Training & Conditioning 14.7

October 2004 Vol. XIV, No. 7 $5.00

◆ Understanding

Pain Meds ◆ Dual Role

ATCs

Middle in Motion New ideas in training the core

Request No. 100

CONTENTS

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Training & Conditioning • October 2004 • Vol. XIV, No. 7

F E AT U R E S ◆ Optimum Performance ◆

Middle in Motion..........11 Everyone’s talking about developing a strong core. But what does that really mean, and how is it accomplished?

By Vern Gambetta ◆ Tr e a t i n g t h e A t h l e t e ◆

For the Temporary Relief of Minor Aches..........19 … there are a plethora of choices. Here’s how to steer your athletes in the right direction when they have questions about pain medications.

By Dr. Stan Reents

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◆ Management ◆

Juggling Jobs..........27 With the proper support and a lot of organization, some athletic trainers are enhancing their careers by taking on additional roles.

By Kenny Berkowitz ◆ Special Focus ◆

Work Wounds..........37 One of the hazards of being an athletic trainer is dealing with back pain—your own back pain, that is. In this article, a back specialist offers advice on how to treat and prevent work-related flare-ups.

By Dr. Craig Liebenson

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D E PA R T M E N T S ◆ Sideline ◆

Increasing Flexibility..........3 ◆ A b o v e t h e C a l l Aw a r d ◆

This Issue’s Winner..........4 Nomination Form..........8 ◆ Bulletin Board ◆

New FLSA Ruling … NSCA Names Winners..........16 ◆ Competitive Edge ◆

No Ice? No Problem!..........43 By mimicking the on-ice movements of ice hockey, you can develop strength and conditioning programs to help players improve while remaining on dry land.

By Steve Myrland

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Advertisers Directory..........48 Pain Management..........49 Hot & Cold..........53 Massage Therapy..........55 Web News..........57 Catalog Showcase..........58 More Products..........58

CEU Quiz: Now for NSCA Credits, too!..........60

Cover Photo by Ezra Shaw/©Getty Images

Great Ideas For Athletes...

TRAINING & CONDITIONING • October 2004 • Vol. XIV, No. 7

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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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

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Brian Goodstein, MS, ATC, CSCS, Head Athletic Trainer, DC United

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

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Gary Gray, PT President, CEO, Functional Design Systems

Publisher Mark Goldberg Editor-in-Chief Eleanor Frankel

Maria Hutsick, MS, ATC/L, CSCS Head Athletic Trainer, Boston University

Circulation Director Mark Shea

Christopher Ingersoll, PhD, ATC, FACSM Director, Graduate Programs in Sports Medicine/Athletic Training University of Virginia

Associate & Assistant Editors R.J. Anderson Dennis Read Kenny Berkowitz Greg Scholand David Hill Laura Smith

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 Michael Merk, MEd, CSCS Director of Health & Fitness, YMCA of Greater Cleveland Jenny Moshak, MS, ATC, CSCS Asst. A.D. for Sports Medicine, University of Tennessee Steve Myrland, CSCS Owner, Manager, Perf. Coach, Myrland Sports Training, LLC Instructor and Consultant, University of Wisconsin Sports Medicine

Art Directors Karen Ires Suzanne Lynch Production Manager Kristin Ayers Assistant Production Manager Kristi Kempf Production Assistant Jonni Campbell Prepress Manager Adam Berenstain Prepress Assistant Steve Rokitka IT Manager Mark Nye Business Manager Pennie Small

Mike Nitka, MS, CSCS Director of Human Performance, Muskego (Wisc.) High School

Special Projects Dave Wohlhueter

Bruno Pauletto, MS, CSCS President, Power Systems, Inc.

Administrative Assistant Sharon Barbell

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

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

Chip Sigmon, CSCS Strength and Conditioning Coach, Carolina Medical Center 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.

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Stretch Your Way to Better Health and Performance Bill Prentice, PhD, ATC

work a particular set of muscles and increase joint motion.

This technique is best used with athletes who are well trained.

Ballistic stretching may cause muscle soreness or injury in sedentary individuals.

Good flexibility (as assessed by the range of joint motion) is essential for preventing injury and maintaining athletic performance.

For instance, a sprinter with tight hamstrings—which limit the movement of the hip joint—will take shorter strides and have slower running times than a more flexible athlete.

That’s why coaches and athletic trainers routinely require players to stretch before and after workouts.

In this article are some common stretching methods and how they impact your players’ health and performance.

Static stretching increases joint motion The most widely used stretching technique, static stretching involves placing the muscle in a position of maximal length and holding it for 20 to 30 seconds. Repeat as many as four times.

Although not as sports-specific as other stretching methods, static stretching is a safe and effective means for increasing joint range of motion.

Ballistic or dynamic stretching best for physically active The oldest of all stretching techniques, ballistic stretching, is named for movement that is "ballistic or dynamic" in nature. This includes kicking, jumping, and running.

Ballistic stretching uses repetition— through a series of jerks, pulls, leg swings, knee hugs or arm circles, to

Guidelines for a sound stretching program: ● Warm up with a slow jog or fast walk before stretching. ● Stretch only to the point of tightness or resistance— not pain. ● Always stretch slowly and with control. ● Maintain normal breathing patterns during a stretch— don’t hold your breath. ● Stretch the muscle beyond its normal range of motion to increase flexibility. ● Use ballistic stretching with highly trained or physically active individuals. ● Increases in range of motion will be specific to the joint being stretched. ● Exercise caution when stretching muscles around painful joints—avoid overstretching. ● Stretch at least three times a week.

PNF leads to dramatic results Propioceptive Neuromuscular Facilitation (PNF) stretching requires two people to work together to contract and relax specific muscles, and often produces dramatic results. In just one session, people can experience a significantly increased range of motion around the joint. PNF techniques can also improve flexibility over an extended training period when compared to other stretching styles.

Conclusion It is well documented that stretching will increase the range of joint movement over time by altering the extensibility of the muscles and connective tissue. An effective flexibility program may also protect an athlete from injury while improving athletic performance.

Bill Prentice, PhD, ATC is the Coordinator of the Sports Medicine Program at the University of North Carolina at Chapel Hill.

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

Sponsored by

T&C’s Above The Call Award October 2004 Winners

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Power Couple This special husband-wife team has done it all.

or 15 years at the University of Kentucky, Al Green and Sue Stanley-Green were a team, dealing with everything from dislocated knees to multiple personality syndrome. From 1982, when Green first hired Stanley, to 1997, when they left for jobs outside the university, they worked side by side, day after day. As the head athletic trainer, he was primarily responsible for emergency care. As associate head athletic trainer, she was in charge of rehabilitation.

Now, after a combined 54 years in the profession, they’ve become the first husband-and-wife team inducted into the National Athletic Trainers’ Association Hall of Fame.

“Being inducted into the Hall of Fame has been a huge honor for each of us, and to be inducted together has just been incredible,” says StanleyGreen, MS, LAT, ATC, Assistant Professor of Athletic Training at Florida Southern College. “When something like this happens to you, it’s a great thrill. But when it happens to your spouse at the same time, the feeling is indescribable.”

“Going into the Hall of Fame together just made sense,” says Green, MEd, LAT, ATC, EMT, Clinical Services Coordinator at Kessler Rehabilitation Centers in Lakeland, Fla. “We’ve been a team for over 15 years, and everything we’ve accomplished

F

4 ◆ T&C O C T O B E R 2 0 0 4 ◆

Wayne Koehler

By Kenny Berkowitz

Sue Stanley-Green and Al Green have worked together and separately to pursue many paths in athletic training.

would have been impossible if we hadn’t been working together.”

Growing up, neither had ever met an athletic trainer, much less thought of joining the profession. Green had been a high school athlete, competing in baseball and football until a broken arm sent him to the sidelines. There, he became the student manager of the football team and used his Boy Scout merit badge in first aid to help take care of injuries. He went on to major in physical education at the University of Michigan and to get his master’s degree from the University of Arizona at a time when there were only two graduate athletic training programs in the entire country.

Going to college at Ohio State University, Stanley had considered becoming a doctor and had shadowed a physical therapist before a chance meeting led her to OSU athletic trainer Linda Daniel. With Daniel’s support, Stanley was allowed to

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observe legendary football coach Woody Hayes and his staff at work, and was immediately hooked, realizing that athletic training would give her an opportunity to balance her interest in medicine with her love for athletics.

She and Green had met briefly in 1979, when he was an assistant athletic trainer at the University of Michigan, and she was a physical education major at OSU. (They still joke about it: She remembers the meeting, but he doesn’t.) Three years later, after Stanley had completed her master’s degree at Purdue University and was working as Assistant Director of Intramural and Recreation Services at East Carolina University, they met again.

He was Head Athletic Trainer at the University of Kentucky, and she was interviewing to become Assistant Kenny Berkowitz is an Assistant Editor at Training & Conditioning.

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Above The Call Award

Award Winner

Award Winner

Sue Stanley-Green

Al Green

Assistant Professor of Athletic Training Florida Southern College

Clinical Services Coordinator Kessler Rehabilitation Centers

Athletic Trainer. The rest, as they say, is history. For the next 15 years, they spent virtually every day together in the athletic training room, becoming great friends, and marrying in 1993.

Along the way, they learned to complement each other’s style, with Green, who also works as an emergency medical technician, handling emergencies and Stanley-Green concentrating on rehabs. They also pushed each other to grow with the changes in the profession.

“Over time, our skill sets as athletic trainers have expanded tremendously,” says Stanley-Green. “Where athletic training used to be about taking care of injuries, it’s now about the total care of the athlete—which could mean nutritional counseling or dealing with psychological issues, or so many different things. If our athletes had a problem, whatever it was, we either dealt with it ourselves or referred them to someone who did.”

Along with adding to their skills on their own, they’ve learned from each other. Green credits StanleyGreen with teaching him about teamwork and becoming more assertive in his communication with coaches. Stanley-Green credits Green with teaching her about tolerance and the benefits of patiently waiting to 6 ◆ T&C O C T O B E R 2 0 0 4 ◆

reach her goals. They agree that their partnership has helped raise the bar for each of them, and improved the care they’ve given their athletes.

“In everything he does, Al goes above the call,” says Stanley-Green.

“He always does things well, even when he’s working in an area that’s new to him. He’s got an attitude that no job is too big or too small, which is something I’ve always admired in him. He covers everything with the same intensity and the same desire to do well.”

“Sue is the exact same way,” adds Green. “If she’s dealing with a rehab, she’ll do whatever it takes. If she’s dealing with academics, she’s going to make sure to create the best experience for her students. She goes above and beyond the call to make sure her students get first-rate care and a first-rate education. It’s a matter of being willing to do the hard things, and always wanting to be the best.”

In their years at Kentucky, some of the most memorable challenges have also been the unlikeliest, both on and off the field. There was one student-athlete with multiple personality syndrome, and others who suffered from severe eating disorders. There was an athlete who was paralyzed with a vascular spinal tumor, and had to learn to walk again. There were athletes who

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died of gunshot wounds, others who were suicidal, and one who was struck in the head by a hammer during the Kentucky Relays and fell into a coma that lasted until his death 16 years later.

“Our challenge on the track at that moment was keeping him alive, which we did,” says Green. “We had done a lot of training for emergency situations, and when it happened, everything in our catastrophic plan went off like clockwork.”

“It brought together so many of the things we’d told our students about,” says Stanley-Green. “We had grief counseling available for the team, for the person who threw the hammer, and for all of us. It was a real life lesson about all the things that go along with catastrophic injury.”

Looking back, even the common injuries provided new challenges, like the back-to-back Saturdays when two offensive linemen severely dislocated their knees. Along with a cheerleader, a walk-on athlete, and the registrar’s 16-year-old daughter, that made five knee rehabs going on at once, with Green and Stanley-Green working the most memorable rehab club in their career together.

“They were a remarkable group in terms of supporting each other,” says Green. “Any time you have athletes in rehab, there’s going to be a down

Above The Call Award

“We’ve made sure to live up to each other’s expectations. I honestly think that working together has made us much better professionals, and I know that it’s made us better people.” period, where they either sink back or reach a plateau, and that can be depressing. The neat thing about these five were that they wouldn’t let each other feel down, and Sue was great at coming up with things for them to do.”

To keep them motivated, StanleyGreen initiated a series of ball exercises, which was a new idea at the time. She harnessed the natural competitiveness of the offensive linemen, setting daily, weekly, and monthly goals for each of them to reach. And in her most memorable lesson, she learned the importance of giving her athletes a chance to talk.

“We try to listen to our athletes, and one of the things we’ve learned

is that this injury may be the worst thing that’s ever happened in their lives,” says Stanley-Green. “We allow them to be upset about that, to be angry, to be a little depressed.

And I saw a difference when we started treating them that way, validating the fact that this is a really lousy thing that happened to them.

That was a real learning process for us, because we saw people who couldn’t let go of their anger, and it was getting in the way of their rehab.

If we couldn’t get them through those stages, we learned to send them for professional counseling.

“We also made the athletic training room a safe place for them to go,”

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she continues. “If they wanted to complain about their coaches, if they needed to yell, if they needed to cry, our training room was a safe place.

Developing that trust made the rest of our work much more effective.”

Outside their work together, they’ve continued to pursue independent projects. Stanley-Green has provided coverage for USA Basketball, taught classes in first aid for the American Red Cross, and given workshops on drug and alcohol abuse. Green has served as medical director for the Bluegrass State Games, taught CPR for the American Heart Association, and spent years as a volunteer firefighter.

At the same time, both have been dedicated to giving back to the profession. Stanley-Green currently serves on the board of directors for the NATABOC, and has been president of the Southeastern Athletic Trainers’ Association and a member of the NATA board of directors. She has received

Above The Call Award the NATA’s Most Distinguished Athletic Trainer Award, the American Academy of Podiatric Sports Medicine Excellence in Athletic Training Award, and the Southeastern Athletic Trainers’ Association Award of Merit. Green is the chair of the NATA’s public relations committee, and is the former president of the College Athletic Trainers’ Society and the Kentucky Athletic Trainers’ Society. In 2001, he was named the NATA’s Most Distinguished Athletic Trainer and Polk County’s Firefighter of the Year.

“There’s an old saying, ‘Never confuse having a career with having a life,’” says Green. “We used to joke about that, because in our case, our careers were our lives. We have so much passion for the profession that our lives have revolved around our work, and to a degree, they still do.”

Since moving to Florida in 1999, they’ve taken jobs that allow them to spend more time with their eight-yearold daughter, and to strike a new balance between home and work. As an assistant professor and the director of the athletic training program at Florida Southern College, StanleyGreen trains the next generation of athletic trainers, while Green works as clinical services coordinator for Kessler Rehabilitation Centers, organizing coverage for 14 high schools in the Tampa Bay area. They keep up with their hands-on athletic training by covering occasional high school and college contests, but both miss the closeness of working on a daily basis with their athletes and with each other.

“I’m proud of the way we took care of the athletes,” says Green. “The fact is that we didn’t bow to coaches, and that we provided care, not just for the injury, but for the whole person.”

“We both can look in the mirror today knowing that we did everything we could for the athletes,” says Stanley-Green. “We’ve held each other in check, didn’t allow the other one to slide, and made sure to live up to each other’s expectations. I honestly think that working together has made us much better professionals, and I know that it’s made us better people.” ◆ 8 ◆ T&C O C T O B E R 2 0 0 4 ◆

Nomination Criteria and Procedures he “Above The Call” Awards Program serves to honor outstanding athletic trainers for work not otherwise recognized. This may include someone who has shown exemplary dedication and devotion to his or her job or outstanding work outside of the everyday ATC duties. The goal is to honor those athletic trainers who go above and beyond the already extraordinary demands placed on anyone in the profession.

T

EXAMPLES INCLUDE: ◆

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Someone who is doing something different and exciting in the profession.

Someone who serves as a role model and mentor to others.

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Someone who has taken on additional significant duties in the field.

Someone who gives 110 percent in all that he or she does.

Someone who has a special way with athletes.

TO NOMINATE AN ATHLETIC TRAINER:

Please fill in the form below, and attach a 500- to 1,000-word description of the athletic trainer’s achievements, including: ◆ Why you think this athletic trainer stands out from the crowd. ◆ Where he or she is currently working and any pertinent academic or work history. ◆ Testimony and/or quotes from those he or she works with.

✁ Above The Call Award Nomination Form Name of Athletic Trainer: ____________________________________ His/Her Phone No.: ________________________________________ Your Name: _______________________________________________ Your Affiliation: ____________________________________________ __________________________________________________________ Your Phone No.: ___________________________________________ Your Address:______________________________________________ __________________________________________________________ Send nominations to: Above The Call Award Training & Conditioning 2488 N. Triphammer Road Ithaca, NY 14850 If you have any questions, feel free to call us at (607) 257-6970, xt. 18, or e-mail us at info@momentummedia.com.

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4HE ULTIMATE SYSTEM TO DEVELOP EXPLOSIVE LEG POWER

THE VERTICAL JUMP FIRST STEP QUICKNESS

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◆

MIDDLE IN MOTION

OPTIMUM PERFORMANCE

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Everyone’s talking about developing a strong core.

But what does that really mean, and how is it accomplished?

By Vern Gambetta ore training is one of the loudest buzzwords in today’s strength and conditioning circles. Most coaches have learned to “start with the core” and that “a strong core leads to a strong athlete.”

But what are the nuances of core training? What does a “strong core” really mean? And how do we turn this buzzword into an effective, practical part of our training programs?

The core is an integrated functional unit consisting of the lumbo-pelvichip complex and the thoracic and cervical spine. It is a muscular corset that lends integrity and support to the body. In addition, it serves as a swivel joint between the hips and shoulders that relays all movement of the body.

The core also functions as one of the largest links in the body’s system of links, often referred to as the kinetic chain. Functional core training is all about taking advantage of this linkage, making the parts of the chain work together in harmony—from toe nails to finger nails—to produce smooth, efficient patterns of movement. A strong core accelerates, decelerates, and dynamically stabilizes the body

C

Vern Gambetta, MA, is the Director of Athletic Development for the New York Mets and President of Gambetta Sports Training Systems in Sarasota, Fla. He is a frequent contributor to Training & Conditioning and can be reached at www.gambetta.com.

Ezra Shaw/©Getty Images ATHLETICBID.COM ◆

T & C O C T O B E R 2 0 0 4 ◆ 11

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OPTIMUM PERFORMANCE

during movement. Without a fully functioning core, efficient movement is not possible.

Therefore, we must shift our focus away from individual muscles to integrated movements. Current thinking would have us focus our training on prone and supine positions that emphasize drawing in the stomach to activate the transverse abdominis and the internal obliques. This is ineffective, however, because the brain does not differentiate between individual muscles. The brain recognizes patterns, which consist of individual muscles working in harmony to produce movement. It is unreasonable to think that two muscles could play such an important role or that they are more important than any other muscles. This leads to a fundamental underlying philosophy that all training is core training.

PRINCIPLES & CONCEPTS

Effective and functional core training is based on two simple principles. The first is to train core strength before extremity strength. A strong, stable core will allow the extremities to better do their job. Therefore, we should train the core first, in both training sessions and training programs.

The second principle is that dynamic postural alignment is the foundation for functional training.

Posture and a strong, stable core are integrally related. The larger core muscles known as “anti-gravity muscles” play a major role in maintaining a sound, functional athletic posture.

Each sport has its own specific postures, and each individual within a sport has his or her own posture. The combination of the two produces great variability. Our goal should not be to fit everyone into certain parameters of a correct posture, but rather to understand what each athlete requires in his or her activities and adjust accordingly.

Along with these two principles, there are a few concepts to keep in mind relative to core training. These concepts relate to balance, gravity, force production and reduction, and proprioception.

Balance is a key aspect of movement that is closely related to the core.

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Posture and a strong, stable core are integrally related …

Our goal should not be to fit everyone into certain parameters of a correct posture, but rather to understand what each athlete requires and adjust accordingly.

Balance is control of one’s center of gravity and body angles to create an equilibrium. Movement is a state of dynamic equilibrium consisting of a constant interplay of imbalance and balance—it is the body constantly trying to regain balance to perform efficient movement. The muscles of the core play a decisive role in balance because of their location and function.

Core training must include balance training to be effective.

To fully understand core function, we must also understand the role that gravity plays in loading the body.

Gravity has an increased effect on a body in motion compared to one at rest. Therefore we must learn to overcome its effects—to cheat it and even occasionally to defeat it.

Gravity and its effects must be a prime consideration when designing and implementing a functional core training program or we are not preparing the body for the forces that it must overcome. Therefore we must be aware of our orientation to gravity when we are training the core. When standing, we are parallel to gravity, and when lying or seated we are perpendicular to gravity. The demands of individual sports will dictate the primary body position we should use to train the core. For most sports, the great majority of core training should be performed in upright and moving positions.

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Force production is what we see as the end result of a sprint, jump, or a throw. It is a shot on goal or a spectacular dunk. But often the key to movement is the ability to reduce force. This is not as easy to see, but it plays a big role in creating quality movement as well as preventing injury.

The muscles of the core play a major role in deceleration. A good functional training program will work on the interplay between force production and force reduction with core training literally and figuratively at the center of the program.

Ultimately, what links everything together into a complete functional program is proprioception. Proprioception is awareness of joint position derived from feedback in the sense receptors in the joints, ligaments, tendons, and muscles. It is a highly trainable quality. We must strive to constantly change proprioceptive demand throughout the training program. In fact, this variable should be adjusted more frequently than changes in exercises.

ASSESSMENT

Before designing your core training program, a thorough assessment of your athletes’ core strength must occur. Traditional assessment methods usually seek to isolate strength of individual muscles in a prone or supine position. Instead, you should implement a functional assessment, using positions that simulate the posture of the specific sport.

I like to divide assessment drills into two categories: movements driven from the top down and movements driven from the bottom up. In the first category, I usually use medicine ball exercises such as chest passes off two legs and one leg, overhead throws (again, both single- and double-leg), and a rotational throw where I compare the distance of throws off the right and left leg. In the second category, I use balance tests, excursion tests, and a lunge, jump, and hop test.

I also assess athletes by taking video of them during their sport activity. I try to video their actions from the front, side, and rear, if possible, and

◆

judge quality of movement. I also look for any patterns of movement that might reveal problems.

Along with testing these specific qualities, it’s also important to carefully assess other areas of the athlete’s performance to make your program effective. Areas to consider include: • Demands of the event or position.

• Physical qualities of the athlete (size, skill, etc.).

• Dynamic postural analysis.

• Injury history.

• Performance and training history.

For example, if after assessing a soccer forward, I find she has poor dynamic posture and is deficient in medicine ball exercises with her left leg, I would likely design a program with an emphasis on correcting these problems. I would stress to her the importance of maintaining correct posture in all exercises, and I would increase exercises that strengthen the left side of her body. I might also try to find game footage that shows her miss-

ing a play because she was insufficiently powerful accelerating from her left side, and show it to her.

TRAINING TOOLS

Progression is the key to any good training program, including developing core strength. It is essential to achieve mastery of each step before moving to the next. Start with easy and simple basic movements and progress to harder and more complex ones. I have found it more effective to emphasize a few simple movements than to add exercises.

You can classify drills into four areas: • Stabilization • Flexion/extension • Rotation • Throwing/catching.

This structure allows us to distribute exercises based on classifications to ensure adequate recovery and effective coverage of all aspects of core movement. My suggestion is, for a six-

OPTIMUM PERFORMANCE

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day-a-week schedule, to train stabilization every day; train flexion/ extension with a major emphasis on Tuesday and Friday and a minor emphasis on Monday and Thursday; make rotation a major emphasis on Monday, Thursday, and Saturday; and have a major emphasis on throwing and catching on Tuesday and Friday.

You also want to choose exercises that work the core in all planes of motion. For example, you should make sure you include: • Trunk flexion and extension, which will work the sagittal plane.

• Lateral flexion, which will work the frontal plane.

• Trunk rotation, which will work the transverse plane.

• Combinations and catching, which will work all three planes.

Exercises should begin in the most challenging position the individual can fully control. As the athletes master simple movements, you can modify the drills to make them more challenging.

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OPTIMUM PERFORMANCE

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Sample Program The following is a sample core-training program. The basic rotations can be done during warmup and are always one set.

The other exercises can vary from one to four sets depending on the time of training year and your overall goals.

BASIC ROTATIONS One set of each exercise x 20 forward, then backward Walking Wide Twist Walking Tight Twist Walking Over The Top Walking Figure Eight CABLE CORE TRAINER (STRETCH CORD) Flexion/Extension x 20 Twisting x 20 (10 each side) Chop x 20 (10 each side) Big Circles x 20 (10 in same direction, 10 in opposite direction) MEDICINE BALL ROTATIONS Standing Full Twist x 10 each direction Standing Half Twist x 10 each direction Half Chop x 10 each direction Seated V-Sit Throw x 20 Seated Side Throw x 10 each direction Solo Med Ball Sit Up x 5 each direction

MEDICINE BALL PARTNER OR WALL THROWS Overhead Throw x 20 Soccer Throw x 20 Chest Pass x 20 Standing Side to Side x 10 each side (cross in front) Standing Cross in Front x 10 each side Around the Back x 10 each side TOTAL BODY THROWS Because these exercises are used to achieve maximum explosiveness, they are never done for volume.

Single-Leg Squat & Throw x 6 each leg Single-Leg Squat & Scoop Throw x 6 each leg Over The Back Throw x 6 Forward Through The Legs x 6 Squat & Throw x 10

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Modify the amount of proprioception by using: • Balance beam • Balance board • Stability ball • Foam roll • Airex pad • ABC ladder™ • BOSU™ • Mini tramp Modify the loading parameters by using: • Bodyweight/gravitational loading • Power ball/kettlebell • Physioball • Dumbbell • Tubing • Weight vest • Bodyblade • Medicine ball • Stretch cord You can also alter body position. I like to change the athletes’ posture from sitting to kneeling to standing. I also switch between walking and running. I use bilateral and unilateral stances.

Some exercises are with partners, while others are solo.

With the increased emphasis on core exercises, there are many drills to choose from. Learn how to select the core training tools that are most appropriate for the task at hand. Combine tools with a specific purpose and goal in mind. Constantly evaluate exercises and environmental modifiers. The key is understanding the purpose of each drill and choosing accordingly.

YEARLY GUIDELINES

Core training should be incorporated daily throughout the training year.

Volume and intensity should be regulated in concert with the total workload in all components of training and the objective of that particular training cycle. Here are some suggestions: Volume Guidelines: Because of the structure and function of the core, relatively high volumes are necessary to achieve any significant training adaptation. For rotational movement,

OPTIMUM PERFORMANCE

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the exercises are usually done in sets of 20 repetitions. For total body throws, the rep range is usually six to 10 repetitions.

For wall throws or partner throws, the number of repetitions is typically 20.

Number of exercises: Use a range of six to 10 exercises per session with the number of reps based on the training objective for each session.

Time requirement: Core work should typically take 15 to 20 minutes each day. But it does not have to be done all in one block. It can be distributed throughout the workout at strategic points.

Where in the workout: Core training can be accomplished during the warmup, when rotations, chopping, and flexion and extension movements are especially effective. Throws should be done as a segment of the workout or as an actual workout in itself in order to ensure high intensity and proper mechanics. After the main workout or during cooldown is the least desirable time to train the core. ◆

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Bulletin Board FLSA Changes Limit Overtime Pay Athletic training is one of the professions most directly affected by recent changes to the federal Fair Labor Standards Act (FLSA), which were implemented on Aug. 23. The new regulations specify that athletic trainers who have completed four years of study at a program accredited by the Commission on Accreditation of Allied Health Education Programs and are certified by the National Athletic Trainers’ Association are considered exempt professionals and are not eligible for overtime pay.

The clarification follows several years of ambiguity, with athletic trainers in a handful of states suing school districts for unpaid overtime with varying results. However, in 1999, a Texas court ruled that a group of San Antonio Independent School District athletic trainers were in fact exempt from overtime. The Supreme Court later refused to hear the case, allowing the decision to stand.

The Department of Labor relied on that court decision, along with the fact that athletic training is a specialized field requiring advanced education and utilizing extensive discretionary judgement, in setting the new regulation. Now, both college and high school certified athletic trainers are ineligible for overtime pay under the FLSA’s professional exemption.

More information on the new regulations is available online at www.dol.gov/esa/regs/compliance/whd/fairpay/main.htm.

NSCA Names Award Winners During its 27th Annual Conference held in Minneapolis, Minn., the National Strength and Conditioning Association honored a number of its members for their noteworthy contributions in the field of strength training and conditioning.

Gerard Martin, CSCS, Head Strength and Conditioning Coach at the University of Connecticut, was named the College Strength and Conditioning Professional of the Year. Martin was honored for his dedication to the profession through service with the NSCA College Strength and Conditioning Professionals Special Interest Group and his work on special NCAA committees. The award winner is chosen by a group of College Strength and Conditioning Professional SIG members.

Bruce Harbach CSCS*D, Strength and Conditioning Coach and Head Football Coach at Lancaster (Pa.) Catholic High School, was named the High School Strength and Conditioning Professional of the Year. Harbach, who also teaches physical education at the school, has presented at NSCA conferences and published articles in association journals.

The Lifetime Achievement Award went to John Garhammer, PhD, CSCS, NSCA-CPT, Professor and Director of the Biomechanics Laboratory at California State University-Long Beach.

To read an article written by Martin on training for basketball published in Training & Conditioning, please visit www.athleticsearch.com and type “Strong to the Hoop” into the search window.

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A joint effort of the American Dietetic Association and the Gatorade Sports Science Institute, the Performance Challenge uses an interactive computer quiz to teach athletes about food, performance, hydration, and safety. Athletes are split into teams and compete against each other as they answer a series of questions.

To access the quiz, athletic trainers or coaches will first need to find a nutritionist in their area to lead their athletes through the program.

Users of the Performance Challenge Web site can type in their ZIP code and receive a list of trained nutritionists in their area who can make presentations. Short profiles of each nutritionist are provided with the list.

It is then up to the athletic trainer to contact a selected nutritionist to arrange for a demonstration at their school.

More details on the Performance Challenge can be found at www.performancechallenge.com.

Mourning Jack Cramer The athletic training world lost one of its legends when Jack Cramer died on Aug. 5 in Olathe, Kan. Cramer was the Chairman of the Board of Cramer Products for 20 years after previously serving as Sales Manager and Promotions and Advertising Manager at the company, which was founded by his father and uncle.

Cramer was an honorary member of the National Athletic Trainers’ Association, which he helped form. In 1982, he was inducted into the Hall of Fame of the National Association of Intercollegiate Athletics.

As a student at Kansas State University in the late 1930s, Cramer served as the school’s head athletic trainer before joining the Army Air Corps. He was a combat instructor in B-25s, B-17s, and A-25s for three years before becoming Operations Officer at Hickom Field in Honolulu.

From 1956 to 1967, Cramer was an athletic training consultant for the Special Services Department of the United States Air Force and traveled to air bases throughout the world.

More information on Cramer Products is available at www.cramersportsmed.com.

If you have any news or interesting trivia items you would like to contribute to T&C’s Bulletin Board, please e-mail them to ef@momentummedia.com, or fax them to (607) 257-7328.

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For the Temporary Relief of Minor Aches… …there are a plethora of choices.

Here’s how to steer your athletes in the right direction when they have questions about pain medications.

By Dr. Stan Reents

S

ometimes it’s to help ease the pain of an injury. Other times it’s for delayed-onset muscle soreness. Or maybe it’s just for a headache. Whatever the reason, pain medications are often needed by athletes.

While athletic trainers are neither physicians nor pharmacists, they are often the first source that athletes turn to for advice on pain medications. Thus, as new drugs continue to be introduced, it’s imperative that athletic trainers keep up with the changes in the field.

In this article, I’ll update athletic trainers on the types of oral medications they should know about (including the newer “selective COX-2 inhibitors”), contraindications, and how to choose among products. I’ll also answer some of the most-asked questions about dosing.

Jorg Greuel/©Getty Images

Stan Reents, PharmD, is President and CEO of AthleteInMe, LLC. He is the author of Sport and Exercise Pharmacology, published by Human Kinetics, and the former Editor-in-Chief of Clinical Pharmacology, at www.cp.gsm.com.

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DIFFERENT TYPES

Although pain medications can be dispensed in many different forms, this article will be limited to pain medications taken orally, which can be grouped as follows: • NSAIDs • aspirin • acetaminophen • opiate agonists NSAID stands for non-steroidal anti-inflammatory drug, and they are used most often when an athlete has pain and/or inflammation. They also help reduce fever. The first NSAID to be marketed was Motrin® (ibuprofen) in 1974, and thus some people refer to NSAIDs as Motrin-like drugs.

Aspirin is a salicylate, and it works similarly to NSAIDs in that it can be used to reduce pain, fever, and inflammation. Acetaminophen, while treating pain and lowering fever, has no anti-inflammatory properties. Opiates are used only for reducing pain and require a physician’s prescription.

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Aspirin and NSAIDs are effective in treating joint injuries, overuse injuries (such as tendinitis and bursitis), and muscle or soft-tissue injuries, including strains and delayed-onset muscle soreness (DOMS). They are also used for headache and fever.

The main differences between types of NSAIDs are their duration of action and their availability as overthe-counter (OTC) or prescriptiononly drugs. (See Table One, on page 24, for a list of first-generation NSAIDs.) They all have similar potency, although OTC forms of a particular drug are always lower strength than their prescription-only equivalents.

Most clinicians consider indomethacin and piroxicam to be the most potent of the group, but determining the relative potency of these drugs is very difficult.

Athletic trainers should be most familiar with the three NSAIDs that are available without a prescription: ibuprofen (sold under the brand names Advil®, Motrin®, and Nuprin®), ketoprofen (Orudis-KT®), and naproxen

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Currently, all of the COX-2 inhibitor drugs can be identified by the ending “-coxib” in the generic name.

Celecoxib (Celebrex®) and rofecoxib (Vioxx®) are two being used to treat pain in athletes.

(Aleve®). Of these three, naproxen is slightly longer-acting, thus it can be dosed less frequently. Other than that difference, these three NSAIDs are essentially interchangeable.

Aspirin and NSAIDs suppress the inflammatory response by inhibiting cyclooxygenase (COX), the enzyme

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responsible for prostaglandin synthesis. Because prostaglandins are also involved in fever and sensitizing nerves, these drugs also reduce fever and have analgesic properties.

In the 1990s, two forms of cyclooxygenase, COX-1 and COX-2, were identified. In 1999, drugs that inhibited COX-2 to a greater degree than COX-1 began to be marketed in the United States. These “selective COX-2 inhibitors” appear to produce fewer adverse reactions than the older, first-generation NSAIDs. However, within both groups, there is substantial variation in the degree to which COX-2 is affected relative to COX-1, making generalizations difficult.

Currently, all of the COX-2 inhibitor drugs can be identified by the ending “-coxib” in the generic name.

Celecoxib (Celebrex®) and rofecoxib (Vioxx®) are two being used to treat pain in athletes, while another, valdecoxib (Bextra®) is not yet FDA-approved for the treatment of pain or other uses that may pertain to athletes.

CHOICES

Because of their convenience and widespread use, OTC NSAIDs are the likely first choice for an analgesic or anti-inflammatory drug by an athlete or athletic trainer. Aspirin is also very effective for most of the minor conditions described here, though it is short-acting and may cause more gastrointestinal (GI) upset than an NSAID. Choices abound in the NSAID group. If one of the OTC NSAIDs (ibuprofen, ketoprofen, naproxen) doesn’t help, ask the athlete’s physician to prescribe a more potent NSAID. Or if the athlete has GI upset with one of the traditional NSAIDs, discuss one of the new COX-2 inhibitors (celecoxib, rofecoxib).

If NSAIDs cannot be used, acetaminophen can be considered, though it is not very effective for joint-related inflammatory pain. Thus, it is not a good choice when you need to treat swelling caused by a twisted ankle, for example.

Finally, when a pure analgesic is needed, a physician may prescribe

opiates. Morphine is a superb analgesic, when dosed correctly. Codeine, hydrocodone, and oxycodone are other examples of opiates that can be administered orally. Meperidine is not recommended as it is not a very good analgesic, despite how frequently it is used. Opiates can cause side effects such as dizziness, however, which the athlete should be made aware of.

For a football player who just broke his leg, or a gymnast who just broke her wrist, morphine has been the traditional choice, since it is highly effective for bone-related pain. However, like acetaminophen, opiates do not offer any anti-inflammatory effects. Thus, combining an opiate with an NSAID is logical and effective. In fact, some pharmaceutical manufacturers offer products with these two components— one example is Vicoprofen ®, which combines the opiate hydrocodone with the NSAID ibuprofen.

Physicians may also prescribe other combination drugs. There are far too many multi-ingredient analgesics

ATHLETICBID.COM ◆

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TREATING THE ATHLETE

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on the market to discuss here. However, the following are prescribed frequently: • Acetaminophen with codeine (Tylenol® No. 3): This drug product combines 300 mg of acetaminophen with 30 mg of codeine. It is strictly an analgesic and thus has no antiinflammatory effects.

• Acetaminophen with oxycodone (Percocet®, Tylox®): These two ingredients are available in several different strength combinations.

Like Tylenol No. 3, this product serves only as an analgesic with no anti-inflammatory effects.

• Hydrocodone with ibuprofen (Vicoprofen®): This drug product combines 7.5 mg of hydrocodone with 200 mg of ibuprofen. It is an excellent choice for moderate to severe pain when an oral medication is needed, for example, in the management of pain associated with a broken bone.

Generally, problems stemming from the chronic use of aspirin and NSAIDs will be seen in the GI tract: epigastric pain, GI bleeding, or liver damage. Chronic use of acetaminophen raises the possibility of liver toxicity, and chronic use of opiates can lead to dependence.

CONTRAINDICATIONS

Along with knowing what works well, it’s just as important to know when a drug is contraindicated.

Aspirin and NSAIDs should NOT be used in the following situations: Undiagnosed abdominal pain or a history of blood in the stool: Anyone, even perfectly healthy athletes, can develop gastritis by taking too 22 ◆ T & C O C T O B E R 2 0 0 4 ◆

much aspirin or NSAIDs. Some evidence shows that strenuous exercise itself, such as marathon running, can cause GI bleeding, so adding one of these drugs only increases that risk.

Most often, this is not a serious problem and recovery is prompt if the offending agent is discontinued. For athletes who have had epigastric pain after taking aspirin or an NSAID and who need an occasional dose of a mild analgesic, acetaminophen (such as Tylenol®) is safer. Alcohol should be avoided while taking aspirin or NSAIDs since the combination may have additive erosive effects on the stomach lining.

Any kind of bleeding problem: This warning always applies to drugs like aspirin and NSAIDs because of their effects on platelet function, but generally, the medical conditions that generate this kind of warning are highly uncommon in athletes. If, however, an athlete develops easy bruising while taking aspirin, discontinue use and consult a physician. Athletes in this situation who need an occasional dose of a mild analgesic should use acetaminophen instead. In addition, if an athlete is bleeding from a laceration, aspirin or NSAIDs should not be administered due to their effects on platelet function.

Liver disease: All types of analgesics discussed here (aspirin, NSAIDs, acetaminophen) have the potential for causing liver damage. Fortunately, this is not very common with occasional use of any of these drugs. Acetaminophen, however, is slightly different. Athletes should not use this drug in high doses (more than 2,400 mg/day) or take it chronically as this increases the risk of liver toxicity. Regular consumption of alcohol and acetaminophen together also increases the risk of liver damage.

Asthma, history of aspirin sensitivity, or allergy to tartrazine dye: This warning is one that always appears in the literature, but fortunately, problems are very rare. Nevertheless, if your athlete is asthmatic, you should question him or her about shortness of breath and any allergies to aspirin, NSAIDs, or any other drugs before administering medications.

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Concussion or altered mental status: If an athlete has just sustained a concussion or is exhibiting anything other than a clear mental state, drugs should not be administered. If the athlete loses consciousness after taking a dose of medication, making an accurate diagnosis is more difficult.

DOSING

With the dozens of available drug products that include an NSAID component, specific dosing information is well beyond the scope of this article.

Instead, I will address general questions about dosing these drugs.

What are the short-term limits of taking NSAIDs? When managing DOMS or simple joint aches not related to a specific injury, NSAIDs can be used for several days, up to a week or two. If the problem does not resolve, the athlete should rest the affected area—using a higher dose or switching to a more potent drug will just cover up the problem.

For management of fever or headache, NSAIDs should not be continued for more than three days. If the fever or headache doesn’t go away quickly, the athlete should be referred to a physician.

What are the long-term limits?

Considering that patients with rheumatoid arthritis take NSAIDs for years and years, these drugs are relatively safe. However, possible long-term effects should not be ignored.

The risk of toxicity and side effects is determined somewhat by frequency of use. If an otherwise healthy athlete takes one or two ibuprofen tablets once a week for an entire season, it is highly unlikely that he or she will develop any long-term toxicities.

However, anyone who takes any of the drugs discussed here daily for months could, and probably will, develop problems. Generally, problems stemming from the chronic use of aspirin and NSAIDs will be seen in the GI tract: epigastric pain, GI bleeding, or liver damage. Chronic use of acetaminophen raises the possibility of liver toxicity, and chronic use of opiates can lead to dependence.

◆

More recently, a condition known as “medication overuse headache” has been attributed to the chronic use of NSAIDs. This situation can be explained as a drug withdrawal phenomenon: When each dose of the drug wears off, the headache returns, and the patient takes another dose, thereby perpetuating a never-ending cycle. Some patients who have chronically taken NSAIDs for migraine headaches find that their headaches stop after they discontinue regular use of NSAIDs for several days. If you have an athlete who takes NSAIDs regularly for headaches, this situation should be considered.

When using NSAIDs in sportsmedicine situations, the duration of time that an athlete should take one of these drugs is usually determined more by the injury than by the drug. If a tennis player cannot serve or a football player cannot run without first consuming anti-inflammatory drugs or analgesics, this suggests that rest and rehabilitation are needed. It would be

TREATING THE ATHLETE

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Take-Home Points Before giving a pain medication to an athlete, consider the following questions: What is the specific injury?

If the injury is severe, acetaminophen, aspirin, or a low dose of an OTC NSAID may not be very effective. If there is substantial bleeding, aspirin should be avoided due to its more pronounced effects on platelet function. If there is any possibility that the athlete might lose consciousness, never administer anything orally.

Is the athlete allergic?

If an athlete has ever had an allergic reaction to aspirin or other drugs, be careful about administering aspirin or NSAIDs. Acetaminophen and the opiates are safe, as long as the specific product does not also contain an NSAID. Does the athlete drink alcohol?

Tell athletes that drinking alcohol while taking aspirin or an NSAID greatly increases the risk of gastritis and GI bleeding. Combining alcohol and acetaminophen increases the risk of liver damage. Combining alcohol with an opiate should never be allowed.

What is an appropriate stopping point?

Talk to your athletes about when to stop medicating. One week should be considered the maximum time frame to self-medicate with an NSAID for musculoskeletal injuries, less for headache or fever. Chronic use of NSAIDs should be discouraged, not only to reduce the risk of an adverse reaction, but also because the condition may require medical attention if it does not resolve within this time period.

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TREATING THE ATHLETE

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(the filtering unit of the kidney). To avoid the possibility of hyponatremia, athletes should drink fluid containing salt and other electrolytes if they exercise for a prolonged period of time while using NSAIDs.

In 1994, Roi and colleagues evaluated healthy, active subjects 30 minutes after a single, 1,000-mg dose of aspirin, and no significant effects on cycle ergometer performance were observed. Lisse and colleagues, in 1991, looked at the effects of a single, 650-mg dose on a two-mile run 30 minutes after runners ingested the aspirin and also found no effect.

Thus, it appears that single doses of aspirin do not affect aerobic performance. But whether daily, continuous ingestion or higher doses produce different results is uncertain. More clinical research is needed to determine the effects of chronic aspirin ingestion on energy metabolism during sustained aerobic exercise.

The effects of NSAIDs on athletic performance may be different. NSAIDs have been shown to increase the production of adenosine, which, in turn, stimulates capillary growth. This pharmacologic action raises the possibility that repeated use of an NSAID over a period of several weeks might boost an athlete’s VO2 max, but this has never been demonstrated.

Opiates may have performanceenhancing qualities for some athletes and thus are banned substances. They also have unwanted side effects, as they adversely affect psychomotor performance and actions that require speed.

EFFECTS ON PERFORMANCE

THE ATC’S ROLE

Do any of these pain medications affect performance? In cases of toxic overdoses, aspirin can disrupt oxidative phosphorylation, leading to life-threatening metabolic disturbances. This raises an interesting question: What is the effect of high doses, or chronic use, of aspirin during prolonged physical exertion? Unfortunately, such a study has never been done.

In 1988, De Meersman studied the acute effects of a single dose of aspirin during 60 minutes of treadmill exercise at 50 percent VO2 max and found no effect on glucose, insulin, or free fatty acid utilization. He concluded that single doses of aspirin should not affect glucoregulatory and counterregulatory metabolism during exercise.

Pain medication is a necessity in athletics, and athletic trainers will be well served to know the implications of the different choices. Controlled substances should never be administered without a physician’s prescription, but athletes need guidance on making OTC choices and will have questions about their prescriptions.

Most important is looking for contraindications and making sure athletes are not taking any pain medications for prolonged periods. Discuss any problems with the prescribing physician and ask to be kept in the loop about any outof-the-ordinary prescriptions. Finally, take the time to read about new types of medications and their application to competitive athletes. ◆

Table One: First Generation NSAIDs Generic Name (Trade Name)

Duration of Action

Rx or OTC

diclofenac (Cataflam®, Voltaren®)

short

Rx

etodolac (Lodine®)

short

Rx

fenoprofen (Nalfon®)

short

Rx

short

Rx

ibuprofen (Advil , Motrin , Nuprin )

short

Rx and OTC

indomethacin (Indocin®)

intermediate

Rx

ketoprofen (Orudis-KT®)

short

Rx and OTC

ketorolac (Toradol®)

short

Rx

long

Rx

naproxen (Aleve , Naprosyn )

intermediate

Rx and OTC

oxaprozin (Daypro®)

long

Rx

piroxicam (Feldene®)

very long

Rx

sulindac (Clinoril )

intermediate

Rx

tolmetin (Tolectin®)

short

Rx

flurbiprofen (Ansaid®) ®

®

®

nabumetone (Relafen®) ®

®

®

illogical to let an athlete go through an entire season dependent on drug therapy to dull the pain of movement.

Should athletes be concerned about developing kidney ailments from taking pain medications?

Aspirin and any of the NSAIDs certainly affect the normal physiology of the kidney. For 98 percent of people, however, it never causes any problems and is quickly reversible when the drug is eliminated.

Following the suggestions mentioned above should ensure no long-term problems arise.

It is possible, however, that these drugs could contribute to hyponatremia and other electrolyte disturbances because of their effects on kidney function. Hyponatremia occurs when athletes participating in endurance events or prolonged strenuous exercise ingest a large volume of water but no salt. NSAIDs have a very real, though low, potential to add to this problem by causing dysregulation of fluid and electrolyte control within the nephron 24 ◆ T & C O C T O B E R 2 0 0 4 ◆

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This new text from the American College of Sports Medicine (ACSM) contains information necessary to develop skills for assessing an individual's health-related physical fitness. It provides the reader with a practical "how-to-do-it" approach for performing these assessment skills effectively, and an understanding of the theory behind and the importance of each skill or assessment.

Marcia K. Anderson, PhD, LATC Susan J. Hall, PhD Malissa Martin, EdD, ATC Formerly titled Sports Injury Management, this third edition sets the new standard for teaching the most current information available in the athletic training field. Using a problem-solving approach, you’ll explore all of the core information an athletic trainer needs to know, including prevention, recognition, assessment, management, and disposition of injuries and diseases common in active individuals. Basic medical concepts and related scientific information are woven throughout to help you build a strong foundation of knowledge in athletic training practices.

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March 2004/200 pages/Approx. 40 illustrations/75 tables/ 0-7817-3471-1/$39.95

Exercise Handouts for Rehabilitation Carole B. Lewis This reference provides exercises for a customized rehabilitation program in the areas of range of motion, progressive strengthening, stretching, and self-mobilization. The authors have provided a description and representative diagram of each exercise for the patient, plus short-term and long-term goals. Using this reference, the clinician is encouraged to copy the pages describing the appropriate exercises and give them to the patient for a future home use. As the patient progresses, additional exercises can be added until a complete rehabilitation program has been created.

Features: • Consistent format, which includes Patient Name, Date, Goals, Exercise Instructions, Special precautions, Comments • Illustrations show exercises and appropriate movements to do the exercise • Exercise hints offer tips for care of specific body regions.

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Therapeutic Exercise William D. Bandy, PhD, PT, SCS, ATC Barbara Sanders, PhD, PT, SCS This practical resource focuses on the implementation of treatment plans and intervention using the appropriate therapeutic exercise techniques.

Designed to be used after the client has been examined and the impairment has been identified, it provides descriptions and rationale for use of a wide range of exercises to improve a client's function and health status and to prevent potential future problems. The techniques presented accomplish a variety of goals, including increased mobility and strength, and introduce the important concepts of balance and posture, body mechanics, and spinal stabilization. The description of the purpose, position and procedure is given for each technique, providing a complete understanding of the exercise.

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Features: • Back-of-book Student Resource CD-ROM includes an interactive study tool with new review questions and the digital teaching tool, Dynamic Human Anatomy (DHA). DHA offers anatomy video clips from Acland's Video Atlas of Human Anatomy and interactive anatomy illustrations.

• New chapter on taping and bracing provides the principles of taping and wrapping with common techniques demonstrated for the upper and lower extremities, including the construction of custom pads and orthotics.

• Information on performance altering substances such as tobacco, caffeine, alcohol, and ergogenic aids.

June 2004/736 pages/Approx. 565 illustrations/ 0-7817-5001-6/$79.95

Comprehensive Sports Injury Management Jim Taylor, PhD Kevin R. Stone, MD Michael Mullin, ATC Todd Ellenbecker MS, PT Ann Walgenbach, RN, FNP, MSN This book provides comprehensive information for the use in day-to-day work of the injury management process. It has three primary goals: (1) to identify important physical, psychological, and logistical issues that will benefit patients; (2) to provide practical information, guidelines, approaches, and strategies to ensure that the handling of these issues facilitates rather than interferes with the injury management process; and (3) to offer sports medicine professionals a framework to provide patients with information about these issues.

Features include: • Easy-to-read layout • Charts, checklists forms, patient handouts, contracts and other practical tools • Tables that summarize information in easy-to-use format.

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MANAGEMENT

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Gale Hughes

Juggling Jobs Chuck Kimmel can juggle not just one, not just two, but three job titles! (Note: beginners should always start with two.)

A

s Head Athletic Trainer at Austin Peay State University, Chuck Kimmel supervises a staff of fulltime, part-time, and student employees, along with providing primary coverage for the football team. As Assistant Athletic Director at the school, he is responsible for the men’s and women’s tennis programs, the indoor and outdoor track and field programs, and the weightroom. At the same time, he’s the new president of the NATA.

By Kenny Berkowitz Being a head athletic trainer is tough enough. Who in their right mind would want to take on any additional roles?

The idea is not for everyone, and it won’t work in every setting, but some athletic trainers are finding benefits to taking on duties outside the norm of their profession. Clearly, there are risks to expanding responsibilities, and you need the right support from

the school and direct supervisors. But, with all the right pieces in place, a dual role can make a job more fulfilling, improve the quality of care, enhance knowledge, and expand job prospects.

BEFORE YOU COMMIT

The key to succeeding in a dual role, says Kimmel, is finding out as much as you can about the position prior to committing to any new responsibilities.

Kenny Berkowitz is an Assistant Editor at Training & Conditioning.

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T & C O C T O B E R 2 0 0 4 ◆ 27

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MANAGEMENT

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condition I had was that I get help,” he says.

“That’s when I got my first assistant. Then my current athletic director added another assistant plus two interns, and with my new NATA duties, I’ve been able to add a third assistant. The university has embraced my NATA participation, which has been an extremely important part of all this.

Because I would never want my athletic director to say, ‘Does Chuck even work here anymore?’”

At APSU, Kimmel’s role model for multi-taskChuck Kimmel poses in the Austin Peay State athletic ing is his athletic director, training room, where he concentrates on rehabs for two who also works as the hours each morning before moving to his office and head men’s basketball tackling his assistant athletic director duties. coach, and the two discussed Kimmel’s dual roles carefully “Before you take on an additional role, before they were finalized. As a result, you need to know what you’re getting for Kimmel, the positives of choosing into,” advises Kimmel, MA, ATC/L. to work multiple roles far outweigh “It should feel like an opportunity, not the negatives. an obligation, and you should be excit“I know that many athletic trained about it.” ers feel overworked and underpaid, Kimmel cautions other athletic and that’s something we hope can be trainers about the dangers of burnout, addressed with time,” he says. “But feeling overwhelmed, and getting in choosing a dual role is a separate over your head. If athletic trainers are issue, one that can take you into a going to add new responsibilities, says completely different realm of responKimmel, it’s important that some of sibilities. When they work well, their other tasks are taken away. The multiple roles can expose athletic department needs to provide support for trainers to different aspects of their the new position, either with release profession, their department, their time or additional staff, and should have university, and their conference.” a plan in place for the athletic trainer’s transition into his or her new dual role.

MANAGING TIME “Ask exactly what your responsiSo, how does Kimmel actually manage bilities are going to be and how your the two jobs? The keys, he says, are prisupervisor’s expectations are going to oritization and time management. “You change,” says Kimmel. “Make sure need to have the ability to prioritize your supervisor understands that the between what is and isn’t important,” new duties may take time away from he says. “If I have more than three or being an athletic trainer. Make sure he four things to do, I’ll make a list and or she is comfortable with that and has attack them one at a time. In setting priprovided staffing to allow you to do orities, I think about urgency, and my both positions.” question is always, ‘Which would best Before taking on any additional serve our student-athletes?’” tasks, Kimmel made sure that he’d be Kimmel divides each work day supported. “When I was first elevated into three parts, one for each of his to assistant athletic director, the only 28 ◆ T & C O C T O B E R 2 0 0 4 ◆

ATHLETICBID.COM

roles. Arriving at his office a couple of hours early, he begins his work for the NATA, answering e-mails and handling paperwork. During the mornings, he sets aside two hours solely for athletic training, concentrating on rehabs. He makes it a policy not to answer telephone calls or schedule meetings for that time.

After that, he returns to his office, where he switches to his duties as assistant athletic director, meeting with coaches and handling administrative responsibilities. Then in the afternoons, he returns to his work as head athletic trainer, providing coverage for the football program and supervising his athletic training staff.

After finishing his first few months as NATA president, Kimmel continues to find his multiple roles manageable.

Buoyed by support from his family, Kimmel sees his presidency as a new way of giving back to the profession. At the same time, it’s expanded his understanding of the field, brought him into closer contact with athletic trainers around the country, and validated his decision to take on another task.

“One good thing about athletic trainers,” says Kimmel, “is that we know how to multi-task. We always have several things going on at once, because that’s our job. The solution to taking on additional roles is to transpose those skills to the new position.”

CHALLENGING YOURSELF

For Gina Leccese, Athletic Director, Athletic Trainer, and Health Teacher at Torrance (Calif.) High School, a typical work day starts at 7:30 in the morning and ends at seven or eight at night. After spending first and second periods as a health teacher, she works as the athletic director until four, and then concentrates on her role as athletic trainer.

“I love the challenge, and I love the kids,” says Leccese, who is also currently pursuing a Master’s in athletic administration. “Wearing the different hats gives me a chance to play three roles. I like what I’m doing, and it’s pretty easy to do all three at the same time. I just wear my hip pack and take my kit with me wherever I go.”

◆

With responsibility for 22 teams playing home games at facilities that are up to two miles away from school, there’s no shortage of challenges for Leccese. She supervises 22 head coaches, plus all their assistant coaches, and makes a point of spending time with each one. During the football season, she works to avoid scheduling conflicts, providing athletic training coverage for all the football games herself, and enlisting the help of her principal and assistant principal to cover athletic director’s duties at other contests. The rest of the year, Leccese generally provides athletic trainer and athletic director coverage for home games. All year around, she’s always on call.

“Sometimes it feels as though my jobs don’t ever stop,” says Leccese. “I get phone calls at all hours of the day and night, and sometimes I’m in the middle of my job as athletic director when one of my health students walks into my office with a question.”

Her solution? To manage the transitions from one task to another, she stays very clear on her priorities: Taking care of athletes comes before

“

I know that many athletic trainers feel overworked

everything else. She also emphasizes the importance of being flexible as she goes from athletic director to athletic trainer and back again.

To cope with the workload, she has student aides who help tape ankles and stock the athletic training room, and student teaching assistants to help grade quizzes, input team rosters, answer telephones, and double-check the athletics calendar. Leccese does much of her preparation at home, and the bulk of her organizing and schedul-

MANAGEMENT

◆

ing during the summer, when she can work in her office without distraction.

Most of all, after two years working as both athletic director and athletic trainer, she’s learned the value of being organized. “The only way to keep everything running is to stay on the ball and always be very organized,” advises Leccese. “You have to be prepared at all times for the moment when you need to change roles. The key is learning when to stop doing one job and start doing the other.

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“Before you take on an additional role, make sure you’re up to the task,” she continues. “Make sure you have the time and energy to put 100 percent of yourself into your job, because that’s what it’s going to take. If you have the will to do it, it can become very, very fulfilling.”

roles is clear: She’s able to simultaneously pursue two different professions. “If you’re looking for something new but don’t want to change professions

IMPROVING CARE

For Pete Friesen, who works as Head Athletic Trainer and Strength and Conditioning Coach for the NHL Carolina Hurricanes, the way to keep calm during hockey season is to quit drinking coffee. And the way to provide his athletes with the best possible care is by coordinating his roles to create a unified, year-round program that emphasizes injury prevention.

“When you can combine the athletic trainer and the strength and conditioning coach into one person, you can maintain a common theme in your athletes’ training,” says Friesen, MS, ATC, PT, CSCS, CAT. “That way, there’s less likelihood of athletes overtraining or under-training. When the two jobs are separate, the athletic trainer and the strength and conditioning coach can sometimes work at cross-purposes.

“Strength coaches have to push their high-performance professional athletes to the nth degree,” he continues. “And sometimes, athletic trainers don’t have a good handle on what strength coaches are doing, and there can be contraindications in the training that they don’t recognize. You can have a strength coach pushing his athletes very hard, while the athletic trainer is trying to hold them back.

And that can be a big problem.”

To handle the demands of his double role, Friesen uses the off-season to order all the equipment and supplies he’ll need for the upcoming year. He also takes educational courses at that time, working to improve weaknesses in either field and to stay current with the latest thinking, techniques, and equipment. That way, when August rolls around, he’s able to concentrate on his highest priority: using his dual role to get his athletes into the best possible shape.

30 ◆ T & C O C T O B E R 2 0 0 4 ◆

For Gina DiCrocco, the advantage of working two

completely, multiple roles are a great way to explore other ideas and learn new skills,” she says.

“I want to spend 99 percent of my time in preseason on conditioning, with the understanding that if I start that emphasis at the beginning, I can help prevent injuries from occurring,” says Friesen. “I integrate all the exercise programs I’ll use during the season, so the athletes will know how their bodies are going to respond. Then, as the season goes on, I spend less time on conditioning and more time on rehabilitation. As professional hockey players, if I tell them what to do, they’re able to monitor themselves. And that frees me to work more on injuries.”

Mastering the combination of the two roles has, ultimately, kept Friesen motivated. “As an athletic trainer, having multiple roles can keep you from burning out,” he says. “It’s tremendously fulfilling when you can do both jobs.”

EXPLORING SOMETHING NEW

Before 2001, the University of Maine at Farmington had never had a fulltime athletic trainer or sports information director. But after working there for three years as a part-time athletic trainer, on top of nine years in the athletic training profession, Gina DiCrocco was glad to add “Sports Information Director” to her job title and become a full-time employee.

“It’s definitely been challenging for me,” says DiCrocco, MEd, LATC, Head Athletic Trainer and Sports Information Director. “As the sports information job has evolved over the last three years, the work has definitely

ATHLETICBID.COM

become more intensive. But I like it.

The fact that I can spend part of my time writing press releases and part on athletic training has kept both jobs feeling fresh. I don’t think every athletic trainer would want to do it, but it’s kept me from getting burned out.”

As sports information director, DiCrocco is responsible for updating and maintaining the department’s Web site, writing press releases and game summaries, taking photographs, keeping statistics, and reporting scores to the North Atlantic Conference. To juggle her two roles, DiCrocco focuses on sports information in the morning and athletic training in the afternoon—but she keeps her schedule flexible, because her most important responsibility is athletic training.

“When athletic training issues come up, they always take priority,” says DiCrocco. “After a game, I don’t do any sports information work until all the players have been taken care of, even if that leads to a pretty long day.

And if I fall behind on sports information, I can get help from the people around me.”

When she first took on the additional responsibilities, DiCrocco requested help from her supervisor, and currently supervises six student employees, five in her role as athletic trainer and one in her role as SID. She relies heavily on her student staff, delegating tasks such as event set-up and tear-down, stocking the athletic training room, and Web site updating.

Continued on page 34

enhance muscle performance with ems

E

Electromuscle stimulation (EMS) has a well-established role in rehabilitation and pain management, but is now the world's worst-kept secret among elite athletes as a way to safely enhance muscle performance. Even more, professional trainers and strength coaches have witnessed that training with EMS produces better results than conventional training alone.

High quality pre-programmed EMS devices are valuable assets to professional and amateur athletes alike. To name a few, NFL Pro Jerry Rice, European athletes like World Champion Skier Hermann Maier and Olympic tennis champion Justine HeninHardenne, and World Champion Triathletes Melanie McQuaid and Simon Lessing continue to benefit from EMS training sessions in conjunction with traditional training inside and outside the weight room. Professional teams for MLB, the NFL, NBA and NHL are also now using EMS outside the training room.

so what is it?

EMS devices generate electrical impulses that trigger an action potential in muscle nerve fibers (motor neurons). In response to this, the motor neuron produces a response known as a twitch. Twitches performed in succession generated by EMS are the same as a muscle contraction generated by the nervous system in response to regular exercise. The work performed by the muscle fibers varies according to the frequency (# of pulses per second) of the electrical stimulation - 10 impulses per second produces low excitement of fibers and 100 impulses per second produces high working power in the fibers.

what can ems do?

Electromuscle stimulation can accomplish three things that are outside of the brain's capabilities: It can recruit up to 100% of the muscle fibers in any muscle group, to perform work or exercise. The brain can only recruit (use) about 45-50% of the muscle fibers.

It can target specific muscle fibers: slow twitch, fast twitch, very fast twitch fibers… the brain cannot discern between these fiber types.

It can create more muscle activity in muscles being worked.The brain has a “limiting switch” that always keeps some of the muscle in reserve for emergency purposes.

what are the benefits of ems?

Scientific research has demonstrated that there are several physiological benefits to using EMS in conjunction with a traditional training program for fitness and sports performance: Recruitment of fast-twitch fibers The “size principle” or the “Henneman law” determines the way muscles respond during exercise whereby the smallest motor units (slow twitch) are activated first because of their low action potential. As demand on the muscle increases, the larger motor units (fast twitch) begin to activate. With EMS, this is reversed; the fast twitch muscles are activated first, thus initiating maximal eccentric movements which also focus on the fast twitch muscle fibers. This is a boon to those athletes who are required to perform maximal eccentrics and plyometrics which can be taxing to the joints and nervous system. Using EMS these athletes can reduce their volume of these training sessions and get better results with less risk of injury.

Increase in Muscle Strength Numerous studies have shown significant strength gains with EMS. Using a Compex® unit for 10 minutes three times per week for three weeks, sprinters

gained 52% in strength. (Ratton and Cometti) Boxers using EMS on the triceps had strength gains of 18.5% in the same three weeks with a similar protocol. (Champion and Pousson) In addition, several studies have shown a cross-education benefit whereby an untrained limb gained strength when the opposite limb was trained with EMS, just as it would be with traditional exercise.

Muscle Mass Gains Only a few studies have been done on muscle hypertrophy in healthy athletes using EMS. In one study, competitive triple jumpers had size gains of 4 to 8% in the quadriceps in 3 weeks, a 2 to 4 times better result than the control group.

(Turostowski,et al.) Competitive wrestlers experienced a 4.5% improvement in muscle mass after a 3 week EMS program. (Gillet and Cometti) Other studies have shown that EMS training can produce more micro-trauma than concentric training therefore leading to more growth.

Increase in Vertical Jump/Power A study was conducted on athletes performing squat jumps and countermovement jumps using EMS for 16 minute sessions three times per week for four and eight weeks. The experimental group used only EMS and the control group used only regular strength training. The SJ increased 14% after 4-weeks for training whereas the CMJ increased 17% after 8-weeks of training. There was a strength increase of 11.45% for the EMS group and 3.65% for the control group over all. Further research showed that EMS and plyometrics together produced significant improvements in the countermovement jumps. (Cometti, Maffiuletti, et al.)

Speed Increases Since EMS impacts the fast twitch fibers, there is good reason to believe that it improves speed even though clinical studies are not yet available. Careful stimulation of the muscles involved in running - quadriceps, rectus femoris, hamstrings, calves, and the gluteals is vital to avoid strength imbalances.

Muscle Recovery When EMS is utilized in sub-tetanic frequency, the pulsation acts like a massage, increasing blood flow, releasing endorphins, causing muscle relaxation and helping to breakdown adhesions between fibers. During recovery, EMS can be used to speed up the muscle ability to perform at high levels. A study (Gregory) showed that active recovery from EMS is effective in removing lactate after exhaustive exercise. Compared to post-exercise rest or light aerobic activity to help the body recover, EMS recovery showed a tendency toward a longer all-out effort than the other forms of recovery.

Work Beyond Normal Limits Psychological, muscular and cardiovascular fatigue are limiting factors in any traditional training scenario. With EMS programs, an athlete can effectively work localized muscles aerobically or anaerobically even after they have finished a traditional training session. EMS training can also take place before traditional training to “pre-fatigue” certain muscle groups before lifting.

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“

I’ve worked in every setting an athletic trainer can, except for professional sports … Having that range of experience has taught me to balance multiple responsibilities, adapt to different conditions, and organize my time effectively.

”

It’s been a great advantage for me.

Continued from page 30

Without any prior experience in sports information, DiCrocco is mostly self-taught, learning about Web design through university workshops and some reading on her own. For DiCrocco, the advantage of working two roles is clear: She’s able to simultaneously pursue two different professions and explore the similarities between them. With good skills in time management and a supportive supervisor, DiCrocco has managed to avoid being overwhelmed.

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“If you’re looking for something new but don’t want to change professions completely, multiple roles are a great way to explore other ideas and learn new skills,” advises DiCrocco.

“Don’t be afraid to explore an opportunity, or even to create a new one for yourself. Just make sure that you manage your time, and that you’ve got supportive supervisors. Because if you don’t, it’s not going to be a good situation for anyone involved.”

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Rodney Brown, MA, ATC, CSCS, EMT-B, likes to joke about his good luck in finding work. Now 51 years old, he’s spent his entire professional life in and around his hometown of Tuscaloosa and is currently the Head Football Athletic Trainer at the University of Alabama. Much of that “good luck,” however, is a result of the experience he’s gained by taking on multiple roles throughout his career.

Before starting his current job, Brown coordinated outreach for Druid City Hospital’s Sports Medicine Department while also serving as Director of Rehabilitation for Alabama football and a part-time instructor in the athletic training education program. Before that, he worked for nine years at Tuscaloosa County High School, where he was the school’s athletic trainer, health education teacher, and football coach.

“I’ve worked in every setting an athletic trainer can, except for

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professional sports,” says Brown.

“Having that range of experience has taught me to balance multiple responsibilities, adapt to different conditions, and organize my time effectively. It’s been a great advantage for me, and it helped me wind up here at Alabama.

“Having all those opportunities has made me a better athletic trainer, no doubt about it,” continues Brown.

“Experience is the best teacher, and having been at all these different settings, I’ve seen how the profession works.”

As a high school athletic trainer, he learned how to work creatively within a limited budget. As a clinic outreach coordinator, he learned how to administer a staff of athletic trainers working with middle school, high school, college, and recreational athletes. Along the way, he’s earned credentials as a strength and conditioning specialist and an emergency medical technician.

Over the years, he’s seen combinations of roles that have worked well—and some that haven’t. Working simultaneously as a high school football coach and athletic trainer, Brown felt he couldn’t do justice to either job—especially when one of his athletes was injured in a game. But once he dropped coaching, he was able to fit his teaching alongside his athletic training, with his academic work in the classroom striking a balance with his hands-on work in the athletic training room.

“Teaching health education and working as an allied health professional complemented each other, because there’s a lot of crossover between the two,” says Brown. “As an athletic trainer, I spent a lot of time counseling athletes about nutrition, exercise, supplements, and drugs— just like I did as a health education teacher. With those two roles, I really enjoyed my work.”

For Brown, the other key to effectively balancing his two roles was

MANAGEMENT

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having a schedule that allowed him to do one job at a time. Unlike the combination of football coach and athletic trainer, the dual role of health teacher and athletic trainer worked because his tasks were clearly separated, with mornings devoted to teaching and afternoons spent training and rehabilitating his student-athletes.

Brown would have been happy to work at Tuscaloosa County High for the rest of his career, but instead, his multiple roles kept leading him to increased job opportunities, until he found himself back at Alabama, his alma mater. “When my students ask me about building their careers, I tell them, ‘You’re probably not going to be as lucky as I was,’” jokes Brown. “But seriously, I’ve never had to move, never had to put my resume on the job hotline, and never had to send my resume out to a bunch of people at once. I tell my students that whatever setting they find themselves in, make the most of that experience.” ◆

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WORK WOUNDS One of the hazards of being an athletic trainer is dealing with back pain—your own back pain, that is.

In this article, a back specialist offers advice on how to treat and prevent work-related flare-ups.

By Dr. Craig Liebenson

A

© Getty Images

thletic trainers spend their days, and many of their nights, trying to keep athletes healthy and in the lineup. But this work can take a toll on its practitioners. Lifting heavy water coolers, taping countless athletes, or even taking a long bus ride with a travelling team can prompt an athletic trainer’s body to clamor for attention of its own. For many athletic trainers, the area of the body that suffers the most is the back.

Back pain can bring even the strongest athlete to his knees and force highly trained players to the sidelines. It can easily do the same with athletic trainers—except there is no sideline for them to go to.

The good news is that back pain rarely results from serious causes, and acute flare-ups of back pain usually improve within a few weeks.

When handled properly, there is typically 80-percent improvement within two weeks of the onset of back pain.

Furthermore, a simple stretching and stabilizing regimen can head off problems before they happen.

The overall gameplan for an aching back is to first soothe the back through palliative care while learning to spare the spine from excessive loads, and then to stabilize the spine through appropriate exercise. Fortunately, a neuromuscular re-education program to rehabilitate the spine can be performed in minimal time. Taking very short stretching

breaks at regular intervals throughout the day can placate an otherwise overstressed back, while a few additional minutes of therapeutic exercise will go a long way toward staving off future back pain episodes.

PAIN RELIEF

To start, it’s important for athletic trainers to understand the effects of the three stage of healing when it comes to back problems: inflammation, repair, and remodeling.

Inflammation will typically last three to seven days. The main goal during this phase is to reduce the pain through palliative care, which allows function to return and lays the groundwork for future stabilization and strengthening.

Although rest is a key part of getting through the inflammation stage, it should consist of relative rest, not complete rest.

Since most problems improve quickly, it’s important to maintain a positive outlook and remain active. Simply shutting down completely will do little to help the healing process. In addition, an overemphasis on passive therapies can lead to a Craig Liebenson, DC, practices at L.A. Sports and Spine, in Los Angeles. He is an Adjunct Professor in the School of Chiropractic at Murdoch University. He is also the author of numerous scientific publications as well as patient education books on both the neck and low back, and is editor of the multidisciplinary text, Rehabilitation of the Spine: A Practitioner’s Manual.

ATHLETICBID.COM ◆

T & C O C T O B E R 2 0 0 4 ◆ 37

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AVOIDING BACK PAIN Some quick tips: • Limit bending, lifting, carrying, and twisting in the early morning.

• Pre-warm the back before strenuous activities.

• Actively brace the spine when lifting or carrying.

• Maintain a “neutral” spine when lifting.

• Use a therapy table of appropriate height to limit bending.

• When sitting or standing in one position, take a “microbreak” every 20 minutes.

deconditioning of the back and reinforce detrimental activity avoidance.

Palliative care can begin immediately and may be used throughout the entire treatment process whenever back pain flares up. Since 80-percent of people with back pain report 80percent improvement within just a few weeks of treatment, palliative measures should be kept as simple as possible and be viewed as temporary.

Palliative care ranges from medication to specific therapeutic exercises.

It’s usually best to start with over-thecounter medications, such as antiinflammatories, and thermal agents, beginning with cold and then moving to heat. The next step is physiotherapy modalities, such as electrical muscle stimulation, and soft-tissue manipulation, especially acupressure, active release therapy, and trigger-point therapy. The key to soft-tissue manipulation is taking a focused diagnostic approach rather than just effleurage and petrissage. You need to find the tender

nodules and stretch them using direct pressure. Specific therapeutic exercise, such as McKenzie technique, can also be used for palliative care.

You will need to limit the demands on your back, however, and take care to not aggravate your injury. Braces and supports are rarely necessary, but spine-sparing strategies will help prevent further damage throughout the treatment process and are especially important during the early stages.

Once pain decreases, it’s time to move to the repair stage. The idea is to let the back begin to rebuild itself, which typically takes one to four weeks, depending on the severity of the injury. Moist heat, stretching, and low-load stability exercises will speed the repair process, and more importantly prevent deconditioning.

As strength returns, remodeling begins. Normally encompassing weeks 3-12 following the onset of pain, remodeling involves preparing the back for the loads it will be expected

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to carry. Unless the tissues are re-educated, the problem can either persist, worsen, or relapse. Therefore, this stage involves training designed to strengthen and stabilize back muscles along with specific functional training.

Once functional performance returns to a pre-injury level, healing is considered complete and maintenance programs can begin.

STABILIZING THE SPINE

The key to strengthening the back is spine stability. A stable back is a strong back that will be able to handle the demands an athletic trainer places on it.

Initially, low-load exercises with wide margins of stability should be performed. Such exercises are able to challenge the muscles while reducing excessive joint compression, shear, or torsion load that could lead to further injury. Usually these keep the spine aligned in a neutral lordosis.

Initial stability exercises include: Cat-camel: While on all fours, round up and then drop the back. This is not a stretch, but a limbering maneuver designed to “floss” the spine.

Quadruped leg reach: While on all fours, brace the spine and then sweep the floor with one leg without allowing the spine to move.

Side bridge on knees: While sidelying with knees and hips flexed, hinge the hips forward as the waist is raised up until the knees and hips are in line with shoulders.

Each exercise should be performed slowly with an isometric hold lasting one to two breaths, which would typically be five or six seconds.

Start with six repetitions per set before progressing to 12 reps per set. Once one set of 12 reps can be performed, progress to three sets using a reversepyramid approach of decreasing repetitions with each successive set.

For example, the first set would

include 12 reps, the next set would include eight reps, and the final set would include four reps.

These initial stabilization exercises can progress to more challenging functional movements as endurance develops. For instance, an opposite arm reach can be added to the quadruped leg reach. The side bridge on knees can be progressed to ankles and a roll over.

Other, more advanced stability exercises can be utilized to isolate the abdominal wall. These include: Trunk curl-up: Raise from the mid-thoracic region only.

Dead-bug: While supine, bring the opposite arm and leg together in the mid-line while maintaining an abdominal brace.

Once a base level of stability has been established, you can move to more advanced functional exercises that mimic athletic training demands.

This functional integrated training includes squats, lunges, tri-planar

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SIGNS OF TROUBLE Although back pain rarely results from serious underlying causes, itâ&#x20AC;&#x2122;s important to remember that it can. If palliative care and stabilization efforts don't have an

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effect after a week or so, consult a physician to rule out serious conditions such as a tumor, infection, or fracture. Any instances of legs giving way or pain around the anus or genitalia should also prompt an urgent visit to a physician.

In some cases, back pain can become chronic if not treated correctly. The following factors indicate a greater risk of developing a chronic problem and are a sign to consult with a physician or back specialist: â&#x20AC;˘ Severe sciatica. â&#x20AC;˘ Decreased trunk extensor endurance (less than 60 seconds hold time on the Sorensen static horizontal extensor test). â&#x20AC;˘ Increased spine flexion mobility (greater than 60 degrees). â&#x20AC;˘ Decreased hip mobility (extension or internal rotation).

push/pull exercises, and whole-body tasks performed with a neutral spine.

For instance, pushing and pulling tasks can be trained using pulleys or resistance bands. Make sure to include movements from floor to waist, floor to shoulder, and waist to shoulder.

Specific functional integrated training exercises can include: Single-leg bridge and functional reaches: Stand on one leg and reach back with the other leg while keeping the spine upright. The reach back may be performed at different angles to isolate the gluteal muscles. The support leg knee should not move inwards of the big toe or forward of the toes.

Angle-lunge with reach: Using a star diagram perform lunges at different angles while reaching across the body with the opposite arm.

Core pull: From a squat or lunge position, pull the weight across the body while maintaining a neutral spine. Keep the shoulders level and spare the spine and shoulder by generating most of the force from the core.

Core push: From a squat or lunge position, push the weight across the body while maintaining a neutral spine. Keep the shoulders level and spare the spine and shoulder by generating most of the force from the core.

All of these exercises are ideal for the recovery phase of a back pain episode. They can also be used as a preventive strategy in a healthy, asymptomatic athletic trainer.

SPARING THE SPINE

Whether you are currently recovering from back pain or want to decrease your chances of developing it, the most important advice I can provide is to spare the spine. This is the key to avoiding repetitive strain on sensitive back tissues. Here are some tips for spine-sparing: Take micro-breaks: Avoid sitting or standing for prolonged periods of time by taking micro-breaks every 20 to 30 minutes. Micro-breaks are brief 10- to 30-second movements performed after prolonged periods of end-range overload, such as stooping over an athlete to tape an ankle. An effective micro-break for athletic trainers is an arm reach overhead and Brugger postural exercise.

Hinge the hip: When performing daily tasks involving trunk flexion, spare the spine by learning to hinge at the hip. This would apply to activities such as lifting a water cooler or athletic training kit.

Warm up: Prior to lifting something heavy, pre-warm the back with

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the arm reach overhead. When lifting you should make sure you maintain an upright lordosis, which is a squat position as opposed to a stooped position.

Lift in the afternoon: Avoidance of early morning flexion has been found to spur recovery. If unavoidable, make sure to take extra time to prepare the back with proper warmups.

Spread the load: Increasing the flexibility of related areas such as the lower-quarter kinetic chain or midthoracic area will increase load sharing and thus spare the spine. Good flexibility exercises include a psoas stretch for hip-extensor flexibility and a back stretch over a foam roll or a gym ball for mid-thoracic mobilization.

Brace the back: Whenever performing high-stress activities, protect the spine by performing abdominal bracing. Abdominal bracing involves agonist-antagonist co-activation of muscles around the neutral (slightly lordotic) lumbar spine. Tense the muscles of the abdominal wall and low

back as if getting ready to receive a punch. Such bracing buttresses the spine with a hoop-like muscle tension that stiffens vulnerable structures during bending, lifting, or twisting tasks.

TEAM APPROACH

Although it may appear strange for athletic trainers to train and warm up in order to perform their duties, these suggestions can go a long way in helping back pain sufferers. They can also help prevent back problems in those who have yet to suffer painful symptoms.

Health-care professionals do not always make the best patients. They are often more concerned about their patients than they are about themselves. But if athletic trainers work together on proper stretching and taking micro-breaks, they can keep each other from back pain flare-ups. The key is for athletic trainers to be as pro-active with their own backs as they are with their athletes. â&#x2014;&#x2020;

Functional Rehabilitation of Sports and Musculoskeletal Injuries by W.B. Kibler, S.A. Herring, and J.M. Press. Published by Aspen, 1998.

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Therapeutic Exercise for Spinal Stabilization in Lower Back Pain by C. Richardson, G. Jull, J. Hides, and P. Hodges. Published

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C O M P E T I T I V E

E D G E

▼

No Ice? No Problem!

By mimicking the on-ice movements of hockey, you can develop strength and conditioning programs to help players improve while remaining on dry land.

UW Athletic Communications

By Steve Myrland

E

ven at first glance, the physical demands of ice hockey are easy to observe. The combination of speed, agility, strength, reaction, and stamina required to succeed is matched by few other sports. While training an athlete for these varying demands presents an obvious challenge for a strength and conditioning coach, there’s another challenge that is even more difficult to address: Except at the highest levels of the game, much of the off-season strength and conditioning work must be done off ice.

Obviously, athletic performance training that is removed from the actual competitive venue can quickly become a frustrating process. Yet, as in other sports, the exercises and drills you employ for ice hockey players

must transfer to the game. If the exercises you use off the ice do not produce results on the ice, you are not only wasting everybody’s time, you may also be increasing the chance of injury.

So, how do you train effectively off ice for an on-ice game? The answer lies in mimicking the demands and movements of the sport as closely as possible in dry-land environments. We do this by emphasizing the movements that make up hockey’s elemental skills and training in short bursts of high-intensity work with limited recovery time between sets, which matches the work patterns players will face in games.

In developing training programs for hockey players, I have leaned heavily on the work and teachings of Jack Blatherwick, a physiologist, teacher,

and genuine coach. His insights into making hockey training relevant have benefited a generation of players and form the foundation for this article.

WHAT IT TAKES

The important elements of hockey are fairly easy to list. They include: 1. Strength 2. Balance 3. Power 4. Speed 5. Agility 6. Endurance Steve Myrland is a conditioning and performance coach and the manager of Beacon Athletics in Middleton, Wis. He is a former Strength and Conditioning Coach at the University of Wisconsin and for the San Jose Sharks.

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T & C O C T O B E R 2 0 0 4 ◆ 43

C O M P E T I T I V E

E D G E

▼ The key to prioritizing this list is progression. Strength is the necessary underpinning of balance, power, speed, and agility. For younger players especially, any improvement in strength will support improvement in all other bio-motor qualities.

I have listed endurance last because you have to develop strength and all the other bio-motor qualities before you can work on sustaining them. You can build a really nice eightweek endurance program, but it won’t help your athletes be strong, and they won’t have power, speed, or agility.

You’ll be building a weak player who can stay on the ice longer, but who will likely be stuck on the bench watching the stronger, more powerful players get all the ice time.

For many years, dry-land training consisted of long runs that were thought to help players develop the endurance they needed to perform well in the third period of a game. But nobody goes out and skates for 30 continuous minutes during a hockey game. Thus, long-distance running doesn’t build hockey players. Instead, we develop hockeyspecific endurance through the same exercises that develop strength, balance, power, speed, and agility.

GET A LEG UP

In terms of strength training, since the underlying skill required of all hockey players is skating, I focus our efforts on improving lower-body strength.

This is not to say that we ignore the upper body, but players usually don’t need as much prompting to do bench presses as they do to develop their core and their legs.

Nearly all movement in hockey (skating, stopping, turning, shooting, checking) results from a weight-shift from one leg to the other. Ignac Kavets, a Slovenian hockey player and coach, once watched a group of my college players struggling to perform one-legged squats at a hockey camp.

He stared, unimpressed, as one after another wobbled about in an attempt to perform a few repetitions.

44 ◆ T & C O C T O B E R 2 0 0 4 ◆

Finally, he shook his head impatiently, and promptly did a set of 20 perfect reps on each leg. When he finished, he turned to me and said, “You must never forget, my friend, that hockey is a game that is played with the legs, legs, legs!” I could only nod.

Point taken: My off-ice program had missed the mark.

I have learned that players must be able to produce and reduce force—with balance and control—on one leg. Twolegged exercises, such as squats and squat-jumps certainly play an important part in developing hockey-specific strength and power. But proficiency at single-legged movements must be a priority. (For an example of a series of single-leg squat exercises, see “Shark Legs” on page 45.)

In addition, we have found a direct correlation between a player’s vertical jump and his or her performance on the ice. The higher their vertical jump, the faster they skate. So any exercise or program that increases vertical jump will improve on-ice performance. This also makes vertical jump an easy and quick way to test an athlete’s progress when ice is not available.

BUILDING SPEED

When training speed, the natural tendency is to train a skater like you would a sprinter. This tactic is okay, as long as you understand how sprinting correlates to skating and how it does not.

Sprinting is most similar to skating in the acceleration phase. In both running and skating, you want to train for long ground-contact times and explosive leg drive to maximize acceleration.

Up-hill and soft-sand sprints work well because they emphasize ground contact and transfer well to the ice.

However, sprinting is quite different than skating when it comes to stride length. In sprinting, stride length is maximized by increasing flight time with a corresponding decrease in ground-contact time. Ground contact is long only during acceleration, and shortens as a runner gathers momentum and elevates to an efficient, hips-tall posture.

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Figure One: Optimum Stride Length

For skaters, minimizing groundcontact time is not a factor. Because skaters glide and ice barely inhibits momentum, there is no reason to concentrate on decreasing ground-contact time. Instead, for hockey players, the key to increasing stride length is focusing on a low center of gravity.

In hockey, stride length is a function of knee-bend, pure and simple.

Keeping the center of gravity as low as possible allows a player to take advantage of the greatest possible stride length, while maintaining balance and control needed in the chaotic, highspeed environment of the game.

Effective play becomes virtually impossible as soon as a skater’s posture becomes too upright. Thus, all exercises must be performed with a knee-bent posture to be effective in building hockey strength. (See Figure One, above.)

Stride length is also influenced by the direction of the force of the movement. In hockey, players move their feet and legs to the side. Therefore, we need to emphasize deep triple-flexion at the ankle, knee, and hip, followed by an explosive triple extension where the force is directed to the side.

The Russian box is an ideal tool to train this deep flexion-extension movement. Athletes progress from short side-to-side bounds on platforms angled at 26 degrees to significantly longer bounds as their strength and power develops.

Landings should be light, in control, and balanced. When you hit the ground, the ground hits you back, and

C O M P E T I T I V E

ultimately the ground is undefeated. If you encounter the ground violently, you can expect a violent result. It’s going to beat up your ankles, the soles of your feet, your joints, and your back.

Stress to athletes the importance of attenuating impact when doing exercises like the Russian box. When bounding off the left leg, for example, if they come down with the right leg tucked up close to their body, they’re going to hit like an airplane that hasn’t put down its landing gear. Instead, they should extend the right leg and hit the ground as softly as they can by gradually applying the brakes—to touch the ground and then gently absorb their weight. This will help exaggerate the knee bend and by the time they bring themselves to a stop, they’ll be at full triple flexion.

Slide boards are another great training tool for developing the strength to maintain good skating posture, with the

E D G E

Shark Legs The “Shark Legs” program can help hockey players develop the single-leg strength needed to succeed on the ice. Athletes should stay as low and well balanced as possible throughout the entire exercise.

One-leg squat and hold: Lower yourself into the “down” position of the one-leg squat and hold your balance in that position for five seconds.

(See Figure Two, at right.) Return to the starting position and repeat on the other foot.

One-leg squat and stride out (skater’s strides): Lower yourself into a one-leg squat and extend the raised leg laterally without changing your upper-body position. Hold for a five-count.

Return to the starting position and repeat on the other foot.

One-leg squat and rotation: Lower yourself into a one-leg squat and rotate the raised knee out and back (like it is a gate swinging open) without changing your upper-body position. Hold for a five-count. Return to the starting position and repeat on the other foot.

Figure Two: Down position of the one-leg squat

One-leg squat and skater’s circles: Lower yourself into a one-leg squat and make five giant circles with the toe of your raised leg, barely touching the floor.

One-leg squat and skater’s kicks: Lower yourself into a one-leg squat and kick your raised foot forward and backward, fully extending your leg five times in each direction.

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▼ Table One: Sprint Intervals The following is an example of extensive tempo sprint intervals. They should be performed at the specified pace, followed by an equal rest time. For example, an advanced-level athlete should run 50 yards and back in 18 seconds followed by an 18-second rest before continuing with the set.

Have athletes rest two minutes between sets.

Distance (and back)

Beginner

Intermediate

Advanced

50 yards x 6

20 sec.

19 sec.

18 sec.

40 yards x 8

17 sec.

16 sec.

15 sec.

30 yards x 10

14 sec.

13 sec.

12 sec.

20 yards x 12

11 sec.

10 sec.

9 sec.

Table Two: Interval Sets The following lists samples of different interval plans that can be used for a variety of exercises, including slide board, in-line skating, and jumping rope. When jumping rope, “fast” intervals can include tricks, double-jumps, lateral movements—anything to raise the physical and mental demand.

Each plan should be preceded by a three-minute warm up at an easy pace. Plan D is best done in pairs, with one partner timing the other for a minute before switching roles.

Plan A Fast 10 sec.

12 sec.

15 sec 20 sec.

30 sec.

(Repeat 2-3 times)

Easy 50 sec.

48 sec.

45 sec.

40 sec.

30 sec.

Plan B Fast 20 sec.

24 sec.

30 sec.

40 sec.

60 sec.

(Repeat 2 times)

Easy 1:40 1:36 1:30 1:20 1:00

Plan C Fast 30 sec.

30 sec.

30 sec.

(Repeat 3-5 times)

Plan D 60 (sec.) easy 30 easy/30 fast 20 fast/20 easy/20 fast 15 easy/15 fast/15 easy/15 fast 10 easy/10 fast x 3 reps 5 easy/5 fast x 6 reps 15 easy/15 fast/15 easy/15 fast 30 easy/30 fast 60 fast Skipping cool-down (easy, relaxed)

added benefit of affording the opportunity to learn about the role of the arms in skating. We might have athletes do 12 to 20 really long, strong strides using a forceful glide, making a strong recovery, and maintaining optimal skating 46 ◆ T & C O C T O B E R 2 0 0 4 ◆

Easy 90 sec.

60 sec.

30 sec.

posture throughout. As soon as players compromise any of those things, they’re done. Maybe this means only doing 10 strides at first and building up to 20, but they all must be performed with the right form or they’re not worth doing.

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Note that we are strengthening here, not conditioning.

The length of the board, and thus of the stride, should be adjustable from eight to 12 feet. The length you use will be determined by the age, size, and ability level of the player you are training. Lengthen the board only when players can demonstrate that they have developed the power to project themselves fully from one side to the other while maintaining good posture throughout.

TRAINING INTENSITY

Perhaps the most pernicious phrase in all of hockey performance training is “aerobic base.” It may be comforting to believe that spending an hour jogging, or performing any other low-intensity activity, will benefit athletes in a game, but it won’t. Hockey does not reward those who can go slowly for long periods of time—it rewards those who can go fast, and then recover quickly to do so again.

You should train like you play because you play like you train. And since hockey is a game of pure physical intensity, training with anything less is simply preparing to lose.

Fortunately, the game provides clear guidelines for setting correct levels of training intensity for off-ice work.

Let’s do the math: A period in a hockey game lasts 20 minutes, or 1,200 seconds. Assuming that an average playing shift lasts 40 seconds means there are 30 shifts per period. Most teams cycle three units of players into the game regularly, so players must be able to perform consistently on a 1:2 work-torest ratio where the duration of the work is around 40 seconds, and the intensity of the work is generally high.

Highly skilled players will find that their work-to-rest ratio in games rises toward 1:1 and sometimes beyond.

When the team is behind in the final period or the game is tied, the coach will shorten the bench to keep the best players on the ice as much as is practicable.

Good players will want to be on the ice in these situations, so they must prepare

C O M P E T I T I V E

E D G E

▼ to play at maximum intensity on minimum rest. Table One and Table Two (on page 46) show some examples of intervals to help condition players while also improving their strength and power.

The same interval idea can apply to other exercise modes, including a slide board or in-line skates. Jumping rope is another effective way to improve hockey conditioning as it also improves the ability to coordinate the hands, eyes, and feet, and teaches players to strike the ground lightly and softly.

Regardless of the specific exercise used, the idea is to work at hockey intensity for progressively increasing periods separated by relatively short recovery periods. After 30 seconds or so, the ability to maintain an effective skating posture will begin to break down, so it’s important to train players to be as powerful as possible for that short period and to recover quickly so they’ll be ready for the next shift. ◆

Traditional Traps Traditions are a big part of what makes ice hockey great. But when it comes to training hockey players, some traditions are best left behind.

Chief among those are long-distance running, skating, and biking, which do little to help players get into hockey shape. Another long-time dry-land training favorite is wall sits (players simply stand with their backs against the wall and slide down until their thighs are parallel to the ground and hold that position for as long as possible). Wall sits make the legs burn, to be sure. But they create an “artificial” strength that does not transfer to the ice, in part because balance is taken out of the equation. As kinesiologist Roger Eischens explains, “You can’t strengthen anything effectively while you are simultaneously supporting it.”

A more recent addition to dry-land training would appear to be much more effective for training hockey players, but it has become greatly overused. In-line skating is similar enough to ice skating that there’s a temptation to view the two as the identical. But ice hockey is about starting, stopping, changing directions, and accelerating. In-line skating is about making good circles. If an ice hockey player is circling, he or she is taking the path of least resistance, and at the higher levels, that path usually leads to the bench.

In addition, many players like to go for long in-line skates, which do little to help skating strength since optimal skating posture breaks down after 20 or 30 seconds. In-line skating can be used, however, as a conditioning alternative, as long as it’s confined to interval training using tight, high-speed turns from an always-improving, strong, hips-low posture. Players should always carry a hockey stick during their in-line intervals.

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Circle No. 201

Biofreeze 800-246-3733 WWW.BIOFREEZE.COM For pain-management programs, use Biofreeze from Performance Health to reduce swelling, pain, and stiffness. It soothes next-day aches and pains and speeds recovery. Biofreeze can also help to increase mobility and flexibility, and improve the overall healing process. The product can be used in situations requiring ice and breathable wraps, or it can be

blended with water for ice cups.

Biofreeze will also prolong the effects and benefits of ultrasound and massagetherapy treatments.

Biofreeze is endorsed by The Florida Chiropractic Association, ProSports Chiropractic, The United States Taekwondo Union, The Florida State Massage Therapy Association, The New York State Society of Massage Therapists, and The Texas Association of Massage Therapists. It is approved for use by the American Physical Therapy Association.

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Cho-Pat 800-221-1601 WWW.CHO-PAT.COM Cho-Pat’s patented Dual Action Knee Strap provides an extra level of relief for painful and weakened knees. It applies pressure to the tendon below the knee to reduce patellar subluxation and improve tracking and elevation. It also puts pressure on the tendon above the knee to provide added support and stability. The Dual Action Knee Strap allows full mobility.

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Concussion Sentinel WWW.CONCUSSIONSENTINEL.COM

Brace International 800-545-1161 WWW.BRACEINT.COM Brace International offers a full line of bracing and support products. The FLUK™ knee strap is ideal for treating such injuries as patellar tendonitis, chondromalacia patella, and OsgoodSchlatter’s disease.

It applies compression to the knee area without restricting circulation.

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Chattanooga Group 800-592-7329 WWW.CHATTGROUP.COM Chattanooga Group is a consistent supporter of America’s Olympic athletes through a partnership with the United States Olympic Committee. The company has contributed to the Olympic and Paralympic games for over 10 years, providing rehabilitation and sports-medicine equipment to the treatment facilities that serve our Olympic athletes. Chattanooga Group products were available to Team USA in the Athletes’ Village Clinic in Athens, and in the Training Center at the American College of Greece.

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Used by athletic trainers as part of their concussion-management system, Concussion Sentinel™ is an easy-touse, computer-based tool that helps the treating physician make return-to-play decisions. Concussion Sentinel provides a benchmark profile of an athlete’s pre-injury cognitive state. Following an injury, the test is retaken.

The after-injury report provides an objective indication of whether the athlete’s cognition has returned to its pre-injury level.

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Dynatronics 800-874-6251 WWW.DYNATRONICS.COM Dynatronics has introduced the Solaris Series, featuring the new Infrared Cluster Probe, which generates 500 mW of power at multiple wavelengths—five times the power of competing devices—reducing average treatment times by 80 percent to save you time and money.

Solaris also includes ultrasound and seven stim waveforms, making it the most powerful and versatile product line in the industry.

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Pain Management The new Ionto+Plus iontophoresis delivery system is available from Dynatronics.

The Ionto+Plus line features four sizes of delivery electrodes: small, medium, large, and butterfly. The delivery electrodes feature a silver/silver/chloride (AgAgCl) conductive layer, providing even current distribution across the surface of the electrode and making treatments more comfortable.

The return electrodes feature a synthetic buffered gel designed specifically for iontophoresis applications. Each box contains 12 treatments.

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Ferno 888-206-7802 WWW.FERNOPERFORMANCEPOOLS.COM Ferno Performance Pools now offers the complete line of MedZone® topical relief products, which are proven to last longer than competitors to minimize swelling, scarring, and scabbing. With six formulas available, athletic trainers can treat pain immediately, and continue treatment with other products as the athlete heals. The MedZone line includes PainZone®, BurnZone®, ChafeZone®, DepthZone®, MassageZone®, and DermalZone®. MedZone products quickly target the source of the condition and get athletes back in the game faster.

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Foot Management, Inc. 800-HOT-FOOT WWW.FOOTMANAGEMENT.COM Replace your athletes’ existing shoe insole with a quality footbed from Foot Management. The One Stop EVA is an ultra-functional, off-the-shelf, multi-density inlay. It is made of an EVA base material with a polyester-covered top 50 ◆ T & C O C T O B E R 2 0 0 4 ◆

layer of soft, comfortable Poron™ for highquality, long-lasting support. The One Stop EVA can be used as is, or modified by heating it in a convection oven. It is extremely cost-effective as a temporary or diagnostic orthotic device.

Circle No. 210 Turf Toe® plates from Foot Management are available on orthoses that fit most cleated shoes, and also on the company’s Shocker® insoles for when extra cushioning is needed.

These plates limit MP dorsiflexion and assist in the prevention and treatment of turf toe. Foot Management also offers many other foot products, including heel lifts, tubular foam, toe spreaders, moleskin, foam, and felt.

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Graston Technique 866-926-2828 WWW.GRASTONTECHNIQUE.COM The Graston Technique, an innovative form of instrument-assisted soft-tissue mobilization, is designed to detect and resolve soft-tissue injuries more completely. Performed by skillfully-trained ATCs, PTs, OTs and DCs, the technique is effective in helping injured athletes achieve higher levels of function and pain relief. The result is better resolution for soft-tissue injuries and a quicker return to normal activity. Visit the company’s Web site for more information on upcoming GT training seminars.

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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 (literally) within minutes or hours, rather than weeks or months. Hartzell contends that RICE is antiquated, and that rest and ice actually prolong the healing process. A video detailing his tractioning

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technique is available for $15. Three Flex Bands® (one average and two mini) are necessary to perform the treatment.

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Laser Therapeutic Technology 800-235-3540 WWW.LASERHEALING.COM The ML830® Laser System is FDA-cleared and has proven effective for 10 years in the treatment and rehabilitation of soft-tissue and repetitive-stress injuries, CTS, back pain, post-operative pain, tennis elbow, golfer’s elbow, plantar fasciitis, tendinitis, and more. The ML830 is a non-thermal laser capable of penetrating deep into tissue, increasing cellular metabolism, expediting cell repair, and stimulating the immune, lymphatic, and vascular systems. Laser Therapeutic Technology is the leading distributor of the ML830 system.

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Lippincott Williams & Wilkins 800-638-3030 WWW.LWW.COM Clinical Mastery in the Treatment of Myofascial Pain,

by Lucy Whyte Ferguson, DC, and Robert Gerwin, MD, is based on the myofascial pain management principles established by Drs. Travell and Simons. This practical resource takes the study of myofascial pain to the next level by defining matrices of muscle groups and offering treatment solutions from a variety of disciplines. The book is full of practical, problem-solving approaches that can help you become more effective in recognizing conditions, developing treatment regimens that reduce the length of treatment, and suggesting patient activities that encourage the recovery process.

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Pain Management Pharmacology for Massage Therapy,

by Jean Wible, is a cutting-edge text that offers comprehensive coverage of clinical pharmacology. It leads you through a deductive reasoning process for developing safe and individualized massage therapy protocols for clients receiving drug therapy. It also includes a basic introduction to pharmacology and massage, with pharmacological terms, concepts, routes of administration, the physiological effects of massage, cautions and contraindications, and drug effects on massage, so you can determine the best massage strokes to use with each client.

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Massage Warehouse 800-910-9955 WWW.MASSAGEWAREHOUSE.COM

Medx 888-363-3112 WWW.MEDXHEALTH.COM

It may be time for you to part ways with that rickety old rolling stool and upgrade to a newer, sleeker model that gets you where you need to go in style. With its adjustable height, comfortable seat padded by threeinch foam, and stable five-leg base, the Rolling Pneumatic Stool from Massage Warehouse makes it easy to scoot around the room in total control. And it’s available at a great price. Take one out for a roll and you’ll never look back.

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Discover the healing nature of light with FDA-cleared Medx PhotoTherapy.

Introduce an innovative, non-invasive, drug-free therapy that can help your patients heal faster and experience pain relief. Medx PhotoTherapy devices deliver photons of light energy using low-level laser diodes and superluminous diodes to stimulate the body’s natural repair processes at the cellular level.

Medx PhotoTherapy has proven to be a highly-effective professional tool capable of producing significant clinical outcomes.

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Deep Muscle Stimulator Balance the Body Increase Endurance Increase Flexibility Increase Strength Reduce Soreness

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.

Call 877-368-7523 to order or visit our website:

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PlyoBacks from Exertools.

Enjoyable. Effective. Affordable.

Get an intense strength and aerobic workout using weighted medicine balls and the time-tested Exertools PlyoBack.™ PlyoBack Pro

Visit us at www.exertools.com or call 800-235-1559 for packages and pricing.

Ask about our our Trade-in Program for your old rebounder in any condition!

THOR Laser 866-251-7743 THORLASER.COM/SPORTS/INDEX

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Both models are fully adjustable for a clinically proven upper body and cardio workouts Professional and Light Institutional models available separately, and as packages All heavy-duty construction with powdercoated steel Proven choice of NFL, Major League Baseball, NHL, college and high schools internationally

©2004 Exertools. All rights reserved.

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The Burst Resistant Exercise Ball!

Available Through Leading Dealers Everywhere!

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The Pressure Positive Co. 800-603-5107 WWW.BACKTOOLS.COM The Backnobber® II is the premier triggerpoint tool for self-treatment of muscular pain and stiffness. The unit breaks down at the push of a button for easy storage and portability. A free, illustrated user’s guide includes tips on trigger points, stretching, and strengthening. The Backnobber II’s simple design offers patients professional-quality therapy from a self-care device.

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Pain Management

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Trainers and clinicians in the United States can now enjoy the high performance and durability offered by Europe’s most popular low-level laser manufacturer, THOR International. THOR has been the preferred supplier to many prominent English, Canadian, and American institutions and sports teams, including Manchester United, the Royal Air Force, and the British Army and Royal Navy. THOR products are FDA-cleared.

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3-Point Products 888-378-7763 WWW.3POINTPRODUCTS.COM The new Action Ultra thumb splint provides the perfect balance of comfort and control, and is ideal for use during athletic participation. Ultra splints can be gently shaped by hand to achieve a custom fit in seconds, and they are fully padded for comfortable cushioning. Choose the Action Ultra Spica whenever wrist and thumb control are needed for support and protection. And because it allows free wrist motion, the Action Ultra MP is ideal for protecting gamekeeper’s thumb and MP dislocation injuries.

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Hot & Cold Biofreeze 800-246-3733 WWW.BIOFREEZE.COM Performance Health, the maker of Biofreeze Pain Relieving Gel, has introduced the new “Single Use Application Gravity Dispenser” package. This single-dose dispensing system is perfect for clinical and training room use, allowing easy distribution of Biofreeze to patients and athletes for trial use and use at home.

Biofreeze provides deeper, longer-lasting relief from pain than other cooling gels. It is effective for enhancing therapy and relieving pain from arthritis, muscle strains, and backaches. It also helps reduce edema and myospasm.

Apply Biofreeze generously for penetrating relief from pain and stiffness in muscles and joints. The cooling effect accelerates the rate of basic healing by relaxing stiff and aching muscles.

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Creative Health Products 800-742-4478 WWW.CHPONLINE.COM Creative Health Products, a leading discount supplier of rehabilitation, fitness, therapy, exercise, and athletic testing and measuring products, offers the Battle Creek Thermophore Heating Pad. This pad's unique design promotes effective, moist, deep heat and has a wider range of temperature settings than other heating pads. The Thermophore is great for treatment of the back, hips, chest, legs, abdomen, and more. It is available in three sizes: 4" x 17", 14" x 14", and 14" x 25".

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Ferno 888-206-7802 WWW.FERNOPERFORMANCEPOOLS.COM Throw away the bulky ice bags and never again worry about re-freezing wraps to treat athletes who have sprains and strains. Ferno Performance Pools now offers Liquid Ice™

non-dyed, nonadhesive bandages to treat injuries with compression cooling. Liquid Ice reduces pain quickly, and stays cold for two hours—six times longer than other systems. The bandages are washable and re-usable, with a recharger solution that allows up to 40 applications.

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Game Ready 888-426-3732 WWW.GAMEREADY.COM Used by almost every pro football team, the Game Ready Accelerated Recovery System simultaneously provides controllable cold therapy and adjustable intermittent compression to help accelerate the healing of acute or chronic injuries. It is also useful for post-operative recovery. “The results have been outstanding, and Game Ready has become our modality of choice for acute and chronic injuries,” says Chuck Barta, Head Athletic Trainer of the NFL’s Minnesota Vikings.

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The Gebauer Co. 800-321-9348 WWW.GEBAUERCO.COM Gebauer has introduced Spray and Stretch as a replacement for the company’s FluoriMethane. Spray and Stretch is a nonflammable, topical skin refrigerant that won't deplete the ozone. It is intended for use with the Spray and Stretch Technique for the management of myofascial pain, restricted motion, and muscle spasms, and the temporary relief of minor sports injuries. Ideal for reducing or relieving

the initial trauma of an injury, Spray and Stretch controls the pain of bruises, contusions, swelling, and minor sprains.

Circle No. 228 From the most trusted name in skin refrigerants for over 100 years comes a new, non-prescription 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.

Instead of using ice for on-the-scene treatment of minor sports injuries, high school and recreational league coaches, athletic trainers, and others can now use what the pros 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,” says 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.”

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Innovation Sports 800-222-4284 WWW.ISPORTS.COM Innovation Sports, maker of the C.Ti.2 knee brace and the TheraCool™ Cold Therapy System, has introduced the new Powertex™ Hot/Cold Therapy Wraps.

Powertex wraps are ideal for treating postoperation or post-injury pain and swelling.

Simply heat the re-usable hot/cold inserts in the microwave or cool them in the freezer for hours of moist heat or penetrating cold.

The wraps come in three models: a knee wrap, an ankle wrap, and a universal wrap for the knee, ankle, elbow, shoulder, back, neck, hip, or thigh.

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Testimonial

Massage Warehouse 800-910-9955 WWW.MASSAGEWAREHOUSE.COM Sore muscles, a tight back, an aching neck, cramps, nagging pains. What’s ailing your clients? One of the most popular treatment applications in use today is the Theratherm Digital Moist Heat Pack.

Its moist heat offers deep penetration to relieve patients’ aches and pains, and makes you look like a miracle worker. The Theratherm heat pack gives you complete control over the temperature and duration of treatment.

The heat packs come with a washable flannel cover and are available in three sizes. When you shop with Massage Warehouse, low prices are guaranteed.

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OPTP 800-367-7393 WWW.OPTP.COM New to OPTP are the affordable Cryopak Flexible Ice Sheets for cold therapy. Each sheet contains rows of small, nontoxic gel cells. Cryopak sheets are inexpensive and convenient for athletes.

The cells can be cut into appropriate sizes for treatment of the shoulders, neck, back, or knees. Each sheet is 16.5” wide and 11.5” long.

They are sold in packs of four sheets, or in cases of 36 sheets. OPTP offers many other products and publications.

Call the company or visit its Web site for more information and a free catalog.

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PRO Orthopedic Devices, Inc. 888-523-5611 WWW.PROORTHOPEDIC.COM

rechargeable battery, or indefinitely on wall power. It can achieve temperatures as low as 34 degrees using simple ice and water.

The low-profile insulated bag maintains ice for hours.

An optional 12-volt converter allows operation in vehicles.

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Whitehall Manufacturing 800-782-7706 WWW.WHITEHALLMFG.COM The ThermaSplint™ features dual voltage, an illuminated on/off switch, and quick heatup time. The unit operates on a solar-powered digital thermometer that allows the temperature to be adjusted with digital readouts for different splinting thermoplastics. The Therma-Splint is constructed from heavy-gauge stainless steel.

Circle No. 234 Whitehall Manufacturing offers a complete line of moist heat-therapy treatment products that are convenient and easy to use. Each heating unit is fabricated from heavygauge stainless steel and polished to a satin finish.

Standard features include a snap-off thermal protector that prevents overheating, and a rounded bottom that minimizes bacteria buildup. The heating units are available in various sizes and in several different colors.

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Quick and efficient on-line concussion testing

Excerpts from the National Athletic Trainers’ Association’s position statement, “How to Reduce Severity of Sport-Related Concussion and Improve Return-To-Play Decisions” Evaluating and Making the Return-To-Play Decision: ● For athletes playing sports with a high risk of concussion, baseline cognitive and postural-stability testing should be considered.

Concussion Assessment Tools: ● Formal cognitive and postural-stability testing is recommended to assist in determining injury severity and readiness to return to play. ● Once symptom-free, the athlete should be reassessed to establish that cognition and postural stability have returned to normal for that player.

“Schutt Sports and Concussion Sentinel are giving physicians who care for studentathletes no excuse for sending them back onto the playing field without the benefit of neuropsychological testing.”

Dr. James Moriarity, Head Team Physician University of Notre Dame “Computerized neuropsych testing can be done quickly and efficiently from anywhere in the United States. A program of pre-season baseline and post-injury neuropsych testing adds another dimension to the evaluation and safety profile for athletes with concussion.”

Dr. William O. Roberts Department of Family Medicine, University of Minnesota Medical School

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 Concussion Sentinel 54 ◆ T & C O C T O B E R 2 0 0 4 ◆

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Massage Therapy Ball Dynamics International 800-752-2255 WWW.BALLDYNAMICS.COM Achieve deep muscular and fascial release with this groundbreaking body therapy program. The FitBALL® Small Ball Release Program provides complete stepby-step instructions for releasing tension in the pelvic, hip, back, neck, and shoulder areas.

Use three balls of decreasing size for increasing challenge as you enhance your skill level on this self-guided journey.

The professional set includes one ball of each size, a 45-minute instructional video, and an 80-page manual.

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DMS 877-368-7523 WWW.D-M-S.COM The Deep Muscle Stimulator provides kinetic forms of percussion and concussion vibration for deep muscle tissue, which in turn offers the patient increased flexibility and strength, improved circulation, and faster rehabilitation. It also helps to break up muscular scar tissue and reduces lactic acid build-up.

The DMS is used by physicians, physical therapists, athletic trainers, outpatient rehab centers, chiropractors, and massage therapists.

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Exertools 800-235-1559 WWW.EXERTOOLS.COM Over the past decade, FOLLER™ foam rollers have become one of the most widely-used therapeutic and conditioning products on the market. Don’t let their simple design fool you—FOLLERS can be used in countless different ways. They easily adapt to a variety of techniques, including mobilization, balance, and strength training, and can be used in supine, prone, sitting, kneeling, side-lying, or standing

positions.

They are available in a variety of sizes and in fulland halfround shapes. Exertools provides the most extensive offering of foam rollers on the market today.

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Oakworks, Inc. 800-558-8850 WWW.OAKWORKS.COM The Boss is a great treatment table designed specifically for ATCs. Its lightweight design and protective carrying case make it easily transportable from training rooms to sidelines. The unique aluminum understructure is tough enough to support 600 lbs. (UL weight-load rating), and the sealed seams and removable field feet make the Boss ideal for use in rain or shine.

With its easy height adjustments, the Boss is the ergonomic answer for every ATC. Circle No. 241 Lighter than the BOSS, the Wellspring is versatile and strong enough to go anywhere. It is ideal for indoor venues and on-the-go treatments and therapy applications. The Wellspring’s incredible strength easily accommodates large and small clients alike, and its durability and safety have been rigorously tested. The table weighs just 25-29 lbs., and has a dynamic load capacity of up to 550 lbs.

Optional features include face rests, portable aluminum arm rests, side arm rests, paper roll holders, table extenders, and field feet.

Circle No. 242 OPTP 800-367-7393 WWW.OPTP.COM Thera Cane® is a unique device that facilitates deep-pressure, solo massage of trigger points and sore muscles. It is

appropriate for deep-muscle massage to the back, neck, shoulders, legs, feet, arms, chest, ribs, abdomen, and buttocks. The versatile Thera Cane is suitable for use in both clinical and hometreatment regimens. Each one comes with a user’s manual that includes stretches, myofascial trigger-point information, and 39 illustrated uses.

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Perform Better 800-556-7464 WWW.PERFORMBETTER.COM Biofoam Rollers from Perform Better are simple, yet very practical. They’re actually two products in one—use them for self-myofascial release massage, and also as a training aid to improve balance, alignment, and stability.

They are available in your choice of full- or half-round shapes, and in 1’ and 3’ lengths. They are made from high-density material for unmatched durability. For pricing or for a copy of the Perform Better catalog, contact the company or visit its Web site.

Circle No. 244 The new Foam Roller Plus from Perform Better lasts up to five times longer than Biofoam Rollers. The five-inch PVC core is covered by a one-inch foam exterior and a washable neoprene cover, providing firmness and comfort. The PVC core keeps the foam from becoming compressed over time. A two-year warranty and exercise instructions are included. Learn more by visiting Perform Better’s Web site.

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Massage Therapy Power Systems, Inc. 800-321-6975 WWW.POWER-SYSTEMS.COM The Stick is an easy-to-use device designed to massage muscle tissue. The rotating spindles increase circulation to muscle fibers prior to exercise, disperse lactic acid after workouts, and diffuse muscle stiffness and knots. Three sizes are available to accommodate all body types: the Marathon Stick for individuals with low body mass, the Original Body Stick for those with average body mass, and the Big Stick for those with high body mass.

Circle No. 246 The unique spiked-peanut shape of the Massage Peanut from Power Systems rejuvenates tired and sore muscles. Use it for relaxation and massage by rolling it back and forth over the affected area. The Massage Peanut is great for foot massage after a hard day of training. For more information on this and all of the company's products, call Power Systems or visit its Web site.

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The Pressure Positive Co. 800-603-5107 WWW.BACKTOOLS.COM The Pressure Positive Co. offers the multi-rotational, omni-directional Orbit Massager.

It glides freely and smoothly over the patient, and is ideal for deep myofascial release when used in conjunction with professional care. The Orbit Massager is ideal for travel, does not vibrate or require batteries, and is both enjoyable and therapeutic. It is available in transparent gemstone colors: ruby red, sapphire blue, emerald green, and amethyst purple.

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Testimonial

Defining Functional Training and Rehabilitation

efi Sports Medicine’s award-winning GRAVITYSystem™ consists of four programming disciplines (Group Training, Pilates, Personal Training, and PostRehab). Each is performed on the GTS machine. The GTS is designed to encourage functional exercise by using an individual’s body weight as resistance.

“In a training and rehabilitation setting, it can be easily adjusted to meet the needs of the client. It merges extremely well with all other aspects of functional rehabilitation.

“The GTS is well designed, and its simplicity and applicability are unparalleled.

It’s simple but extremely effective at doing what it was designed to do—and it does that better than anything else.”

Paul Chek, founder of the C.H.E.K. (Corrective Holistic Exercise Kinesiology) Institute and a prominent expert in the field of holistic heath and corrective and high-performance exercise After more than a quarter century at the forefront of innovation in athletic training, physical therapy, and home fitness, efi Sports Medicine has become the leading manufacturer of functional rehabilitation and conditioning equipment.

Company News

Introducing the NEW Omnisound 3000E Portable Ultrasound The patented OMNISOUND® 3000E Portable Ultrasound System has the most advanced transducer workstation on the market. It allows full 360-degree rotation of the transducer head. The controls for output power, frequency, and Delta T are conveniently located on the transducer handle. Only the OMNISOUND features Accelerated Care Plus’s patented Delta T temperature-control mode of operation. Simply select the desired temperature increase in the tissue: mild (one degree Celsius), moderate (two degrees Celsius), or vigorous (four degrees Celsius). Then select the desired tissue depth and increase the output to a comfortable level. The OMNISOUND does the rest. The timer automatically adjusts to achieve the correct temperature increase. It’s easy to use and highly effective.

“The support and clinical education that Accelerated Care Plus provides after the sale is incredible. It’s why their equipment is in my athletic training room. It’s what makes the difference!”

Jim Ramsay, Head Athletic Trainer New York Rangers Accelerated Care Plus offers a premium line of electrotherapy modalities that have been in the training rooms of the last five Stanley Cup winners. Why do winners choose ACP? The answer is obvious.

efi Sports Medicine 7755 Arjons Dr., San Diego, CA 92126-4366 800-541-4900

Accelerated Care Plus 9855 Double R Blvd., Ste. 100, Reno, NV 89521 800-350-1100

WWW.EFISPORTSMEDICINE.COM

WWW.ACPLUS.COM

Web News CONCUSSION ANALYSIS SOFTWARE AVAILABLE FREE TO HIGH SCHOOLS AND COLLEGES Two significant recent developments are detailed on the Concussion Sentinel Web site: The NATA has announced its recommendation that cognitive testing be implemented at all schools with a competitive sports program, and Schutt Sports has announced that it is sponsoring the release of Concussion Sentinel software free to every high school and collegiate athletic department for the 2004-05 season. The computer-based test, which resembles a card game and can be administered by anyone, creates a baseline profile of an athlete's cognitive speed and accuracy. After a concussion, the athlete re-takes the test, and his or her before and after scores are compared to objectively analyze whether the brain has returned to its normal state and the athlete can return to play. www.concussionsentinel.com WATCH VIDEO DEMONSTRATIONS FROM DM SYSTEMS ON-LINE Informative videos on the Cadlow™ Shoulder Stabilizer are available on DM Systems' Web site. The promotional video gives an overview of the product from concept to development, punctuated by interviews with the inventors and with athletes who wear the stabilizer. Dramatic video showing athletes in action demonstrates the ease with which they 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 CERTIFICATION AND EXAM PREPARATION MATERIALS ARE JUST A CLICK AWAY The NSCA Certification Commission® Web site offers many resources for individuals interested in taking the Certified Strength and Conditioning Specialist® (CSCS®) exam or the NSCA-Certified Personal Trainer® (NSCA-CPT®) exam. There are also resources for those who are already certified. The site allows visitors to view up-to-date exam schedules, register for the exams, and purchase review materials. Other resources include sample exam questions, on-line practice exams, documents that offer suggestions on how to prepare based on one’s educational background, and an extensive "downloads" section. Those who are certified can find continuing-education opportunities and re-certification information. www.nsca-cc.org NEW PRODUCTS FEATURED ON PRO ORTHOPEDIC’S SITE The PRO Orthopedic Devices Web site has been updated to include several new products, including the Zip Cast tubular compression bandages and the PRO Hyperextension elbow brace. Also included is a newly-redesigned custom products ordering form. See photos of all PRO Orthopedic’s braces, supports, stabilizers, and other products, and place your order on-line. www.proorthopedic.com

Validated, Flexall 454® w/ ultrasound.

For a copy of our latest study supporting the benefits of adding Flexall pain relieving gels to your therapeutic ultrasound treatments and a free sample, call toll free 800-527-4923 or email us at arimed@qwest.net.

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More Products

Testimonial

Keiser Corporation 800-888-7009 WWW.KEISER.COM The Triple Trainer is a functional trainer times three. It packs all the benefits of a functional trainer into its space-saving triangular column, which can accommodate up to three athletes at one time. Today’s gyms incorporate areas dedicated to cable and functional training protocols, requiring multiple machines to meet the needs of customers. Like the functional trainer, the Triple Trainer can be used to perform a virtually unlimited number of exercises. Even exercises requiring a great deal of agility, such as in sport specific training, can be done with ease.

Circle No. 251

The Hygenic Corp.

800-321-2135 WWW.THERA-BAND.COM The First Step To Active Health™ kit is an evidence-based, progressive physical-activity program for inactive adults over 50. The kit includes a program manual, instructions for cardiovascular, flexibility, strength, and balance training, and an activity card to track progress. A red (light-resistance) Thera-Band® exercise band is included as well. The First Step to Active Health kit is produced by the manufacturers of Thera-Band products. Visit www.firststeptoactivehealth.com for more information.

Circle No. 252 The new Thera-Band Black Stability Trainer is an extra-soft, air-filled balance pad that provides multi-directional displacement for oneor two-foot applications. It offers a greater challenge than its sister products, the firm (green) and soft (blue) foam pad stability trainers. Together, the three Thera-Band stability trainers offer an integrated system of Progressive Balance 58 ◆ T & C O C T O B E R 2 0 0 4 ◆

Training™. Made of durable PVC, its heavygauge side walls resist the ankle’s tendency to roll during exercise. One side has rounded points for sensorimotor stimulation.

Circle No. 253

Taking soft-tissue injury treatment to a new level

Catalog Showcase Creative Health Products, Inc. 800-742-4478 WWW.CHPONLINE.COM Since 1976, Creative Health Products has been a leading discount supplier of rehabilitation, fitness, exercise, and athletic equipment, as well as health, medical, and fitness testing and measuring products, all at reduced prices. The products offered 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. 254

Power Systems, Inc. 800-321-6975 WWW.POWER-SYSTEMS.COM Power Systems has been a leading supplier of sports performance, fitness, and rehabilitation products and programming since 1986. It’s the one resource for all your training needs. The 2005 catalog has a new look, with better graphics and photos. It includes sections on core strength, medicine balls, speed, plyometrics, agility, strength equipment, strength accessories, and fitness assessment. The catalog features hundreds of new products and dozens of products available exclusively from Power Systems. The company has even lowered some prices, allowing you to get premium products for less. Call or visit the company Web site for your free copy.

Circle No. 255

ATHLETICBID.COM

Dr. Anthony Iselborn, chiropractic physician and certified athletic trainer in Jacksonville, FL, uses Graston Technique® (GT) on all types of athletic injuries.

“Graston Technique takes the treatment of soft-tissue injuries to a whole new level. The GT instruments allow for more specific treatment at a greater depth in the myofascial tissue.

Athletes can feel the technique working as we apply the GT stainless steel instruments to their lesions.

“I have used the technique with success on Olympic lifters who have overused a specific muscle group, distance runners with hamstring injuries, triathletes with foot injuries, nonathletes with carpal tunnel syndrome and rotator cuff injuries, and many other types of injuries.

“Graston Technique works because it is more than just a set of instruments.

It’s a total therapy modality that involves a progressive resistant exercise program designed to maintain muscle flexibility and hold the correction longer.”

Anthony Iselborn, DC, ATC, DACBSP, CSCS, Jacksonville, FL

Graston Technique 205 Worcester Ct., Ste. 85, Falmouth, MA 02540 866-926-2828 WWW.GRASTONTECHNIQUE.COM

Company Q & A

VERSATILITY OF PORTABLE TAPING TABLE WITH RODGER HYLE Rodger Hyle attended Towson State University on a full football scholarship, graduating with a BS in Business Administration and Marketing.

Initially hired as the Business Development Manager for Oakworks' Medical Imaging Products, Rodger currently serves as the Director of the Rehabilitation and Athletic Training Products Division for Oakworks.

Q. WHAT MAKES THE PORTABLE TAPING TABLE THE RIGHT TABLE FOR ANY FIELD?

and then turn around and efficiently change the height for lighter sprinters or gymnasts, without causing wear and tear on their own bodies.

The Portable Taping Table has independently adjustable legs, which can be set as needed to accommodate uneven surfaces.

For example, at many events the recovery area is located wherever there is extra space, often a hillside or maybe a macadam driveway. With the Portable Taping Table, you can make up the differences in ground elevation by adjusting each

Q. ATHLETIC TRAINERS DO A LOT OF TRAVELING. CAN THE PORTABLE TAPING TABLE HANDLE IT? With the Portable Taping Table, Athletic Trainers no longer have to depend on the second-rate equipment they find at their destinations. They can use the same quality equipment on the road that they use at home. Besides its legendary strength, the product is very lightweight. Additionally, the lack of heavy padding eliminates unwanted rips and tears. The materials we use are completely weatherproof and puncture-proof. A Portable Taping Table that’s spent a year outside in the field will look and perform the same as a brand new table.

It’s very cost-effective, as well as convenient.

Q. ATHLETES TAKE A BEATING, AND SO DOES ATHLETIC TRAINING EQUIPMENT. HOW CAN CUSTOMERS BE SURE THE TABLE WILL LAST? leg individually. So no matter what the conditions, after some quick adjustments, the table is solid and stable, giving ATCs a beautifully level working surface.

And Oakworks’ specially-designed field feet keep the table from sinking into soft ground. Athletic Trainers no longer have to use plastic cups or the tops of jars to keep the feet out of the mud or soggy turf.

Q. CAN ATHLETES AND ATHLETIC TRAINERS OF ALL SIZES USE IT? OAKWORKS PO BOX 238 SHREWSBURY, PA 17361-0238 800-558-8850 dantonelli@oakworks.com WWW.OAKWORKS.COM

The Portable Taping Table is light as well as strong. Athletic Trainers are pleased to find that the weight-usage listing is over 600 lbs. When you figure in the adjustability and the weight capacity, you realize the true ergonomic benefits of the table.

Athletic Trainers can easily treat larger athletes, such as linebackers or wrestlers,

We test, test, and test some more.

Athletic Trainers and their clients depend on the safety, reliability, and quality of the products they use. Simply put, nobody else tests like Oakworks. Every one of our tables goes through a rigorous, specialized, four-part testing protocol, which includes a dynamic-load test, a lateral-force test, a stability test, and component and cycle tests. To verify our results, we employ a third party to run additional testing, ensuring that our methods are sound and our findings are accurate. We make sure our equipment will exceed all the demands of the real world out in the field, before it ever gets there.

We take all the risks, so Athletic Trainers don’t have to. If there is an issue with your table, we stand behind all of our products with a limited lifetime warranty.

T&C O C T O B E R 2 0 0 4 ◆

A T H L E T I C B I D . C O M ◆ 59

CEU QUIZ

T&C October 2004 Vol. XIV, No. 7

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 2.0 BOC Athletic Training and 0.2 NSCA (two hours) continuing education units.

INSTRUCTIONS: Fill in the circle on the answer form (on page 62) that represents the best answer for each of the questions below. Complete the form at the bottom of page 62, include a $15 payment to Training & Conditioning, and mail it by November 30, 2004 to the following address: Training & Conditioning, ATTN: 14.7 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 December 15, 2004.

MIDDLE IN MOTION (pages 11-15) Objective: Learning how to plan an effective core training program, and understanding why it is important to focus on core training and to assess core strength.

1. One principle of effective and functional core training is to: a) train extremities first. b) train in dynamic and static positions. c) utilize plyometrics in open and closed chain positions. d) train core strength before extremity strength.

2. The second principle is that: a) dynamic postural alignment is the foundation of functional training. b) static postural strength is the foundation of functional training. c) extremity strength must have a functional baseline prior to core strengthening. d) core and extremity strength are equal and should be done simultaneously.

3. Core training must include _________________ to be effective. a) gravity-eliminated positions b) fast-paced exercise c) balance training d) plyometrics

FOR THE TEMPORARY RELIEF OF MINOR ACHES... (pages 19-24) Objective: To learn about different types of oral pain medication, and become familiar with their effects, side effects, contraindications, and other factors athletes should consider before taking them.

4. In 1974, the first NSAID to be marketed was: a) Aleve®. b) Motrin®. c) Advil®. d) Tylenol®.

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5. ________________ can be used to reduce pain, fever, and inflammation. a) Aspirin b) Acetaminophen c) Opiates d) Guaifenesin 6. Acetaminophen has: a) no fever-reducing properties. b) NSAID properties. c) no pain-reducing properties. d) no anti-inflammatory properties.

7. Opiates are used for: a) pain. b) non-steroidal anti-inflammatory purposes. c) fever. d) inflammation.

8. Some pharmaceutical manufacturers offer products such as Vicoprofen® containing: a) stronger anti-inflammatories. b) longer-lasting fever reducing components. c) OTC Vicodin. d) opiates with NSAIDs. 9. Aspirin and NSAIDs suppress the inflammatory response by: a) decreasing circulation. b) making the cell membrane more permeable. c) increasing circulation. d) inhibiting cyclooxygenase.

10. If an athlete experiences an upset GI system with traditional NSAIDs, consider using: a) one of the COX-2 inhibitors. b) Motrin®. c) aspirin. d) one of the COX-1 inhibitors.

11. Hydrocodone with ibuprofen is a good combination for managing: a) a muscle strain. b) pain associated with a broken bone. c) a bulging disc. d) a fever from illness.

12. Acetaminophen with codeine (Tylenol 3®) is beneficial for its: a) ability to reduce fever. b) anti-inflammatory effects. c) analgesic effects. d) ability to reduce pain and swelling.

13. Liver toxicity may increase with: a) high doses or prolonged use of acetaminophen. b) the presence of asthma. c) short-term use of opiates. d) the presence of bleeding problems.

14. Aspirin and NSAID use is contraindicated: a) during the healing phase. b) when inflammation is present. c) with any kind of bleeding problem. d) with HTN. 15. For management of fever and headache, NSAIDs should not be continued for more than: a) one week. b) two weeks. c) one day. d) three days.

19. In cases of toxic overdoses, aspirin can disrupt: a) oxidative phosphorylation. b) free fatty acid utilization. c) blood flow. d) lung function.

20. Adenosine stimulates: a) the release of the growth hormone. b) estrogen production. c) testosterone production. d) capillary growth.

21. A first generation NSAID considered to be very long acting is: a) Lodine®. b) Advil®. c) Orudis-KT®. d) Feldene®.

WORK WOUNDS (pages 37-42) Objective: Understanding how to treat and prevent back pain caused by performing the daily tasks of an athletic trainer, and learning exercises that promote stability of the back and spine.

22. The three stages of healing are: a) inflammation, scar tissue formation, and restoration of ROM. b) inflammation, repair, and remodeling. c) injury, collagen formation, and revascularization. d) inflammation, phagocytosis, and collagen formation.

16. Chronic use of opiates can lead to: a) medication overuse headaches. b) dependence. c) migraine headaches. d) GI bleeding.

23. _____________ rest is important during the inflammation stage. a) Relative b) Complete c) Prolonged d) Bed

17. A condition known as "medication overuse headache" has been attributed to: a) short-term use of opiates. b) chronic use of NSAIDs. c) chronic use of acetaminophen. d) short-term use of NSAIDs.

24. One important component of rehabilitation after a back injury is: a) heavy lifting. b) complete rest. c) effleurage. d) stabilization exercise.

18. Hyponatremia occurs when athletes participating in prolonged strenuous exercise: a) ingest a large volume of a sports drink. b) ingest a large volume of salt. c) ingest a large volume of water but no salt. d) utilize opiates for a prolonged period.

25. One suggestion for minimizing the risk of a back injury is to: a) take micro-breaks. b) lift heavy objects early in the morning. c) change positions every four hours. d) bend or stoop if lifting more than 10 pounds.

ANSWER SHEET IS ON PAGE 62 ATHLETICBID.COM ◆

T & C O C T O B E R 2 0 0 4 ◆ 61

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: 14.7 Quiz, 2488 N. Triphammer Road, Ithaca, NY 14850, no later than November 30, 2004. Readers who correctly answer 70 percent of the questions will receive 2.0 BOC Athletic Training and 0.2 NSCA (two hours) CEU’s, and will be notified of their earned credit by mail no later than December 15, 2004.

Middle in Motion 1.

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

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ADDITIONAL EDUCATIONAL PROGRAMS

EARN BOC CEUs CEU Accredited as a Home Study Course by NATA, NASM & NSCA Encompassing the most up-to-date & proven information for functional analysis, injury prevention, physical rehabilitation, training & conditioning & performance enhancement.

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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.

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Are you prepared for concussions?

It’s not too late. Help protect the nearly 10% of football players in your care who will suffer a concussion this year.

Concussion Sentinel is an easy to use computer-based system to help doctors decide when it is OK for an athlete to resume play after a concussion. Schutt Sports believes it is so important that they are making it available FREE to all high schools and colleges across America.

Trainers: sign-up FREE at www.concussionsentinel.com “Schutt Sports and Concussion Sentinel are giving physicians who care for student-athletes no excuse for sending them back on the playing field without the benefit of neuropsychological testing” — DR. JAMES MORIARITY, HEAD TEAM PHYSICIAN, UNIVERSITY OF NOTRE DAME

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