Training & Conditioning 16.9 by Momentummedia

December 2006 Vol. XVI, No. 9, $5.00

Adding More Staff A Look at Foam Rollers

Pulling Through New approaches to preventing hamstring injuries

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December 2006, Vol. XVI, No. 9

CONTENTS 25

35 6

Bulletin Board Senate to reconsider Medicare reimbursement … High school injury rates decrease … New study on interval training. Comeback Athlete Courtney Evans Tufts University

Treating The Athlete

Through 13 Pulling As more and more sports-medicine professionals become frustrated with traditional approaches to hamstring care, they are coming up with new ideas on how to treat this bi-articular muscle group. By Dr. Daniel Cipriani Optimum Performance

to Roll 21 Ready Interested in providing a massage therapist for each of your

Sideline Hydration in Basketball

athletes? Try handing them a foam roller. By Michael Boyle Leadership

Straight Talk Seeing the Light

48 50 54 55 57 59

Product Pages Therapy Technologies Plyometrics Topical Analgesics More Products Product Launch State of the Industry

Advertisers Directory

CEU Quiz For NATA and NSCA members

Cover Photo by Getty Images ATHLETICBID.COM

Dreams Come True 25 Making If your recurring dream is to add more staff to your college athletic training room, you’re not alone. If you want to know just how to fulfill that dream, turn to page 25. By Greg Scholand Special Focus

The Ankle Report

35 The amount of research on ankle injuries is expansive—maybe too expansive for a busy athletic trainer to read. That’s why we’ve compiled it all into one comprehensive article. By Dr. Rod Walters Sport Specific

Off & Running

39 Boston University’s strength and conditioning program for women’s softball has the team off and running toward newfound success. By Victor Brown III T&C DECEMBER 2006

There are plenty of good things to say about water. It’s easily available, often free, it quenches thirst and it’s definitely better than nothing at all. There are even some occasions when water is good enough – at meals, while studying, or during a light workout. But when your team is working hard and sweating hard, a scientifically formulated sports drink like Gatorade beats water hands down. Hydration from a sweat gland’s point of view: Exercise increases an athlete’s core body temperature, thereby triggering the production of sweat. Beyond this “sweat threshold,” as exercise intensity increases, so does the rate of sweat production. Furthermore, the increased rate of production limits the reabsorption of electrolytes.

Water is a good thirst quencher for those times when you only need to quench your thirst. ®

The case for drinking Gatorade during exercise. So, when your team is working hard and sweating hard, they’re losing more sodium, chloride and potassium. Water doesn’t replace these electrolytes, which is one reason why a scientifically formulated sports drink like Gatorade beats water hands down. Now you know,

water is fine for reading the playbook, not for reading the defense.

ÂŠ2005 S-VC, Inc.

Circle No. 101

Learn more at gatorade.com/ athletictrainers

Great Ideas For Athletes...

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

Knee Strap Cho-Pat’s Original Knee Strap is designed to alleviate certain knee discomforts due to overuse syndromes, arthritis, and other forms of degeneration. Nearly two million sold! Sizes: XS - XXL • Colors: Black and Tan

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Debra Brooks, CNMT, LMT, PhD CEO, Iowa NeuroMuscular Therapy Center Cindy Chang, MD Head Team Physician, University of California-Berkeley Dan Cipriani, PhD, PT Assistant Professor, Dept. of Exercise and Nutritional Sciences, San Diego State Univ. Gray Cook, MSPT, OCS, CSCS Clinic Director, Orthopedic & Sports Phys. Ther., Dunn, Cook, and Assoc. Keith D’Amelio, ATC, PES, CSCS Head Strength & Conditioning Coach/ Assistant Athletic Trainer, Toronto Raptors

Patented device offers an extra level of pain relief and protection from knee degeneration and overuse syndromes. Stabilizes and strengthens the joint while allowing full mobility. Sizes: Sm - XL

Bernie DePalma, MEd, PT, ATC Head Athl. Trainer/Phys. Therapist, Cornell University

Achilles Tendon Strap

David Ellis, RD, LMNT, CSCS Sports Alliance, Inc.

This patented device will reduce stress upon the Achilles Tendon and provide effective relief from pain and discomfort associated with Achilles Tendonitis. Sizes: Sm - Med - Lrg

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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

Boyd Epley, MEd, CSCS Director of Coaching Performance, National Strength & Conditioning Association Peter Friesen, ATC, NSCA-CPT, CSCS, CAT, Head Ath. Trainer/ Cond. Coach, Carolina Hurricanes Lance Fujiwara, MEd, ATC, EMT Director of Sports Medicine, Virginia Military Institute

Brian Goodstein, MS, ATC, CSCS, Head Athletic Trainer, DC United Gary Gray, PT, President, CEO, Functional Design Systems Allan Johnson, MS, MSCC, CSCS High Performance Fitness Maria Hutsick, MS, ATC/L, CSCS Head Athletic Trainer, Boston University Christopher Ingersoll, PhD, ATC, FACSM Director, Graduate Programs in Sports Medicine/Athletic Training University of Virginia Jeff Konin, PhD, ATC, PT Visiting Associate Professor, University of South Florida Tim McClellan, MS, CSCS Director of Perf. Enhancement, Makeplays.com Center for Human Performance

December 2006 Vol. XVI, No. 9 Publisher Mark Goldberg Editorial Staff Eleanor Frankel, Director R.J. Anderson, Kenny Berkowitz, Nate Dougherty, Abigail Funk, Dennis Read, Greg Scholand, Laura Smith Circulation Staff David Dubin, Director John Callaghan Art Direction Message Brand Advertising

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

Production Staff Don Andersen, Director Jonni Campbell, Jim Harper, Miles Worthington

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

IT Manager Julian Cook

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

Vern Gambetta, MA, President, Gambetta Sports Training Systems

Fred Tedeschi, ATC Head Athletic Trainer, Chicago Bulls

Joe Gieck, EdD, ATR, PT Director of Sports Medicine and Prof., Clinical Orthopaedic Surgery, University of Virginia (retired)

Terrence Todd, PhD, Co-Director, Todd-McLean Physical Culture Collection, Dept. of Kinesiology & Health Ed., University of Texas-Austin

Business Manager Pennie Small Special Projects Dave Wohlhueter Administrative Assistant Sharon Barbell Advertising Materials Coordinator Mike Townsend Marketing Director Sheryl Shaffer Marketing/Sales Assistant Danielle Catalano Advertising Sales Associates Diedra Harkenrider (607) 257-6970, ext. 24 Rob Schoffel (607) 257-6970, ext. 21 T&C editorial/business offices: 31 Dutch Mill Road Ithaca, NY 14850 (607) 257-6970 Fax: (607) 257-7328 info@MomentumMedia.com 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., 31 Dutch Mill 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© 2006 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. Periodicals postage paid at Ithaca, N.Y., and additional mailing offices. POSTMASTER: Send address changes to Training & Conditioning, P.O. Box 4806, Ithaca, NY 14852-4806. Printed in the U.S.A.

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T&C DECEMBER 2006

ATHLETICBID.COM

With the introduction of the new Dynatron X3™ stand-alone light-therapy

device and the new Dynatron XP™ Light Pad, Dynatronics has redeﬁned how light therapy is delivered. The new Dynatron X3 allows 3 independent treatments (2 pads and 1 probe) and is capable of delivering 16,000 mW of light. With its state-of-the-art touch screen, the Dynatron X3 is also simple to operate.

Circle No. 103

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Board Senate to Reconsider Medicare Reimbursement Since 2005, government rules have prevented Medicare from paying for physician-supervised treatment unless provided by a physical therapist, occupational therapist, or speech and language pathologist. As a result, athletic trainers, kinesiotherapists, and other allied health professionals have been left out of the Medicare picture. Now, a Senate bill aims to change those rules, to the benefit of athletic trainers and Medicare beneficiaries alike. The bill, introduced in September by Sen. Craig Thomas (R, Wyo.), is called the Access to Physical Medicine and Rehabilitation Services Improvement Act of 2006 (S. 3963). It would change rules enacted by the government’s Centers for Medicare and Medicaid Services, allowing Medicare reimbursement for doctor-recommended therapy provided by certified athletic trainers and certain other professionals. “This crucial piece of legislation ensures that the maximum number of qualified therapy professionals are available to provide Medicare beneficiaries with the quality care they need and deserve,” Chuck Kimmel, ATC, President of the NATA, said in a statement. “We believe that physicians are best qualified to determine the type of therapy treatments prescribed and to choose the best qualified professionals to deliver those services.” The bill’s supporters note that in addition to improving the quality of care for Medicare users, the policy benefits taxpayers. Recent reports from the Medicare Payment Advisory Commission and the General Accounting Office indicate that physical medicine and rehabilitation services provided in a physician’s office (such as those performed by athletic trainers) are more cost effective than comparable services provided in other medical settings, such as skilled nursing facilities. The Senate Committee on Finance received the bill in late September and has not yet scheduled a vote. The NATA, the American Academy of Physical Medicine and Rehabilitation, the American Medical Society for Sports Medicine, and many other professional groups have announced their support and have formed an ad hoc coalition to advocate for the bill’s passage. ■ To visit the coalition online, go to: www.coalitiontopreservepatientaccess.org.

High School Sports Injury Rate Plummets As high school sports participation continues to rise, injury rates have fallen in the past decade, according to new research. Yet while this data is encouraging, one high school 6

T&C DECEMBER 2006

athletic trainer says more information is needed before drawing any conclusions. The latest numbers come from a study published by the Centers for Disease Control and Prevention (CDC). The authors, led by Dawn Comstock, PhD, of the Columbus (Ohio) Children’s Hospital, looked at injury rates from 100 high schools nationwide in nine different sports—football, wrestling, boys’ and girls’ soccer, boys’ and girls’ basketball, girls’ volleyball, baseball, and softball—for the 2005-06 academic year. They compared their results to the findings of a 1999 study that used data from the mid-1990s and found that in every sport except girls’ volleyball, the injury rate was cut at least in half. “While part of the decrease is due to a different definition of injury, we know that sports-related injury rates are decreasing because of rule changes, improvements in protective gear, and in the diagnosis and treatment of injury,” Comstock told the HealthDay News Service. She said scientific advancements and greater awareness in areas like heat illness and concussions are prime examples of these effects. Jon Almquist, ATC, Athletic Training Program Specialist at Fairfax County (Va.) Schools and Chair of the NATA’s Secondary Schools Committee, says the study’s results are important but cautions against reading too much into them. “We have to look at larger amounts of data before we can make any real claims about a nationwide trend,” he says. “With improvements in athletic training in recent years, hopefully there has been a decrease in injuries. Now there is some evidence of that, but it should be viewed in perspective. It’s one study, and while it’s a great start, there’s still a lot more research to be done.” ■ The study, “Sports-Related Injuries Among High School Athletes: United States, 2005-06 School Year,” was published in the Sept. 29 issue (Vol. 55) of the CDC’s Morbidity and Mortality Weekly Report. To view the full text, go to: www.cdc.gov/mmwr/preview/ mmwrhtml/mm5538a1.htm.

Interval Training: Equal Benefits, Only Faster The practice of interval training—alternating short bouts of high-intensity exercise with longer periods of recovery—has been a mainstay among competitive athletes for years, since it replicates the brief and intense bursts of energy required in most sports. But how does it compare to standard cardio exercise for promoting muscle health to improve performance? A new study suggests the two are essentially equal. In the study, led by Martin Gibala, PhD, Associate Professor of Kinesiology at McMaster University in Canada, college-age males exercised on stationary bicycles three times ATHLETICBID.COM

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a week over a two-week period. One group worked out at peak intensity for 30 seconds, followed by four minutes of slow pedaling for active recovery, during a 20-minute session. The other group rode at a steady, moderate pace for 90 to 120 minutes per session. After the two weeks, researchers tested each participant’s muscle tissue for an enzyme that indicates how efficiently the muscle is using oxygen. To their surprise, both groups exhibited roughly the same increase in enzyme level—around 25 to 30 percent. This suggests interval training offers the same benefits as less intense, more prolonged exercise in only a fraction of the time. “You can think about [interval training] as being able to produce energy more efficiently, being able to go at a faster pace and exercise longer,” Gibala told the Los Angeles Times. “We’re still wrapping our heads around the magnitude of improvement in the interval group.” The study, “Short-Term Sprint Interval Versus Traditional Endurance Training: Similar Initial Adaptations in Human Skeletal Muscle and Exercise Performance,” was published in the September issue (Vol. 575, Issue 3) of the Journal of Physiology. To view the full text, go to: jp.physoc.org/cgi/content/full/575/3/901.

Schwarzenegger “Terminates” ATC Licensure California is one of only six states that doesn’t regulate or officially recognize the title of athletic trainer. And after an October veto by Governor Arnold Schwarzenegger, that won’t be changing anytime soon. The Athletic Trainers Registration Act, which passed convincingly through the California legislature this summer, would have established certification for athletic trainers in the state and imposed penalties on any uncertified person who represented themselves as an “athletic trainer,” “certified athletic trainer,” “registered athletic trainer,” or “ATC.” Schwarzenegger explained his veto in terms of small-government conservatism. “There is no evidence that the existing unregulated status of athletic trainers poses any threat to public health and safety,” he wrote. “While there may be a benefit to consumers by providing a distinction for certified athletic trainers, this bill would place unnecessary regulatory burdens on the athletic training profession.” California Athletic Trainers Association President Mike West vows to continue the fight for recognition. “Have faith that though disappointed, your leadership is not discouraged,” he wrote on the CATA Web site in October. “Much was learned along the way that will ultimately assist us with whatever our next move might be.” ■

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T&C DECEMBER 2006 AccelCare_TC1609.indd 1

ATHLETICBID.COM 11/20/06 12:09:39 PM

Comeback

Athlete

Courtney Evans Tufts University In December of 2004, Courtney Evans should have felt like she was on top of the world. As the top blocker and server on the Tufts University volleyball team, the junior middle hitter led the Jumbos to a 28-6 record and second place in the New England Small College Athletic Conference. Despite that success, she felt nothing like a fine-tuned athlete. Instead, Evans was exhausted and experiencing extreme abdominal pain. She had also noticed a loss of appetite and energy—although she didn’t tell her teammates or coaches. Somewhat concerned, but not overly worried, Evans described the symptoms to her father, Douglas Evans, MD, Surgical Oncology Chief at the University of Texas M.D. Anderson Cancer Center. Initially, Dr. Evans thought his daughter was simply lactose intolerant and recommended a dairy-free diet. When the pain and exhaustion remained, Dr. Evans quizzed a number of the hospital’s gastrointestinal experts, who believed the symptoms were consistent with a bacterial infection and prescribed an antibiotic. The antibiotic alleviated some of Evans’s symptoms, but it wasn’t enough. So at the conclusion of the season, she went to Massachusetts General Hospital for testing. A colonoscopy revealed Evans’s symptoms had a cause: She was in the early stages of Crohn’s Disease, a rare, chronic, episodic illness affecting the gastrointestinal tract that afflicts more than 500,000 people in the United States. Doctors put Evans on Imuran, an immunosuppressant, and she returned to campus. But her energy continued to wane and her appetite plummeted. Evans struggled to get through her final exams, and returned home to Houston for winter break simply exhausted. The cause of Crohn’s Disease is unknown and there is currently no medical or surgical cure. An inflammatory bowel disease, Crohn’s causes blockages in the intestines, resulting in chronic diarrhea, abdominal pain, fever, and weight loss. The pain can be intense, with symptoms dominating a patient’s everyday activities. For Evans, who would lose 30 pounds in the two months following her diagnosis, the disease caused episodes of extreme abdominal pain and diarrhea that had ATHLETICBID.COM

Battling Crohn’s Disease, Courtney Evans led the Tufts University volleyball team to its best record ever and then completed the Boston Marathon the following spring. Above, Evans's teammates and coach accompany her across the marathon finish line. her sprinting to the bathroom every 45 minutes. When Evans told Head Volleyball Coach Cora Thompson, CSCS, about the diagnosis, Thompson was naturally concerned. And when she received a phone call from her star hitter over winter break warning her that the symptoms had worsened and Evans had lost a significant amount of weight, Thompson grew more worried. At 5-foot-11 and 165 pounds, Evans was a lean, lanky athlete for whom bodyweight was already at a premium. However, that phone call could not prepare Thompson for what appeared before her eyes when Evans walked into her office at the start of the spring semester. “My heart dropped as soon as I saw her, and I became extremely concerned,” says Thompson. “Her muscles were completely gone—her arms were so thin. She was so weak and gaunt. It was very, very scary. She didn’t have 20 pounds to lose to begin with!” T&C DECEMBER 2006

Athlete

Comeback

Upon her return, Evans had some tough decisions to make. First, a planned trip to study abroad was cancelled, and Evans signed up for only three courses—the minimum to be considered a full-time student at Tufts. Thompson helped make arrangements for Evans to move to a dorm on campus where she could be more closely monitored. “My parents didn’t want me to go back to school at all, but there was no way I was giving up my senior season,” says Evans, who had been voted co-captain for the upcoming year. “At first, I basically went to class, then straight home to sleep. I was anemic and had zero energy.” Evans’s health continued to decline and by January she had lost another 10 pounds, bringing her down to about 135. “I couldn’t keep anything in my body and I didn’t have an appetite,” says Evans. “I didn’t want to eat because it only made me more sick.” But Evans did not want to hand in her uniform or kneepads either. So, Thompson and Athletic Trainer Patricia Cordeiro, ATC, met with Evans and figured out a strategy to get her back on the court. “We put some very basic plans in place, and vowed to keep everybody on the same page,” says Cordeiro. “We wrote out a timetable for her that said, ‘By this point you need to see this specialist, and by this point you need to do this,’ and so forth.” Evans says creating a formal plan was a big help in her recovery. “That’s something I really needed because I’m a go-with-the-flow type of person and wouldn’t have done it on

my own,” she says. “Pat was very diligent about keeping me in the moment. She never said, ‘This is going to be a really hard road, you'd better get ready.’ It was always, ‘Here’s what we’re going to do, let’s get started.’” Thompson also spent a lot of time on the phone with Evans’s parents, working with them to find the best specialists. Early in the semester, she drove Evans to see a nutritionist in Boston. “Because there is no known cure, a patient’s best method of managing Crohn’s Disease is through medication and improved nutrition,” says Thompson. “Some of the nutritionist’s ideas were a little funky and hard for Courtney to get used to at first, but they helped a lot. For instance, the nutritionist told her she needed more flax seed in her diet. Courtney had to go out to a health food store and buy flax seed and be conscious about adding it to her morning yogurt. Those kinds of details were a big change for her.” Thompson, who also serves as a strength coach at Tufts, tried to find out all she could about what her player was battling. “In addition to researching on the Internet, I talked to our athletic trainers and anybody else who might know anything about Crohn’s,” she says. “But to me, getting her in the hands of the right doctors and helping to expedite the recovery process was more important than becoming an expert on the disease myself. I saw my job as finding the resources she needed and working with her parents and the specialists. “I wanted to make sure Courtney knew I was there for her,” Thompson adds. “I also wanted her to feel structured and to

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T&C DECEMBER 2006

ATHLETICBID.COM

Athlete

Comeback ■ Courtney Evans Injury: Crohn’s Disease Rehab notables: Lost and regained 30 pounds of muscle in eight months.

Result: Returned to starting middle hitter position in 2005 and led the Jumbos to the most wins in Tufts volleyball history. Also completed the 2006 Boston Marathon. Quote from Coach: “It’s so inspirational to think that she started that 15-month ordeal flat on her back and ended it by crossing the finish line of the Boston Marathon. And in the middle, to have the best season in school history—I really couldn’t have scripted a better story.”

feel like part of the team—not like she was out there floating around amongst the masses. And most importantly, I wanted to make sure she knew we weren’t giving up on her.” Though she realized her coach was squarely in her corner, Evans still experienced bouts of depression that spring and decided to get help from a sports psychologist employed by the university. “A lot of times I felt depressed about not being able to do what I used to do, and I didn’t want to burden my friends by talking about it all the time,” says Evans. “So I started seeing the sports psychologist once a week. We not only talked about my illness, but also about dealing with the responsibilities of being a captain the next season. It was really helpful to think ahead about that kind of stuff—it helped me keep my mind focused on getting back to where I was before.” In March, Evans, who was anemic, started getting IV infusions of iron, which were easier for her to take than oral iron supplements. And slowly, she noticed her energy levels rising. At that point, even though she still experienced symptoms of Crohn’s, Evans began working with a Tufts personal trainer for 45 minutes a day, three times a week. “We wanted to prescribe exercises that kept her comfortable, and we found that stretching was the thing,” says Cordeiro. “She did lots of static stretching with long, prolonged movements that lasted for 30 to 120 seconds. She started each session by working on her priority areas—whatever was tightest. And it really seemed to improve some of her symptoms.” By the end of April she began some basic strength training using very light weights. Because the goal was to increase Evans’s body weight, the program was designed to limit her cardio conditioning. “We started doing really basic circuit training on machines,” says Cordeiro. “Eventually, she progressed to lowerbody exercises like squats and leg presses using light weight. By then the team was doing their team lifting and she worked out at the same time. It was a good way to keep her connected with her teammates and focused on her goal.” By the end of the spring semester, Evans had put on more than 10 pounds and was starting to feel a little better about ATHLETICBID.COM

her chances of returning to the court for the 2005 season. But she wasn’t even close to feeling like her old self. So that summer, Evans’s doctors put her on a new IV medication called Remicade. The results were startling. “After two infusions, I felt 100-percent better. After the third infusion, I felt completely normal again,” says Evans. “It took away my symptoms completely. It has been a miracle drug for me.” Spending the summer in Cape Cod, Mass., Evans hired a personal trainer and attacked her workouts with newfound energy and vigor. Intense lifting three times a week packed pounds on Evans’s frame while hardening and tightening her muscles. “That summer I set a personal best in the squat and restored my vertical jump to what it had been before I got sick,” she says. “It was a lot of hard work, but I regained everything I had lost during the spring semester.” When Evans returned to Tufts for volleyball preseason practice in August, Thompson was again blown away by what walked through her office door. “When I first saw Courtney, she flexed and said, ‘Look! Muscles!’” says Thompson. “She was lean and strong and her body mass index had improved over what it was before the Crohn’s. Then I sat back and watched her play a couple pickup games—that’s when I realized she was back to her old form.” And that form carried her team to another level. The Jumbos won a school-record 29 games and advanced to the regional finals in the NCAA Division III championships. During that magical season, Evans played in every match, earning first-team allconference honors. Despite exhausting her collegiate eligibility, Evans was not ready to stop competing. Two weeks after the team’s final game, Evans told Thompson that she wanted to start training for the Boston Marathon. “We were coming off a grueling season and to have her say that was mind boggling,” says Thompson. “She trained all winter long, was eating a ton, and feeling great. It was amazing considering a year earlier she couldn’t even get off the couch. “The whole experience of rehabbing from Crohn’s DisT&C DECEMBER 2006

Athlete

Comeback

ease taught her a lot about nutrition and what her body could handle,” Thompson adds. “And throughout her marathon training she kept asking Pat and I, who have both run marathons, for advice.” That spring, Evans completed the 26.2-mile race in less than six hours. She was escorted to the finish by Thompson, who met Evans at the 17-mile mark, and seven of her teammates, who joined in with four miles to go. “The girls were wearing T-shirts that read, ‘Court Support’ on the back and chanting her name and getting the crowd into it—I’m getting a little choked up just talking about it,” says Thompson. “Granted, they were silent after about a mile as they tried to keep up with Courtney. “It’s so inspirational to think that she started that 15-month ordeal flat on her back and ended it by crossing the finish line of the Boston Marathon,” Thompson continues. “And in the middle, to have the best season in school history—I really couldn’t have scripted a better story.” Evans is currently a teacher and Head J.V. Volleyball Coach at Episcopal High School in Houston. She says the lessons she learned last season have helped shape her coaching philosophy. “The whole never-give-up mentality is the basis of my coaching style,” says Evans. “I never hang my head on the bench and I’m always encouraging our players—no matter how dire the circumstances seem. Cora taught me that if I don’t give up on the girls, they won’t give up on themselves.” Though she still receives Remicade transfusions every

two months, Evans says she has the disease well under control and feels healthy and strong. Ultimately, she says having Crohn’s Disease has taught her a lot about herself. “I always thought I was mentally tough, but I learned exactly how tough I am,” says Evans. “It would have been really easy to let my situation get the best of me, especially at the beginning of that spring semester. I got sad, but I never let it get out of hand and a lot of credit for that goes to my support system: Cora, Pat, my personal trainer Dan, and my friends and parents. “Also, I learned to never say no to somebody who was trying to help me,” she adds. “As a very independent person, it would have been natural for me to say, ‘Thanks, but I can do this on my own.’ If I had done that I don’t think I would have been able to get well as quickly as I did. It helped so much to have other people beside me saying, ‘You’re going to be fine, we have a plan.’ Having people do all those little things really added up.” ■

Send Us Your Success Stories! To nominate an athlete to be featured in this Comeback Athlete section, please send your name, the athlete’s name, his or her rehab story, and contact information to: 31 Dutch Mill Rd., Ithaca, NY 14850; ef@MomentumMedia.com; fax: 607-257-7328; or call us at: 607-257-6970, ext. 18.

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www.nsca-lift.org Circle No. 107

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TREATING THE ATHLETE

Pulling Through

©GETTY IMAGES

BY DR. DANIEL CIPRIANI

As more and more sportsmedicine professionals become frustrated with traditional approaches to hamstring care, they are coming up with new ideas on how to treat this bi-articular muscle group.

ATHLETICBID.COM

n virtually every sport, hamstring injuries account for a larger percentage of lost time than any other musculotendon injury. Not surprisingly, a great deal of research has been devoted to understanding predisposing factors, intervention approaches, and preventative measures involving the muscles of the posterior thigh. Yet, for the most part, these injuries still perplex us. Despite all that we’ve learned, we still repeatedly see athletes clutch the back of their thighs in pain and hobble off the field, court, or track. And once they’ve suffered one ham-

string injury, there is a good chance they’ll suffer another. In response, some sports medicine professionals are starting to think outside the box about the treatment and prevention of hamstring injuries. They are taking a more holistic approach to the hamstring and trying out new ideas and techniques. They are asking themselves: What is unique about this musDaniel Cipriani, PhD, PT, is an Assistant Professor in the Department of Exercise and Nutritional Sciences at San Diego State University. He can be reached at: cipriani@mail.sdsu.edu. T&C DECEMBER 2006

TREATING THE ATHLETE

Most hamstring injuries occur during the late swing phase of running. At this point, the hip is moving through flexion while the knee is extended—the hamstring is generating an eccentric muscle action and being passively lengthened—and is at its greatest tension.

the knee is extended—the hamstring is generating an eccentric muscle action (lengthening contraction) and being passively lengthened simultaneously— and is at its greatest tension. The hamstring is most responsible for controlling the action of hip flexion during the terminal swing, and this swinging leg certainly creates a great deal of angular momentum that must be controlled. Given the complex functional demands placed on the hamstring, a number of predisposing factors related to the incidence of hamstring muscle injuries have been identified. They include inadequate hamstring strength, muscle imbalances between the hamstrings and the quadriceps, excessive anterior rotation of the pelvis (which places the hamstring in an elongated position), inadequate conditioning, and possibly reduced flexibility. In addition, it has been found that the leading cause of hamstring injury is the presence of a prior injury—nearly 30 percent of all hamstring injuries will result in a recurrence.

creating knee-flexion muscle force during backward running and cycling. One argument in support of the hamstring as a “knee muscle” is based on the potential role it plays in preventing an-

NEW APPROACHES The traditional approach to preventing and treating hamstring injuries (following the acute treatment phase) has been to focus on isolated stretching of the hamstrings along with isolated

cle group? Does its dual innervation lead to different types of injuries? And how does training the quadriceps affect the hamstrings? In this article, I will review the most widely accepted predisposing factors of hamstring injuries as well as innovative approaches to intervention and prevention. I’ll examine the role of the quads and hip flexors in hamstring function, and explain how to train this muscle group in its position of greatest tension. A LOT OF MUSCLE The hamstring consists of four muscle bellies originating on the pelvis and inserting below the knee on the lower leg.

On the lateral side of the posterior thigh is the biceps femoris component of the hamstring, and on the medial side are the semimembranosus and semitendonosus. These muscle branches are bi-articular in that they cross two joints: the hip and the knee. From a functional standpoint, this biarticular muscle group can produce and control a multitude of lower-extremity motions. With the leg in a non-weight bearing position (such as during the swing phase of running), the hamstring can shorten concentrically to extend the hip or flex the knee, and it can lengthen eccentrically to control the motion of hip flexion or knee extension. With the leg in a weight-bearing position, the role of the hamstring becomes even more complex. Not only can the muscles work concentrically to extend the hip and eccentrically to control hip flexion (as with the motion of squatting down), they can also produce motion in the pelvis relative to the femur. The hamstring can produce a posterior rotation of the pelvis concentrically (such as when returning the spine from a bent over position), or control an anterior rotation of the pelvis eccentrically (such as when bending forward at the waist). This movement at the pelvis is often referred to as reverse muscle action. Even though the hamstring is gener14

T&C DECEMBER 2006

ally described as a knee muscle, from a torque-producing standpoint, it is actually better designed for actions involving the hip and pelvis. In fact, the hamstring has practically no function at the knee when the leg is bearing weight—any knee flexion in stance is caused by body weight and ground reaction forces. Studies using electromyography (EMG) have documented that the hamstring is more active at the hip than the knee during activities such as forward walking and running, backward walking and running, and cycling. These studies have demonstrated that it is the gastrocnemius, and not the hamstring, that is more responsible for

The hamstring is unique in that it is one of the few biarticular muscles that share a dual innervation … which may result in coordination issues within the muscle during dynamic, high-speed, or high-tension activities. terior cruciate ligament (ACL) injuries. The ACL’s role is to prevent an anterior pull of the tibia relative to the femur. And research has demonstrated that the hamstring can produce a protective posterior pull of the tibia relative to the femur to protect the ACL from tension. However, these studies often miss the fact that the hamstring’s ability to create a posterior-directed force on the tibia depends on the knee being in flexion greater than 30 degrees (which rarely occurs during walking or running). Thus, the ability of the hamstring to protect the ACL may be limited. Regardless of its potential role at the knee, it is not surprising that most hamstring injuries occur during the late swing phase of running. At this point, the hip is moving through flexion while

strengthening. Traditional hamstring strengthening usually includes exercises that emphasize the hamstring’s role at the knee, such as hamstring curls. However, many athletic trainers and physical therapists have become frustrated with the limited results of these methods, and are starting to experiment with newer ideas that include more function-based exercise. An interesting theory regarding hamstring injuries was recently posed by Bernie DePalma, MEd, PT, ATC, Head Athletic Trainer and Physical Therapist at Cornell University. He points out that the hamstring is unique in that it is one of the few bi-articular muscles that share a dual innervation. Rather than a single common innervation, the hamstring is innervated by two differATHLETICBID.COM

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TREATING THE ATHLETE ent levels of spinal nerve roots (the tibial branch and the peroneal branch of the sciatic nerve). This dual innervation may result in coordination issues within the muscle during dynamic, high-speed or high-tension activities. DePalma further notes that the mode of injury to the hamstring differs based on the division of the muscle that is injured. For instance, the upper-middle portion of the hamstring is more prone to injuries during the terminal sub

working concentrically as the hip is in extension. Another compelling observation has been made by Debra Brooks, PhD, CNMT, CEO of the Iowa Neuromuscular Therapy Center, who says, “It is never just the hamstring.” In her practice, she considers all the muscles that interact with the hamstring, and has identified overdeveloped quadriceps and hip flexor muscles as a critical problem area.

Brooks includes in her injury investigation a thorough examination of standing pelvic posture … Above-normal values suggest that the hip flexors and rectus femoris may be substantial contributors to a hamstring injury. phase of swing (deceleration), whereas the lower lateral portion is at greater risk during the push-off sub phase of stance, when there is a quick, explosive contraction. Thus, the muscle can be injured when it is working eccentrically as the hip is in flexion, and it can also be injured when the muscle is

Brooks suggests that in order to fully address hamstring issues, athletic trainers and physical therapists must first address the hamstring’s antagonists: the quadriceps and hip flexors. In her experience, tightness of the quadriceps, hip flexors (psoas, iliacus, sartorius, pectinius, tensor fasciae la-

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tae, longus brevis), and gracilis are associated with an increased incidence of hamstring injuries. She points out that this anterior tightness can promote increased anterior pelvic tilt posture, which places tension on the hamstrings even before the hip begins to flex during walking and running. This anterior pelvic tilt can then predispose the hamstring to further increased tension during many physical activities. Because the hamstring functions predominantly with an eccentric action (to control forward hip flexion), this added tension stretches the hamstring to “within an inch of its life.” IDEAS INTO ACTION Like many progressive clinicians, Brooks considers the entire lower extremity and pelvis when investigating the cause or nature of a muscle injury. Even though the symptoms of a hamstring injury can be fairly obvious, she knows that the actual cause can be more complicated and multifaceted. Therefore, she includes in her injury investigation a thorough examination of standing pelvic posture to

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T&C DECEMBER 2006

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TREATING THE ATHLETE determine the influence of tight hip flexors and the rectus femoris. She notes that the normal standing anterior pelvic tilt for males is approximately zero to five degrees from horizontal (using the PSIS to the ASIS for alignment), and for females it is approximately five to 10 degrees. Above-normal values suggest that the hip flexors and rectus femoris may be substantial contributors to a hamstring injury. Of course, Brooks notes there are also common problems associated with hamstring injuries. For instance, sometimes the hamstring simply has limited flexibility, even when the pelvis is in perfect condition. When it comes to intervention, from a treatment or a prevention standpoint, Brooks strongly believes that pelvic posture must be addressed first if it is outside the norm. Thus, she focuses initial hamstring training on correcting sagittal-plane pelvic posture (PSIS-toASIS angle). She begins by using active isolated stretching techniques to improve the functional excursion of the quadriceps and hip flexor muscles. She addresses both the proximal quadriceps (rectus femoris) and the distal component of the quadriceps (the vasti components). For instance, if the psoas major (hip flexor) is tight, it prevents hip extension and the proximal quadriceps cannot be effectively stretched, so the psoas are also addressed. Improving flexibility of the hip flexors and rectus femoris can help reduce anterior pelvic rotation, and subsequently eliminate some of the tension produced in the hamstring muscles. Once pelvic posture and anterior muscle flexibility have been examined, Brooks determines if there are any spasms and/or trigger points in the hamstring tissue. She also checks to see if hamstring flexibility is normal. She then initiates palpatation to reduce spasm in the hamstring and moves on to strengthening exercises. Here, Brooks once again deviates from the normal approach—she advocates an active exercise program for the hamstring that involves strengthening and predominantly eccentric exercises, rather than stretching. All too often, the first step athletic trainers take is to stretch an injured or elongated muscle group. But Brooks believes that strengthening may be more important for hamstring recovery than stretching the muscles. Research proATHLETICBID.COM

vides some support for this idea: Previous studies have not found a strong link between the incidence of hamstring injury and muscle tightness. DePalma also focuses predominantly on strengthening the hamstring muscles. He recommends that training, conditioning, and rehabilitation of the hamstrings involve eccentric action exercises with the hip in flexion and concentric action exercises with the hip in extension. Further, he believes hamstring training needs to be multifaceted, just like the modes of injury. His hamstring pro-

gram involves high-intensity exercises with multiple sets and repetitions, performed in multiple hip and knee positions, at both high and low speeds. He places a heavy emphasis on the eccentric component of the muscle action with the hip in flexion and the concentric component of the muscle action with the hip in extension. TOUGHER HAMSTRINGS The key to these new ideas is that hamstring conditioning and rehabilitation should focus on the function of the ham-

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TREATING THE ATHLETE string at the hip, predominantly with an eccentric action. Prone lying hamstring knee curls should be replaced with standing, low- and high-speed hip extension exercises. In fact, to truly replicate the function of the hamstring, and mimic the mechanism of its injury, the muscle group should be strengthened in its position of greatest tension, with the hip in forward flexion and the knee in extension, while engaged in the terminal swing phase position of running. To exercise this motion, the strength-

Figure One: The athlete uses the hamstring muscles to control the forward pull of the rubber tubing.

ening emphasis should be on the lengthening muscle contraction (eccentric action). The athlete should focus on controlling a loaded tension as the entire leg is pulled into hip flexion with the knee extended, as in the terminal phase of running. Using the hamstring function at the hip to control this forward pull of the leg trains the hamstring to perform forced eccentric action of the swing leg. This form of eccentric exercise should be initiated with low-speed motions, progressing gradually to greater speed. Rubber tubing exercises are ideal for this type of hamstring training. The elastic tube can be connected to a fixed location on a wall at hip level, then attached to the athlete’s ankle, with the athlete facing the wall and standing far enough away to place maximum tension on the tubing. The athlete then allows the tubing to pull the leg forward, off the ground, into hip flexion and knee extension, using the hamstring muscles to control this forward pull. (See Figure One, at left.) The exercise is performed with slow, controlled repetitions. Eventually the speed of the motion is increased to replicate the high-speed swing phase of running. All of the tension is applied to the hamstring, by the tubing, with the hip pulled into flexion and the knee extended. Exercises derived from the martial arts also provide an excellent training option. For example, the front snap

kick and the straight leg kick train the hamstring to control the rapid acceleration of a swinging leg, which creates stress similar to what is encountered when sprinting or jumping hurdles. In particular, these two activities require that the stance (support) leg be in a position of hip extension while the swing leg flexes at the hip, replicating the position of injury for the hamstring during sprinting activities. The hip extension of the trail leg produces an anterior pelvic tilt, which further stresses the hamstring of the swing leg. The front snap kick exercise is initiated with the “target” leg in a front lunge stance. This target leg is lifted into hip flexion, the knee is sharply extended (front snap kick), and the target leg is then returned to the ground in a front lunge stance. The kicking motion requires the hamstring to work eccentrically with the hip in flexion and knee in extension, and the landing component requires the hamstring to control hip flexion into the lunge. (See Figure Two, below.) In the straight leg kick, the target leg begins as the trail leg, is brought forward in a straight leg kicking fashion, and then lands on the ground in a front lunge stance. (See Figure Three, above right.) This exercise can be advanced across the court or field, alternating between the right and left legs. Because this is a full leg kicking motion, it is more aggressive than the front snap kick.

Figure Two: In the front snap kick, the front leg is the target leg. 18

T&C DECEMBER 2006

ATHLETICBID.COM

TREATING THE ATHLETE In order to exercise the hamstring to prepare it for the weight bearing mode of injury (early stance), which may be a result of either a concentric or eccentric hip action, a number of different exercises can be used. I like to use two-leg

and one-leg deadlifts, which place an emphasis on the hamstring’s function of controlling and moving the pelvis on the femur. These exercises train the muscles to control the anterior rotating pelvis during the lowering phase of the

Figure Three: In the straight leg kick, the back leg is the target leg.

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exercise and to create a posterior rotating pelvis during the raising phase of the exercise. In addition, common exercises such as the forward lunge, two-leg and one-leg squats, and diagonal lunges all force the hamstring to work at the hip, control hip flexion, and produce hip extension in weight bearing. These exercises can be incorporated into any athlete’s training and conditioning regimen. As with any training program, the goals are generally to improve performance and prevent injury. Exercises such as the leg kicking movements, lunges, and deadlifts ensure the athlete is addressing the unique needs of the hamstring as part of an overall physical training program. Obviously, conditioning and rehabilitation of the hamstring requires a number of different exercise approaches. Athletic trainers should always keep in mind that hamstring injuries are not just about the hamstring. Attention to the pelvis and recognition of the multifaceted function of the hamstrings in weight bearing and non-weight bearing functions are essential to effective management of this muscle group. ■

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OPTIMUM PERFORMANCE

Ready to Roll Interested in providing a massage therapist for each of your athletes? Try handing them a foam roller.

Author Michael Boyle begins all his athletes’ workouts with foam rolling.

BY MICHAEL BOYLE

decade ago, strength coaches and athletic trainers would have looked quizzically at a 36 -i nch long cylindrical piece of foam and wondered, “What is that for?” Today, nearly every athletic training room and most strength and conditioning facilities contain an array of foam rollers of different lengths and consistencies. What happened to bring foam rollers into prominence? The change has been in our attitude toward massage therapy. We have been slowly moving away from an injury care mode of isokinetics and electronics to more European-inspired processes that focus on handson soft tissue care. We now realize that techniques like massage, muscle activation therapy (MAT), and active release therapy (ART) can work wonders for sore or injured athletes. In addition, the understanding at the elite athlete level is: If you want to stay healthy, get a good manual therapist in your corner. Thus, athletes at all levels are starting to ask for some form of soft tissue care. What does all this have to do with foam rollers? As coaches and athletic

Michael Boyle, MEd, ATC, is a strength and conditioning coach and consultant based in Boston. He has trained numerous athletes, from amateurs to Olympians and professionals, and can be contacted through his Web site at: www.michaelboyle.biz. ATHLETICBID.COM

MARK MORELLI T&C DECEMBER 2006

OPTIMUM PERFORMANCE

Figure One

Figure Four

MARK MORELLI

Figure Two

Figure Three trainers watched elite-level athletes experience success from various soft tissue techniques, the obvious question arose: How can I make massage available to large groups of athletes at a reasonable cost? Enter the foam roller. National Academy of Sports Medicine President Micheal Clark, DPT, MS, PT, CES, PES, CPT, is credited by many—this author included—with exposing the sports medicine community to the foam roller. In one of Clark’s early manuals, he included a few photos of self-myofascial release using a foam roller. The technique illustrated was simple and self-explanatory: Get a foam roller and use your bodyweight to apply pressure to sore spots. Since then, many of us have discovered more uses for foam rollers, including injury prevention and performance 22

T&C DECEMBER 2006

Figure Five enhancement. We’ve also moved away from the accupressure concept and now use them more for self-massage. And we’ve come up with specific protocols for different situations. Essentially, foam rollers are the poor man’s massage therapist. They provide soft tissue work to the masses in any setting. But you need to know their nuances to get the most out of them. WHAT, HOW & WHEN A foam roller is simply a cylindrical piece of extruded hard-cell foam. Think swimming pool noodles, but a little more dense and larger in diameter. They usually come in one-foot or threefoot lengths. I find the three-foot model works better, but it obviously takes up more space. They are also now available in a

number of densities from relatively soft foam (slightly harder than a pool noodle) to newer high-density rollers that feel much more solid. The denser the athlete, the more dense the roller should be. Large, heavily muscled athletes will do better with a very high density roller whereas a smaller, younger athlete should begin with a less dense product. The application techniques are simple. Clark’s initial recommendation was based on an accupressure concept, in which pressure is placed on specific surfaces of the body. Athletes were instructed to use the roller to apply pressure to sensitive areas in their muscles—sometimes called trigger points, knots, or areas of increased muscle density. The idea was to allow athletes to apply pressure to injury-prone areas themselves. ATHLETICBID.COM

OPTIMUM PERFORMANCE The use of foam rollers has progressed in many circles from an accupressure approach to self-massage, which I’ve found to be more effective. The roller is now usually used to apply longer more sweeping strokes to the long muscle groups like the calves, adductors, and quadriceps, and small directed force to areas like the TFL, hip rotators, and glute medius. Athletes are instructed to use the roller to search for tender areas or trigger points and to roll these areas to decrease density and over-activity of the muscle. With a little direction on where to look, most athletes easily find the tender spots on their own. However, they may need some instruction on the positioning of the roller, such as parallel, perpendicular, or 45 degrees, depending on the muscle. The feel of the roller and intensity of the self-massage should be properly geared to the age, comfort, and fitness level of the athlete. This is one of the plusses of having the athlete roll themselves—they can control the intensity with their own body weight. There is no universal agreement on when to roll, how often to roll, or how long to roll, but generally, techniques are used both before and after a workout. Foam rolling prior to a workout can help decrease muscle density and promote a better warmup. Rolling after a workout may help muscles recover from strenuous exercise. My preference is to have athletes use the rollers before every workout. We also use them after a workout if athletes are sore. One of the nice things about using the foam roller is that it can be done on a daily basis. In fact, in their book, The Trigger Point Therapy Workbook, Clair Davies and Amber Davies recommend trigger point work up to 12 times a day in situations of acute pain. How long an athlete rolls is also determined on a case-by-case basis. I usually allow five to 10 minutes for soft tissue activation work at the beginning of the session prior to warmup. If my athletes roll after their workout, it is done for the same length of time.

prone to the same frequency of upper body strains as lower. The hamstrings and hip flexors seem to experience the most muscle strains, so we concentrate on those areas. Here are some protocols I use: Gluteus Max and Hip Rotators: The athlete sits on the roller with a slight tilt and moves from the iliac crest to the hip joint to address the glute max. To address the hip rotators, the affected leg is crossed to place the hip rotator group in an elongated position. As a general rule of thumb, 10 slow rolls are done

SOME SPECIFICS While the foam roller can be used on almost any area of the body, I have found it works best on the lower extremities. There is not as much dense tissue in the upper body and our athletes are not

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in each position (although there are no hard and fast rules for reps). Often athletes are simply encouraged to roll until the pain disappears. (See Figure One on page 22.) TFL and Gluteus Medius: The tensor fasciae latae and gluteus medius, though small in size, are significant factors in anterior knee pain. To address the TFL, the athlete begins with the body prone and the edge of the roller placed over the TFL, just below the iliac crest (see Figure Two on page 22). After working the TFL, the ath-

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OPTIMUM PERFORMANCE lete turns 90 degrees to a side position (see Figure Three on page 22) and rolls from the hip joint to the iliac crest to address the gluteus medius. Adductors: The adductors are probably the most neglected area of the lower body. A great deal of time and energy is focused on the quadriceps and hamstring groups and very little attention is paid to the adductors. There are two methods to roll the adductors. The first is a floor-based technique that works well for beginners. The user abducts the leg over the roller and places the roller at about a 60-degree angle to the leg (see Figure Four on page 22). The rolling action begins just above the knee in the area of the vastus medialis and pes anserine, and should be done in three portions. To start, 10 short rolls are done covering about one third the length of the femur. Next, the roller is moved to the mid-point of the adductor group and again rolled 10 times in the middle third of the muscle. Last, the roller is positioned high into the groin almost to the pubic symphysis for a final set of 10 rolls.

The second technique for the adductors should be used after the athlete is comfortable with the first one. This exercise requires the athlete to sit on a training room table or the top of a plyometric box, which allows him or her to shift significantly more weight onto the roller and work deeper into the large adductor triangle (see Figure Five on page 22). The athlete then performs the same rolling movements mentioned above. Although I primarily use the rollers for athletes’ legs, they can also be used with upper extremities. The same techniques can be used for pecs, lats, and rotator cuffs, although with a much smaller amplitude—making the movements closer to accupressure. ASSESSING EFFECTIVENESS Foam rolling is hard work that can even border on being painful. Good massage work, and correspondingly good selfmassage work, may be uncomfortable, much like stretching. Therefore, it is important that athletes learn to distinguish between a moderate level of discomfort related to working a trigger point and a discomfort that can lead to injury.

When an athlete has completed foam rolling, he or she should feel better, not worse. And the rollers should never cause bruising. Ask the athlete how his or her muscles feel after each session to assess if the techniques are working. I also judge whether foam rolling is working by monitoring compliance. If I don’t have to tell athletes to get out the foam roller before a workout, I know the techniques are working. Most do it without prompting as they see the benefits. ROLLING VS. MASSAGE The question often arises: “Which is better, massage therapy or a foam roller?” To me the answer is obvious: Hands-on work is better than foam. Hands are directly connected to the brain and can feel. A foam roller cannot feel. If cost was not an issue I would have a team of massage therapists on call for my athletes at all times. However, having an abundance of massage therapists on staff is not in most of our budgets. Therein lies the beauty of the foam rollers: They provide unlimited self-massage for under $20. Sounds like a solution to me. ■

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LEADERSHIP

Making Dreams Come True

CHRIS MURPHY

BY GREG SCHOLAND

rian Coble was reaching the end of his rope. As the one-man athletic training staff at Carroll College, an NAIA school in Helena, Mont., he was spending 12 hours or more a day at work Monday through Saturday, then covering contests and holding treatment time for the football team on Sunday. Coble had heard that his predecessor was known for working 16-hour days, but as a new dad with a young family, that kind of schedule wasn’t sustainable for him.

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If your recurring dream is to add more staff to your college athletic training room, you’re not alone. If you want to know just how to fulfill that dream, read on. Not long into his first year on the job, he decided something had to change. “We were hosting one of the first volleyball games of the year, and I was going to be traveling with the football team,” recalls Coble, MS, ATC, PES, CSCS.

“The volleyball coach came to me and said, ‘We need somebody here tonight.’ And all I could say was, ‘Well, you need to help me find someone.’” The two called physical therapists and high school athletic trainers in the area, scrambling to come up with coverage for the event. “I decided then: We clearly need another staff member,” Coble says. By effectively lobbying his administration, Coble got his wish, and athletic Greg Scholand is an Assistant Editor at Training & Conditioning. He can be reached at: gs@MomentumMedia.com. T&C DECEMBER 2006

LEADERSHIP training at Carroll today is much better for it. With another full-time position in the department, event coverage is reliable, injured athletes receive more attention and better treatment, and teams take part in revamped conditioning programs that help prevent injuries in the first place. What’s more, Coble finally has time for life outside the athletic training room. For college athletic trainers, long hours and daunting workloads have traditionally come with the territory. But in recent years, more and more are questioning the status quo and strategizing about how to change it. Both collective and individual efforts are making headway, with the ultimate goal of keeping the profession strong. CHANGING TIMES If you feel like the problem of too much work and not enough personnel has gotten worse in your college program, you’re probably right. Many new demands have been placed on athletic trainers in recent years, mostly without corresponding staffing increases.

plain about long hours, they think, ‘If you don’t like it here, you could easily be replaced by another athletic trainer, maybe even for less money,’” she explains. “They see others in the department putting in a lot of hours—the coaches and their assistants, the academic counselors—and decide it just comes with the territory.” Dennis Miller, ATC, PT, Head Athletic Trainer at Purdue University, believes this trend may be harming the profession in the long-term. “When we have college athletic trainers putting in 80- and 90-hour weeks, it’s no surprise a lot of quality people choose to leave the job entirely. They can make the same money in a different setting and have a better quality of life,” he says. “That’s bad for the athletic training community, and it also means college programs miss out on a lot of great athletic trainers who do excellent work but don’t want the heavy workload. It’s a very legitimate issue for us.” At Dowling College, Mark Rodman, MSEd, ATC, Assistant Athletic Director for Sports Medicine and Wellness,

When assessing requests for more resources, athletic directors said key factors are how the request would increase overall quality of care, and whether the head athletic trainer appears to have a coherent, creative vision for his or her program. “Athletic training involves a heavy workload—it’s always been that way, and most people know it when they enter the profession,” says Josephine Lee, MS, LAT, ATC, Assistant Director of Sports Medicine at Georgia Tech and President of the College Athletic Trainers’ Society (CATS). “But the fact is, the workload has increased in the last several years. Athletics is a year-round operation now, and as teams have gotten more sophisticated, there are many more workouts and practice sessions that need coverage.” Lee adds a harsh truth: Not all administrators sympathize with overworked athletic trainers. This summer, CATS invited a well-respected former NCAA Division I athletic director to speak at its annual meeting, and he talked frankly from the administrator’s point of view. “He said that when some athletic directors hear a person com26

T&C DECEMBER 2006

has noticed a marked decrease in the number of applicants when he posts athletic training positions. “When I had an opening 10 years ago, I would hear from 50 or 60 people, at minimum,” Rodman says. “This year, I heard from two. One of them had no experience at the college level, and the other had taken the last 10 years off. That tells me either people aren’t as interested in athletic training as they used to be, or people don’t want to enter the college setting because they’re worried about the long hours, stress, and burnout.” GROUP HELP At the national level, several groups have efforts underway to help increase athletic training coverage on a broad scale. Last year, CATS surveyed college administrators to find out what they weigh most heavily when allocating resources. The group focused on NCAA

Division I, but sought input that could be useful across the board. “We asked how athletic trainers can improve their position in the department,” says Lee. “We also asked what factors athletic directors pay most attention to when making judgments about coverage—how they weigh the head athletic trainer’s recommendations, staff evaluations, coaches’ and athletes’ evaluations, and so on.” From the 25 administrators who responded, CATS noticed a few trends. When assessing requests for more resources, several athletic directors said key factors are how the request would increase overall quality of care, and whether the head athletic trainer appears to have a coherent, creative vision for his or her program. Also important was whether the athletic trainers appear to understand the athletic department’s financial “big picture.” “Administrators said we need to realize we’re not the only ones asking for more staff,” explains Lee. “We’re often vying with coaches, academic aids, the strength program, and sports information, and everyone sees their department as not having enough people. If the administrator can’t clearly see how more resources will tangibly improve the quality of care, we’re probably not going to win that battle.” The NCAA, too, has taken a recent interest in the state of college athletic training, looking primarily at ways to ease the burdens created by heavy workloads. Ron Courson, ATC, PT, CSCS, Director of Sports Medicine at the University of Georgia, sits on the NCAA Committee on Competitive Safeguards and Medical Aspects of Sports and the association’s task force that is studying work/life balance issues, and he says many new ideas are being brought to the table. “With the work/life balance task force, we’re hoping to come up with some specific recommendations on how to improve the quality of life for everyone in the athletic department,” Courson says. “For instance, one thing we’ve talked about is encouraging more schools to offer childcare on campus. For people trying to balance being an athletic trainer with being a parent, that could be a real help. “We’re also discussing ideas like mandatory days off for athletics staff,” Courson continues. “We require that for student-athletes because we see it ATHLETICBID.COM

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LEADERSHIP as important to their health and wellbeing. So why shouldn’t the same be true for someone in athletic training who might be working non-stop for entire months at a time?” Courson says the task force’s work could eventually result in a set of NCAA-sponsored best practices athletic departments could apply program-wide, which would help athletic trainers in everything from creating more personal time to attracting more quality people to the profession. “I think we’re realizing more and more that examining these issues is in everyone’s best interest,” he says. “And if we want to keep the athletic training profession healthy, it’s a discussion we need to be having.” The most direct effort at increasing athletic training coverage, however, has come from the NATA. In 1998, the association formed the Appropriate Medical Coverage for Intercollegiate Athletics (AMCIA) Task Force and charged it with creating a comprehensive formula for determining how much medical coverage a college or university should have to fully meet student-athlete needs. The result of their work, released in 2000 and updat-

ed in 2003, was a set of guidelines based on all the important variables related to sports-medicine coverage and studentathlete welfare. “Every year, it seems like coaches and athletic departments ask more from athletic training, and we’re striving to keep up with those demands and constantly improve,” says Miller, who chaired the AMCIA task force. “But clearly, the amount and quality of health care we can provide is linked to the amount of manpower available to do the job. The guidelines are an attempt to translate all of that into some numbers a program can use to evaluate itself.” Miller says the AMCIA guidelines are the centerpiece of the NATA’s effort to help college athletic trainers advocate for more staff, so they’ll be revised and improved on an ongoing basis. “We’re just starting the process of re-evaluating the formula a second time, and we’re seeking feedback from athletic trainers who have used the AMCIA document so we can find out what has and hasn’t worked,” he explains. “We’re currently sending out a questionnaire to our entire membership about that, and hope-

fully next year we’ll make some new recommendations to the board of directors about altering the guidelines so they’re even more useful.” USING THE GUIDELINES How can you apply the AMCIA formula to your program to see whether your coverage level meets the recommendations? First, you must understand how the formula assesses coverage demands, using a system of points called Health Care Units (HCUs). Each sport is assigned a base-level HCU score between zero and four, depending on its injury rate, the number of treatments typically required per injury, and the potential for catastrophic injury. A school takes the HCU score for each of its sports and applies a formula that incorporates roster size, number of active days (practice and competition), length of season, the team’s travel schedule, and athletic trainers’ administrative duties associated with the sport. From there, a total number of HCUs for each sport is determined, and when all sports have been calculated, the HCUs are added up. The formula says a

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LEADERSHIP full-time athletic trainer can be responsible for 12 HCUs per year, so dividing the department’s total HCUs by 12 reveals the number of athletic trainers recommended for appropriate medical coverage department-wide. (For more information on using this formula, see “Applying the AMCIA,” on page 32.) “One central goal of the AMCIA is to provide a measure of how much time an athletic trainer actually spends on each sport,” Miller explains. “Sometimes when athletes have minor or nagging injuries, they won’t miss any practices or games, but treating them takes up a lot of health care time. If the head athletic trainer talks about needing more help, the athletic director may look at rosters and say, ‘How can that be? We only have three people out this week!’ The HCUs give a more accurate picture of the demands athletic trainers face on a regular basis.” Since the AMCIA formula uses hard data about a department’s athletic training services and the demands of each sport, it can add a new dimension to an argument for adding more coverage. One way not to use the formula,

however, is as a “standard of care” to assess legal liability. Miller says that was never the intention, but acknowledges some misconceptions have arisen since the formula was first released. “It’s one thing for an athletic trainer to explain to the athletic director that there isn’t enough coverage in the department,” says Matt Mitten, JD, Professor of Law at Marquette University and Director of the National Sports Law Institute. “But it’s quite different to say, ‘Here’s what we need to do to avoid legal liability.’ That is a much more complicated issue, and it’s not an argument I think athletic trainers ought to be making. “The basic legal standard is that you must use reasonable care to protect against foreseeable harm—the interpretation of that depends on your resources, the plans in place for emergencies, and several other factors,” continues Mitten, a former chair of the NCAA Committee on Competitive Safeguards and Medical Aspects of Sports. “The law simply doesn’t require X number of athletic trainers for a school to be protected.” That said, Mitten does believe the

AMCIA guidelines can still be a useful tool in evaluating a program’s level of coverage. And Miller feels the formula has succeeded in helping athletic trainers present a case that’s more datadriven. “The NATA has fielded a lot of questions about the document, so we know people are using it,” Miller says. “I think for the most part, when you lay the numbers on the table, administrators around the country have said, ‘Okay, let’s see what we can do to improve our program.’” GAINING SUPPORT Along with using the AMCIA formula to advocate for more staff, another effective strategy is to line up support from those you work with. When Coble first arrived at Carroll, he quickly noticed that in the past, some injuries hadn’t been appropriately dealt with, especially outside of football. “I talked to coaches in some of the other sports and they agreed with me,” he says. “They understood immediately how their athletes would be better off with more coverage, and they supported me in my request for more staff.

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LEADERSHIP “When coaches speak up and say, ‘My athletes aren’t getting the same care as someone else’s,’ that catches a lot of people’s attention,” Coble continues. “I also got the backing of our dean of student life and our athletic director after I talked with them about how it would benefit the athletes to hire another athletic trainer. Their support was critical in convincing the senior administration at our school to make room in the budget for a new position.” Athletes’ parents can be a powerful ally, too, as they have a larger voice than ever in their children’s college experience. At Dowling, parents aided in Rodman’s campaign to add two full-time assistant athletic trainers to his staff in the past two years. “I keep athletes’ parents in the loop whenever there’s an injury or a rehab situation, and I talk to them every chance I get at contests,” he says. “If parents see the value of athletic training, maybe they’ll notice at the next away game if there isn’t an athletic trainer traveling with the team. Then they’ll start asking, ‘Why isn’t someone there, and what can I do about it?’

“No one is more concerned about student-athletes’ welfare than their parents, so they’ll go right to the athletic director or even the president of the school with their concerns,” Rodman continues. “If enough people start doing that, you can bet it will have an impact.” Of course, the biggest obstacle in most college programs isn’t that administrators want to settle for less coverage—it’s simply the cost. So another powerful argument can be made by demonstrating how, under some circumstances, employing more athletic trainers will actually save the athletic department money. At Dowling, the vast majority of student-athletes’ injury rehab used to be performed at private clinics and other out-of-house settings. But since adding more staff, the school has brought 90 percent of its rehab in-house, resulting in major savings. “When our insurance carrier realized that we would be handling more of our own treatments, they reduced our premiums and changed some things in our coverage,” Rodman says. “We ended up saving around $135,000.” At Syracuse University, Head Athletic

Trainer Tim Neal, MS, ATC, argued for a larger staff by explaining how it could enhance treatment in significant ways. “We’ve always been very good at conventional care, but with more people on staff we’ve expanded our repertoire and become even better,” says Neal, who has converted three part-time positions to full-time and created a new position all in the past six years. “Recently, two of our athletic trainers became certified in Active Release Technique, and since we incorporated it into our treatments, we’ve cut down on time lost to injury and helped athletes manage chronic injuries more effectively. “And just last summer, all of us took an online course in sound-assisted soft-tissue mobilization, which we’ve had great results with,” he continues. “The net effect is, as the staff has grown in numbers, we’ve been able to branch out and expand what we can do for our athletes.” For Coble, the common thread in all these persuasive tactics is getting administrators to see the many ways athletic training is a wise investment. “It’s part of our nature in this profession to work behind the scenes, out of the

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LEADERSHIP

TURNED DOWN

he truth is, not all requests for more athletic training staff will be successful. What should you do when there simply isn’t room in the budget for another position, but your workload is reaching overload? One solution worth trying is to shift certain administrative duties to others in the athletic department. “A lot of things athletic trainers end up doing, like filling out insurance forms, handling the paperwork for doctor’s visits, and conducting drug testing, don’t need to be exclusively our responsibility,” says Mark Rodman, MSEd, ATC, Assistant Athletic Director for Sports Medicine and Wellness at Dowling College. “If you can designate someone else to handle insurance issues, or to make sure outside doctors get paid, that can save a huge chunk

of time,” he continues. “As more of the job has become administrative work, we have less time to treat athletes, and that’s not ideal for anyone. It’s worth stepping back to look at whether some of those duties should be reassigned.” Creating a paper trail of your unsuccessful personnel requests is also a good idea. “Anytime you ask the administration for more staff, you need to put it in writing,” says Josephine Lee, MS, LAT, ATC, Assistant Director of Sports Medicine at Georgia Tech and President of the College Athletic Trainers’ Society. “If there’s ever a lawsuit because something bad happens, someone could ask why the head athletic trainer didn’t make sure there was more coverage. If you can show you were raising concerns about gaps in coverage on a regular basis, you can prove you saw the problem and did what you could.”

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T&C DECEMBER 2006

LEADERSHIP limelight,” he says. “But when it comes to proving your worth, sometimes you have to step up and tell your athletic director about those 16 athletes you treated this morning, or how you were in the athletic training room until midnight last night. If we don’t talk about that stuff, no one else will. “It’s just like the coach who has to prove he can win before he gets a contract extension or another assistant,” Coble continues. “We have to show that we’re doing a great job, and that we’re really helping the athletic department succeed. If everyone sees

that, it’s a lot easier to make the case.” THE SPOILS OF VICTORY Athletic trainers who have successfully advocated for more staff agree on one more thing: The benefits justify the effort. From quality of care in the program to quality of life for themselves, the positive effects are numerous and worth lobbying for. “Since we’ve added another athletic trainer, we’ve been able to formulate new strength and conditioning programs for several of our teams,” Coble says. “Not only has that addressed their per-

formance needs, but it’s also resulted in fewer injuries because we’re taking more preventative measures. When the athletes are healthier and we’re spending less time treating injuries, everyone wins.” Coble is also finding it much easier to balance his job with the rest of his life. “Sometimes it’s just knowing there’s someone else here if I need to go pick up the kids, or get a hair cut, or take half an hour to work out,” he says. “I have more time now for everyday things that come up, and I’m not worried about being burned out all the time. That’s made a huge difference.” ■

APPLYING THE AMCIA Below is a sample worksheet applying the NATA’s Appropriate Medical Coverage for Intercollegiate Athletics (AMCIA) formula to three teams in a college program. The formula is designed to estimate the amount of athletic training services each sport requires, using Health Care Units (HCUs) as a measure. According to the AMCIA guidelines, each full-time athletic trainer is able to cover 12 HCUs per year. Rows C, D, H, J, and K are filled in with data about each sport program at a particular school. The numbers in row B are provided by the AMCIA guidelines. A B C D E F G H I J K

Sport Baseball Base HCUs (pre-determined for each sport) 1.7 Days per season (practice and competition) 132 Number of athletes on roster 30 Total athlete exposures (CxD) 3,960 Exposure modifier (E/1,000 rounded) 4.0 Adjusted HCUs (BxF) 6.8 % of year sport is active (practice and competition) 50% (.50) Adjusted HCUs per year (GxH) 3.4 Travel adjustment (20 travel days = 1 HCU) 1.5 Administrative Duties (estimated) .50

M Basketball 2.4 132 15 1,980 2.0 4.8 50% (.50) 2.4 1.5 .25

W Basketball 4.0 132 15 1,980 2.0 8.0 50% (.50) 4.0 1.5 .25

Total from row I for all sports + Total from rows J & K for all sports Athletic department’s total HCUs Total HCUs / 12 = recommended number of full-time athletic trainers To download the complete AMCIA document, including instructions and a worksheet on applying the formula to your program, go to: www.nata.org/publicinformation/files/AMCIARecs%20andGuidesRevised.pdf.

T&C DECEMBER 2006

ATHLETICBID.COM

Proper Hydration Improves Boys Basketball Skills Larry Kenney, Ph.D., FACSM, Pennsylvania State University

Dehydration has been suggested to impair athletic performance during short-duration, high-intensity, intermittent activity in adults, yet few studies have examined the impact of dehydration in young athletes participating in similar activities. Even fewer studies have evaluated the effect of carbohydrates in improving intermittent, high-intensity athletic performance in young athletes. A new study from researchers at Penn State University addressing these issues showed that when playing at a two-percent level of dehydration, 12-15-year-old skilled boys basketball players experienced a significant decline in basketball performance.1 Further, the study found that even when fully hydrated the players experienced an increase in shooting percentage and on-court sprint times when consuming a sports drink versus a placebo. In an effort to better understand player hydration issues and the impact these issues have on performance, the multi-phase study compared hydrating with a 6% carbohydrate-electrolyte sports drink versus a placebo (same flavor and electrolytes but no carbohydrates). Researchers studied fifteen highly-skilled basketball players between the ages of 12 and 15 to determine the performance benefits associated with hydrating using a sports drink. As part of the double blind study, athletes completed a sequence of game-like basketball drills designed to simulate four 12-minute quarters of a basketball game including a 10-minute half-time. The quarters were broken into the following sport-specific drills: ᔢ 1st and 3rd quarters: lay-up shooting, suicide sprints, vertical jumps, zigzag defensive slide, around-the-world shooting, and full-court combination defensive drills ᔢ 2nd and 4th quarters: 3-point shooting, court-width sprints, maximum vertical jump, lane slides, free-throw shooting and lateral/front-to-back combined defensive drill. NEGATIVE EFFECTS OF DEHYDRATION

This study showed that even mild dehydration, a loss of 2% of an athlete’s body weight, can impair basketball shooting, sprinting, and lateral movement. Other studies in soccer and football have shown that many players may arrive at practices and games dehydrated. For instance, a recent study showed that nearly 70% of high school football players arrived at practices already likely dehydrated.2 Because athletes may still have difﬁculty maintaining ﬂuid balance, coaches should encourage players to utilize opportunities to drink during time-outs and when on the bench. Some of the performance effects of 2% dehydration (compared to maintaining body weight with the placebo) on the study subjects include: ᔢ Three-point shooting decreased by 18%, free-throw shooting

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fell 11%, and combined shooting percentage declined 15% compared to the hydration trial. ᔢ Average sprinting times were four seconds slower in the dehydrated trial. ᔢ Total lateral movement times were ﬁves seconds slower in the dehydration trial. BENEFIT OF HYDRATING WITH 6% CARBOHYDRATE-ELECTROLYTE SOLUTION

When compared to the electrolyte solution alone, adding 6% carbohydrate to the placebo provided even more benefits for basketball skills. Previous studies have shown that ingestion of a sports drink can result in improved tennis stroke performance at the end of prolonged play3 and faster 20-m sprint times compared to a placebo4. Now this study shows a benefit for basketball players fully hydrating with a sports drink in the form of significantly improved shooting skill performance and on-court sprinting compared with the placebo (water and a little sodium). This is one small step in a series of studies to show the effects of carbohydrate ingestion during exercise. The basketball players demonstrated: ᔢ A 10% increase in shooting percentage which results in one more basket per every ten attempts. ᔢ A 7% increase in sprint times resulting in a player being three seconds faster for every 30-second interval of on-court action. Fluid and carbohydrate replacement is critical to prevent the deterioration in performance and physiological function that accompany dehydration. For that reason, it is important to educate athletes on developing proper hydration strategies that will enhance their health, well-being, and performance. The degree of improvement outlined in this study is especially critical in a sport such as basketball where subtle changes in skill performance could be the deciding factor in winning or losing. References 1 Dougherty, K. et. al. Two percent dehydration impairs and six percent carbohydrate drink improves boys basketball skills. MSSE. 38: 1650-1658. 2 Stover, E.A. et. al. Drinking strategy for improving indicators of hydration status in high school football players. MSSE. 36, 549, 2004. 3 Vergauwen, L. et. al. Carbohydrate supplementation improves stroke performance in tennis. MSSE. 30:1289-1295, 1998. 4 Welsh, R.S. et. al. Carbohydrates and physical/mental performance during intermittent exercise to fatigue. MSSE. 34: 723731, 2002.

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NORTH AMERICA

Exclusive Nor th American Impor ter

SPECIAL FOCUS

BY DR. ROD WALTERS

or over 100 years, medical professionals have been conducting research on the prevention and treatment of ankle injuries. Way back in 1895, V.P. Gibney published an article in the New York Medical Journal titled, “Sprained Ankle: a treatment that involves no loss of time, requires no crutches, and is not attended with an ultimate impairment of function.” Gibney was talking about taping ankles in his article—by wrapping the ankle with strips of rubber plaster. Although Gibney devised this technique for treating ankle injuries, we now know it as an option for prevention. We also know that ankle braces have a role in warding off the ever-prevalent ankle injury. But what is the best way to prevent an initial or recurring ankle sprain? There is not one simple answer. But there is a plethora of research on the topic that gives some direction. For this article, I have analyzed research on ankle injuries from over 80 published manuscripts and textbooks and put it together into one comprehensive piece. From “The effect of ankle wrapping on motor performance,” published in 1972 in Athletic Training, to “Firsttime inversion ankle ligament trauma: the effects of sex, level of competition, and sport on the incidence of injury,” published in the American Journal of Sports Medicine last year, when pieced together, the many studies reveal some interesting advice.

The Ankle Report

The amount of research on ankle injuries is expansive —maybe too expansive for a busy athletic trainer to read. That’s why we’ve compiled it all into one article.

Rod Walters, DA, ATC, is Director for Sports Medicine and an Instructor in Athletic Training at the University of South Carolina. He served on the NATA’s Board of Directors from 1997-2003 and was inducted into the NATA Hall of Fame in 2005. He can be reached at: rwalters@gwm.sc.edu. ATHLETICBID.COM

©GETTY IMAGES

SPECIAL FOCUS BACKGROUND Some of the research reveals no surprises. For example, the foot and ankle are among the most commonly injured body parts of recreational and competitive sports participants. An estimated 25,000 ankle sprains occur daily in the United States. Though recovery from the initial injury is likely, re-injury often results in moderation or discontinuation of sports activity. The ankle joint comprises the tibia, fibula, and talus, and results in the motions of plantar flexion and dorsiflexion. The stability of the joint arises from the bony articulations combined with ligaments and muscles working together. The motions of inversion and eversion occur distal to the ankle joint

The anterior talofibular ligament has the weakest tensile strength of the lateral complex. The addition of inversion to the plantar flexed ankle may further affect the calcaneofibular ligament. Intrinsic risk factors for sprains of the lateral ankle ligaments include a history of ankle sprains, generalized joint laxity (increased talar tilt), and delayed muscle reaction time. The most common risk factor for ankle sprains, however, is a history of sprains. Athletes with a previous ankle sprain have a 500-percent incidence of re-injury. Therefore, a key factor in preventing and treating ankle injuries is understanding chronic ankle instability, which can result from mechanical instability or functional instability. Mechan-

Several authors felt that even though the restrictive effect of athletic tape may be lost over time, the neuromuscular and sensory mechanisms remain effectiveâ&#x20AC;&#x201D; ultimately, they may be of greater importance than the mechanical restriction of movement. at the subtalar articulation. The fibula extends more distal than the tibia, and thus prevents excessive eversion. The mechanism of injury for the lateral ankle sprain is characterized by the classic plantar flexion and inversion. The extent of injury to the ligaments determines the severity of the sprain. A mild sprain is characterized by microscopic tears with no loss of ligamentous integrity. The application of additional forces may produce partial tears of the ligament, or a moderate sprain. Such injuries are significant, even though the tear is not complete. Severe sprains involve complete disruption of the ligament and associated functioning properties. While the American Medical Association uses the terms mild, moderate, and severe to classify the degree of injury, some programs refer to the degree of injury as a Grade I, Grade II, or Grade III sprain. The inversion sprain is more common than the eversion sprain because of the bony anatomy on the lateral side of the ankle, which tends to limit eversion. The most common mechanism of ankle sprains are plantar flexion and inversion. A single ligament tear usually involves the anterior talofibular ligament as it is stressed with plantar flexion. 36

T&C DECEMBER 2006

ical instability is easier to diagnose and treat because it involves a measurable degree of laxity. The ligaments no longer effectively support the ankle joint, making repeated sprains and instability more likely in normal daily activities. The athlete is aware of his or her symptoms and avoids any risky activity. Functional instability is harder to understand (and there is less research on it) because of its subjective nature. Symptoms include lateral pain, difficulty walking on uneven surfaces, a feeling of weakness in the ankles, swelling, stiffness, and tenderness. Individuals have the sense that their ankles will give way if they take a wrong step. Functional instability has more to do with lost or diminished proprioception in the ankle. This type of ankle instability is the most difficult to diagnose and the most challenging to treat. Hans Tropp, MD, PhD, is the foremost researcher on functional instability in ankles, and has found that decreased postural stability is not a function of mechanical instability, thus supporting functional training. He found soccer players with poor postural sway had a higher incidence of injury, and further reported improved postural sway in subjects with functional ankle

instability following training on a balance board for six weeks. To treat an ankle sprain, complete rehabilitation of all muscle groups is important, since eccentric invertor strength deficits may contribute to the symptoms of functional ankle instability. Weak invertors may contribute to functional ankle instability because they are less able to assist in controlling lateral displacement of the shank over the weight-bearing foot. Overall, the gold standard today for preventing chronic ankle dysfunction is multifaceted. It includes an accurate and complete assessment, aggressive treatment and rehabilitation, addressing any underlying problems, and implementing a balance program to train proprioceptively. TAPE IT UP Prophylactic ankle taping has become one of the primary methods used to protect the lateral ligament complex. A review of the literature reveals prophylactic ankle taping techniques are warranted in high-risk sports. Interestingly, the literature is mixed regarding the exact mechanism through which these devices work and the effect they have. Several studies point to the effective use of non-elastic tape to assist in the control of excess motion, to enhance performance, and for injury prevention. Authors also report athletic tape to be critical in the control of excess motion after an acute sprain. Elastic tape has been found to have such characteristics as well, but with some conflicting studies. Most research looks at the use of taping in two key areas: First, does it provide mechanical resistance? And second, does it enhance or diminish performance? At least five recent studies have found that ankle taping provides effective mechanical resistance to sprains. It does so by pulling from an area of strength along the proximal anchor across the weakened or injured area of the ankle back to the area of strength. Two papers explain that taping externally stabilizes the ligamentous structures and prevents joint hypermobility without significantly interfering with normal joint mechanics. Another finds that taping helps prevent the ankle joint from exceeding its physiological and biomechanical limits of motion. And two others say that prophylactic ankle taping decreases ankle motion against forces ATHLETICBID.COM

SPECIAL FOCUS sustained during activity. Several authors found taping effective in controlling motion. One other said that taping specifically restricted plantar flexion and inversion motion, two frequent hallmarks of sprains. Further studies say that taping provides support and stability to the ligaments and joint specifically in the chronic stage when the athlete returns to his or her sport. The research suggests that both mechanical and functional stability of the ankle can be improved with taping (both athletic tape and cloth wraps were used with success). Other studies have looked at the ability of tape to function well over time. A 1997 paper found taping to be virtually ineffective after periods of just 40 minutes. Four others felt ankle taping provided little support because the tape loosened with exercise. In 1973, The Journal of Sports Medicine discouraged taping due to the mobile nature of skin, the moisture that accumulates beneath tape, and disuse atrophy of ankle musculature. However, several authors felt that even though the restrictive effect of athletic tape may be lost over time,

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the neuromuscular and sensory mechanisms remain effectiveâ&#x20AC;&#x201D;ultimately, they may be of greater importance than the mechanical restriction of movement. In terms of performance, most studies look at the effect of taping on the ankleâ&#x20AC;&#x2122;s proprioception. In 1995, Robbins and colleagues assessed ankle proprioception and found the ability to determine the foot position of subjects with taped ankles was greater than over subjects with untaped ankles. Taping in particular helped mitigate decreases in proprioception brought about by wearing athletic shoes. Several factors likely contribute to this increase in proprioception. Taping appears to facilitate dynamic muscle stabilization of the ankle at least in part by improving peroneal muscle activation. Foot position sense is also improved by the deceleration of inversion provided by taping. However, other studies have found different results. In 1972, two articles found that ankle taping decreased agility compared to no protection or using laced ankle stabilizers. The research also found ankle taping to restrict running and jumping activities.

A 1992 study reported that motor performance in taped and untaped subjects was not significantly different. In 1996, Verbrugge compared the effects of ankle taping and bracing on performance during agility drills, sprinting, and vertical jumps. Neither treatment affected the test results. BRACED FOR THE WORST Ankle braces are very popular today and come in many different styles. These various models are designed to provide external support and allow normal biomechanical motion and function. In terms of acute injuries, a long list of studies have found orthotic devices effective as a chosen modality for treatment. More specifically, in 2002, Konradsen reported that orthotic braces used to treat acute Grade III lateral ankle ligament sprains were as effective as cast mobilization. Many studies have found that ankle braces are effective at preventing ankle sprains and do not affect athletic performance. Tropp and colleagues evaluated the effect of an ankle orthosis on ankle injury incidence and concluded

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SPECIAL FOCUS that bracing is effective at preventing ankle injuries. A group headed by Surve evaluated the effect of a semi-rigid ankle orthosis and found that it significantly lowered the incidence of sprains. Sitler, et al., evaluated the effect of a semi-rigid ankle orthosis and found a 3.5 times greater injury rate in un-braced subjects. This study also found that subjects had a generally positive attitude toward use of the braces. Further, Ubell reported braces are effective when landing on an object with one foot unexpectedly, forcing inversion. Hughes and Stells found bracing combined with taping to effectively restrict foot and ankle motion. Various authors reported that brace utilization and hightop shoes combined with prophylactic taping results in fewer injuries. Others reported bracing combined with taping restricts motion, although these limitations did decrease force production and total work. Rovere retrospectively reviewed laced ankle stabilizers with ankle taping over six years and found more than twice the number of initial sprains among the taped group—the effec-

tiveness of the lace-up ankle brace in sprain prevention was statistically significant. Greene and Hillman compared the relative effectiveness of athletic tape and a semi-rigid orthosis in providing inversion-eversion range restriction before, during, and after a three-hour volleyball practice. There were maximal losses (41 percent) in taping restriction for both inversion and eversion 20 minutes into exercise. FINAL FACTORS Clearly, there is an expansive body of research on the use of ankle tape and braces in the prevention of athletic injuries. And the research continues to evolve. It is evident that taping and bracing (or both) can protect an ankle from initial or subsequent injury. But which to choose and when to use them should still be based on the individual athlete and provider preferences. A question often arises as to which is more cost efficient: tape or braces? Olmstead applied the “Numbers Need to Treat” analysis to previous ankle injury research and found that to prevent one ankle sprain in a game among ath-

letes with ankle sprain histories would require taping 26 ankles. Further, 143 ankles would need to be taped among those without a history of ankle sprain to prevent one sprain. Based on these numbers, ankle bracing involves 50 percent the cost of taping over the course of a season. Thus, the use of ankle braces is usually a significant time and money saver for athletic trainers. However, the choice must still come down to what works best in a specific situation. Braces can be effectively recommended for athletes during individual workouts when athletic trainers are not available for taping, while taping allows a more hands-on approach that can ensure the athletic trainer and athlete connect every day. Either way, the research supports supporting the ankle, however you choose to accomplish it. ■

To access references for this article, visit: www.AthleticSearch.com/anklerefs.

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SPORT SPECIFIC

The Terriers led their league in stolen base percentage and broke a school record for total number of steals last season.

Off & Running ROB KLEIN

Boston University’s strength and conditioning program for women’s softball has the team off and running toward newfound success. BY VICTOR BROWN III

he game of softball is characterized by quick reactions and repeated high-poweroutput movements. With only 60 feet separating each base and 40 feet between the pitcher’s plate and home plate, softball players need powerful acceleration in the batting box, on the base paths, and on defense. At Boston University, our softball strength and conditioning program stresses the development of linear and lateral speed and acceleration, rotational strength and power, power endurance, and improved batted ball velocity. For reducing injuries, we emphasize ATHLETICBID.COM

training the posterior chain and a fullbody warmup. This philosophy resulted in team single-season records for stolen bases and home runs in 2006, and helped the Terriers lead the America East Conference in stolen base percentage, with four players contributing 10 or more steals. Additionally, our strength and conditioning program has helped produce the school’s top two career, and top three single-season home run leaders. STRENGTH TO PLAY In order to be successful at the NCAA Division I level, softball players need

to train for power. They need power to hit the ball, make strong throws, and to run and jump on defense and on the base paths. Here at BU, beginning in late October, our players spend four days a week in our off-season strength and conditioning program. Research has shown three factors contribute to batted ball velocity: lean body mass, lower body power, and grip Victor Brown III, MS, ATC, CSCS, NSCA-CPT, is the Associate Strength and Conditioning Coach at Boston University. He can be reached at: vbrown@bu.edu. T&C DECEMBER 2006

SPORT SPECIFIC strength. To develop lean body mass and lower body power, players are put through an initial four-week hypertrophy phase using loads between 60 and 75 percent of their individual 1-RM. That is followed by six weeks of basic strength and power training using approximately 70 to 90 percent of their 1-RM. We then start our preseason training, which lasts three to four weeks, with a goal of attaining peak strength and power. Our staple lifts during these periods include squats, lunges, straight-leg deadlifts, cleans, snatches, glute-ham and partner-ham raises, and sequential/diagonal chops. We also emphasize pulling movements for the scapular-

thoracic joint, such as dumbbell rows, cable-rope rows, bent-over rows, and inverted rows, as well as chin-ups and pull-ups. Other exercises include the bench press, incline bench press, closegrip bench press, and alternating dumbbell incline bench press. The use of overhead lifts by overhead throwing athletes has long been a controversial topic among strength coaches. Athletes who play baseball and softball perform countless sport-specific repetitions during play and practice, using shoulder and arm movements above 90 degrees horizontal abduction. Therefore, I believe it is essential for the athletes to strengthen this plane of movement. However, it is important

to determine when is the most appropriate time during the training year to perform overhead movements because of the susceptibility of the shoulder complex to sustain injury. The key is frequent communication with the sport coach to accurately gauge the amount of overhead stress your athletes are putting on their shoulders and arms outside the weightroom. We train using a high volume of overhead movements during the off-season, when the athlete is performing the least amount of throwing. As the team begins preseason practices, the volume of overhead strength training decreases and combination lifts and complexes are incorporated into their workouts.

SAMPLE WEEK The following is an example of one week of conditioning during fall off-season training. All off-season weightroom sessions start with either a dynamic warmup or an agility ladder and conclude with foam rolling and stretching. MONDAY

TUESDAY

WEDNESDAY

THURSDAY

Drills Seated Arm Swing 1x20 Standing Arm Swing 1x20 Walking Arm Swing 2x20 Pillar March 2x5 Split Stance Acceleration 2x10 meters

Drills Standing Arm Swing 1x20 Walking Arm Swing 1x20 Jogging Arm Swing 2x20 Pillar Knee-Ups 2x5 Ball Drops x2 (split stance)

Drills Walk-to-Jog Arm Swing 2x20m Pillar Single Exchange 2x5 One-Leg High-Knee Walk 1x20m Alternating One-Leg High-Knee Walk 1x20m Lateral Starts x2

Drills One-Leg High-Knee Skip 2x20m High-Knee Skip 2x20m Defensive 1-2 Stick x2 Cross-Over to BasePosition x2 Number Ball Drops x2 (with lateral start)

Plyometrics Jump Squats 4x6 @ 30%

Medicine Ball Routine Close Overhead Throw 3x8 Chest Pass 3x8 Front Facing R/L Twist Throw 3x8 (Pitcher in split stance) Side Facing R/L Twist Throw 3x8 (Hitters in stride step; slappers in split stance)

Abdominals Rope Reverse Crunch 2x20 Off-Bench Obliques 2x10 Conditioning Sprints (1:12) 3x80 yds 5x20 yds 7x10 yds

T&C DECEMBER 2006

Plyometrics Pitchers: Split Jumps 2x5 Others: Lateral Box Jumps 2x5

Conditioning Slide Board 4x 0:30/0:60 Bike Sprints 3x 0:10/0:20 3x 0:15/0:45 3x 0:20/0:40

Plyometrics 90-Degree Box Jumps 2x4 90-Degree Hurdle Hops 2x4 Abdominals Same as Monday

Plyometrics Same as Tuesday Medicine Ball Routine Same as Tuesday Conditioning Slide Board 4x 0:30/0:60 Bike Sprints 6x 0:15/0:45

Conditioning Hill Sprints (1:12) 10x30 yds

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SPORT SPECIFIC Once the season starts, overhead lifts are eliminated. Various forms of grip strengthening and prehab for the hand, wrist, and forearms are done twice a week during

mer, open-the-jar, close-the-jar), which is performed 20 times. And we wrap a towel around the handle for many of the dumbbell exercises, such as dumbbell rows, dumbbell split squats, and walk-

Pitchers perform twist throws in a split stance and progress to using a lunge stepâ&#x20AC;&#x201D;this teaches them to produce force in a sagittal and transverse plane simultaneously. Position players utilize a stride step or simply lift the front foot up and down depending on their hitting style. both off-season and preseason training. When a bat makes contact with a ball, a significant amount of compression occurs to the ball, and much of the initial kinetic energy of the ball is lost. Our goal is to limit the significance of dampening forces. Some of our favorite exercises to do this include dumbbell wrist throws, dumbbell farmerâ&#x20AC;&#x2122;s holds, and plate gripping, as well as towelgrip holds performing chin-ups and inverted rows. We also do a rice bucket forearm/hand circuit (open-close, ham-

ing lunges, allowing players to grasp as a method of incorporating functional grip-strength work. Ballistic-resistance training has been shown to increase throwing and base running performance, and thus it is an integral part of our program. Players begin plyometric training as a group and pitchers and position players are later separated to build strength and power for their position-specific movements. Split jumps are used to improve lowerbody power in pitchers while rotational

and lateral plyometrics are used to teach hitters and position players how to generate power in a rotational and lateral manner. Three of our favorites are 90degree box jumps, 180-degree hurdle hops, and lateral drop jumps. Weighted jump squats are also used occasionally. Medicine ball exercises are implemented to tax the entire kinetic chain in a sequential manner. To work the shoulder complex, players perform overhead wall dribbles and single-arm wall dribbles incorporating a variety of stances based on position-specific needs. Twist throws are also used to develop power for position-specific movements. Pitchers perform twist throws in a split stance and progress to using a lunge stepâ&#x20AC;&#x201D;this teaches them to produce force in a sagittal and transverse plane simultaneously. Position players either utilize a stride step or simply lift the front foot up and down depending on their individual hitting style. Slap hitters perform twist throws in a split stance parallel to the wall. We will progress to performing twist throws on a slide board to teach all players to produce force in a frontal plane while si-

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T&C DECEMBER 2006

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SPORT SPECIFIC multaneously generating force along a transverse plane, which occurs when players swing a bat. Strengthening the hips and groin is also critical. We use the slide board, the mini-band, and lateral resistor work for these areas. Additionally, players perform lunge movements in various planes to prepare for on-the-field demands. Infielders move predominately from sideto-side, thus we use the cross-over step lunge, 45-degree lunge and reach, reverse lunge, and lateral lunge. Outfielders must turn and run to a spot for a driven ball, so for them we use openstep lunges to develop their first-step. Pitchers perform forward lunges and split squats to assist in developing the leg drive that is crucial for their push off. And everyone does walking lunges to develop the propulsive strength needed for running.

of training, we progress the difficulty of our movement efficiency drills and begin to incorporate objects for reaction training. We have found ball drops are an excellent drill for improving acceleration. Both infielders and outfielders can execute the drill from either a defensive ready position or a stealing start position. Towel drops provide another advanced option. The towel is thrown from behind the shoulder of the player, who must sprint to the spot beneath the towel as it comes into sight, the same way they sprint to a fly ball.

During the latter phases of training, movement efficiency drills become even more advanced by adding visual tracking and cognitive training. For example, we use number ball drops, in which six numbers are written on different areas of a tennis ball. Players accelerate upon release of the ball. Immediately prior to catching it, the player is required to call out the last number on the ball they see. Colored ball drops are another option. Execute the drill by using two different colored balls. Upon release, call out the color of the ball the athlete is to grab

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like exploding out of the batter’s box, getting a good jump on the ball defensively, and running the base paths either during a hit-and-run or a straight steal. In response, acceleration and movement efficiency drills are performed on a daily basis in the off-season. During the first phase of training, various pillar and arm-swing drills are executed along with a variety of acceleration drills like lateral starts and splitstance accelerations. In the next phase

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SPORT SPECIFIC as they accelerate toward it. These drills foster quick thinking and precise reactions. We also incorporate resisted sprinting and complex training to improve acceleration during this final stage of training. Hill sprints and towing sleds are used for resisted sprinting. We perform a heavy squat movement followed by a plyometric exercise or maximum effort sprint during our complex training. ADDING IN CONDITIONING Conditioning the softball athlete is im-

portant for many reasons. The first reason is for improving speed. I believe to become faster, we must train the body to fire and move at a greater speed than it is accustomed to. So, even though the athletes may never get to their top speed during competition, I want to see them achieve it during workouts. We use short intervals when doing speed work. The majority of our maximum speed sprint training takes less than 10 seconds. In addition, a 1:12 work-to-rest ratio is used for ATP-PC recovery.

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Power endurance must also be considered for softball performance. The game is characterized by repeated highpower output movements, and the ability to maintain power throughout a long at-bat or a double-header is critical. We begin training using work-to-rest ratios of 1:3, then progress to 1:2. We use various modes of conditioning including slide boards and bike sprints. Maximum speed and metabolic conditioning days are alternated to allow for energy system recovery. In competition, our base runners are called upon to steal and hit-and-run at various times. There are times when the base runner is on the move and the batter hits a ball into foul territory. The base runner must return to the base and get ready to sprint maximally again on the next play with a short amount of rest. During the preseason, we begin to incorporate active recovery into our metabolic conditioning to simulate the demands of this type of base running. To make it more sportspecific, we use a variety of starts and signals for our sprints, like signs for a delayed steal, straight steal, and a simulated windmill pitch. During the season, the players get into a daily routine of performing conditioning drills after our on-field warm-ups, but volume and intensity change weekly based on such variables as number of games in a week or day, how many innings a position player was active, and number of innings pitched. Our speed and acceleration training is primarily performed on game days, and is short in duration, long in recovery. Interval training is carried out on practice days and includes a day of active recovery work. Tempo conditioning is performed at 90-percent effort and administered the day prior to doubleheaders and on Sundays for pitchers and position players who played more than three innings during the previous dayâ&#x20AC;&#x2122;s game(s). PITCHING INJURIES Research has shown that the majority of injuries a softball pitcher encounters are due to overuse, and they primarily involve the shoulder. Understanding the biomechanical movements and what muscles are active during the various phases of the windmill pitching motion is imperative to properly condition a pitcher. The windmill motion consists of three phases: preparatory, force, and

T&C DECEMBER 2006

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SPORT SPECIFIC follow-through. The preparatory phase varies from pitcher to pitcher, with some bringing the arm back to 90 degrees of extension and others using no extension, but all pitchers bring the ball to the six o’clock position to initiate the pitch. The force phase is most important and is comprised of four subdivisions: 1. The arm is elevated from a six o’clock to a three o’clock position. The supraspinatus, infraspinatus, subscapularis, and deltoid are all active in this position. 2. When the arm moves from three o’clock to 12 o’clock, the supraspinatus, infraspinatus, teres minor, and posterior deltoid are functioning. 3. The arm shifts beyond the 12 o’clock position to nine o’clock and the subscapularis, teres minor, serratus anterior, and posterior deltoid are operating. 4. These same muscles remain activated during the final portion of the force phase and also during the followthrough phase. Conditioning just the rotator cuff muscles, however, is insufficient when preparing a windmill pitcher for the demands of a softball season. Training the entire kinetic chain along with the shoulder complex is key. In addition, the posterior deltoid, pectoralis major, and serratus anterior all play critical roles during the pitching motion. Work must be done both above 90 degrees horizontal abduction and in neutral. Our pitchers perform a shoulder complex twice a week during the off-season using both tubing and light dumbbells. To relieve the volume placed on the shoulder region during the spring season, a shoulder complex is performed once a week for maintenance. Here is a sample routine (each exercise is performed 10 times): • Horizontal Abduction to 90/90 External Rotation • Triceps Extension • Biceps Curl • Full Cans • Forward Diagonals • Backward Diagonals • Serratus Punch w/Internal Rotation • Neutral Internal Rotation • Neutral External Rotation • 90/90 Internal Rotation • 90/90 External Rotation • Glenohumeral Extension w/External Rotation ATHLETICBID.COM

The wrist and elbow are also areas of concern and thus we incorporate various modes of training to increase hand, wrist, and forearm strength. Pronation, supination, ulnar and radial deviation, flexion, and extension work are all done, as well as wrist throws and gripping exercises. Much of our grip work is “hidden” in the workout as part of a tri-set or functional-based lifts using towels, ropes, or dumbbells. Adequate lower back strength and endurance are also incorporated to properly prepare for the demands of pitching over the course of the season. THE NORTHEAST GAME A final important element of our strength-training program deals with our geographic location. Research shows that softball players in the colder regions of the Midwest and Northeast sustain more injuries than those in the warmer regions of the South and West. Therefore, we construct our warmup routine very carefully.

Our on-field prep work is active, dynamic, and encompasses movements specific to the throwing, running, and fielding requirements for the game of softball. Traditionally, softball players have started warming up by throwing the ball. But we take a completely different approach using dynamic exercises for the shoulder complex before a single ball is thrown. We warm up to throw, not throw to warm up. (See “On-Field Warmup,” below.) By thinking carefully about the dynamics of the game and considering the injuries its athletes sustain, we have been able to develop a functional, sportspecific program for our softball players here at Boston University. They are looking forward to using it with even more success this spring. ■

To access references for this article, please log on to: www.AthleticSearch.com/BUsoftrefs.

ON-FIELD WARMUP The following is the warmup routine our softball players use before a practice. The movement exercises are done for 20 yards. Jog to Poles x2 Arm Circles w/Pronation x10 Arm Circles w/External Rotation x10 Field Goals x10 Full Cans x10 Diagonals x10 Bear Hugs x10 High-Knee Lunge Walk Heel-to-Butt w/Lean Cross-Over Toe Touch (R+L) Inverted Hamstring w/External Rotation Backward Lunge + Twist Lateral Slide Thru (R+L) High-Knee Skip Cross-Over Skip High Knees x2 Butt Kicks x2 Carioca (R+L) Delayed Steal x75%, x90%, x100% Inchworm

T&C DECEMBER 2006

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STRAIGHT TALK

The Next Generation of Phototherapy Devices

BY DOUGLAS JOHNSON ot long ago, the athletic training community was first introduced to phototherapy as a treatment alternative for pain management. Nearly four years have passed since the first low-level lasers appeared in health care facilities around the United States. Though many were skeptical at first, phototherapy is now gaining wider support from both clinicians and researchers across the country. Early on, the market was dominated by continuous-wave (CW) low-powered laser therapy devices, or LED units. These devices, though effective for some types of treatment, are now being replaced by a new generation of higher-powered diodes. Offering more power and greater energy density, these second-generation devices have proven highly effective in treating injured muscle tissue. They’re also more efficient, requiring less treatment time to provide the same level of therapy. However, there is a limit to how much a CW laser’s power output can be increased. Above roughly 500mW (the output of higher-end of Class IIIb units and all of Class IV), the potential for tissue damage from excess heat becomes too great. As a result, phototherapy

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companies have begun shifting their focus to other types of laser technology. “Super pulsed” lasers, relatively new to the U.S., use a Gallium Arsenide (GaAs) diode that can administer extremely powerful pulses—up to a hundred watts— without the thermal side effect of CW lasers. When a laser is super pulsed, light intensity fluctuates repeatedly between peak output power and zero, with each pulse lasting only between 100 and 200 nanoseconds (one nanosecond is one billionth of a second). With high-intensity pulses coming in rapid succession, the result is an increased likelihood of what experts call “multi-photon effects.” Essentially, this means muscle tissue receives the therapeutic benefits of the laser, with all the energy concentrated on the target site and virtually no thermal side effects. The very intense pulses of GaAs lasers penetrate more deeply than continuous-wave lasers emitting the same amount of power—in fact, testing has shown the depth of penetration of super pulsed lasers to be as great as 30 to 50 millimeters, depending on the type of tissue. Because of these benefits, GaAs lasers are finding greater and greater acceptance in sports medicine settings.

Highly targeted, deeply penetrating energy can be delivered in a short period of time, making laser therapy more attractive than ever. GaAs multi-probes are now being used to boost healing and reduce treatment times for all sorts of softtissue injuries, and many clinicians and athletic trainers have been impressed with the results. Jan Turner and Lars Hode, noted experts in the field of phototherapy, explain it this way: “The GaAs laser is most effective in the treatment of pain, inflammation, and functional disorders in muscles, tendons, and joints (such as epicondylitis, tendonitis, myofascial pain, gonarthrosis, etc.) and for deep-lying disorders in general.” Recent advancements in laser therapy continue to improve clinical outcomes and demonstrate the effectiveness of phototherapy as a treatment protocol. In light of these advances, it’s no surprise that many companies are now looking toward super pulsing technology for their newest laser-therapy devices. ■

Douglas Johnson, ATC, is a Certified Laser Specialist and co-owner of Sports and Industrial Rehab, a rehabilitation facility based in Taylor, Mich. T&C DECEMBER 2006

THERAPY TECHNOLOGIES Laser Therapy Products

Electrotherapy Products

Medical Quant West 877-200-1402 www.superpulsedpractice.com

Accelerated Care Plus 800-350-1100 www.acplus.com

TerraQuant® MQ2000 Laser The TerraQuant MQ2000 offers temporary relief from minor muscle and joint pain, arthritis, muscle spasms, and stiffness. It promotes relaxation of muscle tissue and temporarily increases blood circulation in the treated area. • FDA-cleared for temporary pain relief • Can be used in conjunction with acupuncture • Features four LED and four IRED • Two-year warranty • Available direct from the manufacturer or through distributors • Leasing options and billing reimbursement available Circle No. 500 Dynatronics 800-874-6251 www.dynatronics.com

The Omnisound 3000E is the next generation of ACP’s Omnisound system. There are now over 35 publications supporting the Omnisound 3000E Omnisound 3000 and its Delta T technology. • Fast front-panel access to the patented Delta T mode. • Delta T allows the therapist to select a desired temperature increase for the targeted tissue. • Timer automatically adjusts to achieve the correct temperature increase. • Includes parameters for a wide range of treatments, such as tissue healing, stretching of scar tissue, increasing circulation, and pain management. • Patented rotating sound head Circle No. 502 The Omnistim 500 from Accelerated Care Plus is a multi-modality electrotherapy system.

Dynatron X3 The Dynatron X3 light therapy device generates a total of 1,600mW of light and simultaneously delivers three independent light therapy treatments: two light pad treatments and one light probe treatment. • FDA-approved for temporary relief from minor muscle and joint aches, muscle spasms, minor pain, and arthritis-related pain and stiffness • Features handheld probes and an unattended pad • Multiple energy levels and wavelengths • Two-year warranty • Available through distributors • Many dealers offer lease options, and billing reimbursement is available Circle No. 501 48

T&C DECEMBER 2006

Omnistim 500 • 6.5” x 12” x 3.5”; 4.5 pounds • Runs on D batteries or an AC adapter • An easy-to-use menu adjusts to selected “indications for use” options and protocols • Precise patient care and fast set-up with a timer • Offers NMS, high-voltage, interferential, MFAC, LVPC, and NMES treatment • Two channels and four stimulation modes • Output: 250 volts • One-year warranty • Can be purchased directly from ACP; billing reimbursement and leasing options are available • Training is required to operate the unit Circle No. 503

BioMedical Life Systems, Inc. 800-726-8367 www.bmls.com

QuadStar Elite KQSE The QuadStar Elite is a portable combination electrotherapy device that offers four modalities: INF, TENS, highvoltage, and muscle stimulation. • • • • • • • • • • •

5.55” x 5.25” x 1.65”; 18.5 ounces Internal battery Handheld A sequence of two or more modalities provides total treatment Offers programmed and self-programming treatments; timer included Eight-electrode capability Four channels and four stimulation modes Output voltage (peak to peak): Max 98mA (INF, TENS, NMS); 350 volts (high-voltage) Accessories available Three-year warranty Can be purchased through BioMedical Life Systems or from its distributors; billing reimbursement for both Circle No. 504

Impulse TENS D5 The Impulse TENS D5 offers powerful, safe electrotherapy to enhance your pain management and rehabilitation protocols. • Five modes of operation • For safety, when an electrode is detached from the skin, the unit shuts down • Digital technology • Customizable settings make the unit easy for athletes to use Circle No. 505 ATHLETICBID.COM

THERAPY TECHNOLOGIES Dynatronics 800-874-6251 www.dynatronics.com

patient’s tissue is electrostatically attracted and then released, triggering a unique, deeply penetrating and lasting resonance vibration.

• One-year warranty • Available directly from Neuro Resource Group or through distributors • Leasing options and billing reimbursement available Circle No. 507

• Frequency range: 5-200 Hz., infinitely variable • Ideal for sports physiotherapy applications, including treatment of edema and hematoma • Promotes quick and lasting relaxation of the respiratory musculature • Since Deep Oscillation can be applied at a very early stage in the rehab process, regeneration and healing can be decisively influenced and accelerated considerably Circle No. 508

Physiomed North America 318-368-7266 www.deeposcillation.com Solaris D709 The Solaris D709 offers ultrasound, seven stim waveforms, four optional infrared light probes, and an unattended light pad, making it one of the most powerful and comprehensive devices in the industry. • 14.32” x 4.60” x 12.7”; 13 pounds • Supplies 100 to 240 volts • Battery-powered option for portability • Offers TENS, MENS, NMS, high-voltage, interferential, direct current, biphasic, and Russian treatments • Timer included • Hands-free pads • Two-year warranty • Leasing options and billing reimbursement available from many dealers • Dealers offer training on all Solaris units Circle No. 506

Hivamat® 200 Deep Oscillation® is characterized by an intermittent electrostatic field, which is built up between the hands of the therapist or between the hand applicator and the tissue of the patient using the Hivamat® 200. The

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800-556-7464 • www.performbetter.com Circle No. 133 T&C DECEMBER 2006

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PLYOMETRICS Beacon Athletics 800-747-5985 www.beaconathletics.com Beacon Athletics offers SmartHurdles, designed to give you an array of training options without the common problems associated with using, storing, and transporting training hurdles. SmartHurdles have an innovative three-point base that improves safety and opens up a number of new drill opportunities. The adjustable height of the three larger hurdles adds flexibility to training. The ability to conveniently store and carry multiple hurdles also means your athletes will use them more often. Circle No. 509

Design leads the way in progressive, functional rehabilitation and training. The Shuttle MVP’s horizontal-rebound technology utilizes smooth and predictable resistance, making it perfect for unstable joints, while rapid nonweight-bearing rebounding improves the eccentric phase necessary for injury prevention and power development. Visit the company’s Web site for more information. Circle No. 511 Exertools 800-235-1559 www.exertools.com PowerPlyos does the work of four different exercise machines because it adjusts into four positions: plyo box,

NASM 800-460-6276 www.nasm.org

Contemporary Design Co. 800-334-5633 www.shuttlesystems.com The Shuttle Balance from Contemporary Design functionally trains the neuromuscular systems of athletes and seniors alike. It has long been recognized that the body’s ability to negotiate unpredictable changes in force, direction, and placement in space at the neuromuscular level are critical building blocks for performance and skill development. The Shuttle Balance provides a safe platform for individuals to develop and hone proprioceptive responses while performing a variety of activities. Circle No. 510 From acute-phase closed-chain activities to end-stage plyometrics, the Shuttle MVP from Contemporary

T&C DECEMBER 2006

The 2007 Perform Better catalog features the VertiMax, an excellent device that can serve as the basis for a sound plyometric program. This reactive power training unit improves speed and vertical jump. It is designed to provide the user with uniform resistance all the way to the top of each jump—there’s no slack at the bottom or “yank back” effect at the top. The VertiMax is available in two sizes: 3’ x 4’ and 4’ x 4’. Call or go online for more information. Circle No. 514

V-box, Russian side-jump angle box, and resisted vertical leaper (RVL). The RVL allows users to do hundreds of different exercises to develop strength, quickness, endurance, and explosive power. PowerPlyos offers extremely functional applications of lateral and multi-directional movement. It teaches athletes that by being aggressive with their arms and legs, they can bring their whole body into the exercise. Circle No. 512 Perform Better 800-556-7464 www.performbetter.com There is a separate Plyometrics section in the 2007 Perform Better catalog, containing special plyometric editorial insight from Mike Boyle, MA, ATC. This 68-page Guide to Functional Training includes the latest product offerings in 19 different training and rehab categories. Call or go online to get your copy today. Circle No. 513

Keep your clients off the sideline with NASM ConEd: Corrective Exercise for Foot and Ankle Impairments. This comprehensive online education module covers the functional anatomy of the foot and ankle and shows you how to become proficient in performing foot and ankle assessments. You’ll learn how to utilize exercises, programs, and tools to implement corrective strategies for the foot and ankle and how to market your abilities in a clinic or health and fitness facility. You can earn .2 NASM CEUs, .2 NSCA CEUs, and 4.0 NATABOC CECs for only $59. Call NASM or go online to register. Circle No. 515 With the NASM live workshop OPT for Performance Enhancement, you can get ahead of the game and experience two days of handson performance assessment and exercise techniques. Practice speed, agility, and quickness, and design sportspecific programs. Several dates and locations are available in 2007: Calabasas, CA, March 16-17; Dallas, TX, April 6-7; New York, NY, May 18-19; Chicago, IL, July 20ATHLETICBID.COM

PLYOMETRICS 21; Calabasas, CA, Sept. 20-21; and San Francisco, CA, Nov. 9-10. You can earn 1.6 NASM CEUs, .8 NSCA CEUs, and 16 NATABOC CECs for only $199. Call NASM or go online to register. Circle No. 516 NSCA 800-815-6826 www.nsca-lift.org A featured publication for the National Strength and Conditioning Association, High-Powered Plyometrics by James C. Radcliffe and Robert C. Farentinos gives you the advanced exercises and programs used by top athletes and coaches. This book covers topics from the principles of high-intensity plyometric training to the development of long- and short-term training programs for 21 sports. More than 360 photos illustrate 77 exercises to increase upper-, middle-, and lower-body power. Exercise descriptions and intensity guidelines provide step-by-step instructions to ensure correct technique and proper workload. Circle No. 517 The Plyometric Techniques video from the National Strength and Conditioning Association includes techniques for lowerbody training, medicine ball training, reactive drills, and upper-body plyometrics. The NSCA’s position statement is defined in this video, and it serves as a reference point for the defined exercises. The video contains a total of 47 drills, including warmup. Circle No. 518

NZ Mfg., LLC 800-886-6621 www.nzmfg.com TurfCordz Super Bungies were designed for plyometric, speed, and agility training. They are used by leading pro football, basketball, baseball,

and hockey teams worldwide. Created for the extreme demands of high-level training, TurfCordz Super Bungies are made from wide, high-strength bungie cord with industrial-strength steel snaps. They offer the safety and effectiveness that professional athletes require. To learn more about the entire TurfCordz line, call today or visit NZ Mfg.’s Web site. Circle No. 519

SERIOUS COMPRESSION, SUPERIOR PERFORMANCE

BodyGuard offers a unique combination of both muscle support and performance enhancement in easy-to-use, lightweight, comfortable sportswear products for shoulder, groin/hamstring, knee, elbow, shin and ankle injuries. The BodyGuard’s compressive energy transfer assists muscles in generating torque, reduces muscle vibration, tissue damage, delays muscle fatigue, and keep muscles warm. Antibody, Inc. BodyGuard -Taking Protection and Performance To The Highest Level Visit and shop on-line at www.antibodywear.com Phone 410-581-0900 • Fax 410-581-0991 Circle No. 134

ATHLETICBID.COM

T&C DECEMBER 2006

PLYOMETRICS OPTP 800-367-7393 www.optp.com/ad The Essence of Medicine Ball Training by Juan Carlos Santana, CSCS, demonstrates over 100 medicine ball exercise progressions. This DVD can inspire athletic trainers, coaches, and rehab staff members to apply medicine ball training into their current programs for maximized results. For more information and a free catalog, call OPTP or go online today. Circle No. 520 The new BOSU® DSL Trainer, available from OPTP, features revolutionized fitness balls. It contains a total of five pounds of weighted beads and has a

six-sided design for enhanced function, resistance, and technique. This new design means the unit moves very little or not at all when pushed. It can add fun and variety to your everyday exercise. The DSL Trainer comes with a workout DVD and ball pump. Circle No. 521

adjusts in three-inch increments from 24 inches to 42 inches. Combine multiple height configurations to produce enhanced knee lift, increased flexibility, and more intensity during agility drills. The Series 7 Hurdles are not intended for use as track hurdles. Circle No. 522

Power Systems, Inc. 800-321-6975 www.power-systems.com

Get an explosive edge over the competition by improving lateral agility, speed, and stamina with Power Systems’ Adjustable Lateral Plyo Box. The inclining side platforms can be quickly set at 25, 35,

The new Series 7 Hurdle delivers seven levels of training challenge in one lightweight, foldable, portable steel hurdle. Use it for dynamic warmups and then quickly adjust the springloaded pins on the crossbar to make plyometric bounding and hurdle walks challenging and intense. The hurdle

Fuel your body for maximum strength and power! No other nutrition program will enable you to gain muscle and power— while trimming body fat—more effectively than Power Eating, the leading plan for power athletes, strength trainers, and bodybuilders. Authored by a consultant to NFL and NBA players and world-class bodybuilders, Power Eating combines the most up-to-date scientific and practical advice to address the unique nutritional requirements of the power athlete. The result is an approach that has helped thousands of athletes reach their physique and performance goals—safely and legally. This third edition incorporates the latest nutrition principles and recommendations, specifically addressing and dispelling the myths about carbohydrate and its role in a power athlete’s diet. A revised supplement rating system incorporates new IOC rules and makes the latest findings on vitamins and minerals, muscle-building products, and performancerelated herbs easier to find.

To order call toll-free

NEW!

1-800-747-4457 U.S.

328 pages • ISBN 978-0-7360-6698-3 • $16.95 U.S. • $21.95 Cdn

Also available in bookstores everywhere!

1-800-465-7301 Canada

HUMAN KINETICS

or visit www.HumanKinetics.com

The Premier Publisher for Sports & Fitness P.O. Box 5076 • Champaign, IL 61825-5076

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PLYOMETRICS

TESTIMONIAL

or 45 degrees to optimally target all the muscles of the ankle, leg, and hip while increasing change-of-direction speed. Made of durable 14-gauge one-inch welded steel with a reinforced nonslip platform, it can stand up to even the most powerful athletes. An instructional manual and DVD are available. Circle No. 523

OPTP’s Foam Rollers: Athletic Trainers’ First Choice

Topaz Medical 800-264-5623 www.topazusa.com The Mediball Adjustable Rebounder package from Topaz Medical is one of the most rugged medicine ball training systems available for sports and rehabilitation settings. The Rebounder’s round design ensures consistent returns of the Mediball. The medicine balls are conveniently stored in the included rack. Topaz’s Mediball is the original gel-filled medicine ball and comes in six sizes: two, four, six, nine, 12, and 15 pounds. Call toll-free to learn about available package deals. Circle No. 524 Topaz Medical’s Plyo-Sled is one of the most cost-effective plyometric training devices on the market. If you think of plyometrics as stacks of wobbly boxes, think again. The PlyoSled supports the athlete’s body completely, minimizing spinal compression. Eight selectable elastic bands provide fastacting resistive force, while a silent, frictionless glide system helps make the Plyo-Sled the ultimate machine for developing explosive leg power. The unit is now sold with a versatile attachment for upper-body exercise. Circle No. 525

“I use NASM’s Body Map to prescribe integrated and individualized corrective exercise training. Self-myofascial release exercises using OPTP foam rollers play an important part in Body Map exercise programming, to correct muscular imbalances, improve neuromuscular efficiency, and prevent injury. OPTP has been my source for the best foam rollers and other cuttingedge products for over seven years.” Mark Neumann, ACE-Master Trainer, NASM-PES, CGT, IFS, ACSM-HFI Director of Programming and Education www.AthleticArchitect.com “I’m often asked to evaluate athletes who are having difficulty progressing in rehabilitation. I generally start them on three or four foam roller exercises, and about 80 percent of the time I can improve pain-free functional performance using simple retraining techniques which focus on core stability and neuromuscular rebalancing.” Marjorie A. King, PhD, ATC, PT Director of Graduate Athletic Training Education Plymouth State University “When filming our latest DVD, ‘The Complete Guide to Foam Roller Exercises for Improved Performance,’ we used OPTP’s foam rollers because of their quality and high resistance to compression. I advise my clients to buy foam rollers and other rehabilitation products from OPTP because I know they will get a high-quality product, delivered on time, and at a good price.” Staffan Elgelid, PhD, PT, CFT Associate Professor of Physical Therapy Nazareth College

Why do more than 13,000 unique users each month rely on AthleticBid. com?

With AthleticBid’s online Buyer’s Guide, you may: View the complete product lines of companies listed. ● View catalog pages or spec sheets from many of the top companies. ● Read a profile or description of select companies. ● Send an e-mail directly to a supplier or make a request to be contacted by a company representative. ● Request catalog and sales literature from companies. ●

Quickly find the products, services, and deals you are looking for

OPTP P.O. Box 47009 Minneapolis, MN 55447 800-367-7393 customerservice@optp.com www.optp.com/ad

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T&C DECEMBER 2006 athbid1_3.indd 1

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TOPICAL ANALGESICS Ari-Med Pharmaceuticals 800-527-4923 www.ari-med.com

CytoSport 888-298-6629 www.cytosport.com

Flexall topical pain relieving gels can benefit any therapy protocol and are great with ultrasound. Recent studies verify that a 25-75 Flexallultrasound gel mixture delivers heating results equal to pure ultrasound coupling gel. Flexall (seven percent menthol) and Maximum Strength Flexall (16 percent menthol) provide fast, long-lasting relief from arthritis, backache, bursitis, tendonitis, muscle strains and sprains, bruises, and cramps. Flexall gels absorb quickly and are greaseless, non-staining, and gentle on the skin. Professional sizes are available. Circle No. 526

CytoFlex™ pain relieving gel is a fast-acting, powerful combination of hyaluronic acid, glucosamine, chondroitin, and MSM that helps alleviate pain in overused joints. CytoFlex’s super strength provides penetrating pain relief where you need it, when you need it. Applied topically, results are usually evident from the first use. CytoFlex has been accepted by personal trainers, physical therapists, and athletes seeking joint pain relief. Circle No. 527

HOW TO REQUEST OR RENEW A FREE SUBSCRIPTION: The easiest way to subscribe is to go to our website at www.momentummedia.com and fill out a subscription request form. Alternatively, a subscription request card is provided in every issue. If a request card is not available, then on your institution’s letterhead, provide us with your: 1. request to receive or renew a free subscription 2. signature and date of request 3. title and school or company name 4. mailing address 5. brief description of your job and the type of institution for which you work

ARE YOU MOVING? The USPS will not forward your subscription. In order to keep receiving your free subscription, you must notify us of your new address. All subscription requests and changes of address must be made via our website, or by fax or mail. TRAINING & CONDITIONING, SUBSCRIPTION DEPT., PO BOX 4806, ITHACA, NY 14852-4806 or www.momentummedia.com or faxed to: 607-257-7328 Attn: TRAINING & CONDITIONING, SUBSCRIPTION DEPT.

T&C DECEMBER 2006

Gebauer Co. 800-321-9348 www.gebauerco.com Gebauer’s Spray and Stretch topical anesthetic skin refrigerant replaces Gebauer’s Fluori-Methane, which has been discontinued. Use Gebauer’s Spray and Stretch fine stream spray in conjunction with the spray and stretch technique to effectively manage myofascial pain, restricted motion, trigger points, muscle spasms, and minor sports injuries. The product is non-flammable and available only by prescription. It can be purchased through your medical supplier or wholesaler, or directly from Gebauer. Circle No. 528 Gebauer’s Instant Ice non-prescription skin refrigerant can be used like ice for minor pain and swelling from sprains, strains, bruising, contusions, and minor sports injuries. Gebauer’s Instant Ice is ideal for facilities that restrict the use of flammable components. It is available in a mist spray or stream spray

aerosol can, and can be purchased directly from Gebauer by calling the company or visiting its Web site. Circle No. 529 Biofreeze® 800-246-3733 www.biofreeze.com Biofreeze® pain relieving products include a soothing gel, a convenient roll-on, and the new no-touch natural Cryospray. Applied generously, patients and athletes experience relief immediately. Biofreeze products effectively relieve pain from arthritis, backaches, strains, and sprains. Biofreeze is available in a 16-ounce spray bottle, a 16-ounce gel pump, a 32-ounce gel pump, a gallon gel pump, and a gravity dispenser box for clinical use. The three-ounce gel roll-on, four-ounce spray bottle, and four-ounce gel tube are perfect for at-home treatment between office visits. Biofreeze is endorsed by USA Judo. Circle No. 530 Prossage Heat 866-4-PROSSAGE www.proassage.us Prossage™ Heat is a uniquely blended, 100-percent natural, areaspecific warming ointment formulated specifically for deep-tissue work, myofascial release, and trigger point therapy. Prossage Heat is a revolutionary breakthrough for the treatment of symptoms of soft-tissue pain and dysfunction throughout the body. The non-slip controlled glide allows therapists to work more effectively. Prossage Heat is available in three-ounce, eightounce, and 32-ounce bottles. Circle No. 531

ATHLETICBID.COM

MORE PRODUCTS Human Kinetics 800-747-4457 www.HumanKinetics.com The new edition of Power Eating combines the most up-to-date scientific and practical advice to address the unique nutritional requirements of power athletes. Chapters on supplements cover the vast and ever-changing array of vitamins, minerals, and herbs on the market. There are more than a dozen meal plans for men and women, plus energy-boosting recipes for easy implementation. The result is an approach that has helped thousands of athletes achieve their desired physique and reach their performance goals, safely and legally. Circle No. 532 Nautilus 877-657-7762 www.nautilus.com The XPload™ line brings worldrenowned Nautilus performance to plate-loaded training equipment. XPload machines employ intelligent design and features that make them ideal for elite-level strength training. Strength curves are incorporated through four-bar linkage for the most effective workout possible. Low weight-loading points mean there’s no need to load plates at eye level. Integrated plate storage is standard, and an efficient footprint maximizes your training space. Circle No. 533 PrePak Products, Inc. 800-544-7257 www.prepakproducts.com PrePak’s Web-Slide exercise rail system is for users of exercise equipment such as tubing, bands, and pulleys— devices that provide resistance, stretching, and ROM. The system includes everything you need—fixtures, exercise devices, and instructional materials—to ATHLETICBID.COM

quickly and effectively train and monitor rehab and fitness programs. The new Deluxe Assortment has three additional posters, an ExerBand fitness bar, and EzChange handles on all the tubes. Circle No. 534 Free-Up® massage cream from PrePak is formulated exclusively for healthcare professionals and is noted for its glide, lubricity, and tissue perception. It’s a superb medium that lets you work either on the surface or deep into tissue. Its smooth glide promotes exquisite tissue sense for your fingers and hands. Free-Up is safe, hypoallergenic, and does not contain beeswax. It is available in two sizes (eight ounce and 16 ounce) and in scented or unscented. Circle No. 535 Titleist Performance Institute 888-274-2004 www.MyTPI.com Join the Titleist Performance Institute and the world’s top golf and fitness experts at the four-day World Golf Fitness Summit at the beautiful Disney Coronado Springs Resort in Orlando from April 19 to 22, 2007. This conference will be the second gathering of the top medical, strength, and conditioning experts for golf in the world. Topics to be covered include understanding injury-inducing golf biomechanics; testing for physical limitations that affect performance; mental and nutritional development; power and speed development; and exercise progressions for developing posture, stability, mobility, and coordination. Visit the MyTPI Web site to see the incredible list of speakers at this year’s summit. Attendees can receive 24 NATA CEUs. Circle No. 536

TESTIMONIAL

WerkSan Works For College and NFL Strength Coaches

“Thanks for the great WerkSan bumper plates and Olympic bars. In my 28th year in the business, I have finally come across a product line that fulfills all our requirements and standards for successfully training our team. The plates have the proper dimensions, density, and durability. They are solid, easy to handle, and have a rugged appearance. The bars are ‘alive’ with just the right amount of flex. They also feature a well-designed bearing system that allows the sleeves to roll smoothly and freely. Our order was delivered in a timely and efficient manner by a competent and friendly staff. Customer care has been excellent before and after delivery. I would not hesitate to give WerkSan my highest recommendation.” Rock Gullickson Strength and Conditioning Coach Green Bay Packers “WerkSan equipment has proven to be a dependable addition to our strength and conditioning facility. The training plates have the durability to stand up to daily use by over 500 NCAA Division I athletes. You can expect world-class performance and great value from WerkSan weights. I recommend WerkSan equipment to anyone who aspires to be an international weightlifter, and to young athletes who want to excel in their sport.” Sonny Sano Director of Strength and Conditioning Ohio University

WerkSan Sports USA 876 N. Lenola Rd., Ste. 6F Moorestown, NJ 08057 877-WERKSAN info@werksanusa.com www.werksanusa.com T&C DECEMBER 2006

TESTIMONIAL

WEB NEWS

For Healing and Pain Relief, Zoraflexx Delivers

Bushwalker Bags Are Just a Click Away

“I have used the Zoraflexx™ paste on my athletes at Georgia Tech since 1999. During training camp, we had a total of 10 ankle sprains that we used the paste on. We saw extremely good results. The average injury treatment time was about seven to nine days—using a conventional treatment program only, we probably would have been looking at two weeks. “We also had two hamstring pulls. The average healing time for this injury is two to three weeks. With the paste, we had both players back in 10 days. We are also getting good results using it to treat tendonitis.” Walter Smith Baseball Athletic Trainer Georgia Tech “Zoraflexx has worked well for me. I have used it on several basketball, football, and track athletes. I have experienced success in each sport. I have also used Zoraflexx on chronic swelling and pain, applying it overnight on ankle, knee, thigh, and hamstring injuries. Zoraflexx reduces inflammation and pain overnight. Our athletes are very pleased with Zoraflexx and request it whenever they come to the athletic training room.” Craig Boyd Associate Head Athletic Trainer Morehouse College

Williams Technology International, Inc. P.O. Box 187 Redan, GA 30074 770-413-8291 info@zoraflexx.com www.zoraflexx.com 56

T&C DECEMBER 2006

At the Web site of Ari-Med/Diversa Products Group, you can view photos and get details on the Bushwalker Bags product line. Read about product features, measurements, and standard fabric colors, and see information on embroidery and the company’s warranty. The product line is broken down into sub-categories, such as wheeled med bags, carry med bags, bag and travel accessories, belt packs, crutch bags, field kits and spine board bags, equipment bags, and luggage. Online ordering is available, and there are also instructions for ordering via phone or fax.

www.ari-med.com Dynatronics Revamps Its Online Storefront Dynatronics is launching its new Web site in December, offering an informationdriven layout that provides detailed product specs and user-friendly navigation. Finding a Dynatronics dealer in your area and choosing the perfect piece of equipment is easier than ever. Dynatronics invites you to log on and experience the company’s new and improved site.

www.dynatronics.com Oakworks® Brings User-Friendly Site Navigation to the Table Oakworks, a longtime leader in stationary and portable athletic training tables, offers close-up product views and lots of information on its Web site. Pop-up boxes showing available options and accessories make the site easy to navigate, allowing you to customize your visit. Pages containing special deals and links to Oakworks’ associations and sponsorships are also available. Log on today and see for yourself all that the company’s site has to offer.

www.oakworkspt.com Power Lift’s Site Offers Strong Ideas for Strong Results Power Lift’s Web site is loaded with features to help you make the right purchase for your weightroom or fitness facility. Detailed product specs tell you about each unit’s features and full-color photos show you what you’re reading about. A “Clients” page lists satisfied customers and allows you to see how great their facilities look after installing new Power Lift equipment. Download a PDF of the company’s catalog, fill out an info request form, and read company news and info to get a complete picture of what Power Lift has to offer.

www.power-lift.com To Be a Leader, Partner with One Life Fitness is the manufacturer of one of the top brands of fitness equipment found in health clubs worldwide. The company’s Web site is geared to meet all the needs of fitness facilities. It features Life Fitness Cardio, Life Fitness Strength, and Hammer Strength products, offering in-depth product information, key performance features, and specifications to assist you in making the right purchase. You’ll also find company information, including articles, press releases, facility showcases, printable brochures, career opportunities, and more.

www.lifefitness.com New Presagia Web Site Works for You 2006 has been an exciting year for Presagia. In addition to re-branding its flagship athlete health-management software InjuryZone as Presagia Sports, the company has created an all-new Web site. You will notice some major improvements, including graphic enhancements, a more streamlined design, and updated content. All of these changes have been made to optimize the overall Web-surfing experience for visitors. Presagia is continually updating its site, so check back often for the latest information and news about one of the most advanced software programs available to manage athlete health. Also, read the company’s customer success stories to learn how Presagia can work for you.

www.presagia.com

ATHLETICBID.COM

NEW Product Launch DonJoy Hat Trick Soccer Headguard

Therma Splint

Unique features: • Ideal for players of all ages and ability levels • Meets the soccer headgear standard • Designed with latex-free straps

Unique features: • Stainless steel construction • Set temperature range: 140 degrees F (60 C) to 180 degrees F (82 C) • Internally insulated

Beneﬁts for the user: • Reduces the risk of concussion • Legal on every field • Ball plays true off the head

Beneﬁts for the user: • Water-resistant temperature controller • Removable hinged lid • Available in two sizes to fit all types of splint materials

DJO 800-336-6569 www.betterbraces.com

Whitehall Mfg., Inc. 800-782-7706 www.whitehallmfg.com

Circle No. 537

Impulse TENS D5 Unique features: • Five modes of operation • For safety, the unit shuts down when the electrode becomes detached from the skin Beneﬁts for the user: • Digital technology • Helps athletes manage pain • “Lock” feature allows the athletic trainer to customize settings for ease of use by athletes

BioMedical Life Systems, Inc. 800-726-8367 www.bmls.com Circle No. 539 ATHLETICBID.COM

Circle No. 538

WerkSan IWF-Certified Barbells

Unique features: • Five strategically located carbon-fiber bearings • Synthetic gel lubricant for longevity • Made of one of the most durable synthetic bumper materials available • Ribbed inside plates and sleeves to prohibit sliding • Tested for safety and durability Beneﬁts for the user: • WerkSan produces safer, better-performing, and longer-lasting weight equipment

WerkSan Sports USA 877-WERKSAN www.werksanusa.com Circle No. 540 T&C DECEMBER 2006

ADVERTISERS DIRECTORY CIRCLE COMPANY NO.

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Absolo Fitness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Accelerated Care Plus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 Antibody (The BodyGuard) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51 Beacon Athletics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Biofreeze . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 BioMedical Life Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 BraceSox . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 California University of Pennsylvania . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Cho-Pat . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 Creative Health Products . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 CytoSport . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .IFC Dynatronics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5 Exertools . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Flexall . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Gatorade . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-3 Gebauer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Human Kinetics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 InterX (Neuro Resource Group) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Medical Quant West . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 NASM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

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Nautilus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . IBC NSCA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12 Oakworks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . BC OPTP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Perform Better . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17 Perform Better (seminars) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 Physiomed North America . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Power Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Presagia Sports. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Prossage Heat . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 SAM Medical (Blist-O-Ban) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 SAM Medical (Splint XL) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Samson Weight Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Shuttle Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Titleist Performance Institute . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Topaz Medical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 TurfCordz/NZ Mfg. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 WerkSan Sports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41 Xvest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

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Accelerated Care (Omnisound 3000E) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 Accelerated Care (Omnistim 500) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 Ari-Med (Flexall) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 Beacon Athletics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Biofreeze. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 BioMedical Life (Impulse TENS D5) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 BioMedical Life (product launch) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 BioMedical Life (QuadStar Elite KQSE) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 CytoSport . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 DJO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 Dynatronics (Solaris D709) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 Dynatronics (X3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 Exertools . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Gebauer (Instant Ice) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 Gebauer (Spray and Stretch) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 Human Kinetics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Medical Quant West . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 NASM (Corrective Exercise-Foot/Ankle) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 NASM (Performance Enhancement) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Nautilus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Neuro Resource Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 NSCA (High-Powered Plyometrics) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51 NSCA (Plyometric Techniques video) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51 OPTP (BOSU DSL Trainer) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 OPTP (Medicine Ball Training) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Perform Better (Training Guide). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Perform Better (VertiMax) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Physiomed North America . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 Power Systems (Lateral Plyo Box) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Power Systems (Series 7 Hurdle) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 PrePak Products (Free-Up) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 PrePak Products (Web-Slide) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

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COMPANY

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531 . . . 510 . . . 511 . . . 536 . . . 524 . . . 525 . . . 519 . . . 540 . . . 538 . . .

Prossage Heat . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 Shuttle Systems (Shuttle Balance) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Shuttle Systems (Shuttle MVP) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Titleist Performance Institute . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Topaz Medical (Mediball Rebounder) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Topaz Medical (Plyo-Sled) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 TurfCordz/NZ Mfg. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51 WerkSan Sports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 Whitehall Manufacturing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

State of the Industry 541 . . . 542 . . . 543 . . . 545 . . . 546 . . . 547 . . . 548 . . . 549 . . . 550 . . . 551 . . . 544 . . . 552 . . . 553 . . . 554 . . . 555 . . . 556 . . . 557 . . . 558 . . . 559 . . . 560 . . .

Absolo Fitness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Accelerated Care Plus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Antibody . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Beacon Athletics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . BioMedical Life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . BraceSox . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Cho-Pat . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . CytoSport . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dynatronics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Human Kinetics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Medical Quant West . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NASM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NZ Mfg. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Oakworks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OPTP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Physiomed North America . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Power Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Presagia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Topaz Medical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . WerkSan Sports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

59 59 59 60 60 60 60 61 61 61 59 61 62 62 62 62 63 63 63 63

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STATE OF THE INDUSTRY

New Technology: Absolo was developed primarily to exercise the entire abdominal region, including the oblique muscles. However, due to the innovative concept involved in its design, it can also be used to exercise the upper body and perform cardiovascular workouts. Benefits: The Absolo offers total muscular development in the abdominal region. It also helps users shed unwanted body fat. The Absolo provides a fun and challenging workout that athletes will enjoy doing time and again. For decades, boxers and their coaches have used medicine ball exercises to train the midsection. Now, by using the Absolo, those same time-tested training techniques can produce excellent results for athletes in any sport.

Absolo 877-4AB-SOLO www.absolofitness.com Circle No. 541

New Technology: The BodyGuard™ is a line of patented compression sportswear that revolutionizes how muscle injury is treated and prevented. Utilizing stored elastic energy transfer, the BodyGuard provides performance enhancement and protection against injury. Benefits: Made of a state-of-the-art, highly compressive neoprene polymer that literally attaches to the skin, the BodyGuard transfers elastic energy to the muscle and connective tissue, offering a unique combination of muscle support and performance enhancement. A study at Ball State University’s Human Performance Lab (see the Journal of Sports Sciences, Issue 21, 2003, p. 601-610) found that the BodyGuard increases vertical jump height and stride rate and assists muscles in generating torque. It also reduces muscle vibration, minimizes tissue damage, delays the onset of muscle fatigue, raises muscle temperature, and absorbs direct impact. The result is superior muscle support and enhanced performance. Antibody, Inc. 301-782-3700 www.antibodywear.com Circle No. 543 ATHLETICBID.COM

New Technology: The Omnistim FX2 Pro is among the most sophisticated portable electrotherapy devices available for pain management, tissue healing, and the treatment of muscle dysfunction and sports injuries. It’s easy to use, battery-operated, and designed to meet the needs of athletic trainers. Patterned Electrical Neuromuscular Stimulation (PENS) uses the body’s natural pattern of electrical firing in the muscles identified by EMG studies for functional electrical stimulation protocols. The FX2 Pro uses biphasic asymmetrical pulsed currents to induce contractions in agonist and antagonist muscles, simulating the live firing patterns of muscles during normal activity. Benefits: PENS provides afferent input that assists in the retraining of the CNS and spinal motor loops to promote normal muscle function. This system has all the basic protocols, as well as sport-specific protocols such as walk/run, jump, skate/ski, throw, kick, and cycle. Accelerated Care Plus 800-350-1100 www.acplus.com Circle No. 542

New Technology: Super pulse technology is the latest innovation in low-level lasers. It produces a peak pulse of intense light for a fraction of a second, allowing for the safe delivery of more energy at a deeper level than non-pulsed lasers of a similar wavelength. There are no damaging thermal effects in the tissue because the pulses are extremely short. Further enhancing this technology, the new TerraQuant® MQ2000 uniquely combines advanced super pulse technology with red, infrared, and magnetic field technologies. Benefits: The TerraQuant offers 25,000mW of peak power, deep penetration, and high photon saturation without damaging thermal effects. Practitioners are able to offer powerful, FDA-cleared pain relief for a broader range of conditions, from the skin surface to deep tissue. TerraQuant is used by national sports teams and Olympic teams. Medical Quant West 877-200-1402 www.superpulsedpractice.com Circle No. 544 T&C DECEMBER 2006

STATE OF THE INDUSTRY

Industry Trend: The current trend in training equipment is to acknowledge the importance of safety, compact storage, and mobility. Beacon Athletics has developed one complete training system that addresses all these requirements. Benefits: The Smart-Cart system is a diverse selection of quality training products organized on a single cart to solve issues of storage and transportation for your training tools. It takes care of all the hassles normally associated with getting traditional equipment to your court or field. The sturdy three-point hurdle base sets up quickly and helps make drills safer. The innovative assortment of training equipment can be used to effectively train as many as 60 athletes in a timed rotational circuit. Whether you’re training the pros, working with high school athletes, or rehabilitating injuries, the Smart-Cart system will meet your needs. Beacon Athletics 800-747-5985 www.beaconathletics.com Circle No. 545

Industry Trend: The current trend among portable electrotherapy devices is to include multiple modalities in one portable device. This has encouraged the engineers at BioMedical Life Systems to take things a step further and develop a device with four modalities—interferential, TENS, NMS, and high–voltage—all in one unit. Benefits: A portable, multi-modality device benefits the athletic trainer because he or she is no longer forced to choose between multiple electrotherapy devices and leave some back at the training facility. The QuadStar® Elite by BioMedical Life Systems has everything needed to ensure that the athletic trainer is fully prepared to treat injuries, right on the sidelines, with one unique device. BioMedical Life Systems, Inc. 800-726-8367 www.bmls.com Circle No. 546

Industry Trend: Many collegiate and professional sports teams are bracing their athletes in an attempt to protect their knees from initial injury. The negative side effects of orthopedic bracing, however, include chafing, abrasion, and irritation, causing many athletes to resist wearing the braces. The BraceSox is a soft, supple, and comfortable sleeve that was designed by a college athlete to mitigate the discomfort of orthopedic bracing.

New Technology: Cho-Pat is recognized for the originality and uniqueness of its sports-medical devices, which relieve the discomfort of certain biomechanical disorders. Active individuals have often asked for some sort of protection against bicipital and tricipital tendonitis and tendonosis. Many have felt there was nothing available that could be worn prophylactically or as an adjunct to a course of therapy. Cho-Pat filled that void with the Bicep/Triceps Cuff.

Benefits: The BraceSox gives coaches and athletic trainers a new tool in helping their athletes make the right choice when it comes to protective bracing. Because it’s so comfortable, athletes will choose to wear it and thereby protect themselves from injury. The moisture-wicking BraceSox is made of Supplex/ Lycra™ material, providing a soft layer of comfort. It is a top choice among athletes who wear bracing.

Benefits: This patent-pending cuff offers protection from overuse injuries for individuals performing repetitive lifting in activities such as weight training. It applies dynamic circumference pressure to the upper and lower portions of the bicep and triceps muscles, particularly at the tendon attachments, which spreads out the stress and direct pull to help reduce the likelihood of bicipital and tricipital tendonitis and tendonosis.

BraceSox 831-479-7628 www.bracesox.com Circle No. 547

Cho-Pat 800-221-1601 www.cho-pat.com Circle No. 548

T&C DECEMBER 2006

ATHLETICBID.COM

STATE OF THE INDUSTRY

Industry Trend: A current trend in sports nutrition is an increase in convenient, great-tasting products that satisfy a wide variety of nutritional needs while also meeting compliance standards for college athletics. CytoSport recently developed the Muscle Milk Collegiate line to meet these high standards, creating a new level of excellence.

New Technology: J. Stephen Guffey, EdD, PT, and Jay Wilborn, MEd, MT(ASCP), have been conducting research using Dynatronics light therapy devices. Their work is being published in the journal Photomedicine and Laser Surgery in December 2006. The two examined the potential bactericidal (bacteriakilling) effect of light at 405, 470, and 880nm.

Benefits: Muscle Milk Collegiate offers proper nutrition based on sound scientific principles. A unique combination of ingredients helps maintain muscle glycogen levels and stops muscle breakdown for faster recovery from training. The delicious taste of Muscle Milk Collegiate keeps athletes coming back for more.

Benefits: Their research suggests that 405nm light effectively inhibits the growth of staph and pseudomonas bacteria. A follow-up study is currently being conducted at Weber State University to determine whether 405nm light is equally effective against MRSA—a strain of staph that is resistant to many antibiotics and a common problem in athletic settings. This promising research suggests another beneficial application for Dynatronics light therapy products.

CytoSport, Inc. 888-298-6629 www.cytosport.com Circle No. 549

Dynatronics 800-874-6251 www.dynatronics.com Circle No. 550

Industry Trend: The many ways in which DVDs are used today is a trend that has motivated publisher Human Kinetics to find new ways to bring instructional content to recreational and competitive athletes and their coaches. Benefits: By embracing DVD technology and incorporating it into some of the resources the company publishes, Human Kinetics has begun delivering exactly what people are looking for—books that relay the research, information, and programs relevant to each sport, packaged with a DVD that provides liveaction accompaniment to the information in the book. Some of the first titles to be released in book/DVD format are: John Wooden’s UCLA Offense, Strength Ball Training, Explosive Lifting for Sports, and Complete Conditioning for Hockey. Human Kinetics has more great book/DVD combinations on the way. Human Kinetics 800-747-4457 www.HumanKinetics.com Circle No. 551 ATHLETICBID.COM

Industry Trend: The National Basketball Athletic Trainers Association (NBATA) encourages head athletic trainers and assistant athletic trainers in the NBA to complete the National Academy of Sports Medicine (NASM) Performance Enhancement Specialist (PES) specialization. To date, approximately 91 percent of the head and assistant athletic trainers in the NBA have earned their NASM PES specialization. Benefits: The results speak for themselves. The NBA’s Phoenix Suns have a fully integrated partnership with the NASM. In 2005, the Suns’ athletic trainers reported that they had cut treatments for injuries by more than half (from 2,500 treatments during the 2002-03 season to 950 in 2003-04). The team also reported that the starting lineup had been available for 64 out of 74 games. Contact NASM today to learn more about the PES specialization. NASM 800-460-6276 www.nasm.org Circle No. 552 T&C DECEMBER 2006

STATE OF THE INDUSTRY

Industry Trend: More and more high school and college athletes are looking to benefit from the same tools the pros use to develop quickness, agility, and power. Benefits: TurfCordz were designed specifically for high-level training by professional football, baseball, basketball, and hockey teams. The product provides an excellent training modality for developing explosive starts, increased power, and quicker footwork. The Safety Cord design features a strong nylon cord running the entire length of the heavy latex tube, assuring the safety and reliability that professional athletes demand during rigorous sports training. TurfCordz are distributed by Perform Better.

Benefits: Oakworks’ Boss™ portable treatment table and Portable Taping Table already provide industryleading portability and support for large athletes. They also include an impressive level of height adjustability to provide ergonomic benefits for the athletic trainer. The Boss features a standard height range of 24 to 34 inches, but it can also offer ranges of 17 to 26 inches or 22 to 31 inches. The Portable Taping Table offers adjustability from 32 to 40 inches. Athletic trainers can adjust these tables to ensure the best working height, allowing them to treat athletes while maintaining their own proper body mechanics.

NZ Mfg., LLC 800-886-6621 www.nzmfg.com Circle No. 553

Oakworks 800-916-4603 www.oakworkspt.com Circle No. 554

Industry Trend: Almost everywhere you look these days, you find Pilates. With its emphasis on improving movement patterns and overall mind-body connection, Pilates works to heal the whole body instead of isolating certain areas. Benefits: Pilates can lead to fewer injuries, better coordination, and improved strength and flexibility. By offering new Pilates products and resources, OPTP provides tools to enhance performance in all areas of fitness. Enhancing the lines of communication between the mind and the body will not only result in better performance, but will also help prevent injury and improve the quality of daily life.

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New Technology: Researchers and sports medicine professionals are finding new applications for electrostatic energy in the treatment of soft-tissue injuries. One of the products leading the way in this innovative field is the Hivamat® 200 from Physiomed North America. Benefits: Deep Oscillation®, provided by the Hivamat 200, is characterized by an intermittent electrostatic field that attracts and then releases the patient’s tissue at a selected frequency. This triggers a unique, deeply penetrating, lasting resonance vibration of the treated area. The tissue is thoroughly kneaded by mechanical force, even in areas of acute pain or trauma where very little surface pressure can be applied. Deep Oscillation can supplement and intensify manual modes of treatment. Since it can be applied at a very early stage in the rehabilitation process, it can significantly accelerate regeneration and healing. Physiomed North America www.physiomed.com

OPTP 800-367-7393 www.optp.com

Industry Trend: Portable treatment tables continue to require robust support for large athletes (up to 550 pounds). In addition, they also need to offer ergonomic height adjustability for the athletic trainer.

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STATE OF THE INDUSTRY

Industry Trend: Sports performance training, while standard fare on playing fields and courts worldwide, has started cropping up in unusual places, such as fitness centers, gyms, and YMCAs. This has added a creative twist to Group X classes and personal training sessions. With most of this training happening indoors, changes need to be made to some traditional outdoor equipment for safety and to avoid property damage.

Industry Trend: Web-based electronic health records (EHRs) are being implemented by healthcare organizations worldwide. Offering secure, real-time access to patient information, these programs enable sports medicine professionals to manage centralized health information at the point of care, thereby promoting efficiency and informed decision-making. This technology has the potential to expedite the delivery of care, improve quality, enable trend analysis, and reduce costs.

Benefits: Outdoor agility ladders, traditionally made of hard plastic, can damage expensive fitness room floors, so Power Systems created the durable nylon Indoor Agility Ladder. This 15-foot “soft” ladder has 11 fabric-covered iron bars that keep it in position on smooth surfaces so that foot speed work and agility training can take place indoors, safely and effectively.

Benefits: Presagia has responded by developing Presagia Sports (formerly InjuryZone), the first Webbased total athlete health management system. This software combines a comprehensive EHR program, medical case-management tools, communications, and reporting capabilities to create a powerful system that enhances athlete care. Leveraging flexible and scalable technology, Presagia Sports meets the needs of all sports organizations, from Olympic committees to local sports medicine clinics.

Power Systems, Inc. 800-321-6975 www.power-systems.com Circle No. 557

Presagia Corp. 866-696-7474 www.presagia.com Circle No. 558

Industry Trend: Plyometrics is one of the hottest trends in the fitness and rehabilitation market today. Topaz Medical’s Mediball™ can be a key component of plyometric training. Benefits: Mediballs are an excellent choice for general strength training, improving ball handling and other sport-specific skills, and rehabilitating injuries. They are produced in six popular sizes for all types of exercises and drills, from light one-handed throws to heavy two-handed push presses. Coupled with Topaz’s Mediball Adjustable Rebounder, no training partner is necessary, freeing up the coach or athletic trainer’s valuable time. The Rebounder gives you instant feedback on the accuracy of each throw, allowing you to complete more throws in a given time period than with a human partner. Topaz Medical 800-264-5623 www.topazusa.com Circle No. 559 ATHLETICBID.COM

Industry Trend: A problematic trend in high school strength and conditioning programs is the lack of quality equipment due to budgetary limitations. This has encouraged the engineers at WerkSan to develop top-quality high school weight-training equipment at affordable prices. Benefits: WerkSan understands that high school athletic programs are under a lot of pressure to succeed, but don’t have the quality equipment they need or a lot of money to spend. The company’s high school weight-training equipment offers quality that meets the high standards set by WerkSan’s reputation. WerkSan weight-training bars are guaranteed for life, so you don’t have to worry about replacing the equipment.

WerkSan Sports USA 877-WERKSAN www.werksanusa.com Circle No. 560 T&C DECEMBER 2006

CEU QUIZ

T&C December 2006 Volume XVI, No. 9

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 to MAG, Inc., 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 66) that represents the best answer for each of the questions below. Complete the form at the bottom of page 66, include a $20 payment to MAG, Inc., and mail it by January 15, 2007 to the following address: MAG, Inc., ATTN: T&C 16.9 Quiz, 31 Dutch Mill 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 March 1, 2007.

Comeback Athlete (pages 9-12) Objective: Hear how Tufts University student-athlete Courtney Evans overcame Crohn’s Disease to finish out her college volleyball career. 1. What is Crohn’s Disease? a) An inflammatory joint disease. b) Hypertension with low blood sugar. c) An inflammatory bowel disease. d) Sensitivity to cold.

Pulling Through (pages 13-19) Objective: Learn some of the new approaches sportsmedicine professionals are taking when it comes to preventing and treating hamstring injuries. 2. When the leg is in a weight-bearing position, hamstring muscles work in what way? a) Concentrically only. b) Concentrically and eccentrically. c) Eccentrically only. d) Antagonistically only. 3. Studies have shown that the ____________ is more responsible for creating knee flexion force during backward running and cycling. a) Hamstring. b) Gluteus medius. c) Gastrocnemius. d) Soleus. 4. Other studies show that the hamstring may create a posteriordirected force on the tibia when? a) During running. b) During walking. c) When the knee is flexed greater than 30 degrees. d) During a quick change of directions. 5. The leading cause of a hamstring injury is: a) During a football tackle. b) Running. c) The presence of a prior injury. d) Muscle imbalances.

T&C DECEMBER 2006

6. Bernie DePalma offers the following theory regarding hamstring injuries: a) The dual innervation may result in coordination issues. b) The size difference between quadriceps and hamstrings may result in imbalances. c) The number of muscle cells may be inadequate for the required power during sports. d) Athletes are less active due to increase academic requirements. 7. Debra Brooks suggests looking at ___________ with hamstring injuries. a) Hamstring to hip flexor length. b) Trunk flexion ROM. c) Pelvic posture. d) Gastroc and hamstring tightness.

Ready To Roll (pages 21-24) Objective: Learn how foam rollers can be a substitute for massage therapists and see how one athletic trainer incorporates them into athletes’ workouts. 8. Clark’s initial recommendation for foam rollers was to: a) Provide floatation in the swimming pool. b) Perform standing proprioceptive activities on. c) Allow athletes to apply pressure to sensitive areas, trigger points, or knots on their own. d) Allow athletes to place foam rollers in chairs, car seats, etc. to provide lumbar support. 9. Foam rolling may be: a) Uncomfortable but should not cause injury. b) Performed passively. c) May be beneficial with just one treatment per month. d) Time consuming as 45 minutes per day is required.

Making Dreams Come True (pages 25-32) Objective: Learn how to advocate for expanding your athletic training staff at the collegiate level. 10. The most direct effort at increasing athletic training coverage came from: a) The NATA’s Appropriate Medical Coverage for Intercollegiate Athletics. Task Force. b) The National Coaches Association. c) The Student Athlete Right to Appropriate Care Act. d) The APTA.

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11. The AMICA’s formula to see if coverage meets the recommendations is: a) A system of points called Health Care Units. b) One ATC for every 10 athletes. c) The same number of athletic trainers as there are coaches. d) A ratio of eight athletes to one athletic trainer.

The Ankle Report (pages 35-38) Objective: Update your ankle injury knowledge with a comprehensive report on the latest research into ankle injuries and treatments. 12. An estimated ___________ ankle sprains occur daily in the United States. a) 1,000. b) 10,000. c) 20,000. d) 25,000.

19. Greene and Hillman reported _____ for inversion and eversion 20 minutes into the exercise. a) Complete restriction with taping is best. b) Maximal losses in taping restriction. c) A loss of ankle bracing stability. d) Improved response time with taping. 20. Over the course of a season, ankle bracing involves what percentage of the cost of taping? a) 25. b) 50. c) 75. d) 100.

Off & Running (pages 39-45) Objective: Understand how to implement a strength and conditioning program for collegiate softball players.

13. The American Medical Association classifies the degree of an injury as: a) Grade I, II, or III. b) Mild, moderate, or severe. c) First, second, or third degree. d) Partial thickness, full thickness, or complete.

21. Research has shown that the following three factors contribute to batted ball velocity: a) Lean body mass, lower-body power, and grip strength. b) Body Mass Index 25-30, high protein diet, and lower body power. c) Trunk stability, forearm strength, and lean body mass. d) Trunk stability, lower body power, and lean body mass.

14. What ligament has the weakest tensile strength of the lateral complex? a) Calcaneofibular. b) Deltoid. c) Posterior talofibular. d) Anterior talofibular.

22. According to this article, ____________ has been shown to increase throwing and base running performance. a) Dynamic proprioceptive training. b) Ballistic-resistance training. c) Proprioceptive neuromuscular facilitation. d) Static resistance training.

15. Athletes with a history of sprains have what percentage of an incidence of re-injury? a) 100. b) 200. c) 400. d) 500.

23. Boston University uses what work-to-rest ratio for ATP-PC recovery? a) 1:9. b) 2:9. c) 3:10. d) 1:12.

16. Hans Tropp found that soccer players with ___________ had a higher incidence of injury. a) Hip flexor weakness. b) New cleats. c) Poor postural sway. d) Good quad/hamstring strength ratio.

24. All pitchers bring the ball back to the _________ position to initiate the pitch. a) Three o’clock. b) Six o’clock. c) 45 degree. d) 60 degree.

17. One study found that taping the ankle specifically restricted what? a) The athlete’s acceleration. b) Eversion. c) Plantar flexion and inversion motion. d) Dorsi flexion.

25. According to this article, what phase is the most important? a) Preparatory. b) Force. c) Follow-through. d) Cool-down.

18. Tropp and colleagues found ankle bracing: a) Is effective at preventing ankle injuries. b) Is less effective than taping. c) Is cumbersome and inhibits function. d) Increases the incidence of ankle injuries.

ATHLETICBID.COM

Answer sheet is on page 66

T&C DECEMBER 2006

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 $20 payment to MAG, Inc., and mail it to the following address: MAG, Inc., ATTN: T&C 16.9 Quiz, 31 Dutch Mill Road, Ithaca, NY 14850, no later than January 15, 2007. 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 March 1, 2007.

Comeback Athlete

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12. 13. 14. 15. 16. 17. 18. 19. 20.

Ready To Roll

8. 9.

Making Dreams Come True

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The Ankle Report

Pulling Through

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Off & Running

21. 22. 23. 24. 25.

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ADDITIONAL EDUCATIONAL PROGRAMS

EARN BOC CEUs • Complete quizzes found in the NSCA’s Strength & Conditioning Journal • Complete online quizzes at www.nsca-cc.org Toll-free: 888-746-2378 I Online: www.nsca-cc.org E-mail: commission@nsca-cc.org

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T&C DECEMBER 2006 8/22/06 12:17:46 PM

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Keep your career in motion… NSCA Educational Events for 2006 • NSCA National Conference and Exhibition • NSCA’s Performance Series Symposia

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For dates, locations, and session information call 800-815-6826, or visit www.nsca-lift.org

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