents the eventual presence of paramorphisms or dysmorphisms. No one can substitute for specialists. It is important to institute a collaboration with specialists in kid’s paramorphism and dysmorphism treatment. Working in team always repays and so, a collaboration between families and specialist is very positive.

TO SUM UP:

• paramorphisms are posture flaws, i.e. vitiated attitude due to muscle hypotonia and joint rigidity.
• A paramorphism is reversable through a corrective gymnastics that aims to restore the disturbed muscle balance.
• A dysmorphism represent an irreversible situation and needs a real medial therapy
• The stabilization process of a paramorphism pass through three points which are common to all corrective treatments: awareness, unblocking through mobility exercises and stretching, muscle tone building

In this chapter you will learn:

• How to plan a succession of workouts that follow a specific order according to purposes
• How to insert ECross program in an athletic preparation

Preparing 1,2, or 10 lessons is not complicated thanks to the huge number of variants of exercises and methods. What is difficult is periodizing the work overcoming the classic subdivision in macro periods of specialized sports.

The idea is to apply complementary training methods within the week, varying the order in time and allowing to who train sporadically to partially improve all characteristics. To prepare an effective planning, the trainer should do the following activities in order:

• Creating his own practice schedule and planning activities weekly;
• Defining the lesson prevalence
• Doing a monthly rotation that allow kids to try the various training organizations and to practice exercises which aim to improve both coordination and conditional skills

In general, we recommend to maintain the resistance training in each session and to making rotate the training of mobility, strength, coordination skills and cardiovascular resistance. Instead, in case of sport groups, the planning can vary according to the necessities and to the characteristics to be develop.

Our method organization follow this pattern:

• 5-10’ general warm-up with big and progressive movements
• 5-10’ mobility/technique
• 10’ coordination and/or conditional prevalence
• 10-15’ wod
• 5’ game
• 5’ cool-down

Example of ECross preparation aimed at sport activity

The following example is an example of ECross preparation for almost agonist athletes. So, the month-cycle is set to train both conditional and coordination skills of each tennis player (training were not always attended by the same group), and to give priority to tennis specific aspects.

Physical preparation for tennis 2017/2018

Agonistic group, 10-14-year-old, Fossano

First month-cycle (from 03/10/2017 to 07/10/2017)

Evaluation and anamnesis (medical history), anatomic adaptation, organization of pre-match and post-match work, work on conditional and general coordination skills.

Main aims: organization of pre-match and post-match work, period of general conditioning

Table: conditional skills subdivision: strength, speed and resistance

	Monday	Tuesday	Wednesday	Thursday	Friday
Week 1		Anamnesis	SP – ST		ST – R
Week 2		SP – ST	ST – R		SP
Week 3		R	ST – SP		R
Week 4		S	SP – R		ST – R

This table fixed the training prevalence. It is important to distribute the conditional skills in order to give kids a training continuity, even if they train in different days and with different frequency. The training prevalence does not mean that in that session only that determined conditional skills will be trained, but it is a simple indication about the skill on which kids have to concentrate more.

The next step is represented by the following table, in which we can see the skeletal of the several trainings. So, specific conditional skills should be inserted in the session; e.g. in the day with strength prevalence, we can train strength types such as explosive strength, resistance strength, etc.

Specific table:

	Monday	Tuesday	Wednesday	Thursday	Friday
Week 1		Evaluation and anamnesis (in this example, all kids were present to the first evaluation day)	-warm up – speed – adaptability circuit – mobility – cool-down		Warm-upspatial orientation general strength core stability cool down
Week 2		-warm-up – coordination skills rhythm/combination – speed – upper limbs strength – core – cool down	– warm-up – inferior limbs strength – general resistance – mobility – cool-down		warm-up coordination skills motor combinationcircuit training speed cool down
Week 3		-warm-up -coordination skills – specific resistance – core – mobility – cool down	– warm up – general strength -Specific speed – mobility – cool-down		warm-up coordination skills corepushes strengthspecific resistance  cool down
Week 4		-warm-up – coordination skills – Circuit training with stations – speed – cool-down	Warm-upSpeedGeneral resistanceMobilityCool down		warm-up coordination skills strength specific resistance cool down

Once you have fixed the prevalence, it is possible to organize a complete training schedule. So, it is important to choose tools and methods that fits better to training purposes. The jargon, the schedule overall structure and the method are strictly personal.

A fledgling trainer has to spend more time to complete the training schedule. He has to manage very well spaces and tools (a schematic illustration of the gym could be really useful).

With time and experience, schedules become more systematic offering the trainer a simple order to be followed.

Example:

Training schedule

First month-cycle (training 2 of 12) – Wednesday 4 October 2017

Structure of the activation work:

• leg abduction and adduction on frontal plan 2×15
• leg raise back and forth on sagittal plan 2 x 15
• special mobility 2 x 8
• hip circumduction 2 x 10
• leg flexed abduction and adduction 2 x8
• work with elastics, rotator cuff
• running + arm circumduction forward, backward and alternate
• alternating and skipped step, skip, kicked, alternating skip-kicked, lateral step

speed

• specific word with ladder 10/12’
• short distance sprints with ball recovery, starting while moving

circuit training

8 stations, 25” station, 10” recovery, 1’30” recovery between one round and the next, 4 rounds

• push ups
• lunges
• sit-ups
• back extension
• jump rope
• plank
• shuttle 10 m
• lateral shifts + gesture simulation

mobility

• cat (+back + sphinx)
• bust twisting on all four
• femoral with elastic
• ankles mobility
• psoas stretching
• special mobility
• upper limbs mobility
• foam roller

ECROSS TRAINER’S GENERAL CHARCTERISTICSE

Each ECross trainer must have essential knowledge to professionally manage his lesson and to create personalizes and high-quality training. These essential knowledges comprehend human anatomy and physiology elements (muscles and biomechanics elements), movement ergonomics, posture, spatial position and orientation, methodologies and educational theories according to user type and his age, safety and first aid, pedagogy, hygiene and nutrition, sport psychology, etc. All these elements should be learned in studies, but our staff want to create a continue education by providing articles and specific scientific material to acquire greater knowledge. Furthermore, we will organize stages and education courses with the aim to build a group of prepared and competent trainers.

A good trainer must be able to listen and to dialogue, and must be aware of his role in the development of sport people’s personality, especially that of kids. He must also have good interpersonal abilities and a good predisposition to manage group dynamics. He has to motivate his athletes to improve their sport performance through the maximal possible effort and intensity in the lesson. Furthermore, a good trainer is able to organize and manage the time, to rapidly and correctly solve accidents, and, when necessary, to personalize some exercises to satisfy his customer’s abilities and needs.

Teaching methodology

Didactically, we have identified, at a general level, three ways to explain exercises:

• Exercise description: the trainer uses his verbal skills to synthetically and effectively describe the exercises. It is perfect for consolidated groups or well-prepared athletes;
• Exercise demonstration: the trainer shows the exercise personally or by involving a kid. He explains the principal parameters for a correct execution and the errors not to do;
• According to the third method, the trainer describes the exercise and encourages the group to directly try to do it; this methodology is also recommended for a specific warm-up and for the introduction of more complex exercises.

The typology of training, of exercises and of the abilities to train are parameters that affect trainer’s didactical choice.  The perfect knowledge of exercises, variants and of the scalability principle allows him to be extremely efficient in the corrections in order to minimize the downtime.

The learning will be progressive; once having secured the customer, he can perfect his technique through the gesture repetition. The objective is to correct no more than three errors in order of importance, in order progressively reach the perfect gesture performance.

PERFORMANCE POINTS (PDP)

The Performance points, PDP, are the most important characteristics to correctly interpret an exercise. To explain what the PDP are, we can use a practise example: the squat is a complex and multiarticular exercise which involves several muscle and articulation groups. The PDP that a trainer should control and explain in the first exercise execution are:

• Maintenance of lumbar and dorsal curves while doing the exercise
• Knees position
• Correct ROM according to subject’s motor abilities

The first two point are PDP useful to secure the exercise performance; the third point is a PDP that can increase the performance and the intensity

TEACHING STYLE

We consider the interaction between teacher and kid, in which one’s behaviour affects other’s behaviour and allow to pursue determined purposes.

In time, we have understood that the excellent teaching style does not exist and that the best style depends on lesson goals, on group members and on trainer’s personality. Unfortunately, available evidence seems to suggest that the teaching of physical education is still based on traditional teaching methods which are based on command, demonstration and reproduction of a given model; instead, we have to understand that no teaching method is better that others. The good trainer learns how to change and adapt his teaching style according to the situation. There are several good reasons to adopt this flexible approach and it is natural that each trainer has his own teaching style.

However, we are anchored to a unique strategy that, no matter how effective, could limit our possibilities and our contribution to kid’s development and learning process.

Kids are unique individuals who learns differently from one another, have different needs and aspirations, and, in our ever more multi-ethnic society, has different cultural backgrounds.  Consequently, if we want to enhance the potential of each person, we have to mix different teaching methods.

This will help us not to exclude anyone, since one education and training aim is to promote inclusion. Beyond teaching purposes which are related to specific sport motor contents, the physical education has the chance to stimulate cognitive, social, emotive, and etic abilities, as well as motor skills. It is easy to understand that a unique teaching method is not able to include all these possibilities, and so, it is important to take into account that, if kids do not answer as we planned, we have to change the activities that is being done.

Teaching styles are based on two abilities that occur in various quantities in all human beings:

• Ability to reproduce, i.e. to copy ideas, procedures, movements, already known models, reproductive styles which can be direct or centred on the teacher.
• Ability to produce, i.e. to search new principles, rules, knowledge, movements, models, non-directed productive styles but centred on the pupil

If we use a reproductive style, we select an ability, show kids how it must be performed and give them an appropriate tasks progression to facilitate the learning of that ability; we also provide to children the time in which they commit themselves to practice a specific feedback on their performance, and finally, we organize new tasks for future lessons, according to what has been already learned. From a cognitive point of view, using a reproductive style solicits the memorization of motor programs and the memory recovery when kids have to redo those actions.

Instead, if we use a productive style, we progressively bring children to take decisions about how to use equipment and space, how to form groups and define roles within them, what starting level of intensity choose, when and how make it progress, how to evaluate his own performance, and how to discover always new solution to motor problems.

There are teaching style and strategies classifications that, according to continues variations, bring from a style in which the trainer takes all the decision (command style) to one in which the kid decides autonomously (self-study style); there are intermediate styles in which decisions are shared. So, the level of decision-sharing between teacher and kids is a matter of style.

After explaining the kid what he has to do, and after organizing the space, we give him time for practise (practise style) and the possibility to autonomously monitor his performance (self-evaluation); at this point, we provide him several opportunities and tasks to be done, which are more or less difficult, amongst which he can choose those that he considers more appropriate to him according to his skills and his current abilities (difficulty levels style).

If the trainer has in mind a single possible solution to a task, he can decide to help the kids to discover the solution by making them reason through questions that bring them to the solution (guided discover style); alternatively, he can decide to leave them search for the right possible solution through several attempts (convergent discover style). Instead, if we want to maximize the exploration in various directions, we have to give children tasks in which they must search for several solutions (divergent discovery style).

ECROSS TRAINER’S DECALOUGE

1. Imparting passion, teaching for and with passion
2. Being open, available and punctual
3. Having high problem-solving and adaptability skills
4. Studying and updating constantly
5. Complaining is not allowed 
6. Analysing critically each lesson and aiming to self-improvements at any time
7. Confronting and observing
8. Living the present, laying the foundations for the future, and leaving aside their difficulties while teaching
9. Being wrong as little as possible and aiming to excellence
10. If you are not able to respect these 10 rules, you will not be a good ECross trainer, maybe you will be only an ECross trainer

TO SUM UP:

• There are three didactical choice to explain exercises: description, demonstration and direct experience Trainer has to choose between these types depending on the situation, on the class age and training level.
• The Pdp are the technical points which are important to correctly interpret exercises. The first pdp always concern the exercise safety; then, other pdp can adjust the technique.