Training & Conditioning 14.5 by Momentummedia

July/August 2004 Vol. XIV, No. 5 $5.00

Searching for Symmetry Addressing muscle imbalances through training

â&#x2014;&#x2020; An in-depth look at

heart-related deaths â&#x2014;&#x2020; Body image disorders

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CONTENTS

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Training & Conditioning • July/August 2004 • Vol. XIV, No. 5

F E AT U R E S ◆ Special Focus ◆

In the Shadows..........13 It’s not often discussed and just starting to be researched, but body-image disorders among male athletes are a real—and growing—problem. By R.J. Anderson ◆ Injury Prevention ◆

When a Heart Stops..........21 Although it is rare, sudden cardiac death is a reality in the sports world. Here are the latest ideas on how to reduce heart-related deaths from both traumatic and nontraumatic causes. By Dennis Read

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◆ Optimum Performance ◆

Searching for Symmetry..........31 Athletes at all levels are prone to developing muscle imbalances. Make sure your strength training program is addressing this problem, rather than contributing to it. By David Pollitt ◆ Tr e a t i n g T h e A t h l e t e ◆

Soft Feet, Strong Legs..........37 Want an easy way to help treat lower extremity injuries in your athletes? Orthotics are the answer, although it’s not clear whether they control mechanics or alter neuromuscular activation patterns. By Dr. Jay Hertel and Dr. Lauren Olmsted

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D E PA R T M E N T S ◆ Sideline ◆

Hydration and Performance..........3 ◆ A b o v e t h e C a l l Aw a r d ◆

This Issue’s Winner..........4 Nomination Form..........7 ◆ Student Corner ◆

Choosing a Grad Program..........8 By Dr. Debbie Bradney and Dr. Tim Laurent

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◆ Competitive Edge ◆

Down the Middle..........43 Utilize your football athletes’ warmup time more effectively with these partner core stretches. By Gray Cook, Heath Hylton, and David Lee Advertisers Directory..........58 Heat Stress Prevention..........49 Ankle & Footcare..........53 Aquatic Therapy & Catalog Showcase..........56 More Products & Services..........57 Web News..........62 CEU Quiz..........64

Special Pull-Out Guide…Web Site Supplier Directory…see page 11

Cover Photo: © Getty Images

Great Ideas For Athletes...

TRAINING & CONDITIONING • July/August 2004 • Vol. XIV, No. 5

Editorial Board Marjorie Albohm, MS, ATC/L Director of Sports Medicine and Orthopaedic Research, Orthopaedics Indianapolis Jon Almquist, ATC Specialist, Fairfax County (Va.) Pub. Schools Athletic Training Program Brian Awbrey, MD Dept. of Orthopaedic Surgery, Massachusetts General Hospital, and Instructor in Orthopaedics, Harvard Medical School Jim Berry, MEd, ATC, SCAT/EMT-B Director of Sports Medicine and Head Athletic Trainer, Myrtle Beach (S.C.) High School Leslie Bonci, MPH, RD Director, Sports Medicine Nutrition Program, University of Pittsburgh Medical Ctr. Health System Christine Bonci, MS, ATC Asst. A.D. for Sports Medicine, Women’s Athletics, University of Texas Cynthia “Sam” Booth, ATC, PhD Manager, Outpatient Therapy and Sportsmedicine, MeritCare Health System

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Debra Brooks, CNMT, LMT, PhD CEO, Iowa NeuroMuscular Therapy Center Cindy Chang, MD Head Team Physician, University of California-Berkeley Dan Cipriani, MEd, PT Assistant Professor, Dept. of Physical Therapy, Medical College of Ohio Gray Cook, MSPT, OCS, CSCS Clinic Director, Orthopedic & Sports Phys. Ther., Dunn, Cook, and Assoc. Bernie DePalma, MEd, PT, ATC Head Athl. Trainer/Phys. Therapist, Cornell University Lori Dewald, EdD, ATC, CHES Athletic Training Program Director and Associate Professor of Health Education, University of Minnesota-Duluth Jeff Dilts Director, Business Development & Marketing, National Academy of Sports Medicine David Ellis, RD, LMNT, CSCS Sports Alliance, Inc. Boyd Epley, MEd, CSCS Asst. A.D. & Dir. of Athletic Perf., University of Nebraska Peter Friesen, ATC, NSCA-CPT, CSCS, CAT, Head Ath. Trainer/ Cond. Coach, Carolina Hurricanes Lance Fujiwara, MEd, ATC, EMT Director of Sports Medicine, Virginia Military Institute Vern Gambetta, MA Director of Athletic Development, New York Mets Joe Gieck, EdD, ATC, PT Director of Sports Medicine and Prof., Clinical Orthopaedic Surgery, University of Virginia Brian Goodstein, MS, ATC, CSCS, Head Athletic Trainer, DC United

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Gary Gray, PT President, CEO, Functional Design Systems Maria Hutsick, MS, ATC/L, CSCS Head Athletic Trainer, Boston University Christopher Ingersoll, PhD, ATC, FACSM Director, Graduate Programs in Sports Medicine/Athletic Training University of Virginia Jeff Konin, MEd, ATC, MPT Assistant Athletic Director for Sports Medicine, James Madison University Tim McClellan, MS, CSCS Director of Perf. Enhancement, Makeplays.com Center for Human Performance

Publisher Mark Goldberg Editor-in-Chief Eleanor Frankel Circulation Director Mark Shea Associate & Assistant Editors R.J. Anderson Dennis Read Kenny Berkowitz Greg Scholand David Hill Laura Smith Guillermo Metz Art Directors Karen Ires Suzanne Lynch Production Manager Kristin Ayers Assistant Production Manager Kristi Kempf

Michael Merk, MEd, CSCS Director of Health & Fitness, YMCA of Greater Cleveland

Production Assistants Jonni Campbell Hildi Gerhart

Jenny Moshak, MS, ATC, CSCS Asst. A.D. for Sports Medicine, University of Tennessee

Prepress Manager Adam Berenstain

Steve Myrland, CSCS Owner, Manager, Perf. Coach, Myrland Sports Training, LLC Instructor and Consultant, University of Wisconsin Sports Medicine Mike Nitka, MS, CSCS Director of Human Performance, Muskego (Wisc.) High School Bruno Pauletto, MS, CSCS President, Power Systems, Inc. Stephen Perle, DC, CCSP Associate Prof. of Clin. Sciences, University of Bridgeport College of Chiropractic Brian Roberts, MS, ATC Director, Sport Performance & Rehab. Ctr. Ellyn Robinson, DPE, CSCS, CPT Assistant Professor, Exercise Science Program, Bridgewater State College Kent Scriber, EdD, ATC, PT Professor/Supervisor of Athletic Training, Ithaca College Chip Sigmon, CSCS Strength and Conditioning Coach, Carolina Medical Center

Prepress Assistant Steve Rokitka IT Manager Mark Nye Business Manager Pennie Small Special Projects Dave Wohlhueter Administrative Assistants Sharon Barbell Daniela Reis Amy Walton Advertising Materials Coordinator Mike Townsend Advertising Sales Associates Diedra Harkenrider (607) 257-6970, ext. 24 Sheryl Shaffer (607) 257-6970, ext. 21 T&C editorial/business offices: 2488 N. Triphammer Road Ithaca, NY 14850 (607) 257-6970 Fax: (607) 257-7328 info@MomentumMedia.com

Bonnie J. Siple, MS, ATC Coordinator, Athletic Training Education Program & Services, Slippery Rock University Chad Starkey, PhD, ATC Associate Professor, Athletic Training Educ. Program, Northeastern University Ralph Stephens, LMT, NCTMB Sports Massage Therapist, Ralph Stephens Seminars Fred Tedeschi, ATC Head Athletic Trainer, Chicago Bulls Terrence Todd, PhD Co-Director, Todd-McLean Physical Culture Collection, Dept. of Kinesiology & Health Ed., University of Texas-Austin

Training & Conditioning (ISSN 1058-3548) is published monthly except in January and February, May and June, and July and August, which are bimonthly issues, for a total of nine times a year, by MAG, Inc., 2488 N. Triphammer Rd., Ithaca, NY 14850. T&C is distributed without charge to qualified professionals involved with competitive athletes. The subscription rate is $24 for one year and $48 for two years in the United States, and $30 for one year and $60 for two years in Canada. The single copy price is $5. Copyright© 2004 by MAG, Inc. All rights reserved. Text may not be reproduced in any manner, in whole or in part, without the permission of the publisher. Unsolicited materials will not be returned unless accompanied by a self-addressed, stamped envelope. POSTMASTER: Send address changes to Training & Conditioning, P.O. Box 4806, Ithaca, NY 14852-4806. Printed in the U.S.A.

Experts say Proper Hydration is Critical for Performance Douglas J. Casa, PhD, ATC, FACSM

Dehydration diminishes the mental edge While dehydration affects the body’s physical skills and abilities, it also can—and often does—affect athletes mentally, according to the panel’s findings. Memory, visual motor skills and even mood might all be diminished in a dehydrated player. It goes without saying that reduced capacity does not bode well for athletic performance.

In sports, the difference between winning and losing often comes down to one critical play. This is not a time for dehydration to impact performance. If it does, the opponent is likely to walk away the winner. That’s because your athletes need only be two percent dehydrated to feel its effects on their physical and mental performance. At least that’s what a panel of international experts discussed at a recent meeting of the American College of Sports Medicine meeting in Boston. The group of exercise scientists, sports physicians and athletic trainers gathered to examine the role of hydration on athletic performance and mental functioning.

The panel also determined that it’s difficult to move quickly and accurately and to understand verbal instructions when dehydrated. Not good, considering the challenges a perfectly healthy player faces on the field—now worsened by the inability to think clearly.

Following are other findings and recommendations: Physical effects of dehydration The panel agreed that dehydration might inhibit performance in athletes who lose more than two percent of their body weight in sweat. And that the effects of dehydration on performance worsen when athletes are: ● ●

Engaged in intense activity Active in the heat, whether outside on the field or inside a hot gym.

AP/WIDE WORLD PHOTOS

Have a plan in place for drinking before, during and after activity. ● Consume fluids at regular intervals to stay hydrated and maintain performance and physiological function. ● Get an adequate amount of carbohydrates in a sports drink to enhance cognitive ability, mood, perceived exertion and performance.

Your athletes need only be two percent dehydrated to feel its effects on their physical and mental performance..

Fortunately, however, you can help your athletes by making sure they drink enough to limit the extent of dehydration. While drinking water is better than nothing in providing some relief, the panel recommended a properly formulated carbohydrate and electrolyte beverage as the best option for rehydrating the body. That’s because a good sports drink: ● Replaces the fluids AND key minerals (like sodium) athletes lose when they sweat. ● Provides carbohydrates for energy to sustain athletes throughout training or competition.

Preventing Dehydration is Easy The good news is these scenarios need never happen because dehydration is easily preventable. The panel recommends doing that by working with athletes to make sure they: ●

Douglas J. Casa, PhD, ATC, FACSM is the director of the athletic training education program at the University of Connecticut.

For more information on hydration please visit the Sports Science Center at www.gssiweb.com.

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The Master’s Step How to choose a graduate program that best suits your needs.

By Dr. Debbie Bradney and Dr. Tim Laurent f you are planning on attending graduate school any time in the near future, you need to start thinking about your decision now. No two programs are exactly alike, and while any accredited university can provide a master’s degree, finding the one that best fits your expectations and priorities will ensure that you get the most out of your graduate school years. To choose wisely, you need to discover those schools that offer the best opportunities to cultivate and develop your personal interests. To begin the process of selecting a graduate program, we suggest looking within yourself to gain a sure sense of what you want. Developing clear goals will help you make the selection that’s best for you. What are your career aspirations? What is the best work setting for you? Do you want to combine your athletic training expertise with another area, such as nutrition, exercise physiology, or pharmacology? Do you want secondary credentials such as CSCS, PT, or PA? Your academic interests should match your professional goals so that your graduate degree can provide you with the knowledge and skills to pursue your ideal career. Some people pursue academic areas outside athletic training to give them additional career options, while others acquire dual credentials to reinforce their athletic training education. Still others simply desire advanced athletic training knowledge and skill to help prepare them for professional life. Knowing what you want will help you navigate a plethora of graduate school options. Once you have surveyed your own interests, begin surveying graduate schools. Determine which schools and academic programs are acceptable to you, considering the location, size, and reputation of each school and program. Also consider the prerequisites and entrance requirements for each school. An additional factor students need to consider when looking at athletic training master’s programs is whether

Debbie Bradney, DPE, ATC, is the Coordinator of Clinical Education, and Tim Laurent, EdD, ATC, CSCS, is the Athletic Training Program Director at Lynchburg College in Virginia. 8 ◆ T&C J U L Y / A U G U S T 2 0 0 4 ◆

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they want their athletic training master’s degree to be entrylevel or advanced. Entry-level master’s degrees are designed around the same educational competencies and proficiencies as undergraduate accredited programs. So if you have completed a CAAHEP-accredited undergraduate program, you probably want to enter an advanced master’s program. Repeating an entry-level program will provide you with a master’s degree, but it may not challenge you or advance your athletic training knowledge and skills. Most graduate programs also offer assistantships to provide students with a stipend, full or partial tuition remission, and hands-on experience. Athletic training students have numerous choices. Many schools advertise their graduate assistantships through the NATA Career Center or send announcements to undergraduate athletic training program directors. (The NATA Career Center is available to NATA members at www.nata.org.) By looking at announcements you can learn about stipends, benefits, and responsibilities. Being informed about the types of graduate assistantship positions a school offers will help you to choose a school that fits your needs. If you are thinking about taking on an assistantship, you need to consider the responsibility that comes with it. Graduate assistants are considered to be staff members, and are treated as such. In your undergraduate athletic training experience you were a student who was learning about athletic training. As a graduate assistant you will be a university employee who also goes to school. This is a large shift, and you need to be cognizant of the difference. You will, of course, gain valuable experience, but you are also there to benefit your employer. When comparing graduate assistantships, there are a few questions that need to be asked. What is your job description? Are you expected to work over holiday and semester breaks? When can you make autonomous decisions, and when do you have to consult with another staff athletic trainer? As you look at graduate assistantship announcements you will notice that there are three types of assistantships: Teaching Assistantship (TA), Research Assistantship (RA), and Graduate Assistantship (GA). Being a TA often involves teaching labs or freshman-level courses. These positions are excellent for people who plan on teaching during their professional career. They allow you the opportunity to practice organizing and presenting information in a logical way that aids students’ learning.

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An RA position is excellent for the person who is most Assistantship application and graduate admission interested in publications, presentations, and research, and application are often two separate processes. It is possible they are typically available at large research institutions. to be accepted into a graduate school without receiving an With this position you will be assisting a assistantship. Be sure that the school you professor in conducting his or her research. choose offers the entire package you want— To help you sort through Before accepting an RA, make sure your one that will advance your knowledge and schools, degrees, and programs professor’s area of interest is compatible skill in your area of greatest interest. available, these two Web sites with your own by talking to him or her and Begin early. Your junior year should be may be of assistance: reading his or her research publications. devoted to surveying your interests and A GA position in athletic training comparing them to graduate school offerwww.petersons.com involves providing athletic training health ings. Your senior year should be devoted to www.gradschools.com care service. Some of these assistantships narrowing your choices and applying to are structured so that you serve as a colleprograms. Give yourself enough time to giate assistant athletic trainer. Others assign you to serve as thoroughly surf the Web, visit schools, talk to current stuthe head athletic trainer for one or more sports. Still others dents and alumni, and meet with the professors who will be provide experience at local high schools or clinics. This type your mentors. of assistantship is beneficial for any future athletic training Graduate school is a tremendous beginning to your proemployment, and it can also help you build your resume and fessional career. Do all you can to make the best choice. ◆ establish professional contacts. If you have interest in a particular sport, a GA position can be an opportunity to get some intense experience with that sport. If you are interestIf you are interested in submitting a column of advice for ed in working at a high school, an assistantship with high athletic training students, please send it to: T&C’s Student school responsibility is ideal. Students need to realize that, Corner, 2488 N. Triphammer Rd., Ithaca, NY 14850. although the tasks of a GA are similar to those of an underSubmissions must be double-spaced, 800-1200 words long, graduate athletic training student, the responsibility is and accompanied by the author’s resume or curriculum vita. typically much greater, and so is the stress level. explosive power > acceleration > speed > flexibility > strength > quickness

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In the Shadows © Getty Images

They’re rarely discussed and just starting to be researched, but body-image disorders among male athletes are a real—and growing—problem. By R.J. Anderson magine being in the funhouse at a carnival. You look into one of those distorted mirrors and see a body that is different than your actual proportions. Your head is huge, your torso grossly elongated, and your legs bow like bananas. It’s kind of funny. Imagine looking into your bathroom mirror and having similar results.

After hours of working out at the gym, your chest is flat, your arms look like sticks, and your six-pack bulges out like a pitcher of Kool-Aid. Or at least that’s how it seems to you. If you were a competitive athlete, in the best shape of your life, you wouldn’t be very amused. And for many men suffering from muscle dysmorphia, that is what happens every time they sneak a peak at their reflection. Often referred to as reverse anorexia nervosa, muscle dysmorphia

is a body-image disorder primarily affecting males in which they become preoccupied with the misperception that their muscles are too small. Individuals with the condition are often driven to spend countless hours in the gym, to the detriment of their relationships, social lives, and physical well being. No matter how much or how hard they work out, men with R.J. Anderson is an Assistant Editor at Training & Conditioning.

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muscle dysmorphia never feel muscular enough. But that doesn’t stop them from trying. “Male athletes who have muscle dysmorphia tend to compulsively lift weights, ignoring signs of physical distress to their ligaments and joints,” says Roberto Olivardia, PhD, a clinical psychologist at McLean Hospital in Belmont, Mass., and muscle dysmorphia researcher, as well as co-author of The Adonis Complex: The Secret Crisis of Male Body Obsession. “Even when their bodies tell them to stop, they continue working out, thinking that more is better. They also tend to not pay attention to other physiological needs like hydration and food intake. And a number of them will use anabolic steroids.” In a 2000 study, Olivardia found that 50 percent of men with muscle dysmorphia had used or were using steroids. Olivardia also notes that about one-third of men with muscle dysmorphia have a current eating disorder, a history of an eating disorder, or idiosyncratic eating patterns—such as placing an emphasis on extreme lowfat, high-protein diets. Experts lay much of the blame on the media’s increased glorification of the male physique. “Women have been subjected to images of thin models for a long time and now men are subjected more and more to these hugely muscular icons and imagery,” says Olivardia. “Everything from World Wrestling Entertainment to music videos showing rappers with their shirts off revealing perfectly chiseled pecs and biceps. There’s definitely a pressure that boys today feel, which they didn’t feel as much 15 years ago, to look fit and toned.” As the pressure mounts, so do the statistics. A recent study in Norway revealed that eight percent of elite male athletes in that country suffer from some type of eating disorder. The British Medical Journal found that the number of men who openly report dissatisfaction with their physical appearance has tripled in the last 20 years, and that therapists report seeing 50 percent more men for evaluation and treatment for eating disorders than they 14 ◆ T & C J U L Y / A U G U S T 2 0 0 4 ◆

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Women have been subjected to images of thin models for a long time and now men are subjected more and more to these hugely muscular icons

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and imagery.

did in the 1990s. In the United States, however, the problem has not been researched much. In this article we will take a look at muscle dysmorphia and how to recognize its symptoms in your student-athletes. We’ll also talk to a number of experts about how to approach an athlete you suspect may be in a phase of muscle dysmorphia or experiencing an eating disorder. FROM THE GYM TO THE FIELD

How prevalent is muscle dysmorphia in team-sport athletics? It’s hard to know since much of the earliest research has focused on body builders. But anecdotal information about other athletes is growing. Heidi Skolnik, MS, CDN, a nutritionist for the New York Mets and the New York Giants, sees the problem at the professional level. “I have linemen who are very unhappy about their bodies and it doesn’t matter that they make a lot of money and can outrun most people—they’re not necessarily happy being that big,” says Skolnik. “It’s surprising to hear a lineman say, ‘I feel fat, I don’t fit in my clothes.’ Here’s a professional athlete who you assume would be proud of their largeness, but instead they are very sensitive to how their bodies look.”

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Skolnik says that these athletes often focus their obsession on one particular body part. “They say, ‘I’m okay with my chest, but I hate my stomach or my legs are too big,’” she says. “And I think a lot of it comes from comparing themselves to other guys around the locker room or on the covers of magazines.” At Ohio State University, Jennifer Carter, PhD, a psychologist at the school’s Sports Medicine Center, is working with varsity athletes to study the problem more systematically. She has surveyed Ohio State athletes for the past two years and will do so again, along with athletes from three other schools, this fall. (See “Survey Questions” on page 19.) In her 2002 study, results showed that one percent of the 882 athletes surveyed (of which 57 percent were male) showed possible signs of muscle dysmorphia. While that may not seem like an alarming statistic, Carter is quick to point out that the questionnaire was not anonymous. She explains that one of the biggest problems with studying muscle dysmorphia is that men are very reluctant to admit having any type of negative body image. “The difficulty with this topic is that men do not voluntarily discuss this,” says Carter. “As time has gone on, more men have talked to me during individual counseling about being concerned that they are not muscular enough, but a lot of people don’t even know this problem is going on. I talk to our athletic trainers and occasionally an athletic trainer might refer an athlete to me who they suspect might have this problem, but I don’t think it is being recognized as a huge problem as of yet.” Olivardia explains that, because body image disorders are largely viewed as only affecting women, most men are ashamed to admit they may be suffering from them. “The shame is enormous,” says Olivardia. “I’m often the first person, or the only person, that a lot of men disclose this problem to—and that’s because they know I’m an expert in the field and I’ve written about it.

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Some of these men are married and their wives don’t even know that they struggle with muscle dysmorphia or bulimia because they are so ashamed.” A DEFINITION

Muscle dysmorphia is a subtype of body dysmorphic disorder (BDD). BDD is the diagnosis people get when they are preoccupied with how their body looks—whether it’s their nose, hair, skin, or any part of their body. Muscle dysmorphia is a type of BDD in which the preoccupation happens to be with their muscularity and their physique. Because research within this particular branch of BDD is in its infancy, not much is known about the origins of the disorder, nor is there much information regarding how many people are affected. “We do know that muscle dysmorphia is associated with either a mood or an anxiety disorder,” says Olivardia. “Most men with muscle dysmorphia

tend to have an underlying depression, or underlying anxiety. But we don’t know what comes first. “A lot of men I work with who have muscle dysmorphia say that working out is a way of taking control,” Olivardia continues. “It is similar to what you hear from women who have eating disorders, except women use food as a way of controlling their lives and managing their emotions, while men with muscle dysmorphia rely on exercise to take control. If they are at the gym for five hours a day and the only thing they have to focus on is their body, it can serve as a distraction away from other things in their life that might be completely falling apart.” As with eating disorders, there is a wide range of severity. “Just like in the female population when we talk about eating disorders being a continuum, I’d say it’s the same thing for muscle dysmorphia,” says Skolnik. “There’s this range of eating patterns and body dis-

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satisfaction that is occurring. It doesn’t have to be a full-blown dysmorphic phase, but many men are beginning to take on characteristics of the disorders that are definitely not healthy.” SPOTTING A SUSPECT

Not every athlete who puts in extra time in the weightroom is muscle dysmorphic, and just because an athlete is conscientious about his diet, he does not necessarily have an eating disorder. But where is the line that tells us an athlete is doing too much? How do you know when an athlete’s drive for health has become unhealthy? “In general, coaches and athletic trainers should have a sense as to where the boundaries are that the person has in working out,” says Olivardia. “From there they will be able to notice how an athlete’s workout routine affects his general attitude about his body and if it is getting in the way of other things in his life—

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his relationships, his friendships, his eating habits, his studying.” Excessive mirror-checking is one warning sign that may help tip off whether a person is having issues with body image. “Men with muscle dysmorphia often check mirrors as a way of reassuring,” says Olivardia. “It’s not that they’re vain and like the way they look. It’s actually for the opposite reason—they don’t like the way they look, and they want to find a way to improve it.”

If an athlete is noticeably weightconscious or body-fat conscious, they might be taking things too far. “I see a lot of guys who get into restrictive eating in the name of eating clean and trying to be healthy,” says Skolnik. “I definitely don’t want to discourage guys from being thoughtful about what they eat, but they get to a point where they won’t eat something like a donut. They develop strict rules around what they can and cannot eat versus having guidelines for trying to eat better.”

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Carter echoes the sentiment. Athletes she has worked with who have body image problems report thinking about food, diet, or working out 80 or 90 percent of their day. She adds that substance abuse often accompanies eating and body image disorders among college athletes. Other signs include skipping meals with the team, preferring to eat alone, wearing baggy clothing to cloak perceived inadequacies, not wearing shorts or short-sleeved shirts, and refusing to take their shirt off at the beach. And of course, there is the matter of steroid abuse, the ultimate sign that an athlete is unhappy with his body. “What’s ironic is that most of the men with muscle dysmorphia are in very good shape,” says Olivardia. “In some cases they are above average in terms of their muscularity. A lot of them have a very low body fat percentage, and to the average eye they would be deemed very muscular, but they don’t see it.” TREATMENT & THERAPY

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When you or a member of your staff suspects that an athlete may have an unhealthy preoccupation with body image, how should you approach him? How can you find out what’s going on without causing him to feel ashamed and retreat into a defensive shell? “The most important thing is to take a stance of concern and empathy for that person as opposed to saying, ‘What are you doing to yourself?’ or being sarcastic,” says Olivardia. “You might start by simply saying, ‘I think you’re overdoing it in your workouts.’ “If you come from a point of concern rather than putting them on the defensive, the denial is easier to break through,” Olivardia continues. “Share with them observable behaviors like, ‘I see that you are isolating yourself from the team,’ or ‘I noticed that you worked out four and a half hours today, when typically you’re supposed to work out an hour and a half,’ or ‘I see that you seem very sullen and very sad,’ as opposed to something like, ‘I think you might be depressed.’

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“Sharing with them the concrete behaviors makes it harder for them to argue with you, compared to if you say, ‘I think that you have a body-image problem.’ Because they can just say, ‘No, I don’t.’ Then the conversation is pretty much over.” The idea is to engage the athlete in a preliminary conversation about their habits and fears to glean how serious the problem is. If the athlete’s focus on body image seems fairly minor, there are many ways to steer him back on course and away from full-blown muscle dysmorphia. “Basically, just give a lot of positive reinforcement in terms of what he is accomplishing,” says Olivardia. “Definitely do not use critical language, because men with muscle dysmorphia are hyper-sensitive to criticism. Focus on their strengths and not their weaknesses.” Olivardia says it’s also important for coaches to model balanced behavior themselves—especially strength

Olivardia says it’s also important for coaches to model balanced behavior themselves— especially strength and conditioning coaches. and conditioning coaches. “If you’re a coach who eats, breathes, and sleeps working out, then the athlete will pick up on that,” says Olivardia. “As a coach, if you live a very balanced life yourself, an athlete can look upon you as a model of inspiration—somebody who eats well-balanced meals, who

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exercises appropriately, but also has relationships, has fun, is social, and is comfortable with himself.” Strength coaches can also encourage athletes to seek out relaxation techniques or other activities that offer an alternative to working out when encountering stress. “Coaches should really reinforce self-care,” says Olivardia. “The idea is to make sure that not only are they eating well and working out, but that they are sleeping well, drinking enough water, and getting enough social stimulation.” At Ohio State, Carter tells her coaches to be particularly careful when they talk to an athlete about losing or gaining weight. “We would like them to consult with the medical staff first to see if it’s advisable and if they think it will help the athlete’s performance,” says Carter. “And if so, we then refer the athlete to a dietitian to make sure they are doing it in a healthy way. Often, athletes are instructed to lose or gain weight and have no clue how to do

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that in a healthy way, which can lead to unhealthy behaviors.” OUTSIDE HELP

If an athlete’s behavior or habits reach a level of becoming obsessive or selfdestructive, athletic trainers and strength coaches are encouraged to refer the athlete to a sports psychologist. When an athlete comes to her exhibiting symptoms of an eating or body-image disorder, Carter uses a technique called cognitive behavioral therapy. The technique examines the underlying assumptions athletes have about themselves and how they feel the rest of the world sees them. Says Carter, “For example, when addressing the idea that, ‘People will accept me only if I am very muscular,’ we’ll ask, ‘What are some other aspects of your self that people might like? What are some strengths that you have? Are there muscular people you know who aren’t necessarily popular?’”

“

To limit mirrorchecking, I ask patients to take a baseline of how many times they look in a mirror in a day…The goal is to

”

reduce the number.

Olivardia, who also utilizes cognitive behavioral therapy, says the technique helps correct a lot of distortions these athletes have. “Their thoughts are typically very negative,” says Olivardia. “The behavioral part

of cognitive behavioral therapy should address any of those behaviors that we either want to increase or reduce.” To increase socialization, Olivardia often asks patients who have muscle dysmorphia to step outside of their comfort zone. If a patient feels uncomfortable in social situations, and tends not to wear short-sleeved shirts or shorts because they feel like their arms or legs are too small, Olivardia will have that patient establish a goal to overcome that fear. “I’ll say, ‘Okay, your goal this week is, if it’s 90 degrees outside, you have to wear shorts,’” says Olivardia. “I try to expose them to the very things that they are fearing or avoiding in some way. “To limit mirror-checking, I ask patients to take a baseline of how many times they look in a mirror in a day,” continues Olivardia. “The goal is to reduce the number of times that they are checking the mirror each day.”

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Olivardia also employs general psychotherapy when treating patients with eating or body-image disorders. He talks to patients about their background, looking at some of the issues that might predispose them to the condition, including depression, anxiety, family history, child abuse, negative peer experiences, perfectionist tendencies, or low self-esteem. WHAT’S NEXT?

While muscle dysmorphia and eating disorders among males are not even close to approaching the levels of bodyimage problems experienced by women, they are important to look out for. “I think athletes have an additional

layer of risk because the models they are looking at are people who are specifically invested in muscular physique and toning up,” says Olivardia. “A lot of the products they might buy—protein shakes or fat-burning supplements— typically feature endorsements from men who probably got their body through using steroids. So athletes are measuring themselves up against what is an immeasurable body—one that is the product of drug use. “Muscle dysmorphia is a bodyimage disorder, but when you add the athletic world where there is a pressure to perform, it becomes even more pronounced,” he adds. “One of my patients had an athletic scholar-

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ship, so his base of viability at the university was dependent upon him doing well athletically. As a result, he thought taking steroids was a necessary thing, to both grow his body and enhance his performance.” Part of the problem is that for a long time, the assumption was that these types of disorders didn’t affect men. But they do. It just happens that men are particularly good about hiding these problems, which Olivardia says makes the disorders even more dangerous. “We think that this problem is going to get worse before it gets better,” says Olivardia. “The images that boys and men are bombarded with of muscular men are only increasing.” ◆

Survey Questions Jennifer Carter, PhD, a psychologist at The Ohio State University Sports Medicine Center, gives athletes the following survey to uncover any body-image disorders. The questions originally appeared in the article “An Exploration of the Drive for Muscularity in Adolescent Boys and Girls,” published in the Journal of American College Health. Athletes are asked to answer each statement using a scale of one to six, one being never, and six being always. ___

I wish that I were more muscular.

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I lift weights to build up muscle.

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I use protein or energy supplements.

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I think that I would look better if I gained 10 pounds in bulk.

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I think about taking anabolic steroids.

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I think that I would feel stronger if I gained a little more muscle mass.

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I drink weight-gain or protein shakes.

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I try to consume as many calories as I can in a day.

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I think that my weight-training schedule interferes with other aspects of my life.

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I feel guilty if I miss a weight-training session.

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I think my arms are not muscular enough.

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I think I would feel more confident if I had more muscle mass.

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I think my chest is not muscular enough.

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Other people think I work out with weights too often.

___

I think my legs are not muscular enough.

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Although it is rare, sudden cardiac death is a reality in the sports world. Here are the latest ideas on how to reduce heart-related deaths from both traumatic and non-traumatic causes.

By Dennis Read

t can happen anywhere at anytime. Sometimes there’s a sign of what’s to come, often there’s not. During the past year it occurred in settings as disparate as a lacrosse game in upstate New York and an empty basketball arena in Texas. But whether sudden cardiac death occurs from a traumatic injury or an underlying condition, people are left asking what can be done to prevent it from happening again.

The sad reality is that these deaths are sometimes not preventable. However, people around the country are taking steps to try to reduce the risk of sudden cardiac death, from identifying those athletes most at risk to developing equipment that might better protect the heart. TRAUMATIC

When George Boiardi died on March 17, the shock waves reverberated from one college campus through an entire sport. A senior captain on Cornell

University’s men’s lacrosse team, Boiardi died after being struck in the chest by a shot late in a game against Binghamton University. If Boiardi had a chance to survive, everything was in place to make that happen: Athletic trainers responded immediately, an onsite AED was used, and EMTs arrived minutes later. Yet none of these efforts could save Boiardi. Unfortunately, the lacrosse world was already familiar with this type of scene. Boiardi was the third collegiate lacrosse player in five years to die after being hit in the chest by a ball. A high school player also died the same way during that span. The exact cause of Boiardi’s death will never be known. At the request of his parents, no autopsy was performed. Dennis Read is an Associate Editor at Training & Conditioning.

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But the dangers of a blow to the chest are no secret. The three previous lacrosse deaths were blamed on commotio cordis, which occurs when a non-penetrating blow to the chest directly over the heart during a very narrow phase of the heart beat causes ventricular fibrillation, or other types of arrhythmia, in an otherwise healthy heart. In an article published in Progress in Biophysics & Molecular Biology, Mark S. Link, MD, of the New England Medical Center, Tufts University School of Medicine, reported that the vulnerable period lasts only 10- to 30-thousandths of a second. Commotio cordis is believed to be rare, although the exact number of cases is not known. The Commotio Cordis Registry in Minneapolis has documented more than 150 cases since it formed six years ago and typically adds between five and 10 cases per year. But many past deaths likely went undiagnosed and other cases may still go undocumented. The risk of commotio cordis extends far beyond lacrosse. Of the 128 cases recorded by the Commotio Cordis Registry through 2001, 62 percent occurred in participants in organized sporting events, ranging from youth to professional sports. Of those, 46 involved baseball or softball while 13 involved ice hockey. Five came in lacrosse. In most cases, the speed of the ball or puck was typical for the sport. At higher speed, physical damage to the heart also becomes a danger. High school and youth athletes appear to be most at risk of commotio cordis. The average age of victims was 14 years and nearly 80 percent of cases occurred in people under 18. Some researchers have attributed this to younger athletes having a more pliable chest wall. The search for ways to reduce the risk of traumatic heart death continues. Within lacrosse, both equipment and playing rules are being looked at with an eye toward reducing risk. “We’ve got to do something,” says NCAA Lacrosse Rules Committee Chair Willie Scroggs, Senior Associate Athletic Director at the University of 22 ◆ T & C J U L Y / A U G U S T 2 0 0 4 ◆

Seven cases involved baseball catchers and hockey and lacrosse goalies who suffered commotio cordis despite having their chest protectors take the blow. North Carolina, where he was previously the Head Men’s Lacrosse Coach. “We can’t just sit back and say, ‘I hope it doesn’t happen again,’ if there are things we can do rule-wise, techniquewise, or equipment-wise.” The US Lacrosse Sports Science and Safety Committee has recommended changing the rules of the game to penalize players who intentionally try to block shots by stepping in front of the ball. US Lacrosse Executive Director Steve Stenersen sent letters to both the NFHS and NCAA rules committees asking them to consider a similar change. Some college coaches, though, aren’t waiting for the rules to change. “Hockey players dive in front of the puck all the time, but I’ve taken that type of thing out of my coaching repertoire,” says Dave Urick, Head Men’s Lacrosse Coach at Georgetown University. “It’s not something we teach or encourage them to do anymore, and that’s a direct result of what’s happened to these young men. I just felt like it made sense from a safety standpoint.” CHEST PROTECTION

Efforts are being made on the equipment front as well. Under current lacrosse rules, only goalies are required to wear chest protectors, most of which are similar to those worn by baseball and softball catchers. Other

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players must wear shoulder and arm pads, but unlike the equipment worn by many hockey players, very few lacrosse pads offer chest protection. Scroggs says that equipment manufacturers are working with coaches, players, and medical experts to develop more protective equipment, but he doesn’t expect to see anything new introduced before next season because of the development and testing involved. Equipment may not provide the full answer, anyway. Of the 79 athletic deaths recorded in the Commotio Cordis Registry by 2001, 28 percent happened to players wearing standard chest protection for their sport at the time. Although some football and hockey players suffered their injuries when they were struck directly in the chest by objects that evaded the protective equipment, seven cases involved baseball catchers and hockey and lacrosse goalies who suffered commotio cordis despite having their chest protectors take the blow. Link and his fellow researchers conducted an experiment with anesthetized pigs wearing commercially available chest protectors designed for youth baseball players. The pigs were hit in the chest with baseballs fired at 40 miles per hour. These researchers found that the likelihood of ventricular fibrillation in pigs wearing chest protectors was not statistically different from those not wearing chest protectors. While chest protectors may not offer full protection from commotio cordis, some people believe they are still an important tool in reducing risk. In May, the NATA Age-Specific Task Force issued a statement on commotio cordis that suggested the use of allpurpose chest protectors during practices and games as a way to reduce the danger. At the same time, researchers are looking for ways to construct chest protectors that offer more protection from commotio cordis. Most current equipment is designed to protect against physical trauma, including that which might directly damage the heart. The key will be finding a way to disperse the force of the impact over a

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larger area so that less of it is transmitted to the heart, reducing the chance of sending it into ventricular fibrillation. “Research is finding that certain chest protectors don’t work,” says Keith Gorse, MEd, ATC, Clinical Coordinator and Instructor in the Department of Athletic Training at Duquesne University. “What we’d like to do within the NATA is work with US Lacrosse to research the newer chest protectors that are designed to disperse pressure away from the heart and see if they work.” In the meantime, Gorse advises athletic trainers to decide what will work best for their athletes. “Chest protectors are a big question right now,” he says. “A lot of people are for them and a lot of people aren’t. The most important thing for athletic trainers to do is to research the different types of chest protectors that are out there before buying them.” Link’s study did find some promising prospects for treating commotio cordis, as long as treatment can be provided quickly. Test animals who received defibrillation after one or two minutes of ventricular fibrillation survived 96 percent of the time while the survival rate fell to 46 percent after four minutes and 25 percent after six minutes. In real life events, the Commotio Cordis Registry reported that 25 percent of those who received resuscitative measures in less than four minutes survived, while in 38 cases of delayed resuscitation only one person survived. In some cases where a player has received a dangerous blow to the chest, resuscitation efforts will prove futile, even if, as in Boiardi’s case, they include an immediate response and an AED. But prompt, proper treatment can increase the odds of recovery. “Determine what the problem is as soon as possible, start CPR, and get an AED on that person right away,” Gorse says. “There’s a better than 50-50 chance of survival if you start caring for the person within a minute. But this means making sure there’s an AED on site—it can’t be 400 yards away.” NON-TRAUMATIC

While awareness of commotio cordis is relatively new, medical professionals have long been aware of the connection between athletic participation and sudden cardiac death from non-traumatic causes. The exact prevalence of sudden cardiac death in athletes is unknown, but estimates ranges from one death in 200,000 athletes to one in 300,000 per year. The most common cause of sudden cardiac death in athletes is hypertrophic cardiomyopathy, which is a thickening of the heart. In a June 2004 article in The Physician and Sportsmedicine, Dennis Wen, MD, Associate Professor of Family and Community Medicine at the University of Missouri, says that in fatal cases, hypertrophic cardiomyopathy usually causes arrhythmias, such as ventricular fibrillation or ventricular tachycardia. It can strike without warning, although some victims have histories of chest pains, fatigue, syncope, and palpitations. Wen reports that echocardiography is considered the “gold standard” in diagnosing hypertrophic cardiomyopathy, Request No. 112 24 ◆ T & C J U L Y / A U G U S T 2 0 0 4 ◆

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These conditions may produce fatigue, chest pains, and syncope, but not always. Wen suggests coronary angiography as the most reliable means of finding these anomalies. Echocardiography, especially transesophageal echocardiography, is also helpful. Other rare causes of sudden cardiac death include myocarditis and arrhythmogenic right ventricular dysplasia (ARVD). Myocarditis, which is an inflammation of the heart’s muscular wall, can result from a variety of causes including viruses and bacteria, and may be indicated through echocardiograms in some cases. ARVD affects the muscle in the right ventricle and can cause abnormal heart rhythms. Electrocardiography and echocardiography can both be helpful in detecting ARVD, however, some doctors consider MRIs to be more accurate. TO SCREEN OR NOT?

Since sudden cardiac death can and

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does occur without any prior symptoms, the focus has been on screening for those who may be susceptible to these diseases. Unfortunately, no single test will identify every athlete at risk for sudden cardiac death. These conditions can even go undetected in someone who receives a full battery of tests. “You can add layers and layers of screening tests, but a few are still going to slip through no matter what you do,” Wen says. “The whole problem is that these are such rare conditions. Things that are rare require screening methods—whether they be histories or echos or whatever—that are both extremely sensitive and extremely specific. None of the things we do now even come close to the levels of specificity and sensitivity needed to be useful for something this rare.” Many people liken the screening process to searching for a needle in a haystack. Researchers estimate that, on average, finding one person with a condition that may lead to sudden car-

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but still has several limitations. First, hypertrophic cardiomyopathy may not be apparent until an athlete has reached full maturity, meaning a high school athlete may still be at risk, even if he or she has previously received a negative test. Second, some people with hypertrophic cardiomyopathy have very little risk of sudden cardiac death, but little is known about who is at risk and who is not. In addition, heart murmurs, once considered an effective screen for hypertrophic cardiomyopathy, are apparent in only a small number of people with the condition. Electrocardiograms may show signs of hypertrophic cardiomyopathy, but they also may not. As a result the first symptom often is death. Wen reports that the second most common cause of sudden cardiac death in athletes is coronary anomalies. These can lead to ischemia, arrhythmia, or low blood flow into the coronary artery.

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diac death requires screening 200,000 people, making the odds of finding one person at risk at any school very remote. In addition, there are the problems created by false positive and false negative results. “So the question is, when does it become worthwhile to keep adding layers and layers of screening tests only to find a few more cases, when the majority will still slip through?” Wen says. “If you screen enough kids you’ll find a positive here and a positive there, but does that justify doing millions of tests? Some people say it is worth it to find that one needle in the haystack. Other people say it’s not. In my article, I chose to argue that it’s not worth doing all that testing just to find that one needle.” Ramon Brugada, MD, Director of the Molecular Genetics Program at the Masonic Medical Research Laboratory in Utica, N.Y., which studies cardiac arrhythmias and cardiac disease, holds a different view. Brugada believes that every high school athlete should receive

a cardiological exam. “In Japan, everybody gets an electrocardiogram before puberty, and in Italy every newborn gets an electrocardiogram,” he says. “The benefit of doing the electrocardiogram overshadows the concerns about cost and economical issues. Schools require vaccinations, so why not require an EKG to make sure that everything is fine? The reality is that 99 of 100 patients will be fine, but the single guy who drops dead at age 14 while running at school justifies the testing.” Others aren’t so sure. Michael Koester, MD, FAAP, ATC, CSCS, Primary Care Sports Medicine Fellow at Vanderbilt University, served as a high school team physician in Oregon for the past five years and recommends against doing full cardiological exams on all athletes. “In times of limited budgets and limited resources, I’m concerned that if people start doing EKGs and echos, it will become the standard of care,” he says. “Parents will think, ‘They’re

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doing testing at that school, why aren’t they doing the same testing at my kids’ school?’ “There’s no single test that we can do that will prevent every case of sudden cardiac death, and my biggest concern is the high rate of false positives,” he continues. “Even if you had a test that was close to perfect, you’re going to get thousands of kids who are going to test false positive. And what do you do with those kids? You can tell the parents the kid may be at risk of sudden cardiac death, then they go through test after test only to conclude that the kid is at a risk that is difficult to quantify. “Or after scaring them half to death, you tell them, ‘Nope, that was a false positive and they aren’t at risk of dying suddenly during athletic participation.’ How much does that weigh on the parents, along with the financial cost of having to do more referrals?” For schools that do opt for testing, there is some debate about which tests are the best ones to do. Echo-

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cardiograms check the blood flow in the heart and are better at catching heart abnormalities such as hypertrophic cardiomyopathy. Electrocardiograms, meanwhile, are more likely to find rhythm disturbances, such as WolffParkinson-White or long QT syndrome. Some schools are employing an outside company to administer echocardiograms to their student-athletes. These tests are provided at a flat rate, often around $60. In some cases, all athletes are tested. In others, athletic trainers simply make the testing available for those willing to pay for it. In the Myrtle Beach (S.C.) school district, administrators considered adopting such a program before deciding to stick with the more traditional screening program they have been using. “We have nine high schools in our district with several thousand students who participate in athletics,” says Jim Berry, MEd, ATC, SCAT, NREMT, Director of Sports Medicine and Head Athletic Trainer at Myrtle Beach (S.C.) High School. “It was a situation where, if we offered it, who would take advantage of it? Since we couldn’t afford to cover the cost, was it fair to only test the kids who could afford to have the test done? “We discussed scheduling a time and sending a letter out saying, ‘We’re offering this opportunity if you want your child tested,’” he continues. “But what if a kid gets tested, it comes back negative, and they drop dead two weeks later? What liability will we have? So the district and the athletic trainers decided at this point it wasn’t something we wanted to explore any further. We felt like the system we had in place was appropriate.” FOCUS ON EXAM

Instead of expensive screening tests, Koester suggests that schools rely on good preparticipation physical examinations, including a thorough cardiac history, to help shrink the haystack by identifying athletes who should receive closer examinations. “The most important thing that they need to include are the guidelines set out by the American Heart Association, looking mostly at

“What we’ve done is to strengthen the cardiological part of the history form … We now have a separate cardiac history section with nine specific questions that they must answer.” family history, the athlete’s own history, and physical exam findings,” he says. “There is a history form recommended by the American Heart Association, the American Academy of Pediatrics, the American Academy of Orthopedic Surgeons, and the American Academy of Family Practice Physicians, which is available in the Preparticipation Physical Exam monograph. It’s not perfect, but it’s as close to perfect as we have when you look at cost-tobenefit ratios.” Koester feels strongly enough about the importance of a thorough preparticipation physical exam, including cardiac history, that he suggests funding those efforts first. “I think athletic trainers are being pushed in the direction of buying expensive pieces of equipment like AEDs,” says Koester. “AEDs are great, but number one, sudden cardiac death happens in about one in every 200,000 athletes, so the odds of having an athlete need an AED are slim. Number two, there is no great evidence that automatic external defibrillation is going to reverse the process of these kids who go into a terminal arrhythmia. “I think having those devices is great, but the person you’re most likely to use them on is the referee or someone in the stands,” he continues. “I think funds can be pushed in that direction, but there won’t be a great return on them. The best thing to get is a thorough history and physical exam.”

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Berry leans heavily on cardiac histories to identify athletes who may be at risk of sudden cardiac death. “What we’ve done, and what South Carolina has done through its official physical form, is to strengthen the cardiological part of the history form,” Berry says. “It used to be that a lot of physical forms would just ask, ‘Have you ever had chest pains?’ Well, chest pain can be caused by a lot of things. So now we have a separate cardiac history section with nine specific questions that the kids or their parents must answer about their cardiac history. The family history is important because there is such a strong relationship between what’s happened with the mother or father and what tends to happen with the children.” Jody Jenike, MEd, ATC, Head Athletic Trainer at Xavier University, also relies on the cardiac history as a primary screening device. “We have a five-point questionnaire, and a certified athletic trainer will ask the student-athlete each of those questions to make sure they’re honestly answered,” Jenike says. “And we ask them these questions in addition to the form the family fills out in the summer, so there are checks and balances.” LISTEN TO THE HEART

Jenike also emphasizes the importance of a thorough physical examination. One of her athletes was found to have an atrial septal defect—a serious, but not life-threatening, heart problem— through an echocardiogram, which is performed on all members of the school’s men’s and women’s basketball teams. But Jenike believes the condition should have been caught earlier when the player received a preparticipation physical exam. “At the time, we were working with an internist who was very good at discerning a murmur as being a one, two, three, or four,” Jenike says. “In a quiet room, he could tell you where it was, and he worked alongside our cardiologist. At the time we did the player’s physical, the internist was running late and a physician’s assistant happened to listen to her heart. So she

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was halfway through the physical and onto the orthopedist when the internist arrived. Had we not done the cardiac exam we would not have picked this up. “We don’t have a PA listen to the heart anymore,” she continues. “PAs can help with physicals, but my feeling is you should have an internist—who can be given a quiet room—listen to the heart. Everybody dreads the mass physicals and wants to get through them but I think it’s worth an extra two minutes per kid.” Koester says that any primary care physician should be able to pick up murmurs, be it a pediatrician, internist, or family practice doctor. “In some states, physician assistants and nurse practitioners are licensed to do the PPE and I think that’s reasonable—if they have the appropriate training, which many of them have,” he says. “But I don’t think the chiropractors and naturopaths are able to show that they have the proper training in cardiovascular disease and cardiovascular

“You have to take a step and then improve it each year. I believe in having a oneyear, three-year, and five-year plan, and you push each year to add things.” physical exams to be able to perform the exam. If they can show that they have had training, that’s another thing, but with the standard level of training that they have in detecting cardiac disease, I don’t think they should be performing those exams.”

Koester also suggests putting some thought into who checks the athletes’ blood pressure. “One thing that is often overlooked is whether the people taking blood pressures know what they’re doing,” he says. “To get accurate measurements, make sure you have good cuff sizes, that you’re in a quiet area, and you have nurses or ATCs who are good at measuring blood pressure.” In addition to taking a detailed history and having an internist listen to the heart, Jenike also screens athletes for risk of Marfan syndrome by measuring their arm span. Marfan syndrome is most often found in tall, slender people with unusually long arms and legs, and can result in a weakened aorta. All athletes who raise any red flag through their physical exam or cardiac history are then sent to a cardiologist for a full cardiological evaluation. Koester recommends that, when possible, it’s best to send the athletes to a cardiologist who is familiar with sports medicine.

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Iliotibial Band

KEEPING UP

Preventing heart-related deaths is not straightforward by any means. But for each individual situation, the best strategy, Jenike says, is to keep up with the advances in detection techniques and keep moving your screening program forward. “Everybody lives within their own comfort zone,” Jenike says. “Some schools are out in rural areas where there may not be a cardiologist nearby. But could they have an internist who is experienced listening to the heart brought in from a hospital on the day of the physicals and have the athletic trainer ask the history questions? I believe they can. And the kids who are at risk get sent for further evaluation. “Comfort zones are influenced by money and time,” she continues. “You have to jump in the water somewhere before you can swim. You have to take a step and then improve it each year. If you keep saying you can’t do it because of this or that, you’ll never get there. I believe in having a one-year, three-year, and five-year plan, and you push each year to add things.” You also need to pay attention to any signs or symptoms that can crop up when you least expect them to. “It’s important to be aware that there are some signals the heart gives out that indicate something is amiss,” Brugada says. “If there is anything you don’t feel is normal, seek help. For example, passing out is not a simple thing. It’s a very complicated issue and because of the possible implications [of serious heart problems] it’s something that has to be taken extremely seriously. Athletes should not be passing out.” But, in the absence of symptoms, Wen says it’s important for athletic trainers to explain to parents and other interested parties just how unusual these deaths are. “I think they need to stress the rarity of this and let people know that athletics are still safe and their sons or daughters on an athletic team are probably not at risk of dying,” he says. “We’re talking about an extremely rare thing. And sports and athletic activities—whether recreational or organized—are still very safe. There’s still a lot more to be gained from participating in athletics than not, so you shouldn’t be scared off by the publicity over athletic deaths.” ◆

RESOURCES For more information on commotio cordis, go to www.la12.org/articles/med-research.htm. This page is part of the Louis J. Acompora Memorial Foundation Web site. Acompora was a 14-year-old high school lacrosse player from Northport, N.Y., who was killed by commotio cordis in March 2000. For more information on the American Heart Association recommendations for preparticipation physical exams go to www.americanheart.org and type “preparticipation” in the search window.

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Searching for Symmetry Athletes at all levels are prone to developing muscle imbalances. Make sure your strength training program is addressing this problem, rather than contributing to it.

By David Pollitt n the human body, nothing is perfectly symmetrical. Many people have a leg that is longer than the other or maybe one bicep that is stronger than the other. For athletes, such body imbalances can be problematic. They can lead to less-than-optimal output in strength, flexibility, and coordination that may have negative effects on performance. They can also eventually lead to injuries. Conversely, obtaining

muscular balance allows the body to move more efficiently, display more strength, and reduce injury. Most athletes, however, do not know they have a muscle imbalance until an injury results. At that point it can be time consuming and frustrating to rehabilitate, rebalance, and relearn movements in order to return to previous levels of performance. A better path is to test for imbalances before they become a problem, and develop training protocols that focus on body balance. To do this, it’s important to understand the nuances of

unilateral balance, imbalances within the limb, and sport-specific balance. UNILATERAL BALANCE

For a variety of reasons, the dominant form of strength training seems to be bilateral exercises such as the bench press, squat, barbell curls, and so forth. While these are valuable movements, David Pollitt, CSCS, is the Owner of Optimal Performance Strength and Conditioning Consulting, in Riverside, Calif., and the former Strength & Conditioning Coach for the Banff Hockey Academy.

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Table One: Unilateral Tests The following are samples of unilateral testing exercises: Overhead Squat (one handed with dumbbell)

Test each side maximally and compare the movements of the knees, hips, shoulder girdle, upper body, and depth of squat. Movements should look identical on the right and left sides.

Push Jerks (one handed with dumbbell)

Test each side and compare the shoulder girdle, ease of lift, maximal weight handled on each side, upper-body lean, and hip action.

Pistols (one-leg squats)

Test the depth of the squat, maximum number of repetitions performed or maximal amount of weight for one rep, deviation from optimal form, and flexibility in the lower leg and hip.

One-Arm Bench Press

Test each side maximally and compare ease of lift, deviation from the optimal path of the dumbbell, speed of the movement, range of motion, and angles of the elbows.

One-Arm Rows

Test each side maximally and compare ease of lift, path of the dumbbell, speed of the movement, and range of motion.

One-Arm Pull-Downs (one handed, pronated grip to the side)

Test each side maximally, and compare the range of motion, weight handled, and deviations from an optimal path of resistance.

One-Arm Biceps Curl, Hammer Curls, Calf Raises, and Romanian Deadlifts

Test each side maximally and compare the weight lifted, movement of the dumbbell, speed of the lift, deviation from an optimal lifting path, and range of motion.

External Rotations of Knee

Sit on a flat bench, bring a knee up so it is bent at 90 degrees. Place the elbow of the same side of the body on the knee, and bend so the forearm is vertical. Internally rotate the arm toward your belly button, and return to the vertical position. Test the weight lifted for 10 repetitions for good form, range of motion, and speed of contraction.

Saxon Side Bend

Take two 10-pound dumbbells, press them straight overhead, and then straight to each side as far as possible. Test the range of motion, difficulty of the lift, and deviation from a straight side bend.

Turkish Get-Up

Start lying down with a weight extended vertically (straight arm). Without bending the arm and keeping the arm vertical, stand up. Test for either repetitions or a maximal weight.

Shot Put

Test the distance thrown (after skill acquisition) on both sides.

Standing Medicine-Ball Throws

Test rotational power development on both sides of the body.

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the negative is that they can help hide or even worsen an imbalance in an athleteâ&#x20AC;&#x2122;s body. In my experience, many athletes lack the flexibility, strength, coordination, and technique to do bilateral exercises correctly. When the weight on the bar is light, there is not usually a problem. But, as weight is added to the bar, the stronger, more flexible, or more coordinated limb tends to take on a greater role in the exercise and the body twists, turns, bends, or strains to get the weight up and complete the exercise. These movements are repeated workout after workout, and the result is a furthering of the original imbalance or the creation of a new imbalance. At some point, the imbalanced muscle or scar tissue that may be formed by the incorrect actions opens the athlete up to potential injuries. It is also important to develop unilateral balance for enhanced performance on the field of play. As

The benefit to isolating the limbs during training is that neural drive to the working limb is maximized to a higher degree than with bilateral training. explained by strength and conditioning coaches Peter Twist, MPE, CSCS, and Dusan Benicky, MS, in the Strength and Conditioning Journal (Vol. 18.5, 1996), imbalances can lead to poor reaction when sudden movements are required. In their example, if a defenseman in ice hockey has an imbalance between his two legs, he

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tends to favor the dominant leg by putting more body weight on it. When a forward on the opposing team tries to get around the defenseman to the weaker side, the defenseman must first un-weight the strong leg, shift to the weaker leg, and then push off in that direction to intercept the forward. This brief delay may be all the forward needs to elude the defenseman. According to Charles Poliquin, MS, in The Poliquin Principals, studies have shown that, in some athletes, the dominant leg may be as much as 20 percent stronger than the non-dominant leg. The ramifications of this type of discrepancy can therefore be disastrous if not detected and corrected in a timely manner. The benefit to isolating the limbs during training is that neural drive to the working limb is maximized to a higher degree than with bilateral training. Another advantage of unilateral training is the stimulus it provides to a host of stabilizer muscles. In most

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cases, the degree of the stabilizing effect has a direct effect on the ability of the prime movers to execute heavy movements. For these reasons, it’s critical to focus on unilateral strength and balance before moving to bilateral exercises, which will go a long way to correcting imperfections. Using dumbbells, kettlebells, or other single-limb exercises can provide a wide variety of movements, enhance stabilizer development, and rebalance potential

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problem areas while developing a high level of strength. It is also important to locate any bilateral imbalances. The best way is to test common actions that may show a discrepancy. (Table One, on page 32, outlines some common tests.) When testing specific actions it is important to get as much feedback as possible to make an informed decision. Use mirrors, coaches, training partners, or a video recorder to view the test. The goal of testing is to ensure that there is

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less than a five percent variance in strength between limbs and discover where any imbalance is located. WITHIN THE LIMB

Imbalances within a single limb (such as between the biceps and triceps or biceps and forearm flexors) can also have a negative impact on performance. Genetic flaws, motor recruitment patterns, technique of the exercise or movement, or previous injuries may potentially cause imbalances. As with other forms of imbalances, the stronger muscle or muscles tend to do a higher portion of the work compared with the weaker muscles, which further exaggerates the strength differences. For example, with one of my clients, his forearm flexors were very strong and his biceps were much weaker. I found this out by using a curling exercise that tested his strength with and without the use of his forearm flexors. Training for this client then became a matter of trying to minimize the involvement of the forearms within movements involving the biceps so that these muscles would have a chance to develop and re-balance accordingly with the stronger forearms. The difficulty with imbalances within the limb is that they can be tough to detect until an injury occurs. Oftentimes people will not have any pain in the weaker part of the limb and are still able to make progress with strength training. The best method to evaluate balance within the limb is to isolate the various muscles and compare that strength to the whole movement. For instance, when testing the upper arms, use a curling action and record the weight that can be lifted in a complete movement. Then isolate the biceps by bending the forearms backwards throughout the lift (called a Zottman curl), and vary the hand positions using a neutral and then pronated grip to determine the strength variance when other muscle groups are involved. Take note of the differences in strength using the varying techniques. A certain amount of difference in strength is acceptable, but when the

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Table Two: Within-Limb Tests The following are samples of within-the-limb testing exercises: Compare one-arm bicep curls to one-arm hammer curls and conduct one-arm Zottman curls to test for arm balance. Results should be within 20 percent for each lift. Compare maximal front squats to maximal back squats to test for knee joint balance. Front squat should be 85 percent of back squat. Compare bicep curls to triceps dips to test upper-arm balance Results should be 40-50 percent of max dip. Compare dorsi flexion to calf raises (using the Dynamic Axial Resistance Device). Results should be 8 to 15 percent of max calf raise. Compare hip flexors to hip extensors on multi-hip machine. Results should be close to 50 percent or more.

differences between hand positions or when muscles are isolated are more than 20 percent it is time to use corrective measures. (Table Two, above, outlines some tests for within-the-limb balance.) Once you identify the area that is weaker you can focus more attention on correcting this problem. SPORT-SPECIFIC BALANCE

Athletes are perhaps more prone to imbalances than the general training public. The repetitive movements in athletics such as the golf swing, hockey shot, swimming stroke, and running stride create the potential for what is called a repetitive stress syndrome or pattern overload. These muscles are stressed over and over, perhaps thousands of times in a similar manner, and can create an imbalance compared to the other side of the body. The weakened state of the antagonist muscle or muscle group compared with the much stronger agonist or prime mover predisposes the athlete to injury. The goal for all athletic actions is to improve performance, so the prime movers have to be developed in a sport-specific manner. However, when creating training programs, in order to

avoid imbalances, the movements have to be analyzed to determine the best course of training for the antagonist muscle or muscles as well. In the throwing action, for instance, the external rotators are called upon much less than the prime movers of the abdominals, chest, and shoulders, but they still need to be strong enough to decelerate the arm and thus prevent injury. Another example is ice hockey for which many conditioning programs fail to rebalance the abductors and adductors that are under-developed from skating. When looking at sport actions, try to determine what the antagonist muscle or muscles are that need to be worked and spend time bringing them up to an acceptable level. The difficult task is to figure out what an acceptable level of balanced strength is, as it depends on a number of variables. Unfortunately, there are no hard and fast rules to govern the balance within the body for maximal sport performance and injury prevention. In some actions, such as lateral movements, it has been shown that the best extensor-to-flexor ratio in the upper legs is between 75 to 97 percent.

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In studies with top Canadian sprinters, the hamstring-to-quad strength was up to 125 percent. For most sports, however, the most prudent plan is to develop the antagonist muscles that do not get a significant amount of training from sport activities and assess the particular athlete. Coaches and athletic trainers should take into consideration the range of movement, speed of the limb during the sport action, sex of the athlete (men are typically stronger by body weight than females), prior injury status, and the sport being played. Coaches can video their athletes performing many different sport and training movements, then watch the athletes on a monitor in a slowed down, frame-by-frame mode, where hidden actions or tell-tale signs of imbalances may be discovered. In sports that include a rotational component (such as golf, baseball, racquet sports, hockey), also look to balance the body by spending time strengthening the same type of actions on the opposite side of the body. In the golf swing, for instance, if the golfer hits left handed, the right side of the body should be developed with strength-training exercises similar to the sport action. In addition, a certain amount of sport practice on the right side (perhaps with a right-handed golf swing or right-handed medicine ball toss) should be performed. The weaker side may never achieve a similar performance state as the dominant side, but by using similar sporting actions on the non-dominant side, the goal of reducing potential imbalances can be met. Developing appropriate resistance training programs after a complete assessment can be very beneficial for athletes wishing to train injury free for any length of time. There are many training hazards that can have a negative impact on performance, and it becomes critical to reduce those potential problem areas in order to achieve optimal performance. Understanding the importance of balanced strength in the body is a key factor in this process. ◆

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AP/WIDE WORLD PHOTOS

SOFT FEET, STRONG LEGS Want an easy way to help treat lower extremity injuries in your athletes? Orthotics are the answer, although it’s not clear whether they control mechanics or alter neuromuscular activation patterns. Dr. Jay Hertel and Dr. Lauren Olmsted

hether they like the Nike swoosh, the Adidas stripes or another brand of footwear, most athletes are pretty particular about their athletic shoes. They want them to fit well, be comfortable, and look hip. But what may actually be more important than the shoe they choose is what they are—or are not—putting in the bottom of it. We are referring to foot orthotics, which should be an important part of any athletic trainer’s treatment toolbox for lower extremity injuries. Orthotics

frequently include posts, or wedges, on their bottom side that aim to alter the biomechanics of the lower extremity by controlling faulty motion. Another common use of orthotics is to increase shock absorption by the musculoskeletal system during weight bearing. More recently, the role of orthotics in altering neuromuscular control of the lower extremity has also gained interest. The purpose of this article is to highlight the contemporary clinical uses of foot orthotics in sports medicine. We will also review the mechanisms by which these devices may influence the musculoskeletal system.

DIFFERENT TYPES

Foot orthotics are available in two types: off-the-shelf and custom-made. Off-theshelf orthotics, such as full-length shoe inserts, arch supports, and heel lifts, are sold by shoe size and are not designed to treat specific individuals or pathologies. These devices are frequently sold at Jay Hertel, PhD, ATC, is an Assistant Professor with the Graduate Athletic Training/Sports Medicine program in the Curry School of Education at the University of Virginia. Lauren Olmsted, PhD, ATC, is the Clinical Coordinator and Interim Athletic Training Education Program Director in the Department of Kinesiology at Penn State University.

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pharmacies, athletic shoe stores, and sports medicine clinics. Various types of posts are available in some brands. The more expensive custom-made orthotics are constructed based on an impression of an individual’s feet. The impressions have traditionally been made from plaster or foam casts of the patient’s feet, although more recently digital scanning techniques have also become available. The custom-made orthotic can be made from a wide variety of materials, and specific posts prescribed by the clinician may be added to the outside of the orthotic or may be built directly into it. For both custom and off-the-shelf models, there are three primary stiffness classifications: flexible, semi-rigid, and rigid. The more flexible an orthotic, the less motion can be controlled. Flexible orthotics are prescribed when only a small amount of motion control is needed but considerable shock absorption is desired. Conversely, rigid orthotics are typically used in extreme biomechanical

cases when a great deal of motion control is needed and shock absorption is not of primary concern. Semi-rigid orthotics are the most common orthotics and provide a balance of motion control and shock absorption. HOW DO ORTHOTICS WORK?

Traditionally, foot orthotics have been thought to work by controlling the range and velocity of motion of the foot and proximal segments of the lower extremity. And research has consistently shown that medially posted orthotics decrease the amount of foot pronation and internal tibial rotation, as hypothesized. Additionally, these orthotics significantly decrease knee abduction and adduction movements, demonstrating that orthotics can alter the mechanics of the proximal lower extremity joints. However, there are still some question marks in the literature on orthotics and biomechanics. For one thing, there is research showing lack of significant motion restriction and large variations

in individual responses to orthotic intervention. In addition, there has been very little research examining the differential effects of off-the-shelf and custommade foot orthotics on motion control. Much of the current research on orthotics examines the role that foot orthotics have on the neuromuscular system. At least three studies have found that orthotics enhance the cutaneous sensation on the plantar aspect of the foot thus changing the afferent input from the somatosensory system. This change in sensory input is thought to positively alter the neuromuscular activation patterns of the lower extremity. In a recent study at Penn State, off-the-shelf orthotics, regardless of rearfoot posts, led to increased electromyographic activity of the vastus medialis and gluteus medius muscles, suggesting that the sensory, not the mechanical, effects of the orthotics led to positive changes in lower extremity neuromuscular activity. Similarly, both off-the-shelf and custom orthotics have been shown to

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improve postural control, a measure of neuromuscular function. Also emphasizing the importance of the sensory effect of orthotics is the finding that orthotic comfort is significantly related to the kinematics, kinetics, and neuromuscular activation patterns during gait. Benno Nigg, PhD, Director of the Human Performance Laboratory at the University of Calgary, proposes a new paradigm to explain the effect of orthotics on motion control. He states that forces acting on the foot during the stance phase of gait provide an input signal producing a muscle reaction. The orthotic is thus a tool that may be manipulated to influence the cutaneous receptors on the plantar aspect of the foot as well as the articular and musculotendinous receptors of the lower extremity. Sensory changes can alter motor patterns in either a positive or negative manner. If the adaptation process causes a preferred joint movement path for a given movement task, muscle activi-

ty will decrease. If an intervention counteracts the preferred movement path, muscle activity must be increased. An optimal orthotic will reduce muscle activity and optimize lower extremity function. Further research, however, is needed to validate this intriguing hypothesis. CLINICAL USES

While the research continues on both the biomechanical and neuromuscular aspects of orthotics, athletic trainers can be confident of the devices’ effectiveness in the treatment of a variety of lower extremity conditions: Lower Leg Pain: Perhaps the most common use of foot orthotics is to control hyperpronation, which has been linked to increased incidence of injuries, including medial tibial stress syndrome (shin splints). Excessive foot pronation is often caused by structural malalignments of the foot such as forefoot varus, pes planus, or rearfoot valgus. Thus, orthotics designed to limit excessive

Healthier Feet. Better Training. Superfeet offers a complete line of orthotics to help keep your clients healthier when training or competing. All of our orthotics offer total foot support to: • Control over pronation and improve balance • Enhance endurance • Improve shock absorption • Aid injury recovery • Help prevent repetitive use injuries • Proven for over 27 years

TREATING THE ATHLETE

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hyperpronation aim to do one of three things: control forefoot motion, increase arch support, or control rearfoot motion. Control of forefoot motion in an individual with forefoot varus is typically accomplished by adding a medial post to the orthotic at the level of the metatarsal heads. This is done in an effort to provide a mechanical block to excessive forefoot pronation. Athletes with pes planus need increased support of the medial longitudinal arch to limit hyperpronation. This may be done with a variety of materials including foam, felt, rubber, or plastic. Medial posts of the rearfoot will help to limit hyperpronation in patients with rearfoot valgus. Limiting the range and velocity of pronation through increased medial support is thought to reduce strain of the posterior tibialis and soleus muscle origins on the posteromedial aspect of the tibia. The clinical efficacy of foot orthotics in the treatment of lower leg pain related to hyperpronation has

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been long-established, but some practitioners are also recommending the prophylactic use of custom orthotics. A study among military recruits showed that using orthotics on healthy subjects proved to be beneficial in the prevention of lower extremity stress fractures. Another use for orthotics in the treatment of lower leg pain involves athletes who have suffered stress fractures but have limited foot pronation. Athletes with rigid pes cavus, or high, arched feet do not dissipate as much shock through their arches as do athletes with more flat and less rigid arches. This places them at increased risk of lower leg stress fractures as the tibia and fibula must then absorb more shock during the stance phase of gait. These athletes often benefit from using flexible orthotics made of very compliant materials that absorb shock. Patellofemoral Pain: Using orthotics also works well to help treat chronic patellofemoral pain. Like with

treating lower leg pain, the clinical rationale is that the orthotic will limit hyperpronation. By limiting foot pronation, internal rotation of the long bones of the leg is also reduced. Historically, patellofemoral pain has been linked to abnormal lateral tracking of the patella in the distal femoral groove. But a more contemporary theory suggests that too much internal rotation of the femur is actually the culprit. This leads to a femur that is rotated too far medially and a patella that then rubs against a more prominent lateral femoral condyle. One study, conducted by Janice Eng, PhD, and Michael Pierrynowski, PhD, and published in Physical Therapy in 1993, focused on female adolescents suffering from PFPS with greater than six degrees of rearfoot valgus or forefoot varus. All the girls were subject to a supervised rehabilitation program that emphasized strengthening and flexibility exercises

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for the quadriceps and hamstring muscles. Half the subjects were also treated with soft orthotics with appropriate medial forefoot and rearfoot posts to help limit hyperpronation. Both groups demonstrated improvement in symptoms over eight weeks, but the group treated with the orthotics had significantly greater reduction in symptoms than the control group. The authors speculate that the benefits of using orthotics in the treatment of PFPS are derived from altering the biomechanics associated with hyperpronation at the tibiofemoral and patellofemoral joints. Lateral Ankle Sprains: Use of foot orthotics in the treatment of lateral ankle sprains is less commonly advocated than with lower leg and knee pain, but it is an area that is gaining interest. Some recommend laterally posted rearfoot orthotics, while others suggest using neutral orthotics with no posts. Laterally posted orthotics are hypothesized to work via a mecha-

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nism opposite that of medially posted orthotics. Since the mechanism of injury for lateral ankle sprains is hypersupination (comprised of excessive plantar flexion, inversion, and internal rotation), an orthotic that limits hypersupination would prevent the rearfoot from returning to the position in which the lateral ligaments were injured. Laterally posted orthotics limit hypersupination rather than hyperpronation. The use of a neutral orthotic in the treatment of lateral ankle sprains is advocated for maintaining the subtalar joint in the midrange of its range of motion, which keeps the ankle away from the extremes of both hyperpronation and hypersupination. This is thought to reduce the strain on the healing ligaments that support the subtalar joint including the calcaneofibular, cervical, and interosseous ligaments. When might you use the two different types? Although this is only our anecdotal experience, we’ve found that

athletes with pes planus will respond better to neutral orthotics, whereas those with normal foot structure or pes cavus respond better to lateral posts. Another idea is to use rearfoot orthotics as an intervention to improve postural control in ankle injured subjects. Rearfoot orthotics are hypothesized to stabilize the subtalar joint and thus provide a more stable base of support. One study found that patients suffering from acute lateral ankle sprains who wore orthotics had better balance and less pain while jogging than those who did not wear orthotics. Another study found that athletes recovering from acute ankle sprains demonstrated less postural sway during single leg stance when they were prescribed foot orthotics versus a group not prescribed foot orthotics. Overall, there is not enough empirical evidence yet to support or refute the efficacy of foot orthotics in the treatment of lateral ankle sprains, but these studies show promise.

TREATING THE ATHLETE

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HOW TO CHOOSE

There is still much that is not known about the exact workings of orthotics. The mechanism by which orthotics work is most likely a combination of biomechanics and neuromuscular effects, but the specific contribution of each component is unknown. In addition, there are no rules about when to use off-the-shelf orthotics and when to have them custom-made. Our recommendations: Consider using orthotics when rehabilitating athletes with lower extremity injuries and consider using them as a prophylactic measure if the athlete has suffered a previous injury that was likely caused by hyperpronation, or in the case of stress fracture, too little pronation. If cost is a factor, starting with an off-the-shelf model is justified before getting a prescription for a custom-made orthotic. ◆ For a copy of references for this article, please go to www.AthleticSearch.com/footrefs.

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▼

DOWN THE MIDDLE

David Crane

Utilize your football athletes’ warmup time more effectively with these partner core stretches. ne of the greatest challenges facing today’s coaches is organizing strength or conditioning sessions that involve a large group of athletes. Ideally, a strength coach wants to give as much individual attention as possible during workouts, but in a large group setting, that can be difficult. However, that’s no excuse for shortchanging your strength program. With a little creativity, almost any goal can be accomplished, no matter how large the group of athletes. It is not necessary to accept a lower-quality workout simply because multiple athletes are involved in an activity. Recently, our challenge was to create a series of exercises for a team of high school football players that could

By Gray Cook, Heath Hylton, and David Lee

be accomplished during their warmup and would make the most effective use of their limited time. In response, we created a group of core training partner exercises that can be done on the field with limited supervision. The focus of the exercises is on strengthening the core, a key element for football athletes. A strong core enables both mobility and stability of the body and helps prevent injuries, asymmetries, and muscle imbalance. Because core training is so important for the football athlete, it must be continued throughout the season. Making these exercises a consistent part of the warmup allows the core to maintain its strength up to the very last game. It was also critical to design the exercises based on functional movement patterns, not isolated muscle training. Football athletes will sometimes be skeptical about exercises that don’t have

weights on them, so it is important to explain to them that simply becoming stronger will not yield a better movement pattern. They must develop a combination of strength, stability, joint mobility, and muscular flexibility, which happens through functional drills. Why are core training partner exercises an effective use of time? First of all, by making them part of the warmup, we accomplish two goals at once. Often, time is wasted during the warmup as players loosen up and get ready for practice in a haphazard way. But this is valuable time that can contribute to the Gray Cook, MSPT, OCS, CSCS, is Clinic Director, Heath Hylton, PTA, CSCS, is Clinic Coordinator, and David Lee is an Exercise Physiologist at Orthopedic & Sports Physical Therapy, Dunn, Cook, and Associates, in Danville, Va. Cook is also the author of Athletic Body in Balance, published by Human Kinetics. A special thanks to the Pittsylvania County (Va.) high school coaches for their continual support of and feedback on our programs.

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▼ overall development of the athlete. This program gives structure and meaning to the first 10 to 15 minutes of on-field warmup activity. They are also time-efficient because they use a partner system, which enables the strength coach to occupy all individuals on the field in a session. While half are doing the exercise, the other half are learning more about the exercise by helping their partner. This cuts down on distraction. It also cuts down on the level of supervision needed, as coaches only need to watch half the number of athletes performing the specific move. Of course, partnering also provides a necessary rest break for the individual who is not performing the exercise. This

is not to say that the individual is totally resting. It is an active rest where the level of intensity is not that of the partner, but he is actively watching, participating, and paying close attention to detail. In the following text, we describe several exercises that we developed for this program—all of which can be performed at varying degrees of difficulty. They are based on what we call the Functional Movement Screen™ (Please see “Weak Links” in T&C April 2002 for more detail) and focus on movement patterns like the squat, hurdle step, lunge, push-up, and active straight-leg raise. These are the movements we feel help athletes most effectively elongate muscles and activate the core.

DEEP SQUAT SHOULDER STRETCH PURPOSE: To improve deep squat and shoulder mobility movement patterns. INSTRUCTIONS: The deep squat shoulder stretch incorporates the mobility maneuver needed in the lower extremities to execute a deep squat with the heels flat. Since athletes have varying degrees of ability with a full deep squat, the partner stands with one leg supporting the low back and buttocks region and encourages the squatting athlete to lean forward as much as possible and then to erect the spine in an upright tall spine position. This will engage the core. Once a complete deep squat has been executed, the squatting athlete is cued to press the knees outward using his elbows to create an adductor stretch. He is told to hold the knees in this position and maintain this abducted position of the hips while reaching upward, first with the right arm and then with the left. The partner gives an upward pull or traction stretch and the athlete performing the stretch is encouraged not to let the knee cave in on the side of the stretching arm. NOTE: The arm is not pulled backward. It is pulled upward, thus creating a safe shoulder stretch for the lats and pecs. HALF-KNEELING ROTATION MOBILITY AND STABILITY PURPOSE: To improve lunge, rotary stability, and shoulder mobility movement patterns. INSTRUCTIONS: Both athletes get into a half-kneeling position with the left knee up. One person puts his arms in a “T” position with shoulders abducted 90 degrees. The partner then performs a mobility assist by rotating the first person’s shoulders left and right to 90 degrees while the athlete is instructed not to allow any rotation at the hips or pelvis. They are cued to stay as tall as possible and keep the hip of the back leg extended as much as possible throughout the stretch. The sequence is reversed and the other partner then performs the same stretch. Once both athletes have stretched in a left and right direction, the knee position is reversed. Next, the athletes get into a push-hands position in the center of their bodies and execute an isometric rotation into each other while stabilizing their hip and shoulder position and keeping the spine as tall as possible. They are told to push as hard as possible without losing balance and then to perform the same movement with the opposite hands. The half-kneeling position is then switched to the opposite knee. 44 ◆ T & C J U L Y / A U G U S T 2 0 0 4 ◆

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One thing to note is the importance of matching athletes with partners of equal size, strength, and flexibility. This creates a fair level of competition and provides more consistent feedback between partners. It is important to give the partner an active role with respect to support, spotting, and the opportunity for feedback and technique modification. The partner is almost assuming the role of assistant coach. You should make it clear to the athletes that if a bad set is observed, it is the fault of the partner as much as the exercising athlete. It is important that both individuals feel ownership of the drill even though one will obviously be working his muscles harder.

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▼ STABILITY STRIDE PURPOSE: To improve hurdle step and trunk stability push-up movement patterns. INSTRUCTIONS: The athletes assume a wheelbarrow position where one athlete is in the push-up position and the other holds the partner’s ankles at the level of his hips with a slight knee bend. The supporting athlete can take a stride position to narrow his base and allow for easy cycling action of the legs. The athlete in push-up position cycles each leg, one at a time, toward his chest and back. He must maintain a flat back and a stable core with a head-up position and tuck the right hip as the supporter releases the ankle of the right leg. The athlete is instructed to bring his hip as close to his chest as possible followed by extending it back to the start position and quickly pulling the left leg into the same position. The goal is smooth, quick leg speed while maintaining a stable trunk. The supporter is encouraged to use quick hand action to alternate supporting each leg as the active athlete goes through this stride position. MODIFICATIONS: The athlete exercising can widen or narrow his hand position to change the level of difficulty or go to a prone-on-elbows position to reduce upper-body stress. PLANK POSITION CRUNCH PURPOSE: To improve trunk stability and push-up shoulder mobility movement patterns. This exercise serves to demonstrate to athletes that the spine has both stabilizing and mobilizing roles. The muscles of the spine can either hold the trunk stable or create a curl or twist action. INSTRUCTIONS: One athlete assumes a push-up position (plank position) with the other athlete lying across his back perpendicularly. The athlete on top is instructed to do crunches in the same fashion he would do over a stability ball (full flexion and extension). MODIFICATIONS: The athlete in the support position holding his push-up position can modify his position if he becomes weak by going to a quadruped position. SIDE BEND SHOULDER STABILITY To improve rotary stability, shoulder mobility, and trunk stability push-up movement patterns. INSTRUCTIONS: The athlete performing the exercise assumes a side-lying position on the elbow with the forearm flat and palm down. The partner assumes a quarter-squat position holding the ankles. The athlete on the ground is instructed to elevate the hips up and through until an erect and straight spine can be observed. This move is performed both on the left and right sides. MODIFICATIONS: The athlete doing the side bend can stabilize with the top arm by gripping the wrist on the ground. This will reduce the natural shoulder twist that occurs with the move. PURPOSE:

TRUNK STABILITY SHOULDER PRESS To improve stability push-up, rotary stability, shoulder mobility, and deep squat movement patterns. This also provides a double quadriceps stretch for the partner. INSTRUCTIONS: One athlete holds a push-up position while his partner places that athlete’s ankles on his shoulders while in a tall kneeling position. The supporting athlete keeps the hips as far forward as possible, getting a slight anterior thigh stretch, and then performs a shoulder press holding the ankles of the athlete in push-up position. The athlete in push-up position is instructed to keep a straight and erect spine throughout the entire movement. PURPOSE:

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▼ HIP LIFT WITH PLYO LEG RAISE PURPOSE: To improve hurdle step and active straight-leg raise movement patterns. INSTRUCTIONS: The first athlete lies on his back with his head between the feet of his partner and holds the lower ankle and heel on each side. The athlete on the ground performs a bridge by lifting his buttocks with the knees in a 90 degree flexed position. He then extends one leg and lifts it in a straight-leg position coming backward toward the standing partner. As soon as the leg reaches its full range of motion, the partner pushes the leg downward in a brisk, shoving motion with one arm. The athlete slows down the lower extremity, changes direction, and brings it back upward again. This is done on each side. While performing this exercise, the athlete on the ground is instructed to maintain a hip lift position and not lose hip extension during the leg cycle lift activity. EXTENSION PRESS To improve rotary stability and shoulder mobility movement patterns. INSTRUCTIONS: One athlete sits with his arms supporting him from behind and lifts the legs so that the supporting athlete can hold both the ankles in a quarter-squat position. The athlete on the ground is instructed to press the hips upward until the spine is as straight as possible and to keep the chest up and shoulders back. MODIFICATIONS: The athlete doing the press can go to an “on elbows” position to reduce arm and shoulder stress. ◆ PURPOSE:

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Request No. 131

Heat Stress Prevention

UNDERSTANDING HEAT ILLNESS Heat Stress can appear in many different forms, and it’s important to understand the differences in order to keep your athletes safe. By: Greg Scholand Preventing heat stress is an important responsibility that should always be a top priority for athletic trainers and anyone else who is responsible for athletes’ welfare. High-profile instances of heat illness resulting in serious injury or death at the high school, college, and pro level have opened the eyes of the sports world to the importance of keeping athletes safe during strenuous outdoor activity. In order to keep heat stress from posing a threat to your athletes, it’s essential that you understand the different types of heat illness, what

causes them, and how they can be prevented. The Inter-Association Task Force on Exertional Heat Illnesses, a group spearheaded by the National Athletic Trainers’ Association, issued a consensus statement in June of 2003 outlining the various types of heat illness and how they should be addressed. The statement breaks down the different types of heat illness as follows: Dehydration occurs whenever an athlete loses fluids at a faster rate than he or she replaces them. Dehydration is prob-

lematic not just because of its negative effects on athletic performance, but also because it can interfere with the body’s ability to maintain normal temperature during prolonged strenuous activity. The easiest way for athletes to avoid dehydration is very simple—they should hydrate themselves adequately before, during, and after exercise, especially in adverse weather conditions. Heat Cramps are a common form of heat illness often accompanying dehydration, and they can be very debilitating for exercising athletes. While not fully

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Heat Stress Prevention understood, cramping is thought to result from the depletion of both fluid and sodium through sweat during strenuous activity. Research has shown that some athletes are chronically more prone to cramping than others, and this may be due to habitually insufficient salt intake through diet along with higher than normal salt concentration in sweat. Heat cramps can be treated and prevented by replacement of lost fluids and sodium through sports drinks

(which can have salt added to increase sodium content), along with stretching and treatment of the affected muscle area. Using sports drinks instead of water to replenish fluids can also help to prevent Hyponatremia, a condition in which excessive water intake coupled with high sodium loss dilutes the sodium in an individual’s bloodstream to an unsafe level.

Heat Exhaustion is a more serious form of heat illness, caused by dehydration combined with strenuous exercise in warm or hot weather conditions, and resulting in difficulty sustaining physical activity, decreased overall performance, and elevated body temperature. Heat exhaustion can be prevented by adequate hydration and by providing frequent breaks during strenuous activity, especially in hot, humid conditions. It’s important to remember that factors like the amount of padding worn and exposure to sunshine contribute to increased body temperature as well, and so they can make athletes more susceptible to heat exhaustion. Exertional Heat Stroke is a severe form of heat illness that can cause serious bodily harm or even death. Strenuous exercise combined with a hot, humid environment causes body temperature to rise dramatically (typically to 104˚F or above) and results in nervous system dysfunction, which may include disorientation, convulsions, or lost consciousness. Heat stroke must be treated immediately and aggressively by cooling the body as quickly as possible, ideally with cold water immersion. It is also essential that medical attention be provided as soon as possible, as serious complications such as organ failure and tissue damage may occur.

Introducing the QUESTemp° Series n today's ultra competitive sports environment, managing the health and safety of athletes is paramount to winning. Exertional heat illnesses inhibit an athlete's ability to perform at peak levels, threatens their life safety and exposes your organization to potentially significant liabilities. Quest Technologies is the world leader in heat stress monitoring technologies that allow accurate, real-time understanding of environmental and physiological conditions

that directly affect an athlete's ability to stay healthy and compete successfully. Quest Technologies offers a total solution including monitors on a purchase, rental and rent-to-own basis as well as on-site educational seminars on the subject of heat stress. To learn more, call 1-800-245-0779 or visit our web site at www.Quest-Technologies.com.

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The best strategies for keeping athletes safe from all forms of heat stress, particularly when they will be active in a hot, humid environment, incorporate proper hydration, adequate rest periods, access to shade and/or air conditioning, and careful monitoring of health and performance. Athletes must be actively discouraged from feeling that they should “suck it up” if they feel fatigued, nauseous, overheated, or unable to continue exercising. A plan should also be in place for treating athletes who are showing signs of heat stress, and it should address both onsite treatment and ready access to emergency medical care.

Heat Stress Prevention Acumen, Inc. 800-852-7823 WWW.ACUMENINC.COM Acumen’s Hydra-Alert allows users to concurrently monitor radiant body temperature, heart rate, and humidity to accurately gauge fluid loss during physical activity. Athletes and fitness enthusiasts often fail to properly re-hydrate themselves during and after exercise, and dehydration negatively affects physical performance. Hydra-Alert’s unique features include fluid check, a heat-index monitor, and the ability to prompt users to re-hydrate with an appropriate quantity when necessary. All this helps users maintain proper hydration, achieve maximum performance, and avoid heat stress-related injuries. Circle No. 200

Cool Draft Scientific 866-676-1636 WWW.COOLDRAFT.COM Heat stress is a major concern among

coaches and trainers. Keep your players up and running with the Cool Draft. The portable Cool Draft reduces temperatures up to 30˚. Many NFL, college, and high school football teams around the country use this system. The 18-inch fan produces 5800 CFM of fan-propelled mist. For eight years the Cool Draft has evolved to become one of the most portable and dependable misting systems on the market. To learn more about heat stress, call or visit the company's Web site. Circle No. 201 For 2004, Cool Draft Scientific is launching the long awaited Evolution line of high pressure misting fans. Now your school can afford the same high-quality misting systems used by NFL and college teams. Cool Draft Evolution is a complete line of high-pres-

sure misting fans designed for sidelines and practices. The Evolution was built to meet the needs and budgets of high schools and colleges. Call or visit Cool Draft's Web site for information and pricing. Circle No. 202

CoreControl 888-AVACORE WWW.AVACORE.COM Training and competing in extreme conditions can affect even the most cautious athlete. The portable, non-invasive CoreControl™ cools athletes from the inside out by extracting heat through “thermal portals” in the hand. This innovative method accelerates core body cooling rates, working 200% faster than conventional skin surface cooling methods. CoreControl can be used anywhere to keep athletes safe from the health risks of heat stress, while also enhancing work capacity and endurance. Circle No. 203

Request No. 134

Heat Stress Prevention Energice 888-467-9499 WWW.ENERGICE.NET Heat stress dehydration is one of the greatest challenges for competitive athletes, Athletic Trainers and Strength & Conditioning Coaches. Energice® is a revolutionary product that goes beyond ordinary rehydration benefits. By synergistically addressing rehydration needs, core body temperature cooling, and post exercise muscle recovery, Energice enables athletes to train harder longer and come back faster. Energice combines a key amino acid matrix, valuable mineral electrolytes, and antioxidant vitamins in a refreshing frozen delivery system. Circle No. 204

Extech Instruments 781-890-7440 WWW.EXTECH.COM Heat stress has become a growing concern for recreational and competitive sports enthusiasts. Athletic trainers, coaches, and physical education teachers are particularly concerned about the combination of temperature and humidity

that may become dangerous to their athletes. The HeatWatch™, with its user-set heat index alarm, is a new, patented, fully-featured, multifunction, professional stopwatch which also displays day, date, time, temperature, relative humidity, and calculated heat stress index. Circle No. 205

HQ, Inc. 941-721-7588 WWW.HQINC.NET Assessing core temperature on the field is critical for the prevention of exertional heat illness. The CorTemp™ Core Body Temperature Monitoring System, featuring the CorTemp ingestible temperature pill, recognizes elevated core temperature during practices and games, enabling the ATC to act quickly if heat illness treatment becomes necessary. The patented pill wirelessly transmits the athlete’s temperature harmlessly through the body to the

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CorTemp ambulatory data recorder, held by the ATC. The ATC gains immediate knowledge as to the vital physiological status of athletes wirelessly, comfortably, and with the highest degree of accuracy—every time. Circle No. 206

Mini Mitter Co., Inc. 800-685-2999 WWW.MINIMITTER.COM VitalSense® is a new wireless system that allows for continuous, reliable, accurate monitoring of core-body and skin temperatures of athletes in hot weather. Core temperatures are transmitted every few seconds from a swallowable Jonah™ capsule, while skin temperatures are monitored with adhesive patches. Both transmit data to a VitalSense monitor, which, in Medic Mode™, can receive data from all sensors in range. Circle No. 207

Quest Technologies, Inc. 800-245-0779 WWW.QUEST-TECHNOLOGIES.COM Exertional heat illnesses inhibit an athlete’s ability to perform at peak levels, threatens their safety, and can expose an organization to unprecedented liabilities. Quest’s environmental monitors enable athletic trainers, coaches and sports medicine researchers to obtain comprehensive and accurate information in real-time, display and record correlated core temperature and heart rate, and provide real-time alerts and time history profiles of measured data that directly affect an athlete’s safety and performance. Circle No. 208

RG Medical Diagnostics 888-596-9498 WWW.RGMD.COM RG Medical Diagnostics has introduced the DataTherm® continuous temperature monitor for use by sports medicine professionals in the diagnosis and treatment of Extertional Heat Illnesses (EHI) and Exertional Heat Stroke (EHS). The DataTherm, a compact (1.7 oz.) data processor, continuously displays and records in memory an athlete's body temperature in real time. The instrument, priced under $200, is packaged in a hard case and is supplied with a full array of accessories. Circle No. 209

Ankle & Footcare Aircast, Inc. 800-526-8785 WWW.AIRCAST.COM The AirHeel™ from Aircast®, Inc., is specifically designed to relieve the pain associated with plantar fasciitis and Achilles tendonitis through dynamic functional treatment. With each step, the Aircast AirHeel provides intermittent compression through an aircell under the plantar arch interacting with an aircell surrounding the Achilles tendon. The pulsating compression from these aircells helps minimize swelling and discomfort, and promotes fast pain relief. Circle No. 212

anatomically designed shells lined with the patented Duplex™ aircell system. This exclusive system provides both support and graduated compression to promote efficient edema reduction and help accelerate rehabilitation. Each Ankle Brace comes with a patient guide providing information on brace application and rehabilitation exercises. Circle No. 213

Cropper Medical, Inc. 541-488-0600 WWW.BIOSKIN.COM

Since 1978, the Aircast Air-Stirrup Ankle Brace has been the "standard of care" for the functional management of ankle injuries. Aircast Ankle Braces feature

Secure Footing Value Pricing Designed to fit either right or left foot, the PRO 610 Arizona Ankle Brace is constructed of heavy duty nylon for a low-profile, durable and lightweight brace. Two straps encircle the foot in a figure eight pattern providing easily adjustable lateral and medial support. A neoprene tongue provides a comfortable pad under the laces. Used by thousands of athletes from the pro's to high school, this low-profile brace will not change your shoe size. All for $14.95.

The TriLok™ from Cropper Medical secures ankle motion without restricting plantar-flexion or dorsi-flexion. With a patent-pending soft design, the TriLok is also compact enough to fit

comfortably in your shoe. Patented Bio Skin® material also provides optimal proprioceptive feedback. The TriLok is being used in clinics, on playing fields, and in gyms across America. It is functional, comfortable, and effective—the most effective and versatile brace to replace taping. Circle No. 214

Cho-Pat, Inc. 800-221-1601 WWW.CHO-PAT.COM The Achilles Tendon Strap helps alleviate the pain and discomfort associated with achilles tendonitis. It reduces strain on the tendon by spreading muscular contraction and promoting early heel rise. Developed in cooperation with the Mayo Clinic, this patented strap is used by many sports medicine professionals, who recognize it as an effective addition to the traditional achilles tendonitis treatment procedures. Circle No. 215

Stabilize Chronic Shoulder Dislocators, Separators, and Subluxators With over a decade of experience in shoulder brace design the MAXTM Shoulder Brace by Brace International, Inc. is an evolution in shoulder girdle support. The snug-fitting, lightweight material (under 2 pounds) allows for comfort with movement while its strap design system allows for many options to help protect the glenohumeral joint. Maximum Protection, Maximum Range of Motion

We highly recommend its use for all sports.

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Request No. 137 A T H L E T I C B I D . C O M ◆ T & C J U L Y / A U G U S T 2 0 0 4 ◆ 53

Ankle & Footcare Cramer Products, Inc. 913-856-7511 WWW.CRAMERSPORTSMED.COM Cramer's new AS1 Ankle Brace combines the support of a heel-lock strapping system and superior value versus comparable ankle braces. The brace is constructed with an 840 D nylon shell with a soft neoprene liner for comfort and feel. Nonstretch straps lock in the heel and spring steel stays on each side of the brace provide additional support. Circle No. 216

Foot Management, Inc. 800-HOT-FOOT WWW.FOOTMANAGEMENT.COM The Ortho Arch® Custom Orthotic, manufactured from a durable and long-lasting material called E.V.A., is a semi-rigid orthotic designed to fit easily into the shoe. The orthotic is less bulky and lighter in weight than other semirigid devices. The Ortho Arch aids in shock absorption, pressure relief, and biomechanical control, while remaining flexible, allowing the foot to be a mobile adapter. This Foot Management orthotic can tolerate all weather conditions. Circle No. 217 The Tenderfoot® Medium Custom Orthotic from Foot Management is manufactured from a high-density foam. It is designed for the patient who desires a high level of cushioning as well as a degree of support and control. This orthotic can tolerate all weather conditions. Tenderfoot Firm and Tenderfoot Soft orthotics are also available. Circle No. 218

Jump Stretch, Inc. 800-344-3539 WWW.JUMPSTRETCH.COM Jump Stretch, Inc. founder Dick Hartzell has perfected a way of treating ankle sprains that gets the athlete up and running (literal54 ◆ T & C J U L Y / A U G U S T 2 0 0 4 ◆

ly) within minutes or hours, rather than weeks or months. Hartzell contends that RICE is antiquated, and the Rest and Ice actually prolong the healing process. A video detailing the tractioning technique is available for $15. Three Flex Bands® (one average and two mini) are necessary to perform the treatment. Circle No. 219

Kelly Kinetics 888-645-3559 WWW.KELLYKINETICS.COM Kelly Kinetics has introduced the Pivot Plate, which utilizes a patented Variable Offset Pivot (V.O.P.) system. To increase or decrease the neuromuscular demand, the fulcrum can be placed at varyingmoment arm lengths. The fulcrum can also be selectively placed in the best biomechanical position to target select musculature for strengthening. Unlike with traditional balance boards, the Pivot Plate user is affixed to the platform, which allows the user to vary their center of gravity position for a range of resistance levels. Circle No. 220 The Ankle Isolator™, from Kelly Kinetics, combines an adjustable weighted column that provides a unique resistive torsion and proprioceptive feeling with a patented biomechanical isolation channel that allows for precise placement of the resistance over the insertion of the targeted musculature. Whether it's post-injury or preventative strengthening, stretching, or manipulation, this versatile non-weight-bearing device can be easily adjusted in half-pound increments to accommodate both early-stage patients and fully functional athletes. Circle No. 221

McDavid Sports Medical Products 800-237-8254 WWW.MCDAVIDINC.COM The #188 Ultra Ankle from McDavid

ATHLETICBID.COM

Sports Medical Products is a professional quality hinged ankle brace designed to treat all ankle injuries including high ankle sprains. Engineered to reduce the excessive inversion, eversion, and rotation that causes most ankle injuries, Ultra Ankle incorporates advanced features that make it superior to other hinged ankle braces. Those features include the patented LDC (Lock Down Cuff) Technology with a pivoting posterior cuff that helps reduce excessive rotary forces. The thermal responsive molded pad system provides optimum comfort and fit. The adjustable quick-fit Lock Down Strap allows for quick application and removal. Circle No. 222 McDavid Sports Medical Products offers the #195 Ultralight Ankle Brace. This top quality product features a lightweight nylon/vinyl fabric with stirrup straps that may be adjustable at anytime during play without removing the shoe. These straps simulate a professional taping technique that lends additional support and protection for common injuries. Other support and comfort features include: a padded lining, notched front, elastic heel and tongue, and a sewn-in arch support. Circle No. 223

Medical Specialties, Inc. 800-582-4040 WWW.MEDSPEC.COM The ASO® ankle stabilizing orthosis, from Medical Specialties, is a patented ankle stabilizer that can be worn either preventively or during the treatment of an acute ankle sprain. Features include "figure 8" stabilizing straps and an elastic cuff design that provides superior functionality and support. The finger pulls allow for quick adjustments and continual support. The ASO is made from ballistic nylon and the low-profile design fits easily inside the shoe. Circle No. 224

Ankle & Footcare Mueller Sports Medicine 800-356-9522 WWW.MUELLERSPORTSMED.COM The new ATF® Ankle Brace from Mueller Sports Medicine features the patented inner ATF® Strap now redesigned to self adjust to each individual foot for a universal fit. The brace offers superior protection against inversion sprains while allowing complete plantar and dorsal flexion. Bidirectional stretch elastic over the Achilles tendon area, Comfort Windows™, and flexible steel springs add to the effectiveness of this brace. The high-strength cordura fabric eliminates the need for metal eyelets and adds to the comfortable custom fit. Available in sizes XS -XL. Circle No. 225

OPTP 800-367-7393 WWW.OPTP.COM The Resting Foot Sling from OPTP is a lightweight, comfortable positioning sling designed to place the foot perpendicular or slightly dorsiflexed for passive prolonged stretching of the lower leg and foot. The Resting Foot Sling was developed by a physical therapist and may be used to treat plantar fasciitis, achilles tendinitis, or general stretching. It is an excellent alternative to expensive molded night splints. The Resting Foot Sling can be worn while sleeping, lying, or sitting down. It should not be worn or used for walking. Circle No. 226 The versatile Multi Challenge Board from OPTP is designed to offer an extra degree of challenge as user proficiency increases. A simple twist adjustment increases the board angle from 14 degrees to 17 degrees. Use the OPTP Multi Challenge Board for active and reactive rehabilitation of ankle injuries, core muscle conditioning and stabilization, stretching, improved proprioception and

balance, and motor skill training, as well as ROM and strength conditioning for the lower kinetic chain. Circle No. 227

Pro-Tec Athletics 800-799-3372 WWW.INJURYBEGONE.COM Tired of Achilles tendon pain? Pro-Tec Athletics has the answer with the Achilles Tendon Support. This Achilles Tendon brace offers comfortable compression to stabilize the tendon and reduce stress. It also features an elastic strap, which provides a lift to the heel, preventing excessive stretching to the tendon. Comfortable and effective, the Achilles Tendon Support will help prevent further damage and enhance the healing process, allowing your athlete to get back into competition sooner. Circle No. 228 Pro-Tec Athletics also offers the Arch Support. The Arch Pro-Tec applies upward compression to the arch, alleviating conditions of plantar fasciitis and heel spurs. Circle No. 229

Until recently, most people believed that power athletes were born and not made.

That’s changed. Modern training techniques can make anyone faster, stronger, and more powerful. ISSA’s Specialist in Sports Conditioning and Youth Fitness Trainer programs have been designed to provide you with the knowledge, expertise, and specific training techniques necessary to enable athletes to expand the capacity of their bodies to perform the most difficult athletic feats, while remaining strong and free from injuries. Written by Professor and champion athlete Thomas D. Fahey, PhD, ISSA’s SSC and YFT programs equip you to properly and effectively train athletes and open the door to a new and profitable client base.

Call today for FREE information

1.800.892.4772

Please mention source code TC804

FitnessEducation.com

Tekscan, Inc. 800-248-3669 WWW.TEKSCAN.COM The F-Scan® Mobile system, from Tekscan, is used to enhance the technique and performance of your players by improving weight transfer and timing during various activities. By placing paper-thin insole sensors inside the shoe or cleat, you can record subtle differences in bi-pedal plantar pressures. The information can be used to fine-tune technique, benchmark performance, optimize stance and positioning, evaluate cleat and orthotic efficacy, and re-train after injury. The lightweight system won’t interfere with normal activity so you can capture data virtually anywhere, for any activity. Circle No. 230

GI Bill Approved

Request No. 138 A T H L E T I C B I D . C O M ◆ T & C J U L Y / A U G U S T 2 0 0 4 ◆ 55

Aquatic Therapy Ferno Performance Pools 888-206-7802 WWW.FERNOPERFORMANCEPOOLS.COM Transform a traditional swimming or lap pool into an aquatic exercise environment with the Ferno AquaGaiter™ Underwater Treadmill. Combining traditional treadmill training with the natural properties of water such as buoyancy, resistance, and heat, the AquaGaiter is perfect for a low-impact workout. The AquaGaiter features variable speed adjustments ranging from .5 to 8 mph for any level of conditioning. The AquaGaiter provides athletes the ultimate water workout by strengthening muscles and reducing joint impact. Circle No. 232 Ferno offers over 250 custom and fiberglass therapy, rehabilitation, and fitness pools. With various sizes, depths, and custom configurations available, Ferno offers a pool for every facility. Add an underwater treadmill, aquatic bike, or highresistance therapy jets for the ultimate low-impact workout or therapy session. Other accessories include pool lifts, benches, and exercise bars. Ferno pools include professional installation by factory technicians. Maximize your athletes’ performance with Ferno Performance Pools. Circle No. 233

Perform Better 800-556-7464 WWW.PERFORMBETTER.COM Perform Better offers Aquajogger, the deep water exercise belt that is adjustable and helps you to stay upright during an aquatic workout. Use it for cardiovascular training, rehab from injury, or simply as a supplemental workout with low-impact resistance training. It takes the stress off joints. It is available in men’s and women’s models and a spe-

56 ◆ T & C J U L Y / A U G U S T 2 0 0 4 ◆

cial model for those weighing over 200 lbs. Aquajogger is part of the 2004 Perform Better collection. Circle No. 234

Power Systems, Inc. 800-321-6975 WWW.POWER-SYSTEMS.COM Use Eco Bells and Bar Float from Power Systems on top of the water for buoyant support and stabilization. Use the products underwater for resistance. They feature open-cell foam, and are heat sealed for soft, comfortable feel. The products have sturdy construction with a cushioned handgrip and offer three resistance levels for versatility. The Bar Float is a longer version (27” long) of the “heavy” Eco Bells. An illustrated exercise guide is included. Contact Power Systems foor more information on all of its products and programs. Circle No. 235 Reduce strain and stress on the body and perform exercises you might be unable to do on land with the Water Runner Flotation Belt from Power Systems. During long vigorous workouts, individuals who are overweight or have joint/muscle pain due to injuries cannot complete dynamic tasks due to the high demands being placed on their body. In weight loss or rehabilitation exercises, individuals need to be able to reduce the amount of stress being placed on their body while also be challenged so that they can get the results they need and desire. The Flotation belt allows individuals to exercise and rehab injuries at a high level of intensity without overloading the body’s physical ability/limits. Power Systems offers a complete line of Aquatic Training equipment to fit your needs. Circle No. 236

SwimEx Systems 800-877-7946 WWW.SWIMEX.COM Simulating the elliptical motions of running, the SwimEx Hydrorunner™ is the first aquatic machine of its kind. With adjustable resistance, incline, and footplate positions, the SwimEx

ATHLETICBID.COM

Hydrorunner is perfect for aerobic group activity, circuit training classes, athletic training programs, and rehabilitation conditioning for recovery of the lower limbs. Retails at $3,000. Circle No. 237 The SwimEx Hydrorecline™ allows the user to pedal while keeping the body immersed in water, with legs out in front in a reclined seating position. It is ideal for rehabilitation programs to recondition the knee ligaments following reconstructive surgery or sprains. The SwimEx Hydrorecline is also an effective fitness solution, as the thrusting of the legs promotes a superior cardiovascular workout. Retails at $2,400. Circle No. 238

Catalog Showcase Creative Health 800-742-4478 WWW.CHPONLINE.COM Creative Health Products, in business since 1976, is a leading discount supplier of Rehabilitation, Fitness, Exercise and Athletic Equipment and also Health, Medical, Fitness Testing and Measuring Products—all at discounted prices. Products include Heart Rate Monitors, Blood Pressure Testers, Pulse Oximeters, Bodyfat Calipers, Scales, Strength Testers, Flexibility Testers, Stethoscopes, Pedometers, Exercise Bikes, Ergometers, Stopwatches, Fitness Books and Software, Exercise Bands, Step Benches, Hand and Finger Exercisers, Heating Pads and more. Circle No. 260

More Products 3-Point Products 888-378-7763 WWW.3POINTPRODUCTS.COM Reflex® Putty with Memoryflex®, from 3Point Products, increases resistance the more it is pulled. Reflex® Putty can be pulled and stretched like exercise bands but, unlike bands, it provides consistent resistance throughout the range of stretch. Muscles receive resistance throughout their contraction for a more effective strengthening regime. Available in three resistance levels and in the NEW Pro Series for athletes and others requiring a higher resistance level for rehabilitation. Circle No. 239

Acumen, Inc. 800-852-7823 WWW.ACUMENINC.COM Acumen’s Eon 101 and Eon 102 are heartrate monitors embedded in analog watches that offer precise quartz movement. These unique heart-rate monitors feature a scratchresistant crystal lens, fluorescent minute and

Catalog Showcase Power Systems, Inc. 800-321-6975 WWW.POWER-SYSTEMS.COM Since 1986, Power Systems has been a leading supplier of sport training, health and fitness products. The company prides itself on being the one resource for all of your training needs. Its 2004 catalog has a new look, with better graphics and photos. Categories include core strength, medicine balls, speed, plyometrics, agility, strength equipment, strength accessories, and flooring. The catalog is full of hundreds of new products, and dozens of products available exclusively from Power Systems. The company has lowered some of its prices, enabling the customer to get premium products at great prices. Go online or call Power Systems to request a free 2004 catalog today. Circle No. 262

hour hands for viewing anytime and anywhere, and an EZ-Set Target Zone with visual and audible alarms. The Eon 101 and Eon 102 are the perfect heart-rate monitors for health-conscious individuals seeking to safely enhance their fitness level and have a watch for everyday use. Circle No. 240

Antibody, Inc. 513-310-4316 WWW.ANTIBODYWEAR.COM The BodyGuard compression shorts prevent and accommodate lower-body injuries to the groin, hamstring, quadriceps, hip flexors, and hip pointers. Because of their inner surface and custom design, they attach to the wearer and transfer their stored elastic energy to the muscles, creating torque and assisting with muscle flexion and extension. They also provide constant compression, strain distribution, impact absorption, heat circulation, and absorption of fatigue-inducing muscle vibrations caused by repetitive use. Circle No. 241 The BodyGuard shoulder brace, from Antibody, Inc., is designed to accommodate shoulder injuries, including dislocations, subluxations, and slight separations. Because of its inner surface and custom design, the BodyGuard actually attaches to the wearer and works with the entire muscle group, providing strain distribution over the entire garment and significant compression to the injured area. The BodyGuard is effective for a wide array of sports in which shoulder injuries occur, including baseball, football, basketball, wrestling, hockey, and volleyball. Circle No. 242

Brace International, Inc. 800-545-1161 WWW.BRACEINT.COM Brace International offers the MAX™, a major advancement in the design of shoulder girdle support. The snug-fitting, lightweight material allows for comfort with movement,

yet at the same time helps protect the glenohumeral joint from subluxations and dislocations. Its strap design system allows many options for maximal stability where needed while giving the required range of motion. Circle No. 243

Cropper Medical, Inc. 541-488-0600 WWW.BIOSKIN.COM Compression Shorts by Cropper Medical, Inc., made of the patented Bio Skin® material, are breathable, light, thin, durable, hypoallergenic, and machine washable. Studies show that compression shorts reduce muscle fatigue and improve strength, power, and endurance. Improvements in output result from reduced muscle oscillation, improved proprioception, better hip positioning, and the psychological benefit derived from wearing the shorts. Indications: Quad contusion, ischiocapsular strain, iliofemoral strain, thigh strain. Available in black and white. Circle No. 244

Biofreeze 800-246-3733 WWW.BIOFREEZE.COM For pain management programs, use Biofreeze, from Performance Health, Inc., to reduce swelling, pain and stiffness, next-day aches and pains, and recovery time. It can also help to increase mobility and flexibility, and will aid in the overall healing process. Biofreeze can be used in situations requiring ice and breathable wraps and can be blended with water for ice cups. Biofreeze will also prolong the effects and benefits of ultrasound and massage therapy treatments. Biofreeze is endorsed by the Florida Chiropractic Association, ProSports Chiropractic, the United States Taekwondo Union, The Florida State Massage Therapy Association, The NY State Society of Massage Therapists, The Texas Association of Massage Therapists, and is approved for use by the American Physical Therapy Association. Circle No. 245

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ADVERTISERS DIRECTORY CIRCLE NO.

COMPANY

PAGE NO.

115 . . . . 3-Point Products

PAGE NO.

COMPANY

PAGE NO.

. . . . . . . . . . . . 48

122 . . . . Foot Management . . . . . . . . . . . . 38

113 . . . . OPTP . . . . . . . . . . . . . . . . . . . . . . 25

107 . . . . Aircast. . . . . . . . . . . . . . . . . . . . . . 16

108 . . . . Gebauer . . . . . . . . . . . . . . . . . . . . 17

106 . . . . Perform Better . . . . . . . . . . . . . . . 15

130 . . . . Antibody

. . . . . . . . . . 47

111 . . . . Graston Technique . . . . . . . . . . . . 23

120 . . . . Power Systems . . . . . . . . . . . . . . . 34

103 . . . . Biofreeze. . . . . . . . . . . . . . . . . . . . . 9

114 . . . . HeartSine Technologies. . . . . . . . . 26

104 . . . . PoweringAthletics . . . . . . . . . . . . . 10

105 . . . . BioSkin Performance Supports . . . 12

109 . . . . Hormel HealthLabs

. . . . . . . 18

136 . . . . PRO Orthopedic . . . . . . . . . . . . . . 53

139 . . . . Brace International

(Fluk)

. . . . . . . . 61

132 . . . . HQ . . . . . . . . . . . . . . . . . . . . . . . . 49

117 . . . . Pro-Tec Athletics. . . . . . . . . . . . . . 29

137 . . . . Brace International

(MAX)

. . . . . . . . 53

138 . . . . ISSA . . . . . . . . . . . . . . . . . . . . . . . 55

100 . . . . PROTEAM by Hausmann . . . . . . . IFC

101 . . . . Cho-Pat. . . . . . . . . . . . . . . . . . . . . . 2

129 . . . . Jump Stretch. . . . . . . . . . . . . . . . . 45

133 . . . . Quest Technologies . . . . . . . . . . . 50

141 . . . . Compex Technologies . . . . . . . . IBC

126 . . . . Kelly Kinetics

. . . . . . . . 41

123 . . . . Super Feet . . . . . . . . . . . . . . . . . . 39

112 . . . . Cool Draft Scientific . . . . . . . . . . . 24

121 . . . . McDavid . . . . . . . . . . . . . . . . . . . . 36

127 . . . . SwimEx . . . . . . . . . . . . . . . . . . . . 42

116 . . . . CoreControl . . . . . . . . . . . . . . . . . 28

125 . . . . Medical Specialties . . . . . . . . . . . . 40

140 . . . . TurfCordz/NZ Manufacturing . . . . 61

110 . . . . Cramer . . . . . . . . . . . . . . . . . . . . . 20

134 . . . . Mini Mitter . . . . . . . . . . . . . . . . . . 51

118 . . . . VertiMax . . . . . . . . . . . . . . . . . . . . 30

102 . . . . efi Sports Medicine . . . . . . . . . . . . . 5

124 . . . . Mueller Sports Medicine . . . . . . . . 39

119 . . . . Ferno Performance Pools . . . . . . . 33

128 . . . . NASM . . . . . . . . . . . . . . . . . . . . . . 45

(BodyGuards) .

135 . . . . FitBALL USA

CIRCLE NO.

142 . . . . Oakworks . . . . . . . . . . . . . . . . . . BC

(Hydra-Alert)

. . . . . . . . 28

COMPANY

. . . . . . . 52

131 . . . . Acumen

(Oval-8) .

CIRCLE NO.

(Ball Dynamics)

(Plus-2)

(Pivot Plate) .

PRODUCTS DIRECTORY CIRCLE NO.

COMPANY

PAGE NO.

CIRCLE NO.

COMPANY

PAGE NO.

239 . . . . 3-Point Products . . . . . . . . . . . . . . 57

232 . . . . Ferno

(AquaGaiter)

240 . . . . Acumen

(Eon 101/Eon 102).

233 . . . . Ferno

(custom pools) .

200 . . . . Acumen

(Hydra-Alert)

213 . . . . Aircast

. . . . . . . . 57

. . . . . . . . . . . . . . 56

CIRCLE NO.

COMPANY

PAGE NO.

254 . . . . Oakworks . . . . . . . . . . . . . . . . . . . 60

. . . . . . . . . . . . 56

227 . . . . OPTP

(Multi Challenge Board) (Resting Foot Sling) .

. . . . . . . 55

. . . . . . . . . . . . 51

217 . . . . Foot Management

(Ortho Arch)

. . . . 54

226 . . . . OPTP

. . . . . . 53

218 . . . . Foot Management

(Tenderfoot)

. . . . 54

234 . . . . Perform Better . . . . . . . . . . . . . . . 56

(Air-Stirrup Ankle Brace)

. . . . . . . . . 55

212 . . . . Aircast (AirHeel) . . . . . . . . . . . . . . . . 53

249 . . . . FSI North America. . . . . . . . . . . . . 59

262 . . . . Power Systems

(catalog)

241 . . . . Antibody

(compression shorts).

. . . . . . 57

247 . . . . Gebauer . . . . . . . . . . . . . . . . . . . . 59

235 . . . . Power Systems

(Eco Bells/Bar Float)

242 . . . . Antibody

(shoulder brace)

. . . . . . . . . 57

248 . . . . Graston Technique . . . . . . . . . . . . 59

236 . . . . Power Systems

(flotation belt)

245 . . . . Biofreeze . . . . . . . . . . . . . . . . . . . 57

250 . . . . HeartSine Technologies. . . . . . . . . 59

256 . . . . PRO Orthopedic

(PRO 11 Scissors) .

246 . . . . Biofreeze

206 . . . . HQ . . . . . . . . . . . . . . . . . . . . . . . . 52

255 . . . . PRO Orthopedic

(Versa-Cool) .

251 . . . . ISSA . . . . . . . . . . . . . . . . . . . . . . . 60

228 . . . . Pro-Tec Athletics (Achilles Tendon Support) . 55

. . . . . . . . . 53

219 . . . . Jump Stretch. . . . . . . . . . . . . . . . . 54

229 . . . . Pro-Tec Athletics (Arch Support) . . . . . . . 55

(Single Use Dispenser)

. . . . . 59

244 . . . . BioSkin/Cropper

(compression shorts) .

214 . . . . BioSkin/Cropper

(TriLok)

243 . . . . Brace International . . . . . . . . . . . . 57

221 . . . . Kelly Kinetics

(Ankle Isolator) .

215 . . . . Cho-Pat. . . . . . . . . . . . . . . . . . . . . 53

220 . . . . Kelly Kinetics

(Pivot Plate) .

201 . . . . Cool Draft Scientific . . . . . . . . . . . 51

. . . . . . . . . 57 . . 56

. . . . . . 56 . . 60

. . . . . 60

. . . . . . 54

258 . . . . PROTEAM by Hausmann (model A9068) . 61

. . . . . . . . 54

257 . . . . PROTEAM by Hausmann (taping stations) 61

222 . . . . McDavid (Ultra Ankle) . . . . . . . . . . . . 54

208 . . . . Quest Technologies . . . . . . . . . . . 52

223 . . . . McDavid

. . . . . 54

209 . . . . RG Medical Diagnostics . . . . . . . . 52

203 . . . . CoreControl . . . . . . . . . . . . . . . . . 51

224 . . . . Medical Specialties . . . . . . . . . . . . 54

259 . . . . Rich-Mar . . . . . . . . . . . . . . . . . . . . 61

216 . . . . Cramer

. . . . . . . . . 54

207 . . . . Mini Mitter . . . . . . . . . . . . . . . . . . 52

238 . . . . SwimEx

260 . . . . Creative Health Products. . . . . . . . 56

225 . . . . Mueller Sports Medicine . . . . . . . 55

237 . . . . SwimEx Systems

204 . . . . Energice . . . . . . . . . . . . . . . . . . . . 52

253 . . . . NASM

(Body Map)

230 . . . . Tekscan. . . . . . . . . . . . . . . . . . . . . 55

205 . . . . Extech Instruments . . . . . . . . . . . . 52

252 . . . . NASM

(Optimum Performance Training)

202 . . . . Cool Draft Scientific

(Evolution)

(AS1 Ankle Brace).

. . . . 51

58 ◆ T & C J U L Y / A U G U S T 2 0 0 4 ◆

(Ultralight Ankle Brace)

ATHLETICBID.COM

. . . . . . . . . . . . . . 60 . 60

(Hydrorecline) .

. . . . . . . . . . . 56

(Hydrorunner)

. . . . . 56

More Products

Customer Testimonial

United States Air Force Academy Enlists SwimEx

“At the United States Air Force Academy, we were in dire need of an aquatic therapy pool designated solely for sports rehabilitation and conditioning. Although we have two natatoriums on campus, the cadets only have a few hours in the afternoon for aquatic training and the pools are always full. “We lobbied for an aquatic therapy pool, Congress sent a committee to review our circumstances, and it was decided that the United States Air Force Academy, indeed, needed an aquatic sports medicine solution for our injured cadets. “Without hesitation, we knew we wanted a SwimEx. For years, SwimEx has been recognized as the true standard of the industry—the very best. We knew the Denver Broncos had a SwimEx in their training room, so we went up and saw the practice facility. We were extremely impressed. “At that point, we were in the planning stages of building a new facility. We put SwimEx on our wish list, and when we were granted the funding, we were very pleased. The people at SwimEx were gladly willing to work with us, even though we were five years away from erecting the new building. They were looking to build a relationship with us and they accommodated our needs at every turn. “The SwimEx was installed in January 2004, and our athletic training staff is just beginning to explore the range of protocols that are now possible. We will be able to treat both upperand lower-body injuries, and it will be all up to the creativity of the athletic trainer.” Larry Willock, Head Athletic Trainer United States Air Force Academy

SwimEx Systems 373 Market Street, Warren, RI 02885 800-877-7946 sdasilva@swimex.com

Performance Health, Inc., the makers of Biofreeze Pain Relieving Gel, is proud to introduce the new “Single Use Application Gravity Dispenser” package. The new single dose dispensing system is perfect for clinical and training room use to easily dispense Biofreeze to patients and athletes for trial use and at home. Biofreeze helps provide a deeper, longerlasting relief from pain than most cooling gels. Biofreeze effectively enhances therapy and relieves pain from arthritis, muscle strains, and backaches. It also aids in reducing edema and myospasm. Apply generously for penetrating relief from pain and stiffness of muscles and joints. The cooling effect accelerates the rate of basic healing processes through relaxation of stiff and aching muscles. Circle No. 246

Gebauer Company 800-321-9348 WWW.GEBAUERCO.COM From the most trusted name in skin refrigerants for over 100 years comes a new, nonprescription topical skin refrigerant, Gebauer's Instant Ice™. Use it like ice for the temporary relief of minor pain and swelling from sprains and strains, minor sports injuries, bruising and contusions. Now instead of using ice to treat onthe-scene minor sports injuries, high school and recreational league coaches, high school athletic trainers, and others will be able to use what professional athletic trainers use. In fact, Jim Ramsay, head athletic trainer for the New York Rangers, has been using Gebauer topical skin refrigerants for years. "Instant Ice is great for on-the-scene care," said Ramsay. "If a player gets hit on the wrist or takes a puck off the shin, I can easily anesthetize the area with Instant Ice to reduce the pain, allowing the player to get back in the game quickly. Circle No. 247

Graston Technique 866-926-2828 WWW.GRASTONTECHNIQUE.COM Taught by some of the nation’s leading authorities on soft tissue, Graston

Technique® (GT) is an advanced form of instrument-assisted soft tissue mobilization that provides clinicians with a mechanical advantage in detecting/treating/resolving connective soft tissue dysfunction. Six stainless steel instruments are used to detect fibrotic tissue and treat at greater depth and specificity. To register for a GT seminar near you, call the company or visit its Web site. Where applicable, 12 hours of CE credits can be earned. Circle No. 248

FSI North America 440-891-1523 WWW.FSINORTH.COM FSI North America has introduced its line of portable, inflatable Cooling Shelters. These shelters deploy in as little as one minute, and can be set up virtually anywhere. Air conditioning and/or heating units are also available in various sizes, and configurations can be ducted inside the unit. FSI North America is one of the largest suppliers of inflatable shelters in the world. Shelters are available in multiple sizes, from 7’ by 7’ up to the largest sealed berm shelter in the world— the 1,500 sq. ft. 30’ by 50’ size. Circle No. 249

HeartSine Technologies, Inc. 866-HRT-SINE WWW.HEARTSINE.COM HeartSine has introduced the Samaritan® AED, a defibrillator that is designed for people with basic CPR/AED training. Each Samaritan® comes equipped with a large backlit display for easy viewing. Clear on-screen and audible instructions guide the rescuer through a rescue event. The Samaritan® AED uses a new escalating biphasic waveform, called SCOPE™. Event data is recorded reliably, in the Data-Pak™ Battery / Memory system. Circle No. 250

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More Products

Customer Testimonial

ISSA 800-892-4772 WWW.FITNESSEDUCATION.COM The International Sports Sciences Association is a teaching and certification agency for fitness professionals worldwide. ISSA's Specialist in Sports Conditioning program provides the knowledge, expertise, and training techniques you need to enable athletes to expand the capacity of their bodies, while remaining strong and free from injuries. ISSA's Youth Fitness Trainer course teaches you program design, sport psychology, sports nutrition, injury prevention, and fitness assessment specifically for kids and teens. Circle No. 251

National Academy of Sports Medicine (NASM) 800-460-6276 WWW.NASM.ORG The athlete’s ability to consistently perform at higher levels while avoiding injury is essential to his or her long-term success in any sporting arena. Drawing on the exclusive Optimum Performance Training™ (OPT™) method—a system that has successfully empowered peak performance in professional, Olympic, college, and high-school athletes— Optimum Performance Training™ for the Performance Enhancement Specialist sets the international pace for athletic training and sports medicine professionals. Circle No. 252 The National Academy of Sports Medicine is proud to present Body Map, a unique, stateof-the-art dynamic movement assessment and program-design tool that will revolutionize the way you train. Whether your goal is to lose fat, gain muscle or increase your performance in a specific sport, Body Map helps you reach your goals quickly, safely, and effectively. Based on

NASM’s exclusive Optimum Performance Training (OPT™) model, Body Map takes less than 10 minutes and creates individualized assessments and corrective strategies including flexibility, postural control, and functional strength. If success is your destination, let the Body Map be your guide. For more information about where you can get your Body Map, visit the company's Web site. Circle No. 253

“Our athletes ask for these products by name.”

Oakworks, Inc. 800-558-8850 WWW.OAKWORKS.COM Because the game isn’t played in the locker room, you need the Oakworks Portable Taping Table. It is the only portable adjustable-height table on the market. Weighing only 35 lbs., this table folds flat for easy storage and transportation. Features like a marine-grade plastic top, adjustable height range of 32 42 inches, UL weight rating of 500 lbs., and durable carrying case will maximize effectiveness for every ATC. Circle No. 254

PRO Orthopedic Devices, Inc. 888-523-5611 WWW.PROORTHOPEDIC.COM The PRO Versa-Cool Portable Cold Therapy Unit offers many features not found in other cold therapy products. It will operate for two hours on the rechargeable battery, or indefinitely on wall power. It can achieve temperatures as low as 34 degrees from simple ice and water. The low-profile insulated bag maintains ice for hours. Optional 12 volt converter allows operation in vehicles. Circle No. 255 The PRO 11 Scissors from Pro Orthopedic Devides represent the evolution of the original Super Pro Scissors. The new model features a smaller, easier to use safety tip. The offset

"Pro-Tec Athletics offers the most effective and comfortable orthopedic braces and supports. Our athletes are asking for them by name. More specifically, we have found the Shin Splints Compression Wrap to be very efficient in its ability to alleviate the pain and discomfort of medial and anterior shin splints." Sharon Allanson, ATC (19 years experience) Hamilton College, Clinton, NY "As an avid walker and tennis player, I was having problems with Plantar Fasciitis. I am thrilled with the support and relief I have experienced with the Arch Pro-Tec. I want to thank you so much!!!" Roz Berk Walker, Tennis Player "I recommend Pro-Tec knee supports, far and above the rest, to any athlete or person with chronic knee pain. The Knee Pro-Tec is extremely effective, despite allowing plenty of mobility. The Short Sleeve gives me the warmth and compression I need, and The Lift is a great combination of both!" Dax Holdren #1 ranked professional volleyball player, AVP TOUR

Pro-Tec Athletics 2743 152nd Ave., NE, Redmond, WA 98052 800-779-3372 pro-tec@injurybegone.com WWW.INJURYBEGONE.COM

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More Products handle and large finger rings provide additional leverage and comfort. The new power lock screw will not loosen. They’re indispensable on the field or in the training room. Circle No. 256

PROTEAM by Hausmann 888-428-7626 WWW.PROTEAMTABLES.COM PROTEAM by Hausmann offers the athletic trainer a complete line of all-laminate treatment furniture designed to enhance the functional capacity and appearance of the athletic trainer’s room. PROTEAM Modular Taping Stations are available in a wide variety of sizes and with many options. Individual

Taping units are finished on all sides and can be easily re-positioned to fit your needs or space changes in the future. PROTEAM also offers a wide selection of treatment tables, split-leg tables, cabinets, and stadium lockers. Circle No. 257 PROTEAM by Hausmann offers the athletic trainer a complete line of all-laminate treatment furniture designed to enhance the functionality and appearance of the athletic trainer’s room. The model A9068 Split Leg Lift Table features: spacious full cabinet storage, an optional air spring backrest, a weight capacity of 400 lbs. and positive locking, padded leg rests that adjust up to 45°. PROTEAM offers a wide selection of treatment tables, modular taping stations,

cabinets, and stadium lockers. Circle No. 258

Rich-Mar Corporation 800-762-4665 WWW.RICHMARWEB.COM Rich-Mar now offers the AutoPrism, an automatic, hands-free light therapy product. This unique device is a superluminous diode array that can provide over 600mW output. It can be used as a handheld piece to deliver quick treatments, or as an automatic, hands-free strap-on light therapy applicator. The AutoPrism allows you to use all of the various protocols to apply more energy to your patients efficiently and effectively. Circle No. 259

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ProCordz This Football Season be Faster! Quicker! Stronger! TurfCordz ProCordz Gives You... • Explosive Off-The-Line Starts! • Faster Effortless Footwork! • The Safety and Reliability Pro Football Players Demand! • Call 800-556-7464 or Online at www.performbetter.com TurfCordz are distributed by M-F Athletic Company © 2004 NZ MFG LLC, Tallmadge, OH (TC0704)

Request No. 140 A T H L E T I C B I D . C O M ◆ T & C J U L Y / A U G U S T 2 0 0 4 ◆ 61

Web News

Company News

AIRCAST WEB SITE OFFERS NEW INTERACTIVE PATIENT CENTER Aircast®, Incorporated, the trusted leader in orthopedic devices, now makes it simple to learn about injuries such as sprains, muscle strains, tendonitis, and turf toe (to name just a few) using the Patient Center on the Aircast Web site. Accessible throughout the site, the Patient Center allows users to point and click to quick, interactive information about their symptoms and conditions. For each condition, the Center also suggests clinically proven Aircast products to help treat ailments and relieve symptoms. www.aircast.com NEW LINE OF MISTING FANS FEATURED ON WEB Cool Draft Scientific is now highlighting on its Web site the long-awaited Evolution line of high-pressure misting fans. Visit the site to learn all about the Evolution system, which offers the same high quality enjoyed by NFL and college teams at a price that fits the budgets of high school programs. You can also see product specs, pictures, and pricing for all of Cool Draft’s climate control and personal cooling products, read customer testimonials and information about misting fans, lights, and heaters, and find out how to contact a Cool Draft representative. www.cooldraft.com WATCH VIDEO DEMONSTRATIONS FROM DM SYSTEMS ON-LINE Informative videos on the Cadlow™ Shoulder Stabilizer are available at www.dmsystems.com/videos.html. The promotional video gives an overview of the product from concept to development, punctuated by interviews with the inventors as well as athletes who wear the stabilizer. Dramatic video showing athletes in action demonstrates the ease with which the athletes perform while wearing the Cadlow™ Shoulder Stabilizer. The “Sizing and Application” video is intended for the healthcare professional who will be responsible for fitting the stabilizer. It illustrates the fitting and application process in step-by-step detail. www.dmsystems.com/videos.html FOOT MANAGEMENT’S WEB SITE UPDATED WITH NEW PRODUCTS Foot Management’s newest line of prefabricated insoles is listed on its Web site under Consumer Products. The One Stop E.V.A. and Shocker® Firm fill a need in every setting. The Shocker Firm is lightweight, thin, full length, and available in sizes up to 18—unheard of for off-the-shelf insoles. The One Stop E.V.A. can be heated and molded as an accommodative device or used as-is for extra support. Surf the Foot Management Web site for these and other exciting products. www.footmanagement.com HORMEL HEALTHLABS MAKES IT WASY TO FIND THE RIGHT NUTRITIONAL PRODUCTS To help our customers quickly find any one of our many nutritional products, we have organized the full line of Hormel HealthLabs products by the condition or situation to which they apply. Full nutritional listings on all products and access to online pharmaceutical stores for 'home use' purchases are also available. www.hormelhealthlabs.com POWER SYSTEMS’ NEW WEB SITE MAKES ON-LINE SHOPPING EASIER THAN EVER You spoke and they listened! The Power Systems Web site has been completely revamped to service you, the customer, more efficiently and effectively. Major enhancements include a “My Account” feature, providing quick and customized access to your ordering history and the status of existing orders; an improved search engine that makes the site easier than ever to navigate, returning more relevant links on any search phrase; and a quick order form for customers who know the product numbers of the items they want to buy. All these helpful features are designed to streamline your Power Systems shopping experience. www.power-systems.com NEW TOTAL GYM POWER TOWER BY EFI SPORTS MEDICINE FEATURED ON-LINE efi Sports Medicine’s Web site provides in-depth information on the new Total Gym Power Tower, a fully electronic functional training machine that delivers level changes at the touch of a button for physical therapy and athletic training environments. Additionally, the new press section hosts all the latest news, product releases, updates, and information on events where you can see the products in action. www.efisportsmedicine.com TRAIN TO PLAY’S WEB SITE OFFERS A HOST OF TRAINING INFORMATION Everything you want to know about training and conditioning products can be found on Train To Play’s Web site. On the site, you have full-catalog access with secure online order processing, training seminar information, performance-enhancing articles, instruction guides, and training recommendations. Tradeshow schedules can also be seen. www.traintoplay.com

McDavid Launches New Products to Better Protect Athletes Innovation has been a trademark of the protective equipment manufactured by McDavid Sports Medical Products, and the company has recently introduced new products that utilize technology to provide better protection and comfort to athletes. McDavid has taken protective clothing to a new level with its Hexpad™ Protective Apparel. The Hexpad line of clothing features hundreds of individual pads permanently bonded between two layers of moisture transport 4-way stretch compression fabric. The resulting hexipads are then strategically placed into compression body shirts, compression shorts, arm sleeves and football girdles. The result of the Hexpad System is a line of padded undergarments for athletes that are more protective, super lightweight and breathable. The Hexpads also conform to the body, and flex and stretch far better than any other product on the market. New Hexpad products include: The #755 Hexpad Football Girdle with permanently attached hip and tail Hexpads—with this girdle, you don’t need to purchase separate hip and tail pads; The #787 Body Shirts with rib, spine and shoulder Hexpads that can be used in football, lacrosse, and hockey; The #760 Compression Vest with sternum pad for protection in baseball and football; and The #651 Arm/Elbow Sleeves. McDavid has also recently debuted the new Flexcup™: a hard cup with a resilient impact dampening flexible liner that is permanently molded to the inside. This innovative design provides softer sides for much improved comfort compared to traditional hard cups.

McDavid 10305 Argonne Drive, Woodridge, IL 60517 800-237-8254 info@mcdavidinc.com WWW.MCDAVIDINC.COM

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Company Q& A

AQUATIC THERAPY OPTIONS FROM DAVID PATTERSON Q. WHAT TYPES OF POOLS DOES FERNO OFFER? David Patterson, Vice President of Sales and Marketing for FernoWashington’s Ille Division, is a native of Elkton, Maryland. He has a bachelor’s degree from Bowling Green State University with a major in Business Administration, and an MBA from Lake Erie College. David has over 20 years of experience in the medical industry, having served as President for OptiCenter, Inc., Vice President for TLC Laser Eye Centers, and Vice President of Sales and Marketing for Global Vision, Inc. In his current role at Ferno, David is responsible for three of the company’s divisions: Ferno Performance Pools, Ferno Vet Systems, and Ferno Mortuary.

Ferno has the largest range of pools on the market today, with over 250 configurations. We are also the only company that offers both custom-built and fiberglass pools. The pools can be installed totally in-ground, partially in-ground, or above-ground, with multiple floor depths. For trainers who use contrast therapy, Ferno offers a dual pool, consisting of a hot pool and a chiller pool separated by a common wall seat; or these

WWW.FERNOPERFORMANCEPOOLS.COM

Q. HOW ARE THE POOLS INSTALLED? Our pools are installed by Ferno technicians, and the delivery and installation method depends on the pool size and the installation site. The pools can be shipped pre-plumbed and in one piece, or they can be shipped in smaller sections to fit through standard doorways or windows. This flexibility allows for easy installation at new construction sites or reno-

two pools can be ordered separately. Since Ferno has such an extensive range of pools, customers are able to tell us exactly what they want, and we can give them exactly what they need for their facility.

Q. WHAT ARE THE POOL SIZES? We have pools to fit both small and large facilities. Since we have the ability to customize each pool, we can make a pool that will fit anyone’s needs. We also offer different shapes—everything from the traditional rectangles and squares to octagon-shaped pools.

Q. WHAT OPTIONS OR ACCESSORIES DO YOU OFFER TO ENHANCE YOUR POOLS?

FERNO PERFORMANCE POOLS 70 WEIL WAY WILMINGTON, OH 45177 888-206-4802 INFO@FERNOPERFORMANCEPOOLS.COM

ground or above-ground, so the athlete’s rehab and gait can be monitored. In addition to the windows, a video monitoring system is available to observe the athlete’s progress. Ferno completes the package with pool lifts, whirlpool/resistance jets, exercise rails and grab bars, therapy benches, water line tile or striping, underwater lights, digital temperature display, and water sanitizer systems.

Ferno has numerous options and accessories that can create a total rehab or conditioning pool. The AquaGaiter™ variable speed underwater treadmill provides a rigorous cardiovascular workout with reduced impact and stress on joints. The swim-inplace system gives the swimmer a smooth, variable-speed current to swim against. We offer three different models of aquatic bikes also. Viewing windows can be added to the custom-built pools that are partially in-

vation projects.

Q. WHAT ARE FERNO PERFORMANCE POOLS MADE OF? The custom-built pools are constructed of pre-stressed laminated beams with a heavyduty, custom-manufactured polyvinyl liner. The fiberglass pools are manufactured with the Aqua-Tuff 1000® process that provides a layer-on-layer build-up of fiberglass and resins to obtain the optimum strength and resistance to water penetration. The pool shell is then covered with reinforcing struts built into the fiberglass to make the pool freestanding. The pool floor also has a leveling skid built into it to provide floor strength and a means of leveling the pool, should the floor be uneven or have irregularities.

Q. WHAT ADVANTAGES DOES FERNO PERFORMANCE POOLS HAVE OVER ITS COMPETITORS? Custom, choice, variety, flexibility, quality, prices to fit your needs, the greatest number of options in the industry, service, technical support, factory installation, you name it—Ferno gives you the best the industry has to offer.

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CEU

T&C July/August 2004

QUIZ

Vol. XIV, No. 5

Training & Conditioning is pleased to provide NATA and NSCA members with the opportunity to earn continuing education units through reading issues of the magazine. The following quiz is based on articles that appear in this issue of Training & Conditioning. By satisfactorily completing the quiz and mailing it back to T&C, readers can earn two BOC Athletic Training and 0.2 NSCA continuing education units (two hours).

INSTRUCTIONS: Fill in the circle on the answer form (on page 66) that represents the best answer for each of the questions below. Complete the form at the bottom of page 66, include a $15 payment to Training & Conditioning, and mail it to the following address: Training & Conditioning, ATTN: 14.5 Quiz, 2488 N. Triphammer Road, Ithaca, NY 14850. Readers who correctly answer 70 percent of the questions will be notified of their earned credit by mail no later than October 15, 2004.

IN THE SHADOWS

(pages 13-19)

Objective: To understand the danger that muscle dysmorphia can pose to athletes, as well as learn to identify the warning signs of the disorder and how to approach athletes who may be at risk. 1) Muscle dysmorphia is considered to be: a) A systemic disorder. b) A muscle dysfunction. c) An eating disorder. d) A body-image disorder. 2) Muscle dysmorphia primarily affects: a) Adolescents. b) Children. c) Men. d) Women. 3) Body dysmorphic disorder is the diagnosis people attain when they: a) Work out excessively. b) Are preoccupied with how their body looks. c) Have a significant change in their body physique. d) Have an eating disorder. 4) Muscle dysmorphia is defined as: a) Poor muscle definition. b) Preoccupation with one’s muscularity and physique. c) A mesomorph body type. d) Preoccupation with one’s masculinity. 5) Roberto Olivardia utilizes ___________ to help correct distortions that athletes have a) Measurement of body fat b) Athletic therapy c) Measurements of strength d) Cognitive behavior therapy 6) To increase socialization, Olivardia asks patients/athletes who have muscle dysmorphia to: a) Keep a log of food intake. b) Go outside their comfort zone and overcome uncomortable social situations. c) Limit gym time to 2.5 hours per day. d) Spend 2 hours per week in social situations. 64 ◆ T & C J U L Y / A U G U S T 2 0 0 4 ◆

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7) Those with muscle dysmorphia tend to: a) Ignore physical signs of distress to their ligaments and joints. b) Prefer early morning workouts. c) Have a nutritious diet. d) Increase hydration. 8) Experts largely blame the ____________ for increased glorification of the male physique. a) Drive to turn professional in one’s sport b) Sport coaches c) Strength coaches d) Media 9) According to Olivardia, the most important thing to do when approaching an athlete you are concerned about as possibly having muscle dysmorphia is: a) Take a stance of empathy and concern. b) Approach with direct, critical language. c) Focus on body image. d) Display a drive for perfectionism.

SEARCHING FOR SYMMETRY

(pages 31-35)

Objective: To understand the importance of muscular symmetry and learn how to use a strength-training program to recognize, correct, and avoid muscle imbalances. 10) According to Charles Poliquin, studies have shown that ______________ is maximized to a higher degree when using unilateral training versus bilateral training. a) Muscle fiber recruitment b) Neural drive c) Muscle strength d) Muscle elongation 11) The goal of testing specific actions is to: a) Ensure that there is less than 5% variance in strength between limbs. b) Identify baseline strength. c) Devise a strengthening program. d) Ensure that there is less than 10% variance in strength between agonists and antagonists.

CEU QUIZ 12) When testing strength with the utilization of different hand positions or specific muscle isolation, deficits ______________ should undergo corrective measures. a) Greater than 5% b) Greater than 10% c) Greater than 20% d) Less than 20% 13) For most sports, a prudent plan is to develop: a) Antagonist muscles that do not get a significant amount of training from sport-specific activities. b) Concentric strength more than eccentric. c) Eccentric strength more than concentric. d) Agonist muscles that are primary movers in their sport.

SOFT FEET, STRONG LEGS

19) Athletes with rigid pes cavus may benefit from: a) Flexible orthotics made of very compliant material to absorb shock. b) Laterally posted orthotics. c) Off the shelf semi-rigid orthotics. d) Plantar fascia and gastroc stretching. 20) One study conducted by Eng and Pierrynowski speculated that: a) Laterally posted orthotics change stride length. b) Use of orthotics with shock absorption is a key factor in the treatment of PFPS. c) The benefits of using orthotics in the treatment of PFPS are derived from altering hyperpronation at the tibiofemoral and PF joints. d) Biomechanics cannot be altered with orthotics.

(pages 37-41)

Objective: To learn about the different types of foot orthotics, with a focus on what they do to help athletes and how they can be used to treat a variety of lowerbody injuries. 14) Custom made orthotics are constructed based on impressions made from: a) Polymer casts. b) Plaster casts, foam casts, or digital scanning. c) Photographs. d) Plaster casts and computerized topography. 15) Flexible orthotics are prescribed when: a) Only a small amount of motion control is needed but considerable shock absorption is desired. b) Significant motion control is needed. c) A heel lift is needed. d) Torsion control is needed. 16) Rigid orthotics are prescribed: a) When a balance of motion control and shock absorption is needed. b) To counteract supination. c) When a great deal of motion control is needed and shock absorption is not a primary concern. d) When posting is necessary. 17) Research has consistently shown that ____________ orthotics decrease the amount of foot pronation and internal tibial rotation a) Laterally posted b) Medially posted c) Semi-rigid d) Rigid 18) Three studies have found that orthotics enhance the ____________ on the plantar aspect of the feet thus changing afferent input from the somatosensory system. a) Intrinsic muscles b) Sympathetic input c) Motor input d) Cutaneous sensation

21) The mechanism for a lateral ankle sprain is: a) Dorsi flexion, inversion, and external rotation. b) Plantar flexion, inversion, and internal rotation. c) Plantar flexion, eversion, and external rotation. d) Dorsi flexion, eversion, and internal rotation. 22) Foot orthotics have been shown to be effective in the treatment of: a) Compartment syndrome and medial ankle sprains. b) ACL and PCL insufficiencies. c) Achilles tendonitis and MCL sprains. d) Stress fractures, PF pain, and lateral ankle sprains.

DOWN THE MIDDLE

(pages 43-47)

Objective: To learn how to incorporate core stretching as part of an effective and efficient warmup regimen for football athletes. 23) A strong core enables the facilitation of both ____________ in the body. a) Prevention of injuries and faster healing b) Mobility and stability c) Stamina and stability d) Static and dynamic stabilization 24) _______________ develop(s) a combination of strength, stability, joint mobility, and muscular flexibility. a) Weight training b) Functional drills c) Sprints d) Isolated weight training 25) When matching athletes with partners for core training, it is important to: a) Match athletes of similar positions. b) Perform exercises in small groups. c) Match athletes of equal size, strength, and flexibility. d) Rotate partners frequently.

ANSWER SHEET IS ON PAGE 66 ATHLETICBID.COM â&#x2014;&#x2020;

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CEU Quiz Answer Form INSTRUCTIONS: Fill in the circle on the answer form below that represents your selection of the best answer for each of the previous questions. Complete the form at the bottom of this page, include a $15 payment to Training & Conditioning, and mail it to the following address: Training & Conditioning, ATTN: 14.5 Quiz, 2488 N. Triphammer Road, Ithaca, NY 14850, no later than September 30, 2004. Readers who correctly answer 70 percent of the questions will receive 2.0 BOC Athletic Training and 0.2 NSCA CEU’s, and will be notified of their earned credit by mail no later than October 15, 2004.

Soft Feet, Strong Legs

In The Shadows 1. 2. 3. 4. 5. 6. 7. 8. 9.

❍ ❍ ❍ ❍ ❍ ❍ ❍ ❍ ❍

14. 15. 16. 17. 18. 19. 20. 21. 22.

Searching For Symmetry 10. 11. 12. 13.

❍ ❍ ❍ ❍

❍ ❍ ❍ ❍ ❍ ❍ ❍ ❍ ❍

Down The Middle 23. 24. 25.

❍ ❍ ❍

Last Name_______________________________________First Name_________________________________MI______ Mailing Address______________________________________________________________________________________ City___________________________________________________State_________________Zip Code________________ Daytime Telephone_________________________________E-Mail Address____________________________________

Payment Information __ $15 check or money order (U.S. Funds only) payable to: Training & Conditioning __ Visa

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Athletic Therapy. Rapid return to work and play.

Athletic Therapists are dedicated to the promotion and delivery of quality care through injury prevention and rehabilitation and emergency services. In collaboration with other health care professionals, athletic therapists work to create a healthier environment that encompasses the needs of the active community, including the high-performance athlete.

For more information please visit us online at www.athletictherapy.org

All NATA certified athletic trainers are eligible to receive a free subscription to T&C.

Take your training to the next level. You know the benefits of EMS in the training room. Now thereâ&#x20AC;&#x2122;s a device for the next level. Beyond rehabilitation, now there's EMS for improved muscle performance in sports. Compex is a compact, portable electronic muscle trainer that uses revolutionary electrical muscle stimulation (EMS) technology to take your training to the next level â&#x20AC;&#x201C; work more muscle fibers in less time.

Compex Sport includes over 75 training programs that can be customized for your training goals.

Used by elite European and American champion athletes, Compex is the EMS device for all athletes who want to improve muscle performance. Build muscle strength. Improve power. Increase endurance. Experience faster muscle recovery. Call today or visit us online at www.compex.us/TC to get a free report on how Compex can help you improve muscle performance.

www.compex.us/TC

1-866-826-6739

Compex is used by these athletes and recommended by their trainers:

Compex is cleared by the FDA for sale in the U.S. without a prescription. Request No. 141

h o m e fi e l d a d va n t a g e t o g o

Made in the U.S.A Official Supplier of Treatment Tables and Chairs for the 2004 Sacramento Track and Field Trials.

800.558.8850

w w w. o a k wo r k s . c o m

Request No. 142