Training & Conditioning 18.2

March 2008 Vol. XVIII, No. 2, $7.00

On the Same Page Working with today’s sport coaches

Nutrition during Rehab Aquatic Biofeedback

SPECIAL FOCUS:

Preventing MRSA

Circle No. 100 Circle No. 100

March 2008, Vol. XVIII, No. 2

CONTENTS

13 36 5

Q&A Mark Stoessner Grand Valley State University

10

Student Corner Alumni Connection Tapping into a great resource

By Abigail Funk

20

41 Nutrition

Better to Heal You With 13 The The latest research shows that certain dietary changes during rehab can help athletes get back into the game sooner.

By Dr. John Berardi & Ryan Andrews Optimum Performance

the Same Page 22 On How do you work with sport coaches who question your workouts and want to try all the new fads? By getting on the same page with them.

By Tim Wakeham

Sponsored Pages Power Systems

Treating The Athlete Product News

64 67 68 69 71 73

Antimicrobial Products

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CEU Quiz For NATA and NSCA members

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29 Aquatic therapy creates dynamic, controlled resistance. Biofeedback offers quantifiable information about muscle function. Together, they allow athletes to begin rehab in a supportive, pain-reducing environment.

By Ron Fuller

Product Launch Aquatic Exercise

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On the cover: At Michigan State University, strength coach Tim Wakeham takes a time-out with three of his sport coaches. Story begins on page 22.

Photo by Kelly Gillespie, Looking Glass Photography TR AINING-CONDITIONING.COM

What a Save!

36 To be an effective goalie—in any sport—you need a specific conditioning program that is different from that of position players.

By Jane Koeniges & Pete Koeniges Special Focus: Preventing MRSA

41

Under the Microscope

50 64

Educational Posters

Protecting your athletes from MRSA means taking a close look at how these bacteria function. Here, we delve into your most pressing questions on the topic.

By Greg Scholand

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Gray Cook, MSPT, OCS, CSCS Clinic Director Orthopedic & Sports Phys. Ther.

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

March 2008 Vol. XVIII, No. 2 Publisher Mark Goldberg

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

Editorial Staff Eleanor Frankel, Director R.J. Anderson, Kenny Berkowitz, Nate Dougherty, Abigail Funk, Dennis Read, Greg Scholand

Gary Gray, PT, President, CEO, Functional Design Systems Allan Johnson, MS, MSCC, CSCS Sports Performance Director Velocity Sports Performance

Circulation Staff David Dubin, Director John Callaghan

Maria Hutsick, MS, ATC/L, CSCS Head Athletic Trainer, Medfield (Mass.) High School

Art Direction Message Brand Advertising

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

Production Staff Don Andersen, Director Jonni Campbell, Jim Harper, Neal Betts

Tim McClellan, MS, CSCS Director of Perf. Enhancement, Makeplays.com Center for Human Performance

Business Manager Pennie Small

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

Special Projects Dave Wohlhueter

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

Administrative Assistant Sharon Barbell

Steve Myrland, CSCS Owner, Manager, Perf. Coach, Myrland Sports Training, LLC, Instructor and Consultant, University of Wisconsin Sports Medicine

Advertising Materials Coordinator Mike Townsend Marketing Director Sheryl Shaffer

Mike Nitka, MS, CSCS Director of Human Performance, Muskego (Wisc.) High School Bruno Pauletto, MS, CSCS President, Power Systems, Inc.

Marketing/Sales Assistant Danielle Catalano

Stephen Perle, DC, CCSP Associate Prof. of Clin. Sciences, University of Bridgeport College of Chiropractic

Advertising Sales Associates Diedra Harkenrider (607) 257-6970, ext. 24

Brian Roberts, MS, ATC, Director, Sport Performance & Rehab. Ctr.

Pat Wertman (607) 257-6970, ext. 21

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

Ellyn Robinson, DPE, CSCS, CPT Assistant Professor, Exercise Science Program, Bridgewater State College

Lori Dewald, EdD, ATC, CHES Health Education Program Director, Salisbury University

Kent Scriber, EdD, ATC, PT Professor/Supervisor of Athletic Training, Ithaca College

Jeff Dilts, Director, Business Development & Marketing, National Academy of Sports Medicine

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P.J. Gardner, MS, ATC, CSCS, PES, Athletic Trainer, Colorado Sports & Spine Centers

T&C editorial/business offices: 31 Dutch Mill Road Ithaca, NY 14850 (607) 257-6970 Fax: (607) 257-7328 info@MomentumMedia.com

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

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

Bonnie J. Siple, MS, ATC Coordinator, Athletic Training Education Program & Services, Slippery Rock University

Boyd Epley, MEd, CSCS Director of Coaching Performance, National Strength & Conditioning Association

Chad Starkey, PhD, ATC Visiting Professor, Athletic Training Education Program, Ohio University

Peter Friesen, ATC, NSCA-CPT, CSCS, CAT, Head Ath. Trainer/ Cond. Coach, Carolina Hurricanes

Ralph Stephens, LMT, NCTMB Sports Massage Therapist, Ralph Stephens Seminars

Lance Fujiwara, MEd, ATC, EMT Director of Sports Medicine, Virginia Military Institute Vern Gambetta, MA, President, Gambetta Sports Training Systems

Fred Tedeschi, ATC Head Athletic Trainer, Chicago Bulls Terrence Todd, PhD, Co-Director, Todd-McLean Physical Culture Collection, Dept. of Kinesiology & Health Ed., University of Texas-Austin

Training & Conditioning (ISSN 1058-3548) is published monthly except in January and February, May and June, and July and August, which are bimonthly issues, for a total of nine times a year, by MAG, Inc., 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 $7. Copyright© 2008 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.

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Q&A Mark Stoessner Grand Valley State University When Mark Stoessner, MA, ATC, began work as Head Athletic Trainer at Grand Valley State University in June 2007, he knew a challenge lay ahead. The position had been vacant for five months. Before that, it had been filled by the much-loved Todd Jager, who succumbed to cancer in January 2007 after a 19-month battle.

The football team, which had won NCAA Division II titles in 2005 and 2006, was under pressure to keep its streak alive. The university was hoping to win its fourth consecutive NACDA Director’s Cup, and plans were underway to begin constructing a new athletic facility in the summer of 2008.

Determined to hit the ground running, Stoessner worked closely with administrators, coaches, and the current athletic training staff to make the transition as smooth as possible.

On the opening day of the football season, he passed his first test, helping treat four season-ending injuries. Since then, he’s made steady progress developing relationships with sport coaches, leading his staff, and ensuring optimal dayto-day delivery of athletic training services to 500 studentathletes competing on 19 teams.

Stoessner started his career in 1988 when he became Coordinator of Athletic Training at Northern Michigan University.

Thirteen years later, he moved to the University of Michigan, where he taught in the athletic training education program and worked as an assistant athletic trainer providing coverage for women’s basketball, men’s gymnastics, men’s tennis, men’s volleyball, and women’s water polo. By the time he left for Grand Valley State, he’d become Michigan’s Coordinator of Athletic Medicine and was a respected member of the Michigan Athletic Trainers Society (MATS), where he currently serves as vice president.

In this interview, Stoessner talks about the transition to his new job, the importance of being active in the profession, and the best way to defend against a lawsuit.

T&C: What was the athletic training program like when you started at Grand Valley State?

Stoessner: Todd had been very sick for a long time, and after he passed away, the department didn’t replace him until I came on board. He had had good days and bad days, and he’d been working around his treatment schedule.

TR AINING-CONDITIONING.COM

In Stoessner’s first football game at Grand Valley State, he treated four season-ending injuries for the NCAA Division II defending champions.

When he was diagnosed in May 2005, the department hired one of the graduating graduate students full-time, which meant there were two young athletic trainers running the show with a couple of grad assistants. Obviously they did a great job, because we won five national championships in that time. There was an effective system in place, with a lot of help from the administration, the coaching staff, and the medical community in the area. Everybody pitched in, which allowed the athletic trainers to handle the work.

How are you putting your stamp on the program?

My style is to provide supervision and support to my staff, but to also let them do their jobs. So I spent a lot of time last July getting to know the structure of the athletic training department by talking with Meghan Berry and Adam Buchalski, our two full-time assistant athletic trainers. We spent hours discussing how things had been handled in the past and whether we wanted to change anything.

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Q&A That helped a lot when I started developing a policies and procedures manual, and I got a ton of help from Meghan and Adam in establishing relationships inside and outside the department. In the last few years, a lot has changed in athletic training education, and without a head athletic trainer to communicate with the program staff, that needed some updating.

As a staff, not only do we have to provide quality health care for student-athletes, we also have to provide a quality educational experience for athletic training students.

I’ve spent a lot of time building relationships with the sport coaches. I ask them about their visions for their teams and for our athletic training services. Building good relationships with coaches begins with listening. You need to show you’ve bought into what they’re trying to do. Then, once you’ve developed trust, if you say an athlete can’t play, they’re ready to believe you.

Years ago, if a coach ranted at me, I ranted right back. It wasn’t a very successful strategy, so I now make sure to stay calm and not get into any shouting matches. I need to show them that their vision is important to me, because it’s a lot easier to get along with coaches than it is to fight them.

How did you prepare for the transition from assistant to head athletic trainer and from Division I to Division II? If you’re working at a Division I school like Michigan, you’re going to spend your time taking care of the team

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you’ve been assigned to 24/7. Coming to Division II, one of the biggest challenges I face is making sure every student-athlete has access to the same quality of care, which is something many smaller schools struggle with. For a Division II athletic program, we have a good sized staff and cover a lot of games. We’re well organized, with a weekly meeting to give the staff a chance to talk about things in an informal setting.

What was the most challenging rehab you had last season?

By the end of our first football game, we’d had three ACL injuries and a hip dislocation. I’d never treated a hip dislocation before. Our doctors reduced it on the field, and we got the player into the athletic training room, then quickly transported him to the ER. For six to eight weeks, we gave him very limited, non-weight bearing activity, just allowing the tissue to heal, and then we started working on motion and strength. We went from openchain exercises with cuff weights and bands to functional work as soon as he was able to tolerate it. He’s doing quite well today. He hasn’t played football yet, but he’s getting there.

What did you learn from working on a rehab you hadn’t experienced before?

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Q&A all, whatever it happens to be. For me, this rehab reinforced the idea that it’s the basics that really matter. If somebody is injured, he or she needs to regain range of motion, strength, and sport-specific function. Even with something as significant as a hip dislocation, it still comes down to that.

When did you know you wanted to become an athletic trainer?

When I was 13 or so, I fractured some vertebrae in my neck in a diving accident. My neck healed, but when I was a sophomore in high school, I reinjured it playing football. A much larger, stronger defensive lineman manhandled me and I ended up landing on my head. At the time, there was an athletic trainer at my school. He wasn’t a certified athletic trainer like we have nowadays, but he got me interested in the profession. By the time I started looking at colleges, I knew I wanted to become an athletic trainer.

I went to Bowling Green State University for my bachelor’s and Northern Michigan for my master’s. The head athletic trainer at Northern Michigan resigned just as I finished my master’s, and I was fortunate to move into the head athletic trainer position. I worked primarily with the football and ice hockey teams, and I taught a class on organization and administration. Teaching is a good way to stay current, because there’s nothing worse than having a 19-year-old ask a question you can’t answer.

At Northern Michigan, an athletic training education student sued you for gross negligence. What happened?

In ice hockey, the key is to watch the puck at all times, which is what I tell my athletic training students. We were on the bench at an ice hockey scrimmage, and a student didn’t see the puck coming. I remember ducking as I shouted, “Heads up!” He was standing next to me, and the next thing I know, he’s down in a heap. The puck had hit him right in the eye.

It was a horrific injury, and I felt very bad for him. He sued, saying we were grossly negligent to have him on the bench without a helmet. Fortunately, the legal system didn’t see it that way.

The day they served me the papers, I was up on a ladder painting my house. I immediately drove in to see my boss because I was so upset, and he said, “Welcome to the real world.” So I asked, “Have you been sued?” and he said, “Three or four times. It happens.” That was the start of a long process of depositions and meetings with university officials.

If I’d lost the lawsuit, I would have been in big trouble. But the suit never went to trial. It was thrown out at the local level and again on appeal. It was a very educational experience.

What did you learn?

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Q&A ■ Mark Stoessner Head Athletic Trainer, Grand Valley State University Vice President, Michigan Athletic Trainers Society Previous Positions: Coordinator of Athletic Medicine, University of Michigan, 2004-07 Assistant Athletic Trainer, University of Michigan, 2001-04 Coordinator of Athletic Training, Northern Michigan University, 1988-2001 Education: MS, Northern Michigan University, 1988 BS, Bowling Green State University, 1986

with the athletic training students, and we had video that showed this student was probably not looking at the right part of the rink. That was very important proof.

For the next year or two, I didn’t put students on the bench unless they were well-versed in hockey, but then I realized that wasn’t being fair to them either. We’d been doing things the right way before the injury, and we needed to continue doing them the right way.

What are the biggest issues facing the athletic training profession today?

We need to stop fighting the changes in athletic training education. We need to stop saying, “It wasn’t like this when I was in school,” and start adjusting to the way it is now, whether we like it or not. In the process of fighting, we’re only hurting ourselves. It’s great that young people want to move outside the traditional setting to work at clinics or hospitals, and I think we’re doing a good job preparing them for that.

But we may need to do a better job preparing them to work in a college setting. Traditional athletic training has gotten a bad rap because of the hours and misperception that pay is low. As educators, we need to make sure we’re painting an accurate picture of traditional athletic training as a viable career where you can also have a life and a family.

What do you tell students about juggling life and work?

I tell my students that this is more than just a job. If they’re going to succeed, they need to have a passion for it. I love what I do, but if I treated it like a job, I’d stop being effective.

However, I also tell them, when you’re working, make sure you’re focused at work, and when you’re at home, make sure you’re focused on your family. Make the most of the opportunities you have to be at home.

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As Vice President of MATS, what are you working on?

We had a state law passed at the end of 2006 to introduce licensure for athletic trainers. We’re still in the process of writing the rules, which we hope will be enacted in the next year or so. It’s a huge step, and it’s going to help the profession increase its role as allied healthcare providers. It will enhance opportunities for people who want to work in non-traditional settings and give employers more opportunities to hire athletic trainers. This process started more than 15 years ago, and people in MATS have been very involved from day one. This law wouldn’t have happened without them.

I was a certified athletic trainer for 17 years before I became active in MATS, and the biggest thing I’ve learned is that people who say they don’t have enough time to get involved are just making excuses. The current president of our organization is the Head Athletic Trainer at Michigan State University, and there aren’t a lot of jobs in athletic training as busy as his. Athletic trainers need to do a better job pumping up the profession. Too many spend time complaining about things when they could be adjusting, adapting, and getting young people excited about the profession.

What’s it like to be at a program that has won the Director’s Cup the last four years in a row?

It’s amazing. At the other places I’ve been, I used to wonder whether some of the kids were really hurt or if they were just tired because they weren’t winning. We don’t have that problem here. Everybody wants to be out there every day, and everybody’s goal is to win a national championship. Over the years, I’ve been with successful and unsuccessful teams, and it’s always more fun when you’re winning, that’s for sure. ■ T&C MARCH 2008

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Student

Sponsored by

Corner A special feature for your athletic training students

The Alumni Connection When it comes to making contacts, try starting with your school’s athletic training alumni.

BY ABIGAIL FUNK

A

s an athletic training student, you have chosen a career that is full of caring, helpful professionals—people who not only look after their patients, but also their peers. Whether a colleague needs a second opinion on a diagnosis, help dealing with a difficult workplace situation, or advice on how to ask for a raise, athletic trainers are always willing to help each other out.

However, you don’t have to wait until you’re part of the workforce to tap into this network. As a student, you can look to your school’s athletic training alumni for assistance in many different areas.

“There are several reasons to get in touch with alumni from your school,” says Peter Koehneke, ATC, Director of the Athletic Training Program at Canisius College. “The first and perhaps biggest reason is that one of those individuals may be in a position to hire you down the road or offer you a graduate assistantship.”

Alumni can also help you land an internship or facilitate an opportunity to shadow an athletic trainer. “We Abigail Funk is an Assistant Editor at Training & Conditioning. She can be reached at: afunk@MomentumMedia.com.

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T&C MARCH 2008

have many alums working in the NFL who offer summer internships,” says Vincent Stilger, HSD, ATC, Undergraduate Athletic Training Curriculum Coordinator at West Virginia University. “But it’s up to our students to get in contact with them to secure a position.

By not making that initial contact to inquire about an internship, students can miss out on a great experience.”

So how do you go about making the alumni connection? “One of the easiest ways is to start a mass e-mail group for all alumni and current students,” Stilger says. “The project involves doing legwork to find alumni, but everybody who was in the program knows somebody else who was, too. It will catch on and grow if you nurture it.

“We also have a newsletter to help build up our community,” Stilger continues. “It provides information about new hires, our newly accepted students, and recent graduates, as well as any awards or recognition our alumni have received.”

Iowa State University has a Web page where athletic training alumni can continually update their contact information. “We pay a little extra for the page off of our main site,” says Mary Meier, MS, LAT, ATC, Athletic Training Education Program Director.

“But it has been well worth it for both our alumni and current students. They log in with a user name and password, so only Iowa State students and grads have access.”

While e-mail and the Web are quick and easy—and a great way to make initial contact—face-to-face meetings are also important. “Get to a meet-

ing or convention,” Meier says. “It’s a requirement of our program that students attend two professional meetings in the time they’re here, but every student can and should get to a district, state, or NATA national meeting.”

Like many schools with athletic training education programs, West Virginia sets up an alumni party at the NATA Convention each year, to which undergrads are invited. “The trick is to not be shy,” Stilger says. “What do you have to lose by introducing yourself, talking about where you’re from, and so forth? You have an immediate connection through West Virginia, so go from there.

“I also encourage students to meet alumni whenever and wherever they can,” he continues. “I always like to hear that when a student of ours went to see an alum speak, they introduced themselves after the presentation.”

You can also take advantage of oncampus events involving alumni. Your school may have a general career networking night when all alumni are invited to attend, or your athletic training program may have its own department-specific event. And when one of your alums comes back as a guest lecturer, take a few minutes after the class to introduce yourself and thank them for coming to campus.

It may seem like a lot of work to go to a meeting, help start an e-mail mailing list or newsletter, and seek out alumni for an internship, but it’s time well spent. Your alumni are a part of your school’s past and your future, and it’s never too early to become part of their network. ■ TR AINING-CONDITIONING.COM

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TRAINING-CONDITIONING.COM Circle No. 103

NUTRITION

The Better to Heal You With

The latest research shows that certain dietary changes during rehab can help athletes control inflammation, heal more quickly, and get back into the game sooner.

BY DR. JOHN BERARDI & RYAN ANDREWS hen an athlete is injured, they’re usually eager to follow any protocol or strategy that promises to speed up the rehab process.

They’ll use specialized weightroom plans , come in for therapeutic massage, and try innovative modalities like light therapy or underwater training if they think it will hasten their return to action.

But one area that’s often overlooked is the rehabbing athlete’s diet. A growing body of research reveals that the consumption of certain types of foods, supplements, and even spices can influence how the body responds to inflammation and repairs tissue. That may sound surprising, but it makes sense—after all, food provides the building blocks for cells and influences the messages sent throughout the body to regulate blood flow, tissue replacement, and healing.

While many questions remain, there is now enough information to draw

©VEER IMAGES

W

TR AINING-CONDITIONING.COM

John Berardi, PhD, CSCS, is an Adjunct Professor at the University of Texas and is trained in exercise physiology and exercise nutrition. He is also President of Precision Nutrition. Ryan Andrews, MS, MA, CSCS, RD, LDN, is Director of Research for Precision Nutrition.

To contact the authors and read their nutrition blogs, go to: www.precisionnutrition.com.

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NUTRITION

NATURAL ANTI-INFLAMMATORIES

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ertain dietary herbs can be very beneficial in the first stage of injury recovery. By adding them to an athlete’s diet, you can do a lot more than spice up their entrees—you can help them control post-injury inflammation and decrease (or possibly even eliminate) their dependence on anti-inflammatory drugs such as NSAIDs. Turmeric, a flowering plant in the ginger family and a common ingredient in curry powder, has long been used as an anti-inflammatory agent and in wound healing. Current research shows that its active ingredient, curcumin, is at least partially responsible for these effects.

While adding curry powder to an athlete’s diet after injury is likely a good strategy, a turmeric extract supplement will have a greater effect because it provides a daily dose that even the most die-hard curry fans would find unpalatable in food.

Garlic has been shown to inhibit the activity of two inflammatory enzymes, cyclooxygenase and lipoxygenase. It also affects the function of macrophage cells, which help clear dead tissue from inflammation sites. Like with turmeric, adding more garlic to an athlete’s diet can be helpful, but supplementation will provide the most noticeable results.

The typical recommended dosage is two to four grams of whole garlic clove each day (each clove is about one gram) or 600 to 1,200mg of aged garlic extract.

Bromelain is another anti-inflammatory plant extract. It’s found in pineapple, and while best known for its digestive properties, it is an excellent anti-inflammatory and analgesic compound. It can be found in supplement form, and the typical dose for managing inflammation is 500 to 1,000 mg per day.

Flavonoids (compounds found in cocoa, tea, fruits, vegetables, and legumes) can also help manage inflammation, primarily through their well-known antioxidant properties. These powerful substances have the added bonus of affecting cell growth and the development of new capillaries, both of which are important for tissue regeneration.

Rehabbing athletes should be encouraged to eat more flavonoidrich foods, especially fruits, vegetables, and legumes. If they’re not interested in these dietary changes, flavonoids can be found in supplement form, such as blueberry and grape extracts, green tea extracts, and bioflavonoid supplements.

It’s important to note that you should always be careful and very specific if you recommend supplement use to an athlete. Since most athletes are looking for any competitive edge they can get, they may interpret a harmless message about a food supplement as a tacit endorsement of other, potentially dangerous performance aids. Certain supplements may also contain ingredients that run afoul of substance use rules, particularly at the college level. If an athlete focuses on eating the right foods, supplementation should only be necessary if inflammation becomes a major or chronic problem, at which point any anti-inflammation strategy should be discussed with a physician.

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some meaningful conclusions about how eating habits influence rehab and recovery. In this article, we’ll break down the research findings and translate them into suggestions for helping injured athletes eat their way back from injury.

INFLAMMATION CONNECTION Most athletic injuries follow a consistent pattern of healing that includes three stages: inflammation, proliferation, and remodeling. As researchers have developed a better understanding of the mechanisms involved in each stage, they have identified some stagespecific physical needs for which diet plays an important role.

The initial stage, inflammation, remains the subject of considerable debate. We don’t know exactly how inflammation aids the healing process, but it’s generally thought to be helpful unless it’s so excessive that it causes further tissue damage. The most common theory is that increased blood flow brings extra white blood cells to the injured area, thereby jump-starting the rebuilding of tissue.

During the post-injury inflammation period, which typically lasts four to five days for soft tissue injuries and up to three weeks for bone injuries, research has shown that dietary fat is a key factor. We now know that a diet high in trans-fats, omega-6 rich vegetable oils, and saturated fat promotes inflammation, while a diet high in monounsaturated fats and omega-3 fats inhibits inflammation. In addition, a diet that provides an equal balance of saturated, monounsaturated, and polyunsaturated fats (about one-third each) has been found to promote a healthy inflammatory response.

What does this mean for an injured athlete? Because injury leads to a natural inflammatory response, a diet that further enhances inflammation should be avoided. Research suggests it’s a good idea for athletes to decrease their omega-6 intake and increase omega-3 intake post-injury to help manage inflammation. A high omega-3 to omega6 ratio has also been found to increase collagen deposition, further promoting healing.

In terms of practical advice, some study authors recommend that injured athletes, especially during the inflammation stage, consume anywhere from three to nine grams of fish oil per day TR AINING-CONDITIONING.COM

NUTRITION because of its high omega-3 content (good choices include salmon oil, sardine oil, menhaden oil, and krill oil).

Omega-3 rich foods, such as flax seeds and flax seed oil, walnuts, hemp seeds, perilla oil, salba, green leafy vegetables, salmon, sardines, and other oily fish are also recommended.

At the same time, the athlete should scale back on omega-6 in the diet, which comes mainly from vegetable oils such as corn oil, sunflower oil, safflower oil, cottonseed oil, and soybean oil. These oils are frequently used in crackers, potato chips, and other snack foods, and can also be found in meat from corn-fed animals.

In addition, research has shown that increased consumption of nuts, seeds, and olive oil can mildly reduce inflammatory biomarkers. These foods contain compounds known to reduce COX enzyme activity, giving them an effect similar to ibuprofen. However, it’s worth repeating that some degree of inflammation is beneficial after injury, so any dietary increase in these foods should be moderate at most.

When it comes to fat balance, an easy

strategy for approaching a 1:1:1 ratio of saturated, polyunsaturated, and monounsaturated fats is to balance the saturated fat naturally present in many protein-rich foods with unsaturated fat-containing foods like olive oil, mixed nuts, avocados, flax seed oil, ground flax, and other seeds. However, to avoid unwanted weight gain, athletes should be careful not to overindulge in these fattier foods, especially if their activity level has decreased because of injury.

Certain spices and phytochemicals can also affect an injured athlete’s inflammation response. For details on which ones and how they work, see “Natural Anti-Inflammatories” on page 14.

HEALING FUEL After the inflammation stage, the focus of rehab nutrition shifts and energy intake becomes a top priority as the body begins its proliferation and remodeling processes. When an athlete is healthy, energy needs are obviously high due to their activity level. After an injury, athletes often feel tempted to

drastically reduce energy intake—they might believe that restricting calories is the only way to avoid unwanted weight gain, or they might simply not feel as hungry because they’re less active. But energy needs are quite high while the body repairs itself, mainly because of post-injury hormonal changes and the physical requirements of new tissue formation.

Specifically, basal metabolic rate (BMR) may increase by 15 to 50 percent after injury, depending on the severity of the trauma. Most injuries and minor surgeries raise BMR by 15 to 20 percent, while major surgery may lead to a 50 percent increase.

When trying to determine energy needs during recovery, it’s important to consider this increased demand. Here is an example of how to calculate appropriate energy intake: Athlete: Male, 19 years old, 5’9”, 180 pounds Basal Metabolic Rate: 1,826 kcal/day (based on the mean of three predictive equations)

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NUTRITION Energy needs when sedentary: 2,191 kcal/day, based on activity factor of 1.2 (BMR x 1.2) Energy needs with daily training: 3,104 kcal/day, based on activity factor of 1.7 (BMR x 1.7) Energy needs post-injury: 2,629 kcal/day, based on activity factor of 1.2 and a 20 percent increase in metabolism due to injury recovery (BMR x 1.2 x 1.2) Thus, while optimal energy intake during recovery is lower than during full activity, an athlete will be underfueling if his or her intake does not account for the physical needs associated with injury repair. Depending on their post-injury activity level, an athlete’s appetite may decrease significantly, but they must be encouraged not to undereat, as this can slow the rehab process and lead to other unwanted effects, such as loss of lean body mass.

During the proliferation and remodeling stages, macronutrients also play a key role. And not surprisingly, protein

is one of the most important.

The standard clinical recommendation for protein intake in healthy individuals is 0.8g per kilogram of body weight per day. As the body repairs damaged tissue, protein is extremely valuable, so research indicates that rehabbing athletes should strive to eat at least 2.0g per kilogram of body weight per day.

The carbohydrate picture is quite a bit cloudier. It’s well established that glucose

sciously restricting their carbs for weight loss or any other reason.

ROLE OF MICRONUTRIENTS In all stages of injury recovery, vitamins A, B, C, and D, as well as calcium, copper, iron, magnesium, manganese, and zinc can play vital supporting roles.

(Interestingly, research suggests vitamin E may slow healing, so it should be avoided during rehab.) However, the

Vitamin A supports early inflammation after injury, and helps reverse post-injury immune system suppression. It also assists in collagen formation, and studies have shown that supplementation strengthens collagen cross-linkage and speeds repair. is necessary for injury repair, and consistent carb intake also helps to stabilize insulin concentration in the bloodstream, which may impact wound healing. But no specific carb recommendations have yet been established for post-injury periods. At this point, the best strategy is simply to make sure athletes are not con-

research isn’t clear on exactly why all these micronutrients are helpful. For that reason, we will limit this discussion to those that are best understood and most likely to require supplementation in an injured athlete’s diet.

Vitamin A supports early inflammation after injury, and helps reverse post-

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NUTRITION injury immune system suppression. It also assists in collagen formation, and studies have shown that supplementation strengthens collagen cross-linkage and speeds repair. Typically 25,000 IU (international units) daily is recommended during short periods after serious trauma or surgery, but continuing this dose for too long can lead to toxicity, so it’s wise to consult a physician.

With sports injuries, supplementation with 10,000 IU daily for the first one to two weeks post-injury provides a safe level that may enhance healing but will not lead to vitamin toxicity.

Vitamin C enhances neutrophil and lymphocyte activity during the inflammation phase, and also plays an important role in collagen synthesis as it assists in the formation of bonds between strands of collagen fiber. With vitamin C deficiencies, collagen fibers are formed abnormally and fibrous tissue is weak with poor adhesion. In addition, vitamin C acts as a powerful antioxidant and immune system modulator.

For these reasons, research suggests that supplemental vitamin C can be beneficial after surgery or injury. One to two

grams per day is the typical recommended dose, but only for limited time spans—if this dose is continued longterm, side effects like diarrhea and gas-

is one of the most common micronutrient deficiencies, supplementation of 15 to 30 milligrams per day is recommended, especially during the initial stages

Zinc is required for over 300 enzymes in the body and plays a role in DNA synthesis, cell division, and protein synthesis, all of which are necessary for tissue regeneration and repair ‌ Supplementation of 15 to 30 mg per day is recommended, especially during the initial stages post-injury. trointestinal disturbances may result.

Copper is a mineral that assists in the formation of red blood cells and acts in concert with vitamin C to form elastin and strengthen connective tissue. Two to four milligrams per day is recommended during the first few weeks of injury repair.

Zinc is required for over 300 enzymes in the body and plays a role in DNA synthesis, cell division, and protein synthesis, all of which are necessary for tissue regeneration and repair.

Zinc deficiency has been associated with poor wound healing, and since it

post-injury.

Besides all these, supplemental amino acids may also exert powerful effects on healing, primarily by speeding up the tissue repair process. In one study, the combined administration of 14g arginine, 3g HMB, and 14g glutamine in two divided doses for 14 days significantly increased collagen synthesis in adults. However, most of the research on this application of amino acids has studied elderly or hospitalized subjects, so the relevance of these findings to the athletic community is unknown. Still, there is some evidence that arginine,

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NUTRITION HMB, and glutamine in particular play a role in healing by stimulating collagen deposition.

The take-home message for injured athletes when it comes to the entire family of micronutrients is this: With the exception of vitamin E, moderate supplementation of key vitamins and minerals may significantly aid the rehab process. Because vitamin A, vitamin C, and multivitamin supplements are inexpensive and safe if used properly, they are a responsible addition to any post-injury nutrition strategy.

PRACTICAL APPLICATION So how do you turn all this information into real meal solutions for rehabbing athletes? Try having them follow these dietary guidelines when recovering from an injury.

Frequency: Eat every two to four hours.

Protein: Each meal should contain complete protein, including lean meats, lean dairy, eggs, soy products, or a protein supplement if whole food is not available.

You’ve probably observed many athletes who could stand to improve their dietary habits. In most cases, the rehab process provides a great opportunity to address nutrition with these individuals.

Vegetables and Fruit: Each meal should contain one to two servings of vegetables and/or fruit.

Starches: Additional carbohydrates should come from whole grain, minimally processed sources like whole oats, yams, beans, whole grain rice, or quinoa. Athletes can slightly reduce their intake from this category during rehab, and eat more as soon as they return to active training.

Fats: Athletes should choose from among these “good” fats each day to promote a healthy balance of fat types: avocadoes, olive oil, mixed nuts, flax seeds, and flax oil. In addition, three to nine grams of fish oil should be added to their daily diet.

Supplementation: A multivitamin or other vitamin tablets can be used to supplement micronutrient intake. Natural supplements with anti-inflammatory properties (such as garlic extract, turmeric extract, or bromelain) can also be considered, but should always be used with caution. (See “Natural AntiInflammatories” on page 14 for more information.)

FAMILIAR ADVICE It may have occurred to you that many of the nutrition strategies discussed in this article would be sound advice whether an athlete is injured or not. And you’re right. Biological needs change somewhat when the body is repairing itself and recovering from injury—especially during the inflammation stage. But for the most part, good nutrition is good nutrition.

You’ve probably observed many athletes who could stand to improve their dietary habits. In most cases, the rehab process provides a great opportunity to address nutrition with these individuals. After an injury, athletes are more focused on their physical needs and interested in anything that can help get them back onto the field, court, rink, or track. When they see the benefits of improving their nutritional profile, they may end up changing their habits for the long run. ■ Circle No. 112

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“The Portable VersaPulley adds both eccentric and concentric resistance to an athlete’s workout,” said George Morrison, a wellknown conditioning coach who works with several top professional and amateur athletes.

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Morrison uses the PVP for all types of sportspecific footwork and lateral training. “I use it to apply resistance to lateral drills like the three-step step over, side shuffles and backsteps—even with sprint drills,” he said. “I also add more resistance to the drills by hooking an X-Vest (#1 weighted vest) to the Portable VersaPulley.

A Portable Workout Station for All Sports The PVP’s lightweight, compact design, and ease of mobility is ideal for on-the-field or on-the-court training. You simply secure the PVP with adjustable straps or field stakes; it can also be permanently secured to walls or floors. While the PVP weighs just 60 pounds, its patented technology can produce up to 400 pounds of resistance. Thanks to the Portable VersaPulley, a strength and conditioning coach now has the ability to easily hand-carry this equipment to any location whether it be a football field, tennis court, baseball field etc. basically any setting where athletes are training can now apply a multitude of safe, sport-specific, multiple plane, power enhancing training drills.

The PVP combines speed, power and functional mobility through any range of motion with accommodating inertial resistance at any

Morrison gives two examples of how the PVP can be used with football conditioning drills.

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the quarterback work on maintaining the proper footwork for the drop while becoming fatigue.

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COMPARISON OF JOINT KINETICS DURING FREE WEIGHT AND FLYWHEEL RESISTANCE EXERCISE LOREN Z.F. CHIU AND GEORGE J. SALEM Journal of Strength and Conditioning Research, 2006, 20(3), 555–562 2006 National Strength & Conditioning Association

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Power Base Trainer Exercises designed by Power Systems Education Department

EXERCISES WITH THE BASE TRAINER (Using the Power Builder™) WARM-UP Warm up your muscles with at least 10 minutes of movement, such as walking or riding a stationary bike. Follow the warmup by stretching all your major muscle groups for 20-30 seconds each. Follow the same stretching routine for a cooldown after each workout. Time or distance of the run should be determined by your coach or athletic trainer.

Forward Run/Back Pedal START: Securely fasten the Power Builder around the waist and to the loop on the Base Trainer. Face away from the stand. The tube should be behind the back.

ACTION: Run forward until there is considerable tension on the tube of the Power Builder. Stop and back pedal (backward run, low in the hips) to the stand. Note: There will be resistance as you run away from the stand and assistance from the tube as you back pedal to the return.

Back Pedal/Forward Run START: Securely fasten the Power Builder around the waist and to the loop on the Base Trainer. Face the stand. The tube should be positioned in the front of the belt/stomach.

ACTION: Back pedal (backward run with low hips) until there is considerable resistance on the tube. Forward run back to the stand. Note: There will be resistance as you back pedal away from the stand and assistance from the tube as you return with the forward run.

Side Lunge START: Secure the Power Builder around the waist and to the Base Trainer. Turn so that the side of the body faces the stand. Move away from the stand until there is tension on the tube. Stand with feet roughly hip-distance apart and knees soft.

ACTION: Keeping the chest lifted, step out wide with the outside foot; bend the outside knee and keep the inside leg straight. Lower the body into a one-legged squat/side lunge. Keep the outside knee over the ankle and do not allow it to protrude past the toes. Stand, straightening the outside leg, and push off the outside leg to return to the start. Repeat on the same leg. Change to the other side and do a second set.

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Lunge START: Fasten the Power Builder around the waist and to the Base Trainer. (Tube should be positioned on the back of the waist.) Face away from the stand. Walk out from the stand until there is tension on the tube.

ACTION: Keeping the back to the stand, lunge forward with the left leg. Keep the front knee over the front ankle, making sure the knee doesn’t go past the toes. There should be a roughly 90° angle on the front knee. Return the left foot to the start. Repeat on the right side. Alternate lunges until there is fatigue in the legs. Return to the stand to remove the belt.

Lateral Shuffle START: Securely fasten the Power Builder around the waist and to the loop on the Base Trainer. Turn the belt so that the tube is positioned on the side of the body. The side of the body with the tubing should face the stand.

Push the hips back, sitting low into the legs. Chest remains lifted and weight is in the balls of the feet.

ACTION: Staying low in the legs, perform a lateral shuffle by moving the outside foot away from the Base Trainer and then moving the inside foot closer to the outside foot. Repeat, alternating the outside and inside feet. Travel until there is considerable tension on the tube, and return to the start the same way. Repeat. Do a second set after changing the belt to face the opposite direction. There will be resistance as you move away from the stand and assistance as you move toward it.

Jump Squats START: Secure the Power Builder™ around the waist and to the Base Trainer. (Tube should be positioned on the back of the waist.)Face away from the stand. Walk out from the stand until there is tension on the tube. Stand with the feet hip-distance apart, chest lifted, and knees slightly bent.

ACTION: Pushing the hips back and the weight into the heels, lower the body into a squat.

Knees should remain over the ankles and not protrude past the toes. Lower until glutes are at roughly knee level—no lower. Explode up from the squatted position, jumping as high as possible. Land with knees bent. Reposition the body and repeat.

Author Tim Wakeham goes over a chart with three of his head sport coaches at Michigan State: Rowing Coach Matt Weise, Volleyball Coach Cathy George, and Softball Coach Jacquie Joseph.

KELLY GILLESPIE, LOOKING GLASS PHOTOGRAPHY

OPTIMUM PERFORMANCE

On the

Same Page How do you deal with sport coaches who question your workouts, want to try all the new fads, and are always looking for an edge?

By getting on the same page with them.

BY TIM WAKEHAM

I

f you’re a strength and conditioning coach who works with ambitious sport coaches, you’ve heard these requests: “That school won a national title after doing this type of training—I’d like our team to try it” … “I just read about a new type of strength equipment—let’s get it for our program” … “An expert I know says we should incorporate this latest trend into our workouts—why aren’t we?”

Your first response may be to tell the sport coach to back off. You are the strength coach and you know what you’re doing. You know what’s best for the athletes. Or you may quickly do as the sport coach asks, pulling your hair out in frustration.

In my 16 years as a strength and conditioning coach, I’ve worked with a diverse array of sport coaches and heard every request you could think of. One coach wanted to prescribe 30 as the repetition target for every weight training set. I’ve seen a superstitious hatred of the bench press. Another coach asked whether athletes really need to lift their legs.

What I’ve learned along the way is how to get these coaches—no matter their philosophy or style—to work with me. If I had to name my greatest accomplishment at Michigan State, it would not be titles won or individual athlete’s achievements. It would be the strategies

TR AINING-CONDITIONING.COM

I’ve created that elicit unyielding trust, loyalty, and faith from the sport coaches, instead of turf wars.

Working successfully with sport coaches takes communication, an open mind, and professionalism in everything you do. It means being a leader, a negotiator, and a great strength coach.

It takes time and effort. But it’s all worth it because your athletes will be the winners in the long run.

BEING A LEADER While the head sport coaches at your school may want to have power over every aspect of their program, that doesn’t mean you can’t be in command of the strength and conditioning program. In fact, one of the most important elements of garnering support from coaches is showing strong leadership of your department.

Many people think being a leader means being tough and having strong opinions. But I’ve found that it has more to do with being a consummate professional. Someone who has well thoughtout plans and goals, has done his or her homework, and can articulate the pros and cons of arguments in the field will be seen as a trusted leader.

Here at Michigan State, we begin with a clear mission, which is “to create and lead a safe, engaging, purposeful training environment and experience.” Why

focus on the environment and experience? We have seen that an engaging environment makes athletes want to come to the weightroom. Most of our athletes like coming to train with us—yes, even the females. Don’t get me wrong, hard work is still hard work, but in between the nausea-inducing efforts is designed engagement and even fun.

The overall experience my staff and I sell is purposeful, gratifying, and seriously intense. The tools that we use are caring, “wow” factor, science, and challenge. The results are increased concentration, competitiveness, confidence, and dominant team performances. I sell these outcomes on a daily basis. To me, that is part of being a leader.

My philosophy for strength improvement is progressive overload using mostly multi-joint, multi-set, multimode exercises and moving through multiple planes. To improve power, I use maximum effort to develop force as quickly as possible, using sport movements with optimal efficiency and precision. For conditioning enhancement, I believe in progressive overload of sportTim “Red” Wakeham, MS, SCCC, CSCS, is Director of Strength and Conditioning for Olympic Sports at Michigan State University, where he has worked since 1996. He can be reached at: wakeham@ath.msu.edu.

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OPTIMUM PERFORMANCE specific energy systems using sport- and position-specific movement patterns. I use an average of five modes of equipment in each workout along with various speeds, repetitions, and set schemes,

ed to give athletes a variety to choose from. Our athletes have fun with such choices as the King of Kings, Iron Man, Everest Champions Prepare, Top Gun, the Ultimate, Le Tour de East Lansing,

As a result of our menu approach, athletes perform purposeful workouts and take ownership of their choices.

The sport coaches see us as professionals because we design programs for different teams and make the work engaging. including timed circuits. These philosophical underpinnings never change, even as their applications constantly change to fit individual situations or provide engagement.

FULL MENU Our weightroom contains a little less than 7,000 square feet of space, so we do not have a lot of each type of equipment. But I make sure to have some of each type. The best Olympic strength coaches are like master chefs, who can provide a menu from which all the different sport coaches can confidently order. In my opinion, everything should be on the menu. If the volleyball players, rowers, gymnasts, wrestlers, swimmers, and baseball players are all following the same HIT or Olympic lifting program, it will be hard to convince the athletes and coaches that you’re prescribing something that is ideal for and specific to their sport.

Our “menu” is placed in a large red binder that sits on the front desk in our weightroom. It contains each team’s strength/power workouts, 38 sportspecific conditioning workouts, mini workouts that we use to correct neural inhibition and flexibility problems, pictures of our yoga poses, and myofascial release exercises.

We use Swiss ball exercises for the gymnasts, timed circuits for the wrestlers, platform lifts for track and field, and Keiser power jumping exercises for the volleyball players. There are weighted pulley sprints for the field hockey players, tri-planar shoulder movements for the swimmers, acceleration wall and band exercises for the soccer players, Frankenerg suspension exercises for the rowers, and ground-based push-pull rotation exercises for the baseball and softball players.

Each conditioning workout is cod24

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and the Determinator, to name a few.

As a result of our menu approach, athletes perform purposeful workouts and take ownership of their choices.

The sport coaches see us as professionals because we design programs for different teams and make the work engaging. A huge binder of prescriptions

makes it clear that my staff and I have done our homework and are prepared for whatever needs they have.

A STEP AHEAD Being a leader also means you are a step ahead of the competition. And in our world, that means having the latest, cutting edge equipment. We have Woodway treadmills, Scifit bikes, StairMaster steppers, FreeMotion and Keiser pulley machines, Power Lift platforms, racks, and glute/hams, and Hammer, Prostar, and Nautilus machines. We have a two-lane 25-yard running area, three band stations, ropes, chains, slide boards, sandbags, hurdles, bungee cords, Bulgarian bags, bullet belts, foam rollers, BOSU balls, Swiss balls, and medicine balls.

I choose new equipment based on whether its implementation falls in line with our mission: Will it help us create and lead a safe, engaging, purposeful

STAFF SUPPORT For those of us fortunate enough to have a staff (or some graduate assistants to help), it is important that these people follow our lead in working with sport coaches. That means part of our leadership role is being an effective supervisor, often without a lot of time for staff training.

Here at Michigan State, I coordinate the training of 17 teams with one full-time assistant, one intern that turns over every year, and one graduate assistant that turns over every two years, so there is a lot of pressure on my staff members to learn the system quickly. To ease the learning curve, we have an employee manual that contains the following: • my mission statement • my leadership, management, coaching, and training philosophies • my standards and boundaries • scripts and checklists of how to provide each and every service.

The scripts can be immensely helpful for new hires. Some of our scripts include: • opening and closing procedures • how to train an athlete one-on-one • how to coach the room • how to lead a conditioning session • what to say to recruits • how to discipline • how to handle an emergency.

I believe that what you value you measure and what gets measured gets done. Based on this, I have an accomplishment board for my staff. On the board I tally the number of athletes each staff member personally brings through their workout. My staff is also assessed on how many times they consult with their sport coaches.

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OPTIMUM PERFORMANCE training environment and experience?

A new piece of equipment may not train the athlete better than the old piece of equipment. But if it allows the perception of gaining an edge over the competition and engages the athlete in a new way, it has value.

By the time a coach or group of athletes hears about what the Joneses are doing, we’ve already been doing it for months. That shows we are a step ahead. Additionally, I pay attention to what the gurus and self-proclaimed experts come out with each year and implement some of their suggestions. I think it’s important to embrace some of the guru knowledge if you can make it safe and purposeful within your framework, especially if you have a sport coach who has bought into it.

Being on the cutting edge also means incorporating new techniques that may not be on a coach’s radar screen. For example, we have a goal of decreasing non-contact ACL injuries in our female athletes through a prevention program that I designed while researching and writing a book chapter on the subject.

Another idea we’ve put into place

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is assimilating our incoming freshmen faster. We created a password-protected Web site, through which MSU Spartans from around the world have access to all our strength, power, and condition-

coaches serve the sport coaches. The first rule of negotiation is to get the other party what they want. The days of responding to sport coaches with, “This is my philosophy. I don’t tell you

I’ve come to realize that the “let’s implement the latest trend” visits should be expected … To this end, I am open to all ideas and embrace most of the crazy new trends, as long as I can bracket them with my philosophies. ing workouts, nutrition slides, training guidelines, movies of exercises, and video clips of our athletes training. Our incoming freshmen who have signed a National Letter of Intent have access to “training the Spartan way” months before they get to campus.

NEGOTIATE WELL When sport coaches see you as a professional, it goes a long way toward getting them to listen to your views. The next step in gaining their support is to be an expert negotiator.

My formula for success is to first and foremost know who you serve. Strength

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how to coach so don’t tell me how to train,” are over.

In fact, I’ve come to realize that the “let’s implement the latest trend” visits should be expected. In their quest to gain a competitive edge, more and more sport coaches are being influenced by the latest testimonial or marketing gimmick. It’s their job to be a step ahead of the competition. And if they don’t think your program is working, it’s their right to question you about it.

Strength coaches should be loyal confidants and trusted colleagues to sport coaches. The way to establish trust is to hear coaches out, understand them,

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OPTIMUM PERFORMANCE and empathize with their reality. While there are still times when a sport coach’s ideas make me think to myself, “Are you serious?!” I have learned to take a

es, and I was hesitant at the time. Most strength coaches I knew were staying big and basic with the usual multi-joint exercises. However, the first step in ne-

Behind closed doors I may not always agree with my coaches’ perception of an issue. However, I make sure to be respectful and then always support the coaches’ final decision. When the door opens from our meetings, nobody backs the head coaches more than I do. deep breath and say to myself, “If I’m going to be as good as I aspire to be, I have to be able to make the right plan but also make any plan right, no matter how crazy I might believe it is at first glance.” To this end, I am open to all ideas and embrace most of the crazy new trends, as long as I can bracket them with my philosophies.

When I first started at Michigan State, our women’s gymnastics strength program consisted of free weight and machine exercises. The gymnastics coaches and athletes asked for the inclusion of Swiss ball and band exercis-

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gotiation is getting the other party what they want. I threw in a couple of Swiss ball and band exercises. To ensure purposefulness, I bracketed them with our overload system.

The result? I witnessed magic. The women were much more engaged. The simple addition of two new modes added fun, which made it easier for me to inspire them to work hard on the free weight exercises. Everybody won.

Meeting with new sport coaches is a critical task. I ask them for the specific results they would like to see, and after listening closely, I state that I can

get the outcomes they want. I mention that it has worked well for us in the past when the sport coach allows me to have control over the steps needed to accomplish our goals. I add that if the results aren’t achieved after a reasonable period of time, I will welcome and embrace any and all changes that the head coach wants to make.

Overall, I am striving to build a trusting and cooperative relationship with each sport coach. With that in mind, I drop by and share conversations one or two times every week with the coaching staffs that fully embrace our services.

I make sure to listen, as well as empathize with them.

I am also boldly honest on all issues—whether they relate to strength and conditioning or not—and so are the coaches. Behind closed doors I may not always agree with my coaches’ perception of an issue. However, I make sure to be respectful and then always support the coaches’ final decision. When the door opens from our meetings, nobody backs the head coaches more than I do.

I have only had one coach over the last 16 years hire an outside consultant,

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OPTIMUM PERFORMANCE and that was for Pilates. Our coaches don’t feel the need to look beyond our weightroom, because by the time they stop by to discuss the newest flavor of the month, we’ve usually already implemented it. But even if my sport coaches wanted to hire an outside consultant for a service that I wasn’t offering, I wouldn’t be offended. I have far too much to do to fight a turf war. I welcome all the outside expertise I can get, as long as we continue to work as a team.

APPEALING TO ATHLETES Another huge part of getting coaches on your side comes through implementing a strength training program that appeals to athletes. If your athletes trust, support, and believe in you, their coaches will, too. That’s why we expend a lot of effort implementing what I call “front stage” elements that elicit a “wow” response from athletes and keep them coming back for more. My staff and I work to push every motivational button an athlete has.

Many of these elements are visual.

Upon entering the Spartan weightroom,

you walk over a six-by-four foot Spartan block “S” that is carved into the rubber flooring. Directly behind our front work station is an immense eightby-four foot presentation of a Big Ten championship ring with large raised silver letters alongside it that spell out “ONE FOCUS.” I want to make sure our athletes know that we don’t train because we love training—we train because we love winning. Additionally, we

complished. The purpose was to help develop a Spartan tradition of team cohesiveness and school camaraderie.

On another wall we have an enormous eight-by-four foot signature strength board. I created this to provide clarity regarding how I hope Spartan teams will overcome obstacles and ultimately win. We use conditioning levels as our signature strength because conditioning affects body composition,

If I judge that an athlete consistently demonstrates the attributes for entry into the House of Sparta, they are awarded an antique polished silver key sculpted into the Spartan helmet on one end and our block S on the other.

It is highly coveted. have a large eight-by-six foot “Strength and Power” banner and team pictures of our athletes dominating in their particular sports.

To the left of each exit, I added a large raised and polished silver block “S” that every Spartan touches on their way out after their work has been ac-

injury rate, skill execution, and overall performance, and it can be measured.

Athletes can achieve three different levels: Warrior, Hall of Fame, and Legend.

A majority of team slots are filled with proud and confident Spartans.

I also wanted a “neck-up” standard for our athletes to strive for, so I wrote

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OPTIMUM PERFORMANCE a story about what I call the “House of Sparta.” On one of our pillars, in a four-by-four foot frame under polished glass, is a magnificently presented old scroll. On the scroll is the faded picture of an immense castle on a hill. Printed in an old-fashioned typeface is the story of the House of Sparta and the standards needed to gain entrance, such as focus, embracing pressure and responsibility, sacrifice, and commitment.

If I judge that an athlete consistently demonstrates these attributes, they are awarded an antique polished silver key

sculpted into the Spartan helmet on one end and our block S on the other. It is a beautiful symbol that can be put on a key chain or worn as a charm, and it is highly coveted.

The Navy Seals have a bell that is traditionally rung when someone drops out of a training class. I turned the idea around 180 degrees. We bought a 13inch polished silver bell engraved with the Navy Seal quote, “It Pays To Be A Winner,” and hung it in the middle of our weightroom. When an athlete does the ordinary exceptionally well

and in accordance with our standards and goals, they are bestowed with the honor of ringing the bell. The standards are high but the honor is lasting, and so is the engagement derived from the bell ringing.

We have four 32-inch flat screen monitors that hang down into our training environment, displaying messages on nutrition education and some general sports psych suggestions and quotes.

This is a new and fun way to provide our athletes with information, and it seems to be working. Last week when I was getting in my car to drive home, an athlete rode her bike past me and said, “I’m going home to eat a rainbow.”

One of our slides suggests eating a rainbow of colors to increase nutrient density. The athletes can mock me all they want, as long as I know they’re learning the information.

The monitors also include informational slides regarding my philosophy.

It is my belief that people buy into the leader before they buy into the leader’s vision. These slides let everyone clearly know what I stand for and the vision I have for our training environment.

TAKING ON THE CHALLENGE Leading a strength and conditioning program today is a challenge. The sport coaches are under pressure to win now.

The marketers and gurus are constantly trying to sell their latest and greatest approach or equipment. The strength and conditioning coaches are under pressure to craft a happy experience while magically creating athleticism. I admire all strength coaches who take up the battle.

Creating unyielding trust and enthusiastic loyalty for strength and conditioning requires many strategies. Showing your sport coaches you are a professional and a leader, learning to negotiate with them, and making the experience engaging for athletes are all parts of the challenge. If we can accomplish these goals, we will go a long way toward establishing our credibility and value in the world of competitive athletics. ■

To read the story of the “House of Sparta,” please visit: www.Training-Conditioning.com/ sparta.html.

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TREATING THE ATHLETE

Pooling Resources Aquatic therapy creates dynamic, controlled resistance.

Biofeedback offers quantifiable information about muscle function. Together, they allow athletes to begin rehab in a supportive, pain-reducing environment.

BY RON FULLER

I

A NATURAL COMBINATION On land, therapists and athletic trainers utilize surface EMG biofeedback to target specific muscle groups when they want to address weaknesses, relax tight or overworked muscles, and correct dysfunctional muscle postures and movements. Armed with specific information about what the targeted muscles are doing, the therapist and the athlete can better understand whether specific movements and corrective exercises are achieving their goals and how they can be altered to work even better.

EMG biofeedback works by exposing what a muscle is doing. It involves a locally attached sensor, typically a small needle or a surface electrode, that can detect “electrical potential” within muscle tissue to determine how hard it is working. Today, powerful handheld EMG biofeedback units provide information about the musculoskeletal system that earlier generations of athRon Fuller, PTA, is the Director of Aquatic Rehabilitation for Elliot Health Systems in Manchester, N.H., and an adjunct faculty member at Franklin Pierce College, where he teaches aquatic physical therapy and advanced orthopedic techniques. He is on the teaching faculty of Aquatic Consultants of Georgia and the clinical faculty of the Biofeedback Foundation of Europe. He can be reached at: rfuller101@comcast.net.

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FIGURE PHOTOS: RON FULLER, WATER IMAGE: BIG STOCK PHOTOS

f you’ve been in the athletic training or physical therapy world long enough, you’ve no doubt met athletes who come in looking for a miracle cure, an instant fix, or the “one treatment and I’m ready to go back in” remedy. As highly trained professionals, we know that rarely—if ever—is there a single cure-all that will live up to those expectations.

But every once in a while, something comes along that represents true progress in that direction. Whether it’s a new treatment, a new application for an old treatment, or a combination of protocols that have never been tried together, we are always on the lookout for ways to give our rehab patients better outcomes.

I have enjoyed great success combining electromyography (EMG) biofeedback with aquatic therapy. On their own, each modality has proven itself to be a credible and effective training tool. Together, I believe they enhance one another in exciting ways. Since I’ve implemented this pair of modalities into my practice, they’ve taken my clinical treatments to a new level.

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TREATING THE ATHLETE letes could only dream of knowing. As a result, rehab and training techniques can be more focused and deliberate.

How do you enhance those benefits?

Just add water.

By combining EMG biofeedback with aquatic therapy, I’ve witnessed a whole new realm of possibilities. The natural properties of water—buoyancy, hydrostatic pressure, and resistive drag—allow me to strengthen, relax, and correct musculoskeletal deficiencies in a more supportive, pain-reducing environment. The biggest advantage to combining these two therapeutic tools is that it allows me to start the rehab process sooner and return my patients to their previous level of function more quickly.

As a rehab tool, aquatic therapy offers several well-documented advantages, primarily because it allows for highly customized workouts. Water can unweight the body to varying percentages depend-

ing on the depth of immersion—the deeper the water, the lower the weight burden. As a result, joint compression can be decreased to make exercise less painful, particularly when rehabbing a joint injury or following surgery.

The turbulent drag created by the water allows athletes to modulate the resistance of the exercise to whatever degree of effort they can tolerate. In this highly dynamic workout environment, resistance is applied in virtually every plane of movement, and can be adjusted by altering the movement speed and direction.

The fundamental principles of aquatic biofeedback are not complicated—I take the same techniques I use on land, and simply take into account the changes in resistance and weight load introduced by the water. Whether on land or in water, biofeedback allows me to evaluate specific muscles, and choose tactical approaches for strengthening (up

training), relaxing (down training), developing bilateral symmetry, or correcting muscle strength ratios.

Still, not everything is the same in the pool as on land. Buoyancy and aquatic resistance can affect the data collected by the biofeedback unit and those differences must be taken into account during aquatic rehab sessions.

For instance, if I am testing an athlete’s quads during a slow underwater walking movement in chest-deep water, the output will be lower than during a similar movement on a dry-land treadmill.

But with a faster movment in shallower water, the resistance will outweigh the gravity reduction of buoyancy, leading to increased overall muscle recruitment.

In addition, turbulent drag can produce irregular recruitment patterns on the biofeedback unit screen, due to the varying amount of effort aquatic workouts require. Movement of the extremi-

WIRING UP

Figure One: A bioclusive barrier covers the sensor.

Figure Two: Using a latex “sock.”

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Early on in the development of aquatic EMG biofeedback, it became glaringly obvious that the ability to waterproof the electrical sensors was crucial. Any water coming into contact with the sensors would cause a short out, rendering that sensor ineffective. Another problem was the effect of chlorinated water on the delicate circuitry of the sensors. Simply put, surface EMG biofeedback equipment was poorly suited for the aquatic environment.

Through trials and (many) errors, I have settled on two reliable methods of “waterproofing” EMG sensors (see Figures One and Two, at left). Figure One shows the traditional method of using a bioclusive barrier to cover the sensor. Figure Two shows a newer method using a latex “sock” to cover the extremity being tested.

With either method, the sensor placement and application are the same as on dry land.

With the bioclusive barrier method, I always use alcohol and skin prep wipes to ensure that the barrier will stick to the skin.

The sensor and surrounding area are then covered with the barrier, and the exit wire is sealed tightly so that no water can migrate to the sensor. The lead wires are then connected to the biofeedback unit before the patient enters the water.

The patient wears the EMG biofeedback unit only for certain exercises. The bioclusive barrier is effective for about 30 minutes, but will eventually start to pull off due to immersion and physical movement.

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TREATING THE ATHLETE ties through water is rarely consistent from one repetition to the next. I have found the best way to interpret aquatic biofeedback data is to view it as a “big picture” guideline. I try to keep the variables and movement patterns as precise and consistent as possible, but I don’t micro-manage individual phases of the workout or expect athletes to produce the same consistent muscle effort as they would during a dry-land biofeedback session.

BACKED BY RESEARCH Aquatic EMG biofeedback is largely a new frontier for rehab and athletic training applications. But there is a small body of research evaluating its effectiveness. Several articles have been written looking at aquatic EMG not only for use with athletes and rehab patients but also for its potential to aid in the diagnosis and treatment of certain biomechanical conditions.

Below is a summary of the research articles I have found most useful as I’ve applied aquatic biofeedback in my setting. It’s not a comprehensive list, but these studies have produced some of the

key findings in this area of treatment.

• In 1986, authors Nuber, Jobe, et al., published an article in the American Journal of Sports Medicine after attempting to observe the shoulder

casionally, the needles were accidentally pulled out of the muscle during the swim strokes, revealing an important limitation of this type of testing. Third, it helped establish EMG as a valuable tool

We found that performing closed-chain exercises in varying water depths allowed the athletic trainer to exert greater control over the exercise, thus allowing rehabilitation to start earlier after injury. muscles of swimmers using fine wire EMG. Small needles were inserted bilaterally into specific muscles and a telemetry system was used to analyze the firing sequence of the shoulder musculature during several swim strokes.

This research had several important results. First, it established baseline data on the firing sequence of the shoulder muscles during swimming, which would be subsequently expanded upon by other authors. Second, it showed that the use of EMG needles in strong muscle groups during a fast, repetitive movement may not be the best way to gather data. Oc-

in unlocking the secrets of the human musculoskeletal system and spurred greater curiosity about this modality in the sports medicine field.

• Ten years later, authors Becker, Erlandson, et al., conducted research at the College of St. Catherine comparing the muscle activity of the serratus anterior during prone exercise in water and on land, using an EMG biofeedback unit to contrast the data. This was the first article to directly assess comparable aquatic exercise to land exercise, and it helped show the medical community that aquatic exercise was both

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Figure Three: Three-way tethered mini-squats.

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valid and, more importantly, quantifiable. The authors found that muscle activity in the serratus anterior during prone exercise was the same on land and in water, and that resistive equipment increased muscle activity similarly in both training environments.

• In 1999, I collaborated with Brian Awbrey, MD, and others to publish an article in the American Physical Therapy Association’s Journal of Aquatic Physical Therapy that compared the muscle activity of the vastus medialis oblique (VMO) during a single-leg mini-squat on land and in water at varying depths.

Our research found that the VMO muscle activity generated in waist-deep water was 50 percent of that generated on land. In chest-deep water, the activity was reduced to 25 percent. This correlated well with other studies showing similar immersion-weight reduction ratios. It also made intuitive sense: If your body weight is reduced by half because you’re half underwater, you should only need 50 percent of normal muscle recruitment to perform an activity.

In addition, we found that performing closed-chain exercises in varying

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water depths allowed the physical therapist or athletic trainer to exert greater control over the exercise, thus allowing rehabilitation to start earlier after injury. We used a sample of 50 research subjects, making it one of the most extensive studies on the topic to date and adding further validity to aquatic biofeedback as a rehab protocol.

• Authors Kelly, Roskin, et al., published a paper in the Journal of Orthopedic and Sports Physical Therapy in 2000 based on their research into the shoulder rotator cuff musculature working at three different speeds of movement on land and in water. Observing movements ranging from 0 to 90 degrees in the scapular plane, they found that activation of the rotator cuff muscles at the slower test speeds (30 degrees/second and 45 degrees/second) was significantly lower in the water than on land. This result implied that using aquatic therapy for early movement after surgical rotator cuff repair would not compromise the graft site or the surrounding tissue, because the movement is performed at slower speeds. Safe, early active movement is an important consideration in

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TREATING THE ATHLETE

BEYOND EMG

Figure Four: Step-ups and step-downs.

The therapy discussed in this article involves one segment of the biofeedback spectrum: electromyogram (EMG) biofeedback designed to sense muscle tension and activation. But biofeedback is an umbrella term encompassing several different types of treatment, and biofeedback units are now available to detect everything from heart rate and blood pressure to brain activity.

One of the most promising applications for biofeedback in athletic settings centers on its ability to prolong the effectiveness of pain-management protocols. When used in conjunction with electrical stimulation, a device that incorporates biofeedback can provide more targeted, longer-lasting pain relief.

For instance, transcutaneous electrical nerve stimulation (TENS) is well known in the sports medicine community as a pain-relieving modality. But as the nervous system becomes habituated to an electrical stimulus, the treatment becomes less effective and the pain can return. A biofeedback device can be used to sense the response of soft tissue to electrostimulation, and by altering the intensity and delivery of the current accordingly, it can prevent habituation to TENS. Other uses for biofeedback include alternative medicine and mind-body therapy for the treatment of conditions ranging from high blood pressure to asthma and from attention deficit hyperactivity disorder to epilepsy. According to the Biofeedback Certification Institute of America (BCIA), “[Biofeedback] signals typically measure skin temperature, muscle tension, and/or brainwave function. With this information, patients can learn to make changes so subtle that at first they cannot be consciously perceived. With practice, however, the new responses and behaviors can help to bring relief and improvement to a variety of disorders.”

For more information, visit the BCIA online at: www.bcia.org.

Figure Five: Forward step-up sequence. restoring normal joint kinematics, so this finding was significant.

• In 2001, I collaborated with Thom Stowell, DC, DPT, and George Fulk, DPT, to explore the possibility of using the aquatic environment to improve the motor function of a subject who had suffered an incomplete spinal cord injury.

Our hope was to mimic the effects of a harness-assisted body weight gait training system. We used EMG biofeedback both on land and in the water to assess muscle activity and recruitment, as well as to direct the aquatic exercise routines.

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We observed one very interesting trend during our three months of treatment sessions: EMG output of the lower extremities increased both on land and in the pool. This revealed that the patient’s general function and mobility were improving, even though Manual Muscle Test results remained unchanged. When we published our research in the Journal of Aquatic Physical Therapy, we wrote that EMG biofeedback played a key role in the patient’s rehab, and speculated that it might have significant potential in treating spinal cord injuries.

PRACTICAL APPLICATION What does aquatic biofeedback work actually look like? The sample workout below was designed for a patient suffering from patellofemoral pain syndrome.

1. Water walking forward, backward, and sideways, with a focus on slow, exaggerated steps and a normalized gait pattern.

2. Bilateral lower extremity progressive resistance exercises (straight-leg flexion/extension and abduction/adduction).

3. Three-way tethered mini-squats with T&C MARCH 2008

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TREATING THE ATHLETE EMG biofeedback (see Figure Three on page 32).

4. Step-ups and step-downs with EMG biofeedback (see Figure Four on page 33).

5. Forward step-up sequence (see Figure Five on page 33).

6. Deep-water scissors.

7. Deep-water abduction/adduction.

8. Deep-water mini-squats on a board with EMG biofeedback (see Figure Six, at left).

9. Deep-water “up-out-open-close-indown.”

10. Deep-water bicycles.

Figure Six: Deep water mini squats.

As patients make progress, I add variations of all these exercises to introduce greater challenges. For instance, as their endurance level and overall conditioning improves, I’ll increase the number of reps or the speed of the exercise, or I’ll add resistive equipment. If necessary, I will also tape the patella while the patient is in the pool to promote normal tracking.

The EMG biofeedback unit displays the level of muscle activation created by each modification I make, and the patient keeps me updated on their pain

level. Using those two guides, I’ll adjust the depth of squats, range of motion, immersion level, and other variables.

AN EMERGING MODALITY Aquatic biofeedback allows therapists to work on specific muscles and focused techniques early in the rehab process. It provides a new level of control and specificity. And because it reduces pain, it can help make rehab less difficult and ultimately more beneficial for athletes.

I strongly believe that aquatic biofeedback has a bright future in athletic training facilities and rehabilitation clinics. Since I’ve begun using this approach, the success I’ve seen has convinced me that it can be an effective tool for athletes in a wide variety of rehab and training situations. ■

To view complete references for the published research mentioned in this article, please go to: www.TrainingConditioning.com/references.

Thought Technology Ltd. Tel: 1-800-361-3651 • 514-489-8251 Fax: 514-489-8255

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Saving Knocked-Out Teeth During Sports 800,000 teeth are knocked out during sports each year!

These teeth can be saved, but do you know what to do?

Now you can have Save-A-Tooth® as a vital first aid component Each year approximately eight hundred thousand teeth are knocked out (avulsed) during sports activities in the U.S. alone.

Studies have shown that only 10% of athletes comply with rules that require wearing their mouthguards during all sports activities.

Knocked-out teeth begin to die within 15 minutes, and teeth knocked out during sports events have little chance of being saved unless prompt action is taken.

Why can knocked-out teeth be saved…

Every tooth is connected to its surrounding bone by a ligament, the periodontal ligament (PDL). (See figure on right.) The tooth and surrounding cementum, bone, and gingiva receive nourishment from the blood supply through this ligament. When a tooth is avulsed, this ligament is stretched and splits in half; half stays on the tooth root and half stays on the socket wall. If these two halves can be kept alive, the tooth can be replanted and the halves of the ligament will reattach and the tooth will remain vital.

The half that stays on the socket wall, since it remains connected to the bone blood supply, is naturally kept alive. However, the PDL cells that remain on the tooth root must be artificially maintained. They must be protected from two potentially destructive processes: cell crushing and loss of normal cell metabolism.

Although some dentists advise that the best treatment for an avulsed tooth is immediate replantation, for a variety of reasons this is often difficult. Often multiple teeth are avulsed and an athletic trainer may not know into which socket an individual tooth belongs. The athlete may have other more serious injuries that require more immediate attention such as a severe eye injury or a severely lacerated bleeding lip or gum that prevent easy visualization of the socket. Bone chips or debris may be in the sockets, which will prevent complete reimplantation.

If avulsed teeth are not reimplanted immediately, then all treatment between the time of the accident and the ultimate replantation must be focused on preventing further damage to the teeth and maintaining the PDL cells in the optimal condition.

Save-A-Tooth®…

In order to be prepared for these incidents, athletic trainers should have Save-A-Tooth , emergency tooth preserving systems, available with their first aid supplies. Save-A-Tooth® contains a pH-balanced cell preserving solution, called Hank’s Balanced Salt Solution, and a removable basket and net that suspends knocked-out teeth in the solution preventing cell crushing.

According to Henry Rankow, DDS (from Pennsylvania), “SaveA-Tooth overcomes all of the obstacles encountered with avulsed tooth storage. It preserves and protects the tooth for 24 hours successfully.”

A recent study showed that knocked-out teeth stored in Save-ATooth® showed 91% success and another study found that 20% of Save-A-Tooth kits are used within the first year. One of these kits was used by the Director of Health and Athletics for Baldwinsville Central School District, who wrote about his experience: Last year we had an unfortunate incident at one of our boy’s varsity soccer matches where one of our students lost a tooth during play. Luckily, we had one of the Save-ATooth kits in our medical box and the tooth was preserved and successfully implanted back into our player.

Athletic trainers must be prepared to institute the optimum treatment for knocked-out teeth, and this includes having Save-ATooth available. In the case of knocked-out teeth, being prepared and knowing what to do can mean the difference between athlete’s losing knocked-out teeth for life or keeping their own natural smiles.

Be Prepared! Order Save-A-Tooth® Today

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(888) 788-6684

SPORT SPECIFIC

What To be an effective goalie—in any sport—you need a certain mindset. You also need a specific strength and conditioning program that is different from that of position players.

BY JANE KOENIGES & PETE KOENIGES hey’re your last line of defense.

They can make bad teams good and good teams great.

The best ones can take over an entire game by themselves.

There is no other athlete quite like the goalkeeper. In soccer, ice hockey, lacrosse, and field hockey, they’re the most important people on the pitch, rink, or field. The physical and mental demands of the position set them apart from their teammates—yet all too often, they don’t have a conditioning program that reflects those unique demands.

To experience maximum performance benefits from training, goalies need to exercise differently than offensive and defensive “field players.” They need to focus more on certain aspects of strength and conditioning and less on others.

Creating a specialized regimen for goalies can seem like a daunting task for any conditioning coach. But once you realize that goalies from all sports share some common needs, the job becomes much more manageable. A strong foundation of goalie-specific exercises and conditioning work can help take any team’s backstopper to the next level.

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TOP AND BOTTOM: AP PHOTOS

SIMILAR & DIFFERENT When you consider a goalkeeper’s role during a soccer, ice hockey, lacrosse, or field hockey match, the similarities are clear. Their first responsibility is to get themselves or their equipment in front of the ball or puck to prevent it from 36

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going into the net. They have to rely on quick movements and lightning-fast reactions to get in position and make the save. They also have to be acutely aware of their surroundings at all times, to prepare for rebounds, deflections, and passes between opposing players.

Most goalies also play a vital role as leaders of the defense. Some are very vocal in directing teammates’ movements when the play is in their zone. Goalies are the starting point for many counter-attacks, making them an important (though often underappreciated) part of the offense. Finally, many goalies set their team’s emotional thermostat. A dramatic, timely save or a key penalty kill can swing the momentum for the rest of the game.

There are, of course, critical sportspecific skills for each type of goalie. In soccer, goalies rely heavily on vertical jumps, lateral dives, and short sprints, often accompanied by quick changes in direction. In addition to stopping shots by catching the ball, they must be able to execute deflection saves and punch clears. To start the counter-attack, they also need to be adept at throwing, punting, and kicking.

Ice hockey goalies, by comparison, have much less space to cover, but must move forward, backward, and laterally very quickly to cut down shooting angles and make saves. Fast reflexes and full-body coordination are major keys, as they use the leg pads, the catching glove, the blocker, and the stick to thwart shooters. They require incredible flexibility for positions such as the split, and rely on explosive power to push off one leg for many lateral movements. They must also have the eyehand coordination necessary to snare fast-moving pucks.

In lacrosse, the goalkeeper’s job is to stop shots, gain possession, and start a counter-attack. Straight-ahead sprinting is particularly important, as are eye-hand coordination and the ability to follow a fast-moving ball, often when

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SPORT SPECIFIC

a Save! looking through traffic. Lacrosse goalies must also be skilled at sport-specific catching and throwing movements.

Field hockey goalies, meanwhile, are mostly concerned with stopping or redirecting shots and clearing the ball by kicking it outside the striking circle to eliminate second and third scoring chances. The primary movement patterns are lateral, forward/backward, up/down (from a diving, laying-out position back to their feet in a ready position), diving, and splits. The main sport-specific skills are kicking and the hand block.

Of course, this is only a broad overview—there are many subtler aspects of goalkeeping in each sport, and goalies’ individual styles can vary dramatically.

Thus, goalie conditioning is not about providing a one-size-fits-all training regimen. Instead, it’s about taking the movement patterns and sport skills the athletes use, breaking them down to identify the key biomechanical movements, and then devising a program that trains and develops those movements and the related muscle groups.

PIECE BY PIECE Optimal workouts for goalies need to address all aspects of performance.

The most successful programs focus on several crucial building blocks: the metabolic system, muscular strength, muscular endurance, coordination, and quickness. Leaving out any of these areas from a goalie’s training may result in weaknesses—which opponents will be all too happy to exploit.

Below, we’ll briefly explain each building block. Then we’ll discuss how to assemble them into an effective goalie training program.

The metabolic system can be divided into two parts: aerobic and anaerobic.

Every activity and position in goaltending relies partially on both systems— it’s the proportion of each that’s the key. The majority of goalie movement is anaerobic, consisting of short bouts of intense activity with intermittent rest TR AINING-CONDITIONING.COM

in between. Nevertheless, some level of aerobic training is useful for general conditioning and endurance development, especially in soccer and lacrosse, where goalies are expected to sprint for short distances several times a game.

Muscular strength is important in many movements, especially in generating power when clearing and starting the counter-attack. Soccer goalkeepers also use muscular strength during vertical jumps when leaping or challenging an opponent.

Muscular endurance is essential for performing skills and movements over and over during a game. When goalkeepers experience a breakdown in form or technique late in contests, muscular fatigue is often to blame. For this reason, muscle endurance should always be a major focus of goalie training.

Coordination is an obvious necessity for all types of athletes, but it’s of utmost importance to goalies. In the blink of an eye, they have to decide whether to kick out a leg, flash a catching glove, or dive forward or laterally, all without losing control and ending up offbalance and out of position. The best goalies often think one or two moves ahead of what they’re doing at any given moment, and they must be highly coordinated to produce fluid, dynamic movements in rapid succession.

Jane Koeniges, CSCS, is the Assistant Field Hockey and Women’s Lacrosse Coach at East Stroudsburg University, and the former Assistant Field Hockey Coach at Lafayette College. She can be reached at: jkoeniges@po-box.esu.edu.

Her brother, Pete Koeniges, MEd, ATC, CSCS, is the Athletic Trainer and Strength Coach for the New Jersey Pride of Major League Lacrosse and at Northern Highlands Regional High School in Allendale, N.J. He can be reached through his Web site, www.lacrossestrength.com, which is dedicated to improving performance and reducing injuries in lacrosse.

TOP: PERRY HEBARD, BOTTOM: AP PHOTOS

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SPORT SPECIFIC Quickness is the keystone for most successful goalkeepers. The term can mean different things to different athletes, but in this context, it’s a blend of two main attributes: speed and agility. For everything from establishing position to making saves to preventing injuries, quickness is a goalie’s best friend. Developing it should be a focus of every training regimen.

POWER BUILDING How do you fit all these building blocks together to form a wall in front of the net? To translate them into a specific training program, let’s first focus on strength and power development.

For starters, a solid warmup is essential. We recommend a 10 to 15 minute cycle of jumping rope, hurdle jumps, ladder drills, and basic hip mobility drills. These will increase blood flow and joint fluids, neurologically activate key stability muscles, and loosen up the musculotendinous unit of the foot and lower leg. The athlete should also warm up with activation exercises focusing on the glutes, hip stabilizers, and psoas.

For instance, bridging helps to activate the glutes. Possible variations include two-leg bridging with feet on the floor,

single-leg bridging with one leg on the floor and the other knee pulled in to the chest, and feet-elevated bridging, with the feet placed on a four-inch box.

Isometric hip abduction can stimulate the external rotators of the hip. We like to use an elastic green mini-band to provide resistance, having the athlete perform three to four sets of 10-second holds. Hip flexion, with the hip flexed greater than 90 degrees, can effectively activate the psoas—with the athlete lying down, keeping one leg straight and flexing the opposite knee to the chest, the hip is flexed greater than 90 degrees. A light band can be wrapped around the flexed knee and the opposite foot for resistance. Try having the athlete hold this contraction for three to four sets of 10 seconds. To increase the difficulty, have the athlete do the exercise while standing.

After warmup, take advantage of the neuromuscular system’s freshness by heading straight into power exercises aimed at boosting muscular strength and endurance. Olympic lifts, such as the clean and the snatch, are great for strength development, but they shouldn’t be the sole focus. Squat jumps, box

PREGAME WARMUP Before each contest, many goalies follow highly ritualized warmup routines. To ensure they’re preparing themselves optimally, take a look at your goalies’ routines to see if they involve a sensible progression.

The first part of the warmup should involve gross motor movements.

These can include jogging, active stretching, and light plyometrics.

Most teams perform these activities as a single unit, and there’s no reason why goalies shouldn’t join their teammates for this phase.

Next should come position-specific movement skills. This can include basic hand-eye coordination drills, simulated ladder drills and other footwork, and lateral movements. Flexibility should be incorporated at this time as well, especially in sports where the goalkeeper must be able to execute splits or other similar extensions.

The warmup should then move on to game-specific activity. A good example is moving around the goalmouth while facing shots in a controlled environment. As the goalie gets more comfortable, the shots should increase in speed and variety.

The final step is the introduction of shooting drills. These should be as game-like as possible to help the goalie get into the flow of the action, and they should force him or her to make as many different types of saves as possible. When this warmup is finished, the goalie should be mentally and physically ready for the starting whistle.

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jumps, medicine ball tosses, push presses, and Olympic variations like the high pull and dumbbell snatch are also effective exercises for building power. Because these exercises require greater neuromuscular coordination than traditional lifts, they may even have more direct crossover to the movements and techniques involved in goaltending. However, because of their high neuromuscular demand, the sets should be small—typically no more than five reps each.

Next you can incorporate a bi-set, using two different exercises back-toback with different movement patterns.

This tandem approach increases the intensity of the workout and makes it more efficient. Devise pairs that challenge the whole body, since activating non-adjacent muscle groups in close succession can help develop coordination along with overall strength. For instance, we like to pair a knee- and hip-dominated exercise with a vertical pulling exercise: Have the athlete perform a lunge or squat for five to eight reps, followed immediately by six to 10 pull-ups. Three to five sets of this rotation provide an adequate challenge.

(See “Exercise Breakdown” on page 39 for specific exercise ideas divided into movement categories).

A tri-set should follow, focusing on horizontal pulling, pushing, and hip dominance. Choose exercises that relate to the biomechanical movements used in the goalie’s sport—for example, a lacrosse goalie’s tri-set might include a dumbbell bench press, a dumbbell row, and a straight-leg deadlift. The rowing movement helps develop strength and stability in the scapula, which is important for force transference from the core to the upper extremities. This allows a lacrosse goalie to make stronger longdistance outlet passes.

Lastly, core and accessory exercises should complete the resistance portion of each workout. Plank exercises and their variations are great for improving core strength and providing lumbar stability.

Three to four sets of a 30-second plank on the elbows and toes can be a good starting point. When the athlete becomes more proficient, try the same exercise with one foot elevated, two feet and one arm extended, and one arm and the opposite foot elevated. You can also use side planks on both sides. Accessory exercises can focus on more isolated types of power and movement, such as grip strength and shoulder external rotation.

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SPORT SPECIFIC FLEXIBLE, FAST & FOCUSED Soft-tissue treatment should also be a part of the goalie’s workout. This can include static stretching to improve muscle length (especially with ice hockey goalies, for whom flexibility is paramount), and using foam rollers to improve tissue density. Focus on areas of tightness and trigger points within the muscle. Periodic deep-tissue massage can also be helpful for goalies, as it improves local blood flow and helps relieve muscle spasms. Massage also promotes relaxation and reduces stress.

Some goalies today are turning to less-traditional types of flexibility development as well, particularly yoga and Pilates. For example, Trevor Tierney, recently retired goalie for the Denver Outlaws of Major League Lacrosse, performed yoga not only for flexibility but also to hone his mental focus.

He feels the concentration required to perform the various yoga positions and the warm environment in which he performs them help him prepare to be sharp and relaxed under pressure. This type of training isn’t for everyone, but if you introduce it to your goalies, they

EXERCISE BREAKDOWN Below is a list of some of the most important exercises for goaltender strength training, broken down into categories based on the primary biomechanical movement involved.

Power/Explosiveness Box jumps Squat jumps Dumbbell snatch Knee-dominant Squats (back/front) Lunges Single-leg squats Hip-dominant Deadlifts Romanian deadlifts Single-leg deadlifts Good mornings Vertical Pull Pull-ups Chin ups Lat pull-downs

Vertical Press Shoulder barbell press Shoulder dumbbell press Horizontal Pull Bent-over row One-armed row Inverted row Horizontal Press Bench press Dumbbell press Alternating dumbbell press Push-ups Trunk Stability Planks Reverse crunches Wood chops

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TALK IT UP Implementing these training recommendations can lead to significant performance gains, particularly if your goalies haven’t used position-specific conditioning in the past. But for such improvements to occur, players must understand and buy into the new workout regimen. For that reason, great communication is vital.

If your ice hockey goalie says he hates aerobic training and he has no problems with endurance during games, try eliminating it entirely. If your soccer goalie feels Olympic lifts create bulk that limits her movement, reduce the weight or shift to more flexibility exercises. When working with such specialized athletes, nothing should be set in stone.

Goalies are used to shouldering individual responsibility for their performance, so let them take the lead in customizing their workouts. If you listen to their needs and are prepared to offer targeted conditioning advice, they’ll be better prepared than ever to rack up wins and frustrate opposing shooters. ■

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may be surprised at the positive results.

Interval sprint training should also be part of the program, as it can improve speed, power, and VO2 max. The intervals can be broken down by time or physiological recovery. For instance, a soccer goalie can sprint the width of the goal box for six reps, or an ice hockey goalie can sprint from blue line to blue line. Mike Boyle, MA, ATC, Strength and Conditioning Coach for the Boston University men’s ice hockey team, recommends that the rest intervals during this type of training be determined by the athlete’s heart rate recovery. Using heart rate monitors and simple math, you can prescribe appropriate rest periods during sprinting activity. When the recovery heart rate falls below 60 percent of the athlete’s max, it’s time for the next set.

It’s important to remember that a large focus on aerobic training is unnecessary for goalies, and may even be counterproductive. Aerobic work can reduce the ratio of explosive, fast-twitch fibers to slow-twitch fibers, which is definitely not what goalies want. The right amount depends on each individual, but examples of safe starting points would be six to eight sets of five- to 10-yard sprints for soccer goalies and five- to 50-yard runs for lacrosse goalies.

Vision training is another area that can pay large dividends for goalies. There are many different exercises for honing visual perception along with reaction time, some simple and some complex. For instance, playing ping-pong requires athletes to focus on a much smaller ball than they’re used to. You can also put numbers on soccer balls and have the goalie call out each incoming ball’s number during shooting drills. This exercise forces the eyes to follow and concentrate on the ball more closely than they normally would. (For more vision training ideas, go to www.training-conditioning.com and type “Goalie Vision” into the search window.)

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References: Boyle, Michael. Designing Strength Training Programs and Facilities. Boston: 2006.

Sahrmann, Shirley. Diagnosis and Treatment of Movement Impairment Syndromes. St. Louis: Mosby, 2002.

Siff, Mel. Supertraining. Denver: Supertraining Institute, 2003.

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SPECIAL FOCUS: PREVENTING MRSA

A magnified view of the MRSA bacterium

Protecting your athletes from MRSA means taking a close look at how these bacteria function. Here, we delve into your most pressing questions on the topic.

BY GREG SCHOLAND or anyone who has seen recent headlines from around the country related to methicillinresistant Staphylococcus aureus (MRSA), a sense of alarm seems perfectly natural. In Wellington, Ohio: “Staph Takes Down Wrestlers.”

In Fayetteville, N.C.: “MRSA Infects Teenager’s Life.” In Austin, Texas: “Texas Football Succumbs to Virulent Staph Infection.” In Battle Creek, Mich.:

F

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“The Next Epidemic?” In Gillette, Wyo.: “Keeping a Killer at Bay.” From coast to coast, this tiny bacterium is creating anxiety, if not panic.

Athletic trainers, coaches, parents, student-athletes, school officials, and everyone else in the athletic world can feel like there are more questions than answers. Is our school at risk? Are we doing enough to prevent an outbreak?

What should we do if one occurs? Why is MRSA so dangerous, anyway?

In this article, we’ll answer some important questions about MRSA and the challenges it poses in an athletic setting.

Infectious disease experts and athletics professionals will explain what MRSA is and how it spreads, outline ways to keep athletes safe, and debunk a few common myths about the nature of the risk. Some of what follows is information you’ll hopefully never need—but the

DENNIS KUNKEL MICROSCOPY, INC.

Under the Microscope better educated and prepared you are, the more you can be an effective leader in confronting this serious subject.

What are staph and MRSA, and how do they cause infections?

Staphylococcus aureus, or staph for short, is a very common species of bacteria. The Centers for Disease Control and Prevention (CDC) estimates that 25 to 30 percent of people in the U.S. have it living in their nasal passages or on their skin. These individuals are said to be “colonized” with staph, but that doesn’t mean they’re infected, and they exhibit no symptoms.

Infection occurs when the bacteria find an entry point into the body.

Greg Scholand is an Assistant Editor at Training & Conditioning. He can be reached at: gs@MomentumMedia.com.

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SPECIAL FOCUS: PREVENTING MRSA “Staph needs a break in the skin to cause a skin infection—typically a cut, scrape, or other abrasion,” explains Jeff Hageman, MS, an epidemiologist at the CDC who specializes in staph infections. “The bacteria don’t need a large opening. Even an ingrown hair or the small, imperceptible tears caused by shaving with a razor can be enough.”

Because colonized people have the bacteria present on their bodies, they can spread it just by touching another person or something in their environment. If the bacteria then find their way to compromised skin—on a colonized or non-colonized person—they can take up residence and form an infection.

CDC estimates that around one percent of the current U.S. population is colonized with MRSA bacteria.

“In several large studies performed across the country, we’ve seen that about 60 percent of skin infections that have pus associated with them are now caused by MRSA bacteria,” Hageman says. “The percentage is higher in some regions than others, but it’s clear that MRSA is a predominant cause of skin infections in the general population today.

“In Atlanta, where the CDC is located, it has become so prevalent that when a skin infection is brought to the emergency room at some local hos-

“Athletic departments could do themselves a huge favor by requiring athletes to shower immediately after all practices and games … Many athletes put off showering until they get home. They don’t realize that by doing so, they’re seriously increasing MRSA risk.”

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Methicillin-resistant Staphylococcus aureus is like other types of staph, but with one important difference: MRSA strains are immune to many common antibiotics, including penicillin and amoxicillin. (Methicillin itself, a form of penicillin, is no longer used to treat infections, though its name is still used to identify drug-resistant staph strains.)

MRSA is more dangerous than ordinary staph because if an infected person is prescribed an antibiotic that can’t kill the bacteria, the infection grows worse and can lead to serious and potentially fatal complications, such as pneumonia and bloodstream infections. Untreated MRSA also releases a dangerous toxin called Panton-Valentine leukocidin (PVL) into the blood.

With the right antibiotics and prompt infection-site treatment, a MRSA infection can be cured fairly easily in almost all cases. Most serious health problems and MRSA-related deaths are caused by late or incorrect diagnosis and treatment of the infection, which is why awareness is such an important step in preventing serious outbreaks.

How common are MRSA infections?

MRSA used to be found only around hospitals, prisons, nursing homes, and other similar facilities, but in the past decade, it has become much more prevalent in the community at large. The

pitals, they automatically assume it’s MRSA,” continues Hageman. “That’s partially because it’s better to err on the safe side when treating a potential MRSA infection. But it’s also because MRSA has become such a common source of infection.”

How does someone typically get a MRSA infection?

Anyone is susceptible to a MRSA infection when they have a skin opening. All they have to do is come into direct contact with someone or something harboring the bacteria.

“In athletic settings, MRSA is usually spread through physical contact,” Hageman says. “In football, wrestling, rugby, and any other sport with skinto-skin contact, there are countless opportunities for the transmission of bacteria. And because athletes in those sports frequently experience skin abrasions, the risk is increased.”

In addition, many objects and surfaces in athletic settings can be “transiently colonized,” meaning the bacteria are deposited on them for a short period of time and can thus be passed to a new person.

For instance, whenever an athlete comes into contact with a towel, razor, bar of soap, locker room bench, or athletic field, he or she may leave live bacteria behind, and another athlete in the same environment may pick them up.

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Circle No. 124

SPECIAL FOCUS: PREVENTING MRSA Colonized athletes with perfectly healthy skin can spread staph and MRSA bacteria, but the risk is heightened once someone is actually infected.

MRSA skin infections typically produce pus and other organic matter that’s rich in bacteria and can easily be left behind

How can I prevent my athletes from spreading staph and MRSA bacteria among themselves?

“The famous physician Sir William Osler once said, ‘Soap and water and common sense are the best disinfectants.’ Anyone looking to avoid MRSA

“Some MRSA outbreaks among athletes have been linked to towels used on the field … A towel on the sideline can be transiently colonized by one person and then picked up by another person, who can infect himself by using it on skin that has been compromised.” when the infection site comes into contact with an object or surface.

“Covering all infected skin with clean bandages is one of the most effective ways to prevent isolated MRSA infections from turning into outbreaks,” says Eddie Hedrick, MT (ASCP), CIC, Emerging Infections Coordinator for the Missouri Department of Health and Senior Services. “The key is to prevent the sharing of bacteria as much as possible, especially if someone has an infection.”

should always remember that,” says Hedrick, who also coaches the men’s club lacrosse team at the University of Missouri. “When confronting a serious danger, it’s tempting to think your prevention measures have to be elaborate.

But practicing basic personal cleanliness is as important as anything.”

One of the most common ways athletes put themselves and others at heightened risk is by eschewing the shower room. “Athletic departments

could do themselves a huge favor by requiring athletes to shower immediately after all practices and games,” says Jim Thornton, MS, ATC, PES, Head Athletic Trainer at Clarion University and a member of the NATA Board of Directors. “That’s critical for several reasons. First, it washes away bacteria the athletes have picked up on their bodies during activity. If they have a cut or scrape, they can remove the bacteria before it has a chance to create an infection. And just as important, it reduces the odds that they’ll spread bacteria around when they touch things.

“Many athletes today, in high school and college, put off showering until they get home or back to their dorm,” Thornton continues. “They don’t realize that by doing so, they’re seriously increasing staph and MRSA risk.”

Hand washing is another key prevention measure. “Anytime you touch a surface—a doorknob, a table, a piece of athletic equipment—you can pick up harmful bacteria. But if you remove it from your skin quickly, it won’t cause infection,” explains Hageman. “Since

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SPECIAL FOCUS: PREVENTING MRSA our hands are constantly touching things, they’re both picking up and spreading bacteria. Cleaning them frequently needs to be a top priority.”

Several studies have shown that effective hand washing can be performed with plain or antibacterial soap. “When you form a lather, you’re lifting the dirt and germs from your skin, so it’s not particularly important that the soap be antibacterial,” Hageman says. “In group settings, liquid soap is preferable because it eliminates the potential for a shared bar of soap to transmit bacteria.”

Virtually any shared item can be a conduit for bacteria, so sharing should be actively discouraged in all locker rooms and playing areas. “Some MRSA outbreaks among athletes have been linked to shared razors, locker room towels, and towels used on the field,” says Hageman. “It’s hard to keep track of who has used a towel on the sideline—it can be transiently colonized by one person and then picked up by another person, who can infect himself by using it on skin that has been compromised.”

What does a MRSA infection look like, and how is it identified?

At first, many MRSA skin infections are mistaken for spider bites, ingrown hairs, or pimples. The common symptoms include redness (and sometimes the presence of red streaks or other

Identifying a MRSA infection through a standard wound culture used to take several days, but in January, the Food and Drug Administration (FDA) approved a new test called the BD GeneOhm StaphSR assay, which can identify MRSA in just two hours. As this

“Anytime we see something suspicious on an athlete’s skin, we either have the team physician look at them or we send them straight to the emergency room—we don’t waste any time. A physician needs to be brought into the picture immediately.” discoloration), swelling, the formation of a pustule or pus and other drainage, and the sensation of heat. “Anytime we see something suspicious on an athlete’s skin, we either have the team physician look at them or we send them straight to the emergency room—we don’t waste any time,” says Thornton. “A physician needs to be brought into the picture immediately to begin treatment and decide whether the wound should be cultured.”

test gains acceptance at hospitals and doctors’ offices, it should make diagnosis more efficient, leading to faster recovery and better outcomes for MRSA-infected people.

What can I do to prevent MRSA from endangering my athletes?

Luckily, information about MRSA can spread more easily than the bacterium itself. A well-educated athletic department, with coaches, athletes, and

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SPECIAL FOCUS: PREVENTING MRSA parents understanding the risks and prevention strategies, can go a long way in keeping your program safe.

“Communication is everything when it comes to facing MRSA,” says Michael Stutzke, Athletic Director at Sebastian (Fla.) River High School.

“When we first heard about MRSA in our area, I sat down with our athletic trainer to discuss how we would approach it at our school. We decided the most important thing was to make sure everyone was in the loop.”

The athletic trainer took the lead, talking to coaches about the importance of making sure athletes report every suspicious skin mark or wound, and asking them to discuss proper hygiene with their teams. “Within 24 hours, she had distributed and put up posters in all of our locker rooms and bathrooms, telling student-athletes what to look for on their skin and explaining how simple things like washing their hands and showering after practice could help them stay healthy.

What should parents be told about MRSA? Parents need to receive the same information about prevention as their children do—the importance of hygiene, being proactive about wound protection, keeping an eye on even minor skin problems, and contacting a healthcare professional about any suspicious wound. They also need to be told to communicate with the school if their child contracts an infection.

“If a high school student thinks they have a skin infection, their parents will usually take them to the family physician, and the school may never be notified,” says Hageman. “That’s a real problem, because if multiple athletes on the same team react that way, it can prevent anyone from noticing an outbreak is underway. Other teammates might be experiencing early symptoms, but not yet realize what it is.

“Schools should set up some sort of policy for reporting,” Hageman continues. “Parents should be told to inform a designated person so the athletic trainer or school nurse can be made

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“Some posters also had pictures of what MRSA infections look like, which was both educational and attention-grabbing,” Stutzke continues.

“The old adage that a picture is worth a thousand words definitely applies with MRSA. When athletes saw the various stages of what at first looked like a pimple becoming a serious infection, it helped them realize they need to take this seriously.”

Sebastian River’s athletic trainer and coaches also spread the message in the weightroom, at practices, and in the hallways. “Young athletes need constant reminders about something like this,” Stutzke says. “Around our facilities, you’ll frequently hear a coach say, ‘Why isn’t that cut covered?’ or ‘Hey, I see your band aid fell off—take a break and go get a new one.’”

Well-educated coaches can also take the lead in informing parents. “Many parents have heard only a little about MRSA, but they know it’s dangerous and could affect their kids,” says Stutzke. “It’s natural that they’ll stand up at a meeting and express concerns.

If the coach is prepared to offer a brief explanation of what MRSA is, how athletes can protect themselves, and what steps the school is taking to protect them, that means a lot.”

10/30/07 2:57:41 PM

SPECIAL FOCUS: PREVENTING MRSA aware of the situation, and someone can put all the pieces together to see if there’s a trend.”

With any infectious disease, parents and athletes may be tempted to keep things quiet to avoid embarrassment, so it’s important to set procedures carefully. “You should assure everyone that the athlete’s privacy will be respected,” says Stutzke. “You don’t want things to get worse just because an athlete was afraid to tell anyone about their infection.”

Should MRSA-infected athletes be segregated from their teammates?

Parents of healthy athletes may wish to see anyone with a MRSA infection kept as far away from their children as possible. But as long as common sense is used, there’s no need to make anyone feel like a plague carrier.

“The last thing you want to do is make an athlete with MRSA feel like an outcast, because that will discourage others who may have an infection from speaking up,” advises Thornton, who has seen all manner of reactions to skin infections as the NATA’s liaison to the NCAA Wrestling Rules

Committee. “The truth is, once they’re under the care of a physician and receiving treatment, they will not put teammates at risk as long as they follow good hygiene practices and take

“When a student in Virginia died recently after contracting MRSA, they closed all the area schools to clean and disinfect everything inside. That was an overreaction. As soon as the students came back, they brought the bacteria right back with them.” care of the infection site.”

“A doctor can provide specific guidelines, but in general, an infected person only has to be excluded from activities that may lead to transmission—such as those involving direct physical contact with others,” says Hageman. “If they can keep the infection covered and wash their hands frequently, there’s a low risk of transmission to other people through everyday interaction.

“The one definite thing we recommend, though, is for MRSA-infected people to avoid using common water

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sources, like whirlpools or swimming pools, until the infection has healed completely,” he adds. “A shared whirlpool can easily become a mode of transmission for bacteria. Even healthy athletes

should shower before using a whirlpool to prevent bacteria from spreading.”

How should we clean our school’s athletic facilities and locker rooms to help prevent the spread of MRSA? Surfaces that should be singled out for most frequent cleaning are those that people touch most often, such as benches, treatment tables, and door handles.

“Take the weightroom for example,” says Hedrick. “In many facilities, it is now common practice to keep a spray bottle near the machines, and for each

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SPECIAL FOCUS: PREVENTING MRSA person to wipe down the equipment after using it. That’s a great idea, because those surfaces are shared by multiple users in close succession.

“On the other hand, when a student in

There are many cleaning and disinfecting products on the market today specifically formulated to be effective against MRSA bacteria. But to have the desired effect, and for the safety of ev-

“With any disinfecting product, it’s important to closely follow the directions on the label. Some products may cause irritation if they come into contact with skin, so if they’re being used on an athletic training table, for instance, the surface has to be rinsed afterward.”

Virginia died recently after contracting MRSA, they closed all the area schools to clean and disinfect everything inside,” he continues. “That was an overreaction. As soon as the students came back, they brought the bacteria right back with them. The focus should be making it standard practice to frequently clean areas that are most often touched—not making an all-out one-time effort.”

What should our custodians and others who clean our athletic facilities know about MRSA?

eryone who shares your facilities, these products have to be used properly.

“With any disinfecting product, it’s important to closely follow the directions on the label,” notes Hageman.

“Some products may cause irritation if they come into contact with skin, so if they’re being used on an athletic training table, for instance, the surface has to be rinsed afterward.”

In addition, some products are made for use only on hard surfaces, and thus should not be used to clean porous objects. For instance, athletic padding is of-

ten made with materials that cannot be rinsed thoroughly enough to ensure that the chemicals from a cleaning agent are completely removed. The product label will usually indicate what types of surfaces a product can safely be used on.

“Contact time is also very important with disinfectants—they need to stay on a surface long enough to be effective against the bacteria they’re targeting,” Hageman adds. “Whoever is using the product should always carefully read the instructions first.”

How about the care and maintenance of athletic equipment?

After practices, many athletes throw their sweaty gear in a gym bag, drop it in a locker or on the floor at home, and don’t take it out again until the next time it’s needed. This creates a moist, dark, warm environment, which is ideal for bacteria growth.

“A couple of years ago, our campus hosted a coaches’ clinic where I gave a short presentation on MRSA infections, and I brought up the subject of gym bags full of dirty, sweaty clothes,” recalls Thornton. “When I explained

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SPECIAL FOCUS: PREVENTING MRSA how this produced a great environment for bacteria, the coaches couldn’t believe they’d never thought of that.

Washing workout clothing and letting pads dry out after each use seems like such a simple thing. But sometimes, it’s the simple things that escape us.”

How can I stay informed about the MRSA risk at my school and in my area?

Both on and off campus, there are resources you can use to make sure MRSA never catches your school by surprise.

“I keep as many channels of communication open as possible—from regularly talking with our school nurse to sharing information with nearby athletic directors,” says Stutzke.

Staying in touch with peers at other institutions is a particularly valuable step. “If I hear from our county’s Director of Risk Management about an illness that’s going around, I’ll send an e-mail to all the athletic directors in my conference and ask them what they know about it,” Stutzke continues.

“Our athletes are continually competing against each other, so it’s important that we keep each other informed about

any student-athlete health issues.”

Hedrick adds that local public health professionals can be an asset as well.

“A local health department can often point you toward an infectious disease expert at an area hospital, provide educational resources, or even help investigate to find the underlying cause of an outbreak,” he says. “We also bring individual outbreaks into a reporting structure so that patterns can be identified at the state or national level, which is what public health is all about.

“With MRSA, you always want to eliminate the ‘uh-oh’ factor,” continues Hedrick. “You don’t want to learn about an outbreak and say, ‘Uh-oh, we weren’t doing this or that which could have prevented it.’ If you’re following the right procedures, making sure everyone is educated, and remaining aware of what’s going on around you, you’ve created a culture where MRSA isn’t something to be afraid of.” ■

A version of this article is also appearing in our sister publication, Athletic Management.

RESOURCES www.cdc.gov/MRSA The Centers for Disease Control and Prevention offers extensive information on preventing and managing MRSA outbreaks. www.ncaa.org/health-safety ➪ click on “Injury Prevention” ➪ click on “Skin Infection Prevention.”

The NCAA’s Web site includes the association’s sports medicine guidelines for skin infections, along with downloadable educational materials for coaches and athletes. www.training-conditioning. com/MRSA.html Visit our Web site to download free posters that can help educate everyone in your athletic program about the risk of MRSA and how to protect themselves.

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Warning Signs: How to spot the warning signs of MRSA Hand Hygiene: Proper techniques for washing away MRSA Keeping Facilities Safe: Suggestions about MRSA and athletic facilities Equipment Management: Why equipment storage is critical On the Sidelines: Important gametime procedures for ATCs Wound Care: How to treat and cover wounds Tips for Parents: A special poster to educate parents In the Locker Room: Tips for athletes in the locker room Athletic Training Room Procedures: A poster for athletic training rooms

You can also download any of these posters for FREE or you can receive all nine 12” x 18” color posters for $35 per set.

To order, visit: www.Training-Conditioning.com/mrsa.html

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Special Focus:

Preventing MRSA

Warning Signs It’s fairly common for athletes to have pimples, cuts, and abrasions on their skin. So how do you know when it might be MRSA and should be referred to a doctor or hospital for a more complete evaluation?

Here are some warning signs to look for and ask about when deciding whether a wound requires medical intervention: ●

Longer than normal healing time

●

Any increase in size

●

Unexplained or unusual pain or sensitivity

●

The presence of pus or a pustule

●

Induration (hardness)

●

The sensation of heat

●

Abnormal swelling or redness

●

Red streaks around the lesion

●

Abnormal coloration

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Circle No. 132 Circle No. 142

Special Focus:

Preventing MRSA

Wound Care Staph infections such as MRSA can proliferate in athletic settings. Skinto-skin contact, moist environments, and the potential for scrapes and abrasions make athletes a prime target for infection. A big part of keeping athletes safe is proactive treatment for all skin wounds.

Follow these wound care rules to help protect your athletes: • Make sure athletes know to report all injuries

and open wounds, no matter how minor, to the athletic training staff, the team physician, or a school nurse for treatment.

• Thoroughly clean wounds by washing away

debris and exudate without traumatizing fragile tissue.

• Cover all wounds, even very small ones, during

and after activity and tell athletes to keep them covered at all times. Covered wounds heal faster.

• Use antimicrobial wound dressings to inhibit

the growth and spread of bacteria plus reduce the potential for infection.

• If a wound looks suspicious or isn’t healing

normally, send the athlete to a doctor or to the hospital to have it cultured and tested for MRSA. • Educate athletes and coaches about first aid

for wounds and teach them how to recognize wounds that may be infected. Follow all other MRSA prevention guidelines and recommendations issued by the NATA and the CDC. Sponsored by:

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Special Focus:

Preventing MRSA

Keeping Facilities Safe Everyone wants their athletic facilities to be safe environments. That’s why you make sure gym walls are padded, fields are maintained, and a spotter is always on hand in the weightroom. But some potential hazards are harder to see: At the microscopic level, MRSA and other types of bacteria could put your athletes at risk for infection.

Here are some tips about MRSA and athletic facilities: • Frequently touched surfaces should be cleaned and

disinfected on a regular basis. This includes weightroom equipment, athletic training tables, lockers, benches, and mats.

• Implement a no-sharing rule. Athletes should not

share towels, toiletries, clothing, or athletic equipment.

• Encourage frequent hand washing among all athletes

and staff.

• Pay attention to the storage of athletic equipment. A

dark, moist, warm environment is perfect for bacteria growth, so storage areas for padding and other equipment must be open and well-ventilated.

• Products that kill MRSA can be applied to many

surfaces, equipment, and athletic apparel.

• The research is inconclusive on whether athletic

fields can harbor MRSA bacteria. Since some studies have shown that the possibility exists, there are companies that offer antimicrobial treatments for athletic fields and other surfaces and substrates.

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Special Focus:

Preventing MRSA

Equipment Management Athletic equipment is supposed to keep the wearer safe, but if it’s not properly taken care of, it can create a serious health hazard. When sweaty pads and uniforms are thrown into a bag or locker, the result is a warm, dark, moist environment that’s perfect for MRSA bacteria to grow.

The problem can be exacerbated on equipment with large surface areas that are difficult to dry out, such as shoulder pads and gloves.

Take these precautions to help prevent equipment from harboring MRSA bacteria:

Make sure padding and other equipment is stored someplace where it can dry out after each use.

•

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• Don’t

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• Whether

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If one or more athletes in your program are infected with MRSA, launder their uniforms and other washables separately from the rest of the team’s.

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Preventing MRSA

Tips for Parents As the parent of a student-athlete, you’d do anything to keep your child safe. When it comes to preventing MRSA, a potentially serious bacterial infection, a few common-sense preventative measures can make a big difference.

Here are some ways to help your child avoid the risks of MRSA: • Launder workout clothing and uniforms after

each use, using hot water and detergent.

• Clean any equipment your child brings home, and designate a place where it can thoroughly dry out after each use. Wet padding and other equipment left in a gym bag creates an ideal environment for MRSA bacteria to grow.

• Encourage frequent hand washing with

antibacterial soap. Clean hands are a key defense against the spread of infection.

• Tell your child to shower immediately after

practice or competition, especially if he or she participates in a contact sport.

• Any time your child has a skin wound, clean

and treat it with an antiseptic. Make sure it remains covered until it is fully healed since MRSA usually enters the body through an unprotected break in the skin.

• Make sure your child reports all skin wounds,

no matter how minor, to a coach, athletic trainer, school nurse, or someone else who can decide whether medical attention is warranted. If it’s infected with MRSA, early detection is critical.

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Special Focus:

Preventing MRSA

Athletic Training Room Procedures In the athletic training room, preventing the spread of MRSA and other types of infection should always be a top priority. It’s a place athletes pass through frequently, and a few simple precautions can play a big part in keeping them safe.

Implement these rules in your athletic training room: • Make frequent hand washing a standard

practice for everyone who spends time in the room.

• Clean and disinfect treatment tables and other

athletic training room apparatus frequently. Antibacterial wipes are a great choice because they’re convenient for day-to-day use.

• If your room has a waiting area, make it a clean

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• When an athlete visits the athletic training

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Staphylococ

Concentrated!

One gallon of Whizzer® concentrate makes 128 gallons of cleaner/disinfectant IT’S POWERFUL Whizzer® kills HIV-1 (AIDS Virus), Hepatitis B & C, Herpes Simplex Virus Types 1 and 2, Norwalk Virus, SARS and other viruses. Kills a broad spectrum of bacteria (including MRSA) and fungus germs on contact. Whizzer ® helps prevent the spread of athlete’s foot. It’s a cleaner, fungicide, mildew stat, virucide and deodorizer all in one! EPA Registered.

F R E Eottles ay b r p s 2

IT’S VERSATILE Whizzer® is the perfect choice for homes, schools, locker rooms, camps, fitness centers, salons, daycare centers and hospitals. Anywhere people gather. Use Whizzer® to kill bacteria on floors, walls, training tables, benches, door knobs, shower and bath areas, toilets, counters, athletic equipment, whirlpools and more!

Also Try… StaphAseptic® First aid bactericide gel prevents skin infections caused by methicillin resistant staph (MRSA) and other germs.

StaphAseptic® is a registered trademark of Tec Labs, Albany, OR

Sani-Cloth® Plus Pre-moistened cloths contain powerful disinfectant to kill germs, such as MRSA, on hard surfaces.

Sani-Cloth® Plus is a registered trademark of PDI, Orangeburg, NY

Mueller Sports Medicine, Inc. One Quench Drive, PO Box 99, Prairie du Sac, WI 53578 USA © 2008 Mueller Sports Medicine, Inc.

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Special Focus:

Preventing MRSA

Hand Hygiene Every athletic trainer knows the importance of hand cleanliness when treating athletes. However, studies of health care professionals in many different settings have found that proper hand washing procedures are not always followed, and the result may be an increased risk for transmitting infections such as MRSA.

Here are some helpful reminders on proper techniques for hand hygiene: • When using an alcohol-based hand rub, apply the product to the palm of one hand and then rub both hands together, covering all surfaces of the hands and fingers, until hands are dry.

• When washing hands with soap and water, wet both hands first, apply soap, then rub hands together vigorously for at least 15 seconds, covering all surfaces of the hands and fingers. Rinse hands with water.

• Thoroughly dry hands with a disposable towel or one treated with an antimicrobial solution. Use the disposable or treated towel to turn off the faucet.

• Avoid using very hot water, since repeated exposure to it may increase the risk of dermatitis.

• If your sink is equipped with bar soap, only use small bars and make sure your soap rack allows for drainage.

• In between washings, use antimicrobial solutions and products that inhibit the growth of bacteria.

Sponsored by:

To download as a printable poster visit: www.Training-Conditioning.com/mrsa.html

Special Focus:

Preventing MRSA

In the Locker Room If you’re like most athletes, you enjoy the camaraderie in your team’s locker room. It’s a place to relax, feel safe, and bond with teammates.

But a locker room can also be a harbor for MRSA, a type of staph infection that can be deadly if left untreated.

Here are some precautions for preventing the spread of MRSA in the locker room: • Shower

immediately after practices and competitions. If MRSA bacteria are present on your skin, you can wash them away before they have a chance to cause infection.

• Don’t

share towels, razors, soap, and other personal items and toiletries.

• Get

every skin wound, no matter how minor, checked out by your coach, athletic trainer, or team physician.

• Cover

all wounds to help prevent infection, especially during practice and competition. If a bandage or wrapping falls off, have it replaced immediately.

• Dry

out your equipment and padding after each use. Do not store in a dark, moist, warm environment.

• Wash

your hands often. Frequent hand washing with antibacterial soap is one of the best ways to prevent MRSA. Sponsored by:

To download as a printable poster visit: www.Training-Conditioning.com/mrsa.html

STRAIGHT TALK

Antimicrobial Products Many of the companies that advertise in Training & Conditioning have products which can help prevent MRSA and other microbial diseases. Below is information from several of these companies on a few of their antimicrobial products.

Bac-Shield™ from Adams USA is a bacteria inhibitor that disrupts the growth of odor-causing bacteria and fungi.

Athletic facilities, equipment, apparel, towels, and playing surfaces can be excellent host environments for bacteria, fungi, mold, and mildew. Bac-Shield “fills the gap” and makes your hygiene program more effective by inhibiting the reproduction of harmful microbes between cleanings and disinfections. The active ingredient in Bac-Shield, chitosan, has a long history of safe and effective applications. Use Bac-Shield for laundry, locker rooms, athletic surfaces, mats, and practically any place bacteria can be present. It is available in pint, gallon, and five-gallon sizes.

For more information, call 800-251-6857 or go to their Web site at www.adamsusa.com.

Circle No. 500 Pro Tex Sport hand and skin sanitizing foam has an efficacy rate of up to 99.999 percent for reducing MRSA, staph, strep, e coli, and more. It’s alcohol-free so your hands won’t crack or dry out. Unlike alcohol-based products, Pro Tex Sport has an active ingredient that actually increases with daily usage. Pro Tex Sport is non-flammable, non-staining, fragrance-free, and leaves your skin with a smooth, natural, non-sticky feeling.

To find out more, call 508-878-8739 or visit their Web site at www.athleticlean.com for a complete list of the company’s hygiene products.

Circle No. 501 CleenFreek® SportsHygiene® manufactures patented antimicrobial performance products and solutions. CleenFreek SportsHygiene addresses the needs of athletic directors, coaches, athletic trainers, and athletes at all levels by providing 360-degree, 24/7 protection and prevention against MRSA, staph infections, athlete’s foot, and other infectious diseases.

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in antimicrobial technology that addresses cross-contamination of germs and offers protection for locker rooms, athletic training rooms, workout rooms, synthetic turf, court surfaces, and mats. CleenFreek SportsHygiene keeps athletes protected and in the game.

To learn more, call 800-591-3585 or visit their Web site at www.cleenfreek.com Circle No. 502 FabricAide™ from CSG/SportsCoatings inhibits the growth of bacteria, fungi, and mold on washable fabrics for 30 washes. FabricAide integrates the world’s most unique and reliable antimicrobial technology into washable fabrics. Microbial contaminants such as bacteria and fungi can be a source of serious infections.

FabricAide continually fights the growth of bacteria, fungi, and mold and lasts for 30 washes.

For more information, call 888-510-2847 or go to their Web site at www.csgsportscoatings.com.

Circle No. 503 TELFA™ AMD antimicrobial wound dressings from Covidien are effective against MRSA and Staphylococcus aureus. AMD dressings contain PHMB (polyhexamethylene biguanide), an antimicrobial component proven to resist bacterial colonization within the dressing and also resist bacterial penetration through the dressing.

At just pennies per day, this product offers inexpensive infection control. It is compliant with existing protocols, and proven to prevent bacterial proliferation and limit crosscontamination. Studies have demonstrated AMD’s effectiveness against a host of bacteria, including Staphylococcus aureus and MRSA. For more information, call Covidien at 800-962-9888 or visit www.covidien.com.

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STRAIGHT TALK Z-Cool shoulder pads from Gear 2000 are patented air- and moisture-transferring shoulder pads with antibacterial foam padding. The foam used to make Z-Cool shoulder pads will not absorb moisture from perspiration. As a result, odor buildup is eliminated and the pads are 35 percent lighter and cooler for the wearer, which can contribute to enhanced performance on the field. These pads are used by pro athletes, NCAA Division I college programs, and high school state champions.

To find out more, call 785-625-6060 or go to their Web site at www.gear2000.com.

Circle No. 505 Kill the Hibigeebies with Hibiclens®. This product, from Molnlycke Health Care, is an antimicrobial, antiseptic skin cleanser that can be an effective defense against the spread of MRSA and other staph infections. Its active ingredient, chlorhexidine gluconate (four percent), works in a unique way. It kills germs on contact and bonds with the skin to keep killing microorganisms even after washing. It’s ideal for cleaning skin wounds, general skin cleansing, and personal hand washing.

For more details, call 800-843-8497 or go to their Web site at www.hibigeebies.com/sports.

Circle No. 506 Whizzer® cleaner and disinfectant from Mueller Sports Medicine is a concentrated cleaner and deodorizer that kills a broad spectrum of bacteria, including MRSA, as well as viruses and fungi on non-porous surfaces. Whizzer is EPA-registered, and one gallon makes 128 gallons of cleaner/disinfectant. This product inhibits the growth of mold and mildew (and their odors) when used as directed. Versatile and powerful, Whizzer kills HIV-1 (the AIDS virus), hepatitis B and C, herpes simplex 1 and 2, SARS, and other viruses. It also kills strep, staph (including MRSA), and fungus on contact. In addition, it helps prevent the spread of athlete’s foot.

To find out more, call 800-356-9522 or visit the company’s Web site at www.muellersportsmed.com.

Circle No. 507 Phenomenal is a total-release aerosol fogger containing a hospital-grade broad-spectrum disinfectant and antimicrobial agent. Each sixounce fogger treats 6,000 cubic feet for viruses, fungi, and bacteria, including staph, HIV-1, and herpes simplex 1 and 2. Hard surfaces must be pre-cleaned. The phenolic ingredients allow for residual kill.

For more information, call Silver Leaf Solutions at 800-292-3653 or visit their website at www.silverleafsanitation.com.

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Stromgren compression and protective performance garments are treated with an antimicrobial agent that may assist in protecting the wearer from MRSA bacteria. The antimicrobial agent has been developed to attack and hopefully kill MRSA. To find out more, call 800-527-1988 or go to www.stromgren.com.

Circle No. 509 StaphAseptic® first aid antiseptic/pain relieving gel, by Tec Labs, helps prevent MRSA infections when applied to cuts, scrapes, and other abrasions. In a recent Oregon State University study, StaphAseptic was tested for its effectiveness at killing four strains of MRSA against compounds made with neomycin and polymyxin, and polymyxin and gramicidin. StaphAseptic was the only compound to have a genuine bactericidal effect against all four MRSA strains.

Use it on cuts, scrapes, and other abrasions to help prevent skin infections from MRSA, staph, strep, and other germs.

StaphAseptic also contains lidocaine for pain relief.

Call 888-MRSA-HELP or visit www.staphaseptic.com for more information.

Circle No. 510 The Infection Control Towel™, created and distributed by SportPharm™, is a disposable towel designed to help fight the battle against MRSA. The Infection Control Towel helps to combat MRSA skin infection outbreaks, which pose a threat to professional, college, and high school sports teams. Unlike cotton towels, which can easily spread infection if they are shared or improperly laundered, The Infection Control Towel is disposable and intended for individual use only. It’s soft, custom-interwoven, and has a cotton-like texture with ultra-absorbent qualities to wipe away sweat that may contain bacteria. The towels can be discarded quickly and easily, thus helping to decrease the risk of MRSA outbreaks among sports teams and their facilities.

For more information on The Infection Control Towel, contact SportPharm at orders@sportpharm.com or by phone at 800-272-4767.

Circle No. 511 GymWipes Antibacterial PLUS and CareWipes Antibacterial PLUS wipes are made with a full-spectrum EPA-registered disinfectant that kills MRSA, HIV, tuberculosis, staph, and a host of other germs. These pre-moistened, disposable, surface-disinfecting wipes have been developed to stop cross-contamination on surfaces. They’re very convenient and a great choice for disinfecting seat pads, leg and arm rests, benches, hand grips, chrome plating, painted surfaces, steel and rubber surfaces, tanning beds, electronic panels, and many other frequently touched surfaces.

The wipes contain no alcohol, phenol, bleach or ammonia, and have a fresh scent.

For more information, call 2XL Corp. at 888-977-3726 or visit www.2xlcorp.com.

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ANTIMICROBIAL PRODUCTS

Researching Antimicrobial Products Online The companies listed below prominently feature products and services related to antimicrobial protection on their Web sites.

This is not a comprehensive list, but it may be a helpful starting point for athletic trainers and sports medicine professionals researching infection control and preventive strategies.

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Adams USA

adamsusa.com

Exclusive distributor of Bac-Shield™ antimicrobial product for textiles and surfaces

AthletiClean

athleticlean.com

Antimicrobial and antibacterial disinfectants for the skin, synthetic turf, surfaces, and fabrics

Canberra

canberra.com

Husky 891 Arena Disinfectant kills CA-MRSA on equipment, surfaces, and facilities

Clean Gear USA

cleangearusa.com

Athletic equipment sanitizing and reconditioning

CleenFreek® SportsHygiene®

cleenfreek.com

Antimicrobial towels, hand sanitizers, surface wipes, and equipment

Covidien

covidien.com

Wound care products

Cramer Products

cramersportsmed.com

A wide selection of antiseptic ointments, antibiotic creams, and wound care products

CSG/SportsCoatings

csgsportscoatings.com

Antimicrobial treatments for many applications, including surfaces, equipment, and facilities

Esporta Wash Systems, Inc.

esporta.ca

Cleaning, sanitizing, and reconditioning products and services for athletic equipment

Gear 2000

gear2000.com

Z-Cool shoulder pads with 3-D Air Flow foam and antibacterial agents

Henry Schein

henryschein.com

Antimicrobial cleaning products and sanitizers

Kendall Products

dri-dek.com

Self-draining interlocking floor tiles with antimicrobial properties

Kennedy Industries

kennedyindustries.com

Kenclean Plus athletic surface disinfectant and cleaner for killing MRSA and many other pathogens; hair and skin antibacterial products designed for athletes

Medco Sports Medicine

medco-athletics.com

Antimicrobial cleaning products and hand sanitizers

Molnlycke Healthcare

hibigeebies.com/sports

Hibiclens® and Hibistat® antiseptic and antimicrobial skin cleansers

Mueller Sports Medicine

muellersportsmed.com

Whizzer® cleaner and disinfectant kills MRSA, fungus, viruses, and many other pathogens

Preventec International, LLC

germstopper.net

Comprehensive programs aimed at preventing and controlling the spread of microorganisms

Reebok

rbk.com

Team and performance sportswear featuring an antimicrobial fabric

Resilite

resilite.com

Antimicrobial technology used to create the protective coating of wrestling mats

RG Medical Diagnostics

rgmd.com

Guardian Plus antibacterial hand sanitizer that won’t dry the user’s skin

Safe4Hours

safe4hours.com

Safe4Hours sanitizing skin lotion

School Health Corp.

schoolhealth.com

CleenFreek® antimicrobial cleaning product kills MRSA, fungi, mold, and mildew

Shock Doctor

shockdoctor.com

Athletic equipment with SmartSilver™ antimicrobial and anti-odor technology

Silver Leaf Solutions

silverleafsanitation.com

Antimicrobial cleaning products

Sport Systems Canada

sportsystemscanada.com

Mats and wall padding treated with antimicrobial agents

SportPharm™

sportpharm.com

ICC Towel™ and Hand Rub™ antimicrobial products

Sports-O-Zone

sportsozone.com

Treatment for athletic equipment to kill MRSA and other bacteria, viruses, and mold

StaphAseptic

staphaseptic.com

Pain relieving antiseptic gel

Stromgren Supports

stromgren.com

FlexPad™ football compression girdle made with antimicrobial fabric

2XL Corp.

2xlcorp.com

Developer of antibacterial GymWipes and CareWipes

Zimek

zimek.com

Room and vehicle sterilizing system helps eliminate harmful environmental contaminants such as MRSA and toxic molds

T&C MARCH 2008

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NEW Product Launch Collegiate Series Combo Power Rack Unique features: • Standard features include weight storage, fixed bar hooks, two pairs of safety spot bars, two straight-bar chin-up handles, and bar storage • Can be used in conjunction with Collegiate Series benches and platforms to create a modular training station

Pro-Tec Athletics Hot/Cold Therapy Wrap Unique features: • Improved design features 4.5-inch straps • Advanced technology gel packs remain flexible during application and retain cold or heat longer

Benefits for the user: • Allows up to eight users to rotate through their workouts at one station in a space-saving design

Benefits for the user: • The new XL form-fitting shoulder wrap offers the same great dual strapping system as the original, providing even, effective compression to the entire target area • The addition of a second pack allows for greater coverage and treatment to both sides of the shoulder

Power Lift www.power-lift.com 800-872-1543

Pro-Tec Athletics www.injurybegone.com 800-779-3372

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Pete Newell’s Playing Big Book/DVD Package Unique features: • Teaches the tactics and techniques of playing big and dominating the inside game • Contains drills and sidebars featuring prominent players who performed in and around the paint • Includes specific points and insights highlighted

by Pete Newell himself

Human Kinetics www.HumanKinetics.com 800-747-4457 Circle No. 517

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The MyoTool Unique features: • Developed by manual therapists • Effective for self-massage, assisted stretching, and enhancing mobility, flexibility, and circulation Benefits for the user: • The user can control the pressure, movement, and precise areas targeted • Allows for self-massage techniques similar to what is received in a clinical setting

OPTP www.optp.com 800-367-7393 Circle No. 518

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AQUATIC EXERCISE AquaJogger 800-922-9544 www.aquajogger.com AquaJogger has introduced the TriFit bar for swim training and aquatic exercise. The 30-inch TriFit bar is different, as there is no padded grip to limit its uses.

Grips keep the foam rounds separated, offering only a few ways to utilize the equipment. The TriFit bar allows three positions for buoyancy distribution, producing an increased number of exercise options and training effects.

It’s excellent for underwater swing training. A waterproof exercise card is included.

Circle No. 519 NZ Mfg., Inc. 800-886-6621 www.nzmfg.com StrechCordz dry-side and in-water resistance swim training tools improve stamina, power, stroke, and individual medley times for international Olympians and novice swimmers alike.

StrechCordz products provide resistance training for tricep extensions, rowing, overhead raises, chest flys, proper hip rotation, stroke efficiency, and more. Stretch your limits to enhance performance through resistance. (Dry-land StrechCordz with paddles are shown.)

Circle No. 520 Power Systems 800-321-6975 www.power-systems.com To reduce stress on the lower back and help maintain a vertical position during aquatic workouts, strap on the Premium Water Flotation Belt from Power Systems. Its contoured shape 68

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provides comfort and long-lasting support by distributing buoyancy around

the entire torso. To make it both durable and comfortable, this flotation belt is made with soft, non-abrasive closed-cell EVA foam and has an adjustable nylon waist belt. It’s available in three sizes.

Circle No. 521 To add cardio to aquatic workouts, fasten on a pair of Premium Water Cuffs from Power Systems. Designed for versatility, these water cuffs can be worn on the ankles or wrists.

Simply adjust the nylon strap to the size needed and secure it with the Velcro™ closure. Premium Water Cuffs are made of soft, nonabrasive closed-cell EVA foam, so they won’t chip or absorb water.

Circle No. 522 SwimEx, Inc. 800-877-7946 www.swimex.com SwimEx makes the only pool on the market today that combines a paddlewheel water-propulsion sys-

tem, molded fiberglass composite construction, multiple water depths, and built-in workstations to provide reliable performance and a superior functional aquatic therapy session.

Visit SwimEx’s Web site to learn more about all of the company’s products, including its new motorized, integrated treadmill—the industry’s most challenging water conditioning workout.

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SwimEx, the manufacturer of choice for nearly 200 professional and collegiate sports teams nationwide, has introduced a new motorized, integrated treadmill. When combined with the SwimEx wall of water, it creates one of the most challenging water conditioning workouts on the market today.

Constructed of durable high-traction rubber with a non-corrosive frame, the treadmill is integrated into the SwimEx pool floor and features variable speeds of up to eight miles per hour, a speed indicator, and a removable hand rail for optional support. Athletes enjoy the benefits of high-intensity aquatic protocols in a low-impact environment.

Circle No. 524 Sprint Aquatics 800-235-2156 www.sprintaquatics.com Sprint Aquatics has been supplying the aquatics world for more than 36 years. The company’s combination of quality, great prices, and customer

service is unsurpassed. Sprint has brought a myriad of innovative and thought-provoking products to the market over the years that have altered the course of sports conditioning and set the pace for the industry.

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STAY CONNECTED, STAY CURRENT...

DAILY Training & Conditioning has developed an innovative Web site to keep you in touch with issues facing sports medicine and fitness professionals:

training-conditioning.com TR AINING-CONDITIONING.COM

CATALOG SHOWCASE Adams USA 800-251-6857 www.adamsusa.com Athletic facilities, equipment, apparel, towels, and playing surfaces are excellent host environments for odor-causing bacteria, fungi, mold, and mildew. BacShield™, an antimicrobial for textiles and surfaces, inhibits the growth of odor-causing bacteria and fungi. Use it on uniforms, sports equipment, locker rooms, carpets, and all protective padding. EPA-registered and tested in the laboratory and field, Bac-Shield is available in a convenient spray bottle for laundry and larger quantities for big areas. Bac-Shield is distributed by Adams USA. Circle No. 527

AquaJogger 800-922-9544 www.aquajogger.com AquaJogger produces a 12-page color catalog that includes a full range of aquatic exercise equipment. The catalog offers nine choices of buoyancy belts and specializes in offering belts that fit individual body type needs. This range includes belts for children, adults, and competitive athletes. AquaJogger also offers a wide range of resistance equipment for the arms and legs. Multiple buoyancy options are available depending on the amount of resistance desired.

Creative Health Products, Inc. 800-742-4478 www.chponline.com

DM Systems, Inc. 800-254-5438 www.dmsystems.com The Rehabilitation Products brochure from DM Systems offers information on three DM rehabilitation products. Included in the product presentation are the Cadlow Shoulder Stabilizer, the AnkleTough Rehab System, and the Adjusticizer Exerciser System. Each section includes detailed information and photography depicting the application of each product.

Since 1976, Creative Health Products has been a leading discount supplier of rehabilitation, fitness, exercise, and athletic equipment, as well as health, medical, and fitness testing and measuring products, all available at reduced prices. Creative Health Products offers heart rate monitors; blood pressure testers; pulse oximeters; body fat calipers; scales; strength testers; flexibility testers; stethoscopes; pedometers; exercise bikes; ergometers; stopwatches; fitness books and software; exercise bands; step benches; hand and finger exercisers; heating pads; and more.

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Cho-Pat 800-221-1601 www.cho-pat.com Incorporating unique design characteristics, excellent craftsmanship, and quality materials, Cho-Pat products are effective, dependable, durable, and highly recommended by medical professionals, physical therapists, athletic trainers, athletes, and individuals for their role in preventing or reducing pain and discomfort. The company’s catalog provides information about all of its products, including descriptions, pictures, and sizing, as well as pricing and purchasing terms. Call today to request your copy.

Circle No. 529 Dynatronics 800-874-6251 www.dynatronics.com The Dynatronics catalog contains more than 8,000 items offering unmatched technology and name brands at affordable prices. This year’s catalog features new modular taping stations and innovative modalities such as the new X5 Oscillation Therapy device. If you need it, Dynatronics has it. Give the company a call to order or to arrange demonstrations of any of its electrotherapy equipment.

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G&W Heel Lift, Inc. 800-235-4387 www.gwheellift.com G&W Heel Lift has remained in the business of manufacturing and distributing heel lifts for more than 40 years. The company has done so by providing excellent products, outstanding service, and a guarantee of 100-percent satisfaction. G&W Heel Lift’s 2008 catalog features many types of heel lifts, varus/valgus wedges, foot beds, pelvic lifts, clinical treatment information, and resources for the athletic trainer and healthcare professional.

Gear 2000 Co. 785-625-6060 www.gear2000.com Gear 2000 Co. offers a 16-page full-color catalog featuring the Z-Cool line of football shoulder pads that are used by pro players, top-50 NCAA Division I college programs, and high school state champions. The catalog illustrates the many unique features and advantages of the Z-Cool line and Z-Cool accessories that are offered for use with the shoulder pads.

The catalog also includes other quality Gear 2000 shoulder pad lines and ZCool compression girdles.

Genetic Potential/VertiMax® 800-699-5867 www.strengthcoach.us The new VertiMax® V6+ is a revolutionary advancement in functional sportspecific, totalbody training. It is capable of applying asynchronous loading to the arms and shoulders while athletes perform explosive lower-body training. The V6+ is strongly endorsed by many NFL, NBA, and NCAA Division I head coaches.

Visit VertiMax’s Web site for more details and call today for a free video.

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CATALOG SHOWCASE

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Mueller Sports Medicine 800-356-9522 www.muellersportsmed.com The 2007-08 Mueller Sports Medicine product catalog features a complete listing of Mueller products with full-color photos and descriptive copy. New and featured products in the catalog include TapeWrap Premium, Stretch M-Tape Premium, No Glare glare-reducing strips in assorted shapes, and the Hg80 ankle brace with straps. In addition, learn how to receive Mueller’s instructional DVD on taping and bracing techniques. A handy guide to the Mueller SportCare packaging features is available in a special fold-out section.

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OPTP 800-367-7393 www.optp.com OPTP has released its Volume 20 product catalog, complete with a new design, images, and prices printed right in the catalog for your convenience. The company has added new products, but still carries all your favorites, including the Stretch Out Strap, foam rollers, and other products for your fitness needs. To request a copy of Volume 20, call OPTP or go online today.

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Power Lift 800-872-1543 www.power-lift.com Power Lift’s Collegiate Series brochure features the company’s new product line. Featured items include the Half Rack, Power Rack, Combo Power Rack, Multi-Angle Dumbbell Bench, and Olympic lifting platforms.

All of the Collegiate Series racks feature straight-bar chin-up handles, weight storage, fixed bar tabs, dual vertical bar storage, and safety spot bars. The Multi-Angle bench adjusts from a threedegree decline to an 80-degree incline with six adjustment positions. The Olympic platforms feature a red oak center and a custom logo.

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Power Systems 800-321-6975 www.power-systems.com Power Systems continues to advance health, fitness, and physical performance by offering sports and fitness professionals and enthusiasts more than 200 new products in its 2008 catalogs.

Power Systems carries more than 2,000 innovative products, many of which are the company’s own brand. The three catalogs include an 88-page comprehensive edition packed with fitness and sports performance equipment, a 72-page edition for sports performance professionals, and a 24page strength insert featuring strength equipment, flooring, and specialty bars.

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Pro-Tec Athletics 800-779-3372 www.injurybegone.com Pro-Tec Athletics, a leading sports medicine company, offers new and existing products specializing in orthopedic support and cryotherapy, all showcased in its 2008 catalog. The catalog also highlights the company’s involvement with and support of communities at home and across the globe. Pro-Tec’s 2008 catalog is your injury information source, as the last two pages are devoted to stretching and strengthening exercises. Call to request your copy today.

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Samson Weight Training Equipment 800-472-6766 www.samsonequipment.com The newly revamped Samson Equipment Web site is an online catalog showcasing new products, video demonstrations, a full range of equipment from squat racks to athletic training equipment, featured equipped facilities, and sample paint/upholstery charts.

Everything you could possibly need to outfit a top-of-the-line strength training facility can be found on the site.

StaphAseptic 800-482-4464 www.staphaseptic.com Antibiotic-resistant staph infections caused by MRSA are a growing problem for all athletes.

Protect yourself and your athletes from MRSA with a complete staph prevention program including StaphAseptic® first aid antiseptic/pain relieving gel. Apply it to cuts, scrapes, and abrasions to help prevent skin infections from MRSA, staph, strep and other germs. In-vitro studies have shown that StaphAseptic kills more than 99.9 percent of MRSA bacteria. Go online for more information.

SwimEx, Inc. 800-877-7946 www.swimex.com SwimEx is a pioneer in the development of fiberglass swimming and conditioning pools for aquatic therapy and training. Designed to meet the aquatic exercise needs of health professionals, athletic trainers, physical therapists, and homeowners, SwimEx pools are used by professional and collegiate athletic programs, as well as health clubs, physical therapists, and fitness-minded individuals around the world. SwimEx now offers nine therapy pools models for 2008.

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Perform Better 800-556-7464 www.performbetter.com The Perform Better 2008 catalog, The Guide to Functional Training, is now available. This 76-page publication is conveniently organized into 18 different categories covering a wide range of products from balance and stabilization training to speed and agility training. Included in each section are expert insights focusing on training and rehabilitation tips. Call today or go online to request your free copy.

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CATALOG SHOWCASE

HOT & COLD THERAPIES

Thera-Band®/Hygenic Performance Health 800-246-3733 www.thera-band.com

Cold One Therapy, LLC 503-317-5273 503-841-0980 www.coldonetherapy.com

The new Thera-Band® Rehab and Wellness Station is designed for strength, balance, and core training. It features Thera-Band clip-connect resistance tubing, stability trainers, and the new Pro Series SCP™ exercise ball.

It provides three planes of movement for upper- and lower-extremity strength training. Slide tracks with one-hand lockdown capability provide significant flexibility for user setup, charting, and documentation.

Cold One Therapy markets ice and compression therapy wraps for the common athlete. If you are looking for faster recovery from muscle soreness, injury, or strain, Cold One cold muscle wraps are the perfect solution. At the company’s Web site, you can browse its selection of back wraps, knee wraps, foot wraps, elbow wraps, hamstring wraps, shoulder wraps, wrist wraps, and more. Whether your sport is football, bowling, soccer, basketball, golf, running, tennis, swimming, or boxing, there is a wrap for you.

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Circle No. 545 Thought Technology 800-361-3651 www.thoughttechnology.com MyoTrac Infiniti allows you to measure two channels of high-resolution surface electromyography (SEMG) and provide two channels of electrical stimulation (STIM) in a wide variety of configurations. MyoTrac Infiniti stands apart from the competition by including SEMG-triggered stimulation (ETS), where the SEMG signal is used to trigger stimulation to help patients improve volitional activation of targeted muscle groups.

This combination of three modalities enhances treatment possibilities and eliminates the need for multiple devices.

Circle No. 546 TurfCordz by NZ Mfg., Inc. 800-886-6621 www.nzmfg.com TurfCordz resistance products are engineered for high-level athletic agility and strength training. Leading professional sports teams and international Olympians train with TurfCordz for explosive start drills, power-building footwork, and simulated play action to enhance performance through resistance. Stamina, power, strength, speed, and flexibility are achieved with TurfCordz. Also available from NZ Mfg. are the top-quality MediCordz rehabilitation products and StrechCordz swim training products.

Circle No. 547 TR AINING-CONDITIONING.COM

Biofreeze®/Hygenic Performance Health® 800-246-3733 www.biofreeze.com Applied generously, Biofreeze® pain relieving gel and roll-on effectively relieve pain from heel injuries, sore arches, muscle spasms, strains, sprains, and tendonitis, and will help minimize nextday aches and pains. Use it up to four times a day. It’s available in a 16-ounce spray bottle and 16-ounce, 32-ounce, and gallon gel pump bottles.

Also available is a gravity dispenser box with 100 five-gram single-use application packets for clinical settings.

Circle No. 549 Pro-Tec Athletics 800-779-3372 www.injurybegone.com

portable ice massager. It offers effective treatment in just five to seven minutes, and quick deep-tissue relief for ligament, tendon, and muscular injuries. Ice massage increases treatment effectiveness and speeds recovery. The Ice Up has a leak-proof design to keep your sports bag dry. A portable carry cooler keeps the Ice Up stick frozen for up to 12 hours, so it can be taken anywhere for pre- or post-activity ice massage.

Circle No. 550 Whitehall Mfg., Inc. 800-782-7706 www.whitehallmfg.com The ThermaSplint™ from Whitehall Mfg. features dual voltage, an illuminated on/off switch, and quick heat-up time.

The unit operates on a solar-powered digital thermometer that allows the temperature to be adjusted with digital readouts for different splinting thermoplastics.

The ThermaSplint is constructed of heavy-gauge stainless steel.

Circle No. 551 Whitehall Mfg. offers a complete line of moist heat-therapy treatment products that are convenient and easy to use. Each heating unit is fabricated from heavygauge stainless steel and polished to a satin finish.

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

Circle No. 552

Experience the benefits of direct, active ice massage with the Ice Up

WEB NEWS

To Get Athletes Back Into Action Faster, Just Add Water HydroWorx, a premier manufacturer of aquatic rehabilitation and fitness products, offers innovation in every pool, with fully adjustable floors, underwater treadmills, resistance jets, deep tissue massage, and options to fit every application and budget. At the company’s Web site, you can find extensive details on its entire collection of pools: the HydroWorx 2000, 1200, 1100, 1000, 600, 500, ThermalPlunge, and PolarPlunge. These products have proven to be among the most versatile pools for athletic trainers worldwide. Log on to the Rapid Recovery Center at the site to learn how athletic trainers and other clinicians are accelerating their athletes’ recovery and getting them back onto the field sooner with HydroWorx.

www.hydroworx.com T&C MARCH 2008

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Adams USA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51 AquaJogger . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 AthletiClean . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Avazzia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Biofreeze®/Hygenic Performance Health® . . . . . . . . . . . . . . . . . . . . .11 California University of Pennsylvania . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Cho-Pat . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 CleenFreek SportsHygiene. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .47 Cold One (Two Cool) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 Covidien . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Creative Health Products . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 CSG/SportsCoatings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Dynatronics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . IBC G&W Heel Lift . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Gatorade . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-3 Gear 2000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 GymWipes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 Hibiclens (Molnlycke Health Care). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Hibistat (Molnlycke Health Care) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 HQ, Inc. (CorTemp™) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Indiana Athletic Trainers Association . . . . . . . . . . . . . . . . . . . . . . . . . . .17

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Adams USA (Bac-Shield). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Adams USA (catalog) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 AquaJogger (catalog) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 AquaJogger (TriFit bar) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 AthletiClean . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Avazzia Med-Sport (BEST-RSI) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 Avazzia Med-Sport (Med-Sport). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 Biofreeze®/Hygenic Performance Health® . . . . . . . . . . . . . . . . . . . . 71 California University of Pennsylvania . . . . . . . . . . . . . . . . . . . . . . . . . . 73 Cho-Pat (catalog) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 Cho-Pat (Compression Sleeve) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 CleenFreek SportsHygiene. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Cold One (Two Cool) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 Covidien . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Creative Health Products . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 CSG/SportsCoatings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 CytoSport (Cytomax) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 CytoSport (Muscle Milk Collegiate) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 DM Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 Dynatronics (catalog). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 Dynatronics (X5 Oscillation Device) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 G&W Heel Lift . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 Gear 2000 (catalog) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 Gear 2000 (Z-Cool shoulder pads) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 GymWipes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 HeartSine Technologies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 HQ, Inc. (CorTemp™) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 Human Kinetics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 Molnlycke Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 Mueller (catalog). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 Mueller (Whizzer) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 NASM (Corrective Exercise Specialist) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .74 NASM (Performance Enhancement) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .74 NZ Mfg. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 OPTP (catalog) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70

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TR AINING-CONDITIONING.COM

MORE PRODUCTS Avazzia 214-575-2820 www.avazzia.com The BEST-RSI™ is an FDA-cleared microcurrent biofeedback electrostimulation device from Avazzia that interactively detects the body’s response and adapts the microcurrent stimulus, so every output signal is modified according to the body’s response. The result is improved non-pharmaceutical relief from pain, quicker return of range of motion, and accelerated return to activities. This battery-operated, handheld unit is easy to use and delivers outstanding results.

Circle No. 553 The next generation of the Med-Sport interactive biofeedback therapy device from Avazzia detects and adapts to the microcurrent stimulus, so every output signal is modified according to the body’s response.

The result is improved nonpharmaceutical relief and accelerated return to activities. It offers microcurrent electrotherapy with automatic interactive biofeedback, all in an economical handheld unit with auto timeout. This device is not just a TENS unit. Administer an automatic biofeedback system with various frequencies of pulsed or damped bi-phasic sinusoidal waveforms. Avazzia has earned the prestigious ISO13485 quality supplier certification.

Circle No. 554 California University of Pennsylvania 866-595-6348 www.cup.edu/go California University of Pennsylvania has helped build the character and careers of its students for more than 150 years. Cal U’s dedication to providing high-quality, in-demand programs to its students continTR AINING-CONDITIONING.COM

ues through the University’s Global Online 100-percent online programs of study. Through an asynchronous format, Global Online allows students the opportunity to complete coursework anytime, anywhere. All that’s required is a computer with Internet access. Go online for more information.

Circle No. 555 CytoSport, Inc. 888-298-6629 www.cytosport.com CytoSport has introduced the new Muscle Milk Collegiate energy bar.

With 150 calories, three grams of fiber, and 11 grams of the company’s highquality multi-source protein blend, this bar is big on taste and big on results. Muscle Milk Collegiate bars are permissible under NCAA bylaw 16.5.2.2 for nutritional supplements and are a great addition to any postworkout nutrition program. They’re available in vanilla, toffee, and chocolate peanut caramel flavors. For more information, visit CytoSport online. **NCAA is a registered trademark of the National Collegiate Athletic Association.

Circle No. 556 Drink Cytomax from CytoSport while training or exercising to ensure proper hydration, electrolyte replacement, energy balance, and reduced fatigue.

Drink it 15 minutes prior to training and consistently during workouts for the best results.

Patented alpha L-polylactate buffers lactic acid production and minimizes post-exercise muscle soreness. Complex carbs provide sustained energy without the sugar “crash” and antioxidants help prevent free-radical damage to muscle cells.

Circle No. 557 HeartSine Technologies 866-478-7463 www.heartsine.com Sudden cardiac arrest is a leading cause of death. If it happens in your workplace, be prepared. The HeartSine

Samaritan PAD is the most compact, easiest to use, most durable automatic external defibrillator (AED) available, making it an ideal choice for athletic programs and sports teams. For more information, call HeartSine Technologies or visit the company’s Web site.

Circle No. 558 Thera-Band®/Hygenic Performance Health® 800-246-3733 www.thera-band.com The new Thera-Band® Rehab and Wellness Station is designed for strength, balance, and core training. It features Thera-Band clip-connect resistance tubing, stability trainers, and the new Pro Series SCP™ exercise ball. It provides three planes of movement for upperand lower-extremity strength training. Slide tracks provide significant flexibility for user setup, charting, and documentation. Each unit includes four posters with 115 exercises, plus a CD with more than 170 exercises for resistance bands or tubing, exercise balls, and balance boards.

Circle No. 559 Perform Better 800-556-7464 www.performbetter.com Perform Better presents the new Posture Ball. Its small size helps release muscle tension in hardto-reach places.

It is great for myofascial release and maintaining body posture. Made of closed-cell EVA foam materials, the Posture Ball is available in six-inch and eight-inch sizes. This durable and lightweight product retains its shape after exercise. See the Posture Ball in the 2008 Perform Better catalog. Request your copy today by calling or going online.

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MORE PRODUCTS NASM 800-460-6276 www.nasm.org

these posters and other products, call OPTP or visit the company online.

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The NASM Performance Enhancement Specialist (NASM-PES) advanced specialization offers professionals the ability to learn cutting-edge performance assessment techniques and sport-specific program design. Individuals with this credential deliver consistent results in rehabilitation, reconditioning, and performance enhancement. Learn to individualize integrated training programs to keep your athletes performing at the highest level, and utilize the OPT™ method for outstanding, measurable results. The PES offers scientifically valid, evidence-based applications that help you achieve remarkable results with top professionals and weekend warriors alike. CEUs: NASM 1.9; NSCA 1.6; ACE 1.8; NATABOC 27.

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Power Lift 800-872-1543 www.power-lift.com

NASM’s Corrective Exercise Specialist (CES) advanced specialization provides you with evidence-based knowledge, skills, and abilities to achieve superior results with clients suffering from musculoskeletal impairments, imbalances, and postrehabilitation concerns.

Comprising nine modules that cover advanced corrective topics such as movement assessment, inhibitory techniques, muscle activation techniques, and common musculoskeletal impairments, the CES integrates innovative science and solutions for optimal success. Go online to find out more.

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Samson Weight Training Equipment 800-472-6766 www.samsonequipment.com

OPTP 800-367-7393 www.optp.com The convenient Foam Roller Techniques poster set is broken down by upper- and lower-body exercises.

At 18” x 24” each, the posters are an ideal resource for fitness centers, rehab facilities, homes, and even the office.

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Power Lift’s Dual Stack Functional Trainer is an ideal equipment piece for every strength and fitness facility.

Two 200-pound weight stacks feature a 2:1 resistance level that is ideal for both strength training and rehabilitation movements.

Standard features include Power Lift’s patented Rotating Chin-Up Handles, weight stack guards, accessory storage handles, and two D-ring handles. The wide opening is ideal for users working on a physio ball.

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The new Samson Belt Squat is yet another way Samson Equipment is leading the way in custom heavy-duty weight training equipment. The brand new design limits the amount of floor space needed for this unique piece, and it’s easy for athletes of all different sizes to use. It features adjustable handles, a unique load release that brings the athlete’s hands closer together while performing the exercise, an adjustable yoke that allows each athlete’s hips to stay in their natural range of motion, and an adjustable chain with three different size belts. Go online to learn more.

Circle No. 565 Save-A-Tooth® 888-788-6684 www.save-a-tooth.com Without proper care, a knocked-out tooth begins to die in 15 minutes. The Save-A-Tooth® emergency tooth preserving system utilizes Hank’s Balanced

Salt Solution (HBSS) to not only preserve, but also reconstitute many of the degenerated cells. The patented basket and net container are designed to protect tooth root cells.

This is the only system that keeps tooth cells alive for up to 24 hours.

Circle No. 566 Source 1 Medical 800-217-6690 www.source1medical.com The 2738K Intelect TranSport® Combo is equally adept on the go and in the clinic. The unit’s unique design makes it ideal for tabletop, wall mount, therapy cart, or mobile use. It features fully functional 1 and 3.3 MHz frequencies, two channels of electrical stimulation output, 10 user-defined memory positions for user protocols, and four standard waveforms: interferential, premodulated, Russian, and high-voltage.

This unit has pulsed and continuous therapy operation (10, 20, 50, and 100 percent), a lightweight design, a battery option, and a custom carrying bag for convenient portability.

Circle No. 567 Thought Technology 800-361-3651 www.thoughttechnology.com During the past 34 years, more than 10,000 Olympic and professional athletes have used Thought Technology’s biofeedback equipment. The FlexComp Infiniti 10-channel system is being used to assess muscle fatigue by some of the best athletes in the world. All your needs are met in a monitoring system that monitors your athlete with BioGraph Infiniti software. Acquire data in the field using compact flash memory or a monitor and train your athlete directly to your PC or wirelessly up to 300 feet away.

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MORE PRODUCTS Cho-Pat 800-221-1601 www.cho-pat.com

Dynatronics 800-874-6251 www.dynatronics.com

HQ, Inc. 941-723-4197 www.hqinc.net

Cho-Pat’s Shin Splint Compression Sleeve eases the pain associated with shin splints. Designed and evaluated by medical professionals, this unique device tackles inflammation and discomfort by using gentle compression to support the lower leg muscles. It also stimulates circulation, maintains warmth, and controls excess fluid.

Finally, two straps act as shock absorbers to reduce microtrauma to the tendons and other soft tissue and keep the device in proper position. Call Cho-Pat or visit the company’s Web site for more information.

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The new Dynatron X5 Soft-Tissue Oscillation Device is a highly effective treatment for both acute and chronic pain. This remarkable machine features two independent channels and six treatment modes, and includes both large and small treatment probes. Featuring four frequency sweeps, frequency ranges from 0 to 200 Hz, a conductance meter, and a two-year warranty, the X5 is cost-effective and affordable. Feeling is believing: For a free demonstration, call your Dynatronics dealer or contact the company to learn more.

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Research indicates that external methods of temperature measurement are not accurate in assessing core body temperature during intense activity in the heat. The CorTemp™ system, featuring the CorTemp ingestible core body temperature pill and data monitor, provides an easy, affordable approach to assessing elevated core temperature on the field. It can also be used to monitor the effectiveness of cooling methods on the sidelines. CorTemp is FDA-cleared and used by professional and collegiate teams nationwide. Order early for this year’s heat season.

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Calling Cards Here is what these companies are most known for...

Implementing the art and science of performance and well-being. www.chekinstitute.com

Winning taste... Championship results. www.cytosport.com

Manufacturer and distributor of advanced-technology medical and rehabilitation equipment, supplies, and treatment tables. www.dynatronics.com

The ultimate pool for home, healthcare, and sports. www.hydroworx.com

Hammer Strength is a world-leading brand of plate-loaded equipment. www.hammerstrength.com

Manufacturer of quality therapeutic devices and supplies for 50 years. www.mettlerelectronics.com

Supplier of quality tools and resources for more than 30 years. www.optp.com

Equipment for training without straining. www.shuttlesystems.com

Custom weight training equipment built for strength since 1976. www.samsonequipment.com

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CEU QUIZ

T&C March 2008 Volume XVIII, No. 2

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 78) that represents the best answer for each of the questions below.

Complete the form at the bottom of page 78, include a $25 payment to MAG, Inc., and mail it by May 30, 2008 to the following address: MAG, Inc., ATTN: T&C 18.2 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 within 30 days.

The Better To Heal You With (pages 13-18) Objective: Understand the most recent research on how nutritional intake can affect an athleteâ&#x20AC;&#x2122;s rehabilitation progress.

1. Research has shown that dietary fat is a key factor during what rehab stage? a) Post-injury inflammation period. b) Inflammatory period. c) Chronic phase. d) Training phase.

2. Research suggests athletes should decrease _____ and increase _____ post-injury. a) Vitamin A, Vitamin D. b) Omega-3, omega-6. c) Omega-6, omega-3. d) Omega-6, Vitamin C. 3. Some authors recommend injured athletes consume how many grams of fish oil per day? a) One to two. b) Two to four. c) Three to nine. d) Nine to 15.

4. What is an example of an Omega-3 rich food? a) Cottonseed oil. b) Beef. c) Sunflower oil. d) Flax seed.

5. Research has shown that increased consumption of nuts, seeds, and olive oil can: a) Decrease satiety. b) Reduce performance. c) Mildly reduce inflammatory biomarkers. d) Significantly increase inflammation.

6. What ratio should fats be balanced at during rehabilitation? a) 2 saturated: 1 polyunsaturated. b) 1 saturated: 1 polyunsaturated: 1 monounsaturated. c) 1 polyunsaturated: 1 monounsaturated. d) 1 saturated: 2 polyunsaturated: 1 monounsaturated.

7. After the inflammation stage, the focus of rehab nutrition shifts to what? a) Endurance. b) Glycogen loading. c) Energy intake. d) Low carbohydrate intake.

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8. Basal metabolic rate may increase: a) 25 percent during the season. b) 15 to 20 percent after injury. c) 60 percent with significant injury or surgery. d) Five percent after injury.

9. A standard clinical recommendation for protein intake is _____ grams per kilogram of body weight per day in healthy individuals and _____ grams per kilogram of body weight per day in athletes undergoing rehabilitation. a) 0.8, 1.0. b) 0.8, 2.0. c) 0.7, 3.0. d) 0.5, 3.0.

10. What vitamin helps reverse post-injury immune system suppression? a) A. b) B. c) C. d) D. 11. With vitamin _____ deficiencies, collagen fibers are formed abnormally and fibrous tissue is weak with poor adhesion. a) A. b) B. c) C. d) D.

On The Same Page (pages 22-28) Objective: Get advice on how to work with individual sport coaches who may question your workouts.

12. The author indicates the first step in his formula for success is to: a) Always follow the coachâ&#x20AC;&#x2122;s direction/lead. b) Only use equipment with a researched background. c) Have sturdy, proven equipment. d) Know who you serve.

Pooling Resources (pages 29-34) Objective: Learn how combining biofeedback with aquatic therapy can get athletes on the road to rehab quickly.

13. A benefit of aquatic therapy may be: a) Decreased joint compression. b) Increased weight bearing. c) Consistent movements with each repetition. d) An overall increase in muscle recruitment.

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14. Research indicates that VMO activity generated in waist deep water is what percentage of that generated on land? a) 20. b) 30. c) 40. d) 50.

What A Save! (pages 36-40) Objective: Understand how to construct an effective strength and conditioning program for the goalkeepers on your teams.

19. Jeff Hageman says, â&#x20AC;&#x153;Staph needs _____ to cause a skin infection.â&#x20AC;? a) Direct contact with the skin. b) A break in the skin. c) A weakened immune system. d) Resistance to antibiotics.

20. Untreated MRSA releases a dangerous toxin called what? a) Methicillin leukocidin. b) Bacterial Meningitis. c) Panton-Valentine leukocidin. d) Valentine Leukemia.

15. This article discussed the following crucial building blocks for goalies: a) Aerobic training, muscle flexibility, and coordination. b) The metabolic system, muscular strength, muscular endurance, coordination, and quickness. c) Plyometric training, stabilization, and endurance. d) Anaerobic training, core stabilization, and the metabolic system.

21. Several large studies said _____ percent of skin infections that have pus associated with them are now caused by MRSA bacteria. a) 50. b) 60. c) 70. d) 80.

16. What is often to blame when goalkeepers experience a breakdown in form or technique late in a game? a) Coaching. b) Muscle tightness. c) Fatigue. d) Coordination.

22. One major key to preventing the spread of MRSA is for athletes to: a) Shower immediately after practice. b) Wear sandals. c) Wear two pair of socks. d) Use fresh towels each game.

17. The keystone component for most successful goalkeepers is: a) Strength. b) Flexibility. c) Quickness. d) A good warmup.

23. The new test called the BD GeneOhm StaphSR assay: a) Can identify MRSA in just two hours. b) Is a standard wound culture test. c) Identifies pustules and redness. d) Evaluates spider bites.

Under The Microscope (pages 41-49) Objective: Get all the questions you have about MRSA, including how to prevent it, answered by experts in the field.

18. The CDC estimates that what percentage of people in the United States are colonized with staph? a) 10 to 15. b) 15 to 25. c) 25 to 30. d) 30 to 35.

24. General guidelines recommend excluding an infected athlete from: a) Entering the training room. b) Activities that involve direct physical contact from others. c) Showering in the public showers. d) Participation.

25. What are some signs that a wound may be infected with MRSA? a) Redness. b) Swelling. c) Formation of a postule. d) All of the above.

Answer sheet is on page 78 TR AINING-CONDITIONING.COM

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CEU QUIZ

ANSWER FORM

Instructions: Fill in the circle on the answer form below that represents your selection of the best answer for each of the previous questions. Complete the form at the bottom of this page, include a $25 payment to MAG, Inc., and mail it to the following address: MAG, Inc., ATTN: T&C 18.2 Quiz, 31 Dutch Mill Road, Ithaca, NY 14850, no later than May 30, 2008. 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 within 30 days.

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Last Name ____________________________________ First Name _______________________________ MI______ Title ______________________________________________________________________________________________ Mailing Address ____________________________________________________________________________________ City ________________________________________________ State _________ Zip Code _____________________ Daytime Telephone ( _________ ) ________________________________________ E-Mail Address ____________________________________________________________________________________ Payment Information

❏ $25 check or money order (U.S. Funds only) payable to: MAG, Inc. (please note “T&C 18.2 Quiz” on check) ❏ Visa

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Account Number _______________________________________________ Expiration Date ____________________ Name on Card _____________________________________ Signature ______________________________________

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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 MARCH 2008

79

OVERTIME

Next Stop: Web Site Our editorial continues on www.Training-Conditioning.com Here is a sampling of the editorial now on the Web site:

WEEKLY BLOGS

MONTHLY FEATURES

Grappling with Wrestling Injuries

Underwater Installation

The Center for Injury Research and Policy at The Research Institute at Nationwide Children’s Hospital provides T&C with an inside look at their studies of high school athletics injuries in wrestling.

Jenks High School in Tulsa, Okla., recently opened its own sports medicine center, which includes everything from an area for student athletic trainers to dress to an underwater treadmill.

NATA Sues APTA

Bridging the Gap

We examine the lawsuit recently filed by the National Athletic Trainers’ Association against the American Physical Therapy Association.

Performance Enhancement Awareness

James Onate, Assistant Professor and Director of the Sports Medicine Research Laboratory at Old Dominion University, discusses the need to improve the understanding of applying clinical practice into research and the importance of applying studies into clinical practice.

Dave Ellis, offers his opinions on the Mitchell Report and how to spot an athlete who may be using steroids.

www.training-conditioning.com/features.html

www.training-conditioning.com/blogs.html

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