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General Anatomy 1

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The Cell

The living cell is the smallest unit capable of generating life. In humans, the size of a cell may vary from 5 to 20 microns and also its lifespan is variable. Some cells, such as the white cell, which accounts for the majority of adipose tissue in the body, live for only a few days, unlike some special nerve cells, which can even survive an entire lifetime. Single-celled animals exist in nature and there are scientifically known as protozoa, whereas those made up of more cells are called mesozoa.All cells are surrounded by a membrane, also referred to as the plasmalemma (5), which protects the elements that make up the cell itself (Figure 1):

• The cytoplasm (1), further divided into three substances: the hyaloplasm - the main liquid component, the metaplasm, made up of various components, deriv-ing from the hyaloplasm, and the para-plasm, composed of the various prod-ucts of cellular metabolism.

• The nucleus (2), made up of proteins and ribonucleic acid (RNA). Its size de-pends mainly on the type of cell and it is separated from the cytoplasm by a nu-clear membrane (4). Some cells can be polynuclear, in other words, may have more than one nucleus in the same cell.

• The nucleolus (3) is a structure found in the nucleus of cells and its function

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Figure 1. Three dimensional diagram of an animal cell summarizing the ultrastructural features.

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Anatomical Systems

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Cardiocirculatory system

The human body uses a series of highly spe-cialised apparatus, in addition to its locomo-tion framework (muscles and bones), to per-form all the necessary functions for which it is designed. One of these is the cardiovas-cular system, comparable to a closed circuit hydraulic system.This apparatus is composed of: the cardiac muscle, located at the centre of the rib cage, ellipsoid in shape with a longer longitudinal axis and a shorter transverse one consist-ing primarily of muscle fibres that structure the myocardium. It is enclosed in a protec-tive sac called the pericardium. The weight of an adult heart is approximately 350 g in males 300 g in females. A cross section of the heart shows four chambers called atria and ventricles subdivided into atrium and right ventricle and atrium and left ventricle. The atria at the top of the heart contain thinner muscle fibres than the ventricles, which oc-cupy more than half of the cardiac volume .The atria are divided longitudinally by the interatrial septum whereas the ventricles are separated by means of a longitudinal in-terventricular septum.Horizontally, the atrial cavities are separat-ed from the ventricular cavities by means of the atrioventricular valves: the tricuspid valve (consisting of three valve flaps), lo-cated between the right atrium and ventri-cle and bicuspid or mitral valve (consisting of two valve flaps), located between the left atrium and ventricle. The alternating open-ing and closing of the heart valves gives the blood being pumped from the heart a unidi-rectional flow. The flow process within the heart chambers is regulated in a fully auton-omous manner, both right and left. The right half receives oxygen-poor blood from the peripheral tissues via the superior vena cava and the inferior vena cava draining into the atrium. Passing through the tricuspid, the

blood comes into the right ventricle, the part and which acts as an authentic pump, which sends it to the lungs to reoxygenate, releas-ing carbon dioxide. The left side works as a mirror system, receiving blood rich in O2 in the left atrium through the pulmonary arter-ies, pumping it outwards again exploiting the circulation from the left ventricle, in the form of the aorta, the largest vessel in the human body.Other valve devices, called semilunar valves, are positioned at the entrance of the pulmo-nary arteries and aorta.The contractile activity of the heart is relat-ed to the autonomous nervous system which helps it adapt to physical strain, external influences, stress, climatic factors and mus-cle activity. The impulses for contraction, having left the brain, reach the heart where specialized structures provide for the or-ganization of the stimuli. The first collection centre consists of the nodal tissue, located in the posterior wall of the right atrium, from which branches off another tissue called the sinoatrial node, whose task is to convey the impulse to both atria. The right atrium be-gins contraction slightly before the left. The walls of the atria, having no muscular con-nection to the ventricles, spread the impulse by contraction of the latter via another node, called the atrioventricular node (see Figure 21) from where the Bundle of His branches out, whose task is to transmit the impulse to all portions of the ventricular muscles. The ventricular contraction occurs simultane-ously: in this way, the wave of stimulation spreads to the entire heart muscle.The rhythmic contraction of the heart , known as the heartbeat, triggers the so-called cardi-ac cycle that consists in a contraction phase, the systole, and a relaxation phase called the diastole. In the systolic phase the atria begin their contraction in order to push the blood into the ventricles, which in this particular phase are found to be completely relaxed

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Sports endocrinology

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Introduction

Any form of movement, even if not related to sports performance, and if produced with medium-high intensity, stimulates a signif-icant number of responses from the endo-crine system. These are adaptive responses and are associated not only with muscle ef-fort, but also with the entire range of emo-tional expressions that sport, in its com-petitive aspect, manifests. It is, therefore, a question of fully restoring the hormonal balance (homeostasis) required by the qual-ity of the effort, its intensity and duration in time. The first adaptation to stress is the ac-tivation of the adrenal cortex that stimulates the production of corticosteroids via the production of ACTH (adreno- cortico- trope hormone) from the anterior pituitary gland. Stress, according to Selye, produces three stages of endocrine activation in our body. The first, called the alarm reaction, encom-passes a whole range of non-specific reac-tions produced by particular types of stress such as rapid and violent stress, to which there is no physical adaptation, neither qual-itative nor quantitative. This first phase is divided in turn into two other periods: one called shock, in which the body passively suffers the stressful event, and the second is known as counter shock, characterized by the implementation of all the mechanisms of a hormonal response.The second phase, called the adaptation phase or stage of resistance, includes all those processes in which the body has deter-mined the amount of elements to face the ad-aptation and the specificity of the reactions that join forces in order to protect the organ-ism, resisting harmful external actions.The last phase, namely the stage of ex-haustion, corresponds to the period when the protective reserves have been used up and the body succumbs to stress. The time it takes to get to this stage depends on the

response capacity of each individual, it may however, not take place if the stressful situa-tion is short-lived. This general adaptation and defence syn-drome is particularly linked to the produc-tion of corticoids: in fact, any form of stress adaptation is always a hypertrophy of the adrenal glands.

The hormonal sequence in response to stressful stimuli begins, more specifical-ly, with the production of catecholamines (adrenaline and noradrenaline) and ADH, followed by ACTH and beta -endorphins from the pituitary gland, that stimulate a hypersecretion of corticoids and glucocor-ticoids, which in turn, perform the delicate task of defending and adapting the organism. This sequence is identical in both trained and untrained individuals: the only difference is in the quality and quantity of the response. Because of their adaption process to stress, trained individuals, unlike, the untrained, will have a response of low magnitude.

Even in emotional adaptations there is a de-gree of subjectivity in the response. Individ-uals who are more stable or with a degree of control over their emotional factors, respond with a lower production of aldosterone and catecholamines. The role of catecholamines is to prepare the body for a proportionate increase in energy expenditure. Adrenaline, or epinephrine, for example, is a chemical mediator typical of the class of vertebrates, a hormone and a neurotransmitter which be-longs to a class of substances called catecho-lamines and has the ability to influence sev-eral physiological processes consisting in:

• Acceleration of energy processes.• Increased heart rate and contractility.• Increased glycogenolysis in the liver and

muscles.• Stimulation of lipolysis in adipose tissue.

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Energy systems

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Introduction

Before discussing the physical qualities of human performance, an explanation of the energy systems is necessary in order to bet-ter understand the topic.It is therefore essential to introduce the con-cept of metabolism and its chemical trans-formations related to the human machine.The definition of metabolism, metabolḗ, orig-inated in ancient Greece, and is understood as a process of change. It represents, howev-er, the set of chemical and energy processes that take place in living organisms, respon-sible for any vital function or performance: growth, weight maintenance, the preserva-tion of the forms and structures of the body, the performance of specific functional activ-ities, the production of heat and work. In the many chemical changes that continuously take place in the body, it is possible to rec-ognize two main phases that can be summa-rized as follows:

• splitting and degradation processes (dis-similation or catabolism) through which the cellular constituents and reserve sub-stances are transformed into smaller mol-ecules;

• processes of assimilation and synthesis, which allow the formation of new living matter or accumulation of new reserve ma-terial (anabolism) in the cells.

Energy is released in the course of the cat-abolic processes, a significant quantity of which is released into the environment in the form of heat or work (thermal and mechan-ical energy) and the remaining part is used for reforming other molecules. The energy used by living organisms is potential ener-gy of a chemical nature, contained in cer-tain organic constituents of the tissues. The cells relentlessly consume this energy, which would ultimately run out if not renewed con-

tinuously and this is where nutrition comes into play. The molecules introduced via food (carbohydrates, proteins, lipids) are the real bio-fuels. In humans and animals these fuels are broken down in the presence of oxygen and reduced to carbon dioxide and water. This process takes place by means of hun-dreds of intermediate chemical reactions and multiple energy transformations. In higher animals, the elementary nutritional principles that are formed by the digestion of carbohydrates, proteins and triglycerides or, glucose, fatty acids, amino acids, etc., re-tain an unchanged intrinsic energy content of the substances of origin. For the produc-tion of energy, however, it is necessary for these molecules to be completely demol-ished. For this to happen, specific redox en-zymes must be involved, which transform the molecules of glucose, fatty acids and amino acids into smaller fragments, until they form a compound of two carbon atoms, the acetyl-CoA metabolite. Such a complex metabolic transformation is the so-called in-termediate metabolism. On conclusion of the intermediate metabolism, about a third of the energy contained in the starting material is made available to the cells. The remaining two thirds are released and used in a subse-quent series of cyclical metabolic reactions: the Krebs cycle, also catalyzed by redox en-zymes. Through these reactions, the acetyl-CoA is completely degraded until it creates a formation of carbon dioxide and water (terminal metabolism). Energy metabolism varies greatly depending on the individual’s activity, this is of utmost importance for the determination of metabolism under stand-ard conditions, in other words, the determi-nation of basal metabolism. The conditions in which we calculate the basal metabolic rate are: fasting, immobility, the horizontal position of the body, the tranquillity of the environment and the comfortable tempera-ture. In an individual who has fasted for 12

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Physical characteristics of sports

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Introduction

Muscular strength is the ability of the man-machine to face all situations in which he must either win or oppose resistance. Muscular strength increases in the very first months of life, taking the body on a journey which begins with crawling and leads to walking, running and jumping. As puberty comes about, bringing with it a hormonal revolution, the parameters relat-ed to strength are biologically overturned to its advantage, creating fertile ground in the most suitable individuals in order to plan a good standard of sports performance. Obvi-ously it takes much more than a physical pre-disposition to become a champion: a cham-pion must follow a logical, appropriate and personalised training program.

In modern sport, all sporting activities in-volve workouts aimed at improving strength with weights. The latter, sometimes unfairly criticized in the past, are the most appro-priate means for increasing the levels of strength and muscle mass.Before discussing the specific methodology of strength training, it is necessary to ana-lyze this phenomenon from the physical point of view of Newton’s laws of motion, in order to have a clearer understanding of the biomechanical concepts that govern man’s strength.

Newton and his lawsFor centuries the problem concerning the motion of bodies has been an issue of great

Motor skills in sport

Conditional skills Coordination skills

Maximalstrength

Endurancestrength

Rapid strength

Reactionspeed

Frequencyspeed

Action speed

Short termendurance

Medium termendurance

Long term endurance

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Flexibility Motor learning

skills

Direction and movement control skills

Adjustmentand

transformationskills

Balance skillsPace skills

Combination and coupling skillsKinesthetic di�erentiation skills

Spatio-temporal orientation skillsReaction skills

Figure 58. Motor skills in sport.

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Motor learning

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Motor learning

In order to understand how an individual assimilates motor learning, it is essential to define what it actually is and the neuromus-cular mechanisms behind it. Motor learning can be defined as a set of processes that take place whenever the individual acquires nov-el actions or movements. In this regard, from the beginning of the 1900s there have been many theories attempting to explain the con-cept of learning.

Learning by associationAccording to this theory, all behaviour is learned through processes of association between a series of stimuli and a number of responses. Behaviour is therefore complete-ly regulated by external stimuli and the in-dividual consequently emits behavioural re-sponses. This theory studies the observable, in other words, the stimulation and the re-sponse, completely neglecting the higher or-der processes that may regulate behaviour. Within this theoretical approach, learning consists in the ability to create associations. But, how can an association be structured? According to this theory, every type of be-haviour can be learned through conditioning processes. Based on these assumptions, it is easy to see that for these theorists, all behav-iour is easily learned and there are no limits to the ability to create various types of as-sociations between stimuli and multiple re-sponses, as long as the association between a stimulus and a response produces positive effects. Indeed, in the absence of gratifica-tion for the individual, it will be very difficult to influence the appearance of any kind of behaviour. In this type of learning, the mo-tor behaviour of an athlete is the result of the learning of motor habits. With these basic assumptions as a starting point, two types of learning by association theories have been developed:

• classical conditioning;• instrumental conditioning.

The Russian physiologist Pavlov was the first to demonstrate classical conditioning. His experiments, relative to the response of a dog’s salivation in the presence of food, are well known. What did Pavlov’s dog basically learn? That when a light appeared that it was about to receive food: it had therefore creat-ed an association between two stimuli. The first was the unconditioned stimulus (SI - food) followed by the physiological response of salivation (RI - unconditioned response), the second was the conditioning stimulus (CS - light) that would never have elicited the response of salivation if no association had been created with the unconditioned stim-ulus. Learning, therefore, consists precisely in the association between the two stimuli. Pavlov’s experiment shows that by condi-tioning, various types of associations can be provoked between stimuli and, how the lat-ter induce behavioural changes. Obviously, in order to condition a response, it is essential to analyse the factors affecting the condition-ing process itself. These are schematically:

1. the importance of considering the time interval between the unconditioned stim-ulus and visual stimulus of the light CS (conditioning stimulus): they must be rapid succession. If in the described ex-periment there had been a long pause between the light and the food, the dog would most likely not have created an as-sociation between the two stimuli;

2. the conditioning stimulus must have a strong intensity (the light must be clearly visible) it must be bright and not be con-fused with other possible sources of stim-ulation;

3. it is necessary to match the unconditioned stimulus SI and the conditioning stimulus SC several times in order to guarantee the

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General principles of training

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Introduction

When a beginner or an advanced athlete de-cides to take part in a training programme, they must carefully follow some general prin-ciples not only to achieve the best and lasting results, but also, and above all, to avoid nega-tive consequences such as injuries.In the light of this basic principle, the first point to be addressed is that of reducing any pathological disorders, in other words, the physical disharmony and posture that can damage the articulation, by using appropri-ate equipment for this purpose (medicine balls, sticks, weights, Swiss balls, equipment for training in unstable conditions, or for training in suspension).Another principle is that of so-called cen-trifugal training, which initially strengthens the areas close to the body’s centre of gravity (core) and then progresses to other areas. For example, the lumbar-abdominal must be addressed before the lower limbs; shoul-ders before arms, etc. This is because the weights put pressure or traction firstly on the proximal structures and subsequently on the distal ones. Failure to observe this often disregarded principle causes suffering in the weakest body areas, which can be felt even years later.

Other principles determining a rational con-struction of training are those of the progres-sive and gradual nature of the load. Trainers are always recommended to apply these principles, however, it is more often than not accepted as a cautionary recommendation: the temptation to rush into things is often a significant error, especially as the use of intensive workloads rewards the beginner, who immediately sees an improvement in

performance; however, the trainer must be aware and must advise the athlete that the results are short-lived, as the ligaments and the muscles have different adaptation times (heterocronismo), therefore, even if the mus-cles sustain a new load well, the tendons and joints may not have the same reaction. The consequences are easy to predict: in the long run it will be precisely those structures that will suffer from degenerative or inflamma-tory conditions, or indeed tears and breaks. The principle of continuity in training is also crucial. It is essential not to allow long in-terruptions between one load and another, except those aimed at a correct physical psy-chological and functional recovery. Exercises to improve psychophysical quality should alternate suitably, varying the choice, inten-sity and quality of exercise, inserting active recovery intervals to encourage the process of adaptation.This training development must be imple-mented with full awareness; you should always be sure of why you perform certain exercises and not others, their use, their purpose, etc. A workout should not be ap-plied uncritically, it should be discussed and analysed with the athletes, to discover any “dislikes” for some exercises, any states of mental or physical fatigue, as well as with the other figures that revolve around athlete: physiotherapists or medical psychologists.This is all related to the need to personalise training; it is necessary to find all the strat-egies to better adapt the training to the in-dividual and not vice versa: everybody has their own physical and mental characteris-tics, a strictly personal motor history, and the training programme must be developed around the individual, in compliance with all other general principles.

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Postural assessment

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The above postural conditions and problems are the most visible, and often build up, so it is up to the trainer to define the causes.

Usually the areas with a reduction of stabil-ity are the knees, pelvis and shoulders be-cause they compensate for a reduction in the mobility of the ankles, hips and the dorsal spine. This further demonstrates how our body uses and adapts the kinetic chains, and it is for this reason that there must be initial-ly an overall analysis of the athlete’s charac-teristics and subsequently detailed. The only limitation of this test is that it is related to the subjective interpretation of the tester as there is no numerical feedback, therefore the interpretation calls for great attention and experience on the part of the tester. As evidenced by the photos showing the se-quence of the five positions in the squat test, it can be measured more accurately by ana-lyzing the position with dedicated software capable of measuring work angles and any asymmetries. Some of these software can be downloaded free from the Internet. Among the most well-known is Kinovea (http://www.kinovea.org/) with which these images have been treated.

The purpose of performing such a test is to better understand how to plan a training programme, therefore, knowing whether to begin by structuring a rebalancing pro-gramme, eliminating unsuitable exercises or to carry out further tests of a more analytical or medical nature.

Developing core stability

Introduction A limit in the process of stability and, con-sequently in performance, is often due to an inadequate development of Core Stabil-ity, whose functional balance is essential in protecting the spine and pelvis from injuries caused by dysfunctional loads. Although the common opinion is that stability plays an im-portant role in rehabilitation after injuries and in preventive treatments, not all agree on its definition. Anders Bergmark (1980) defines the con-cept of Core Stability as a model of muscu-loskeletal interaction. Panjabi in 1992, pro-posed a conceptual model able to represent the interaction between the components that contribute to the stability.

Figure 100. Panjabi Spinal Stability Model (1992).

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Physical activity in the third age

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Society and the third age

On careful examination of the latest data provided by Istat (Italian National Institute of Statistics) on the ageing of the Italian pop-ulation, with a statistical projection as far as 2020, we can clearly state that “the elderly will be the youth of tomorrow”.Trends indicate, in fact, that the current 18% (almost 10 million) of over sixty-five year olds will make up 23% of the future Italian population. The increase in Italian life ex-pectancy (Istat data) is set at 78.6 years for men and 84.1 years for women, tying for first place with Japan as the longest-living population in the world. A recent Istat sur-vey shows that the average lifespan of Italian men is second in Europe only to the Swedes (78.9), the Dutch (77.9) and the Irish (77.6). The same is true for women, second only to France (84.4) but ahead of Spain (83.9) and Sweden (83.1). The calculated average of men and women shows that Italians have the longest life expectancy in Europe. An-other world record for the Italian popula-tion, that we will deal with in this chapter, is that over sixty-five year olds outnumber the under fifteen year olds. Among the segment of the population considered elderly, a high percentage is represented by octogenarians who, according to some demographic fore-casts, by 2041 should reach 10% of the total population.On a global level, Europe appears to hold the record, compared to the other continents, counting 14.6% of people over 65.The prospect of an increase in the elderly population will not have the same effect, in numerical terms, on the world’s population. UN demographers are certain that in the middle of the next century there will be not only an interruption, but an actual decrease in the number of people on Earth. This pre-diction is supported by a careful study on fertility in the world.

Taking into consideration the twenty-year pe-riod from 1975 to 1995 you can see the his-toric low reached by the world’s population in terms of procreation, so if the data shown in figure follow the same trend, in a medi-um-term forecast, we can hypothesize that in 2050 there will indeed be a reduction in the world population.

If these data are confirmed, it will be equally true that social development policies will be obliged to take into close consideration these parameters of demographic change; energy must be channelled into studies and research that make the most of this valuable human re-source: the elderly.The Third Age that makes up our communi-ty is the result, for better or for worse, of the industrial society which, if on one hand has led to well-being and longevity, on the other it has taken its toll on the elderly. Up until the present day, the industrial society, has not paid great attention to the presence and the increasing numbers of the elderly population. It has not believed in the possibility of their involvement in social work, has never focused on their experience, has never given them the opportunity to remain young at heart by in-vesting in cultural, sporting and social activi-ties for this age group. If something has been done, it has been done thanks primarily to the private sector. The numbers, however, are changing dramatically, the elderly are in net growth and in the future they will be forced to continue to work until late in life in order to support to the economy of their countries.These changes, however, cannot occur by chance, retirement cannot be postponed be-cause the average life span has increased; conditions need to be created so as over six-ty-five year olds are physically capable, effi-cient and healthy.For these reasons, the world of sports must also concentrate on programming training structures and means in this direction.

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Biomechanics: the basic concepts

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Biomechanics of human movement

Biomechanics is the science that studies the laws of mechanics applied to human move-ment, namely:• inematics;• Static;• Dynamics.

The biomechanics of human motion also refers to the application of mechanics to the study of the various biological systems, in order to meas-ure the conditions that arise in two particular situations:• static situation: interests the conditions

of equilibrium of the bodies and forces that interact in order to maintain this equilibrium;

• dynamic situation: studies the move-ment from the point of view of the caus-es, namely the forces that determine it. It therefore deals with kinematics and kinetics.

The forces acting on a body can be expressed in two ways:• with a static effect: contributing to keep-

ing it in current state;• with a dynamic effect: changing the state

of rest or motion.

through:• the decomposition of forces;• the composition of the forces that act di-

rectly on a body.

The composition and decomposition of forces can be expressed in the following ways:

• collinear: if they act on the same line;• concurrent: if they converge on the same

point;• coplanar: if they act on the same level.

One of the objectives of biomechanics is the study of human motion and the effects it pro-duces on the body, in order to reconstruct how an organism expresses and organises (strate-gies) its force capacity, and the posture it adopts which may actually limit performance.

Kinematics: Kinematics is the branch of Clas-sical Mechanics that studies the motion of ma-terial bodies in purely geometric terms, without examining the causes which have produced this particular type of motion. Motions are de-scribed within a reference frame, consisting of three mutually perpendicular axes with an ini-tial point in common.

To determine a movement it is necessary to know the trajectory, defined as: a line in which the movable points represent the single positions occupied by the moving point (or material).

Kinematic description

The following motions can be defined in rela-tion to space:• translational motion: each point on the

body moves along parallel trajectories and the longitudinal axis is parallel to itself.

• rotational motion: the longitudinal axis of the body rotates with a certain angle;

• complex motion: a combination of the above two.

The following motions can be defined in rela-tion to time:• uniform motion: where equal spaces are

covered in equal times (constant speed);• non-uniform motion: where different

spaces are covered in equal times (var-ying speed).

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Communication

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by Dr Francesco Riccardo Psycologist and psychotherapist

Introduction

Human relationships are made up of vari-ous forms of communication. The ability of the those involved to exchange information properly depends on the interpersonal re-lationship, effective communication and the likelihood that the common goal will be reached.A message is never neutral, it always bears characteristics of the personality of the per-son who expressed it. Similarly, those who receive it, will structure a response by inte-grating it with their own personality.For communication to be successful, we must be sure that these messages have been accepted by the other person in the way that the person who expressed them intended, without misunderstandings of any kind, to avoid conflict between verbal communica-tion (VC) and non-verbal communication (NVC). It is also important to ensure that the other person has understood and, therefore, formulated a response in keeping with the message received and deciphered (feedback mechanism). To be sure of this, we must con-stantly monitor our own and others’ VC and NVC.The term “communicate” is historically con-nected to the common word, which derives from the Latin verb communicare (“share”, “make common”), the Latin root of the word emphasizes the “depth” of communicating something, unlike the superficiality of in-forming someone about something.According to Anolli, communication is “( ... ) an interactive exchange of messages between

two or more agents, characterised by recipro-cal intentions and by a certain degree of con-sciousness which allows specific meanings’ sharing, based on symbolic and conventional processes (established by culture) through which people establish the link between a symbol and a referent.”

Some elements of a general nature can be identified in communication:

• open or bidirectional characterisation (sometimes multi-directional) of the ex-change;

• possibility of reversal of roles between sender and receiver;

• assessment of the active role of the re-cipient, even in cases where the role is simply that of recipient;

• attention to the effects of communica-tion action;

• willingness to consider the relationship of communication such as peer interac-tion, and thus as at least a form of poten-tial conversation.

Each communicative exchange implies and involves the “personality” of the interlocu-tors (individual or collective), and subjec-tively puts them into play in the plot that their relationship is building, beyond the objectively exchangeable information and content.

The psychologist William James (1890) not surprisingly argued that “whenever two peo-ple meet there are really six people present. There is each man as he sees himself, each man as the other person sees him, and each man as he really is”.