Training & Conditioning 18.3 by Momentummedia

April 2008 Vol. XVIII, No. 3, $7.00

Assessing Nutritional Supplements Strength for Football

Micro Holes, Macro Results Advances in microfracture knee surgery

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April 2008, Vol. XVIII, No. 3

CONTENTS

23 6

Bulletin Board US Lacrosse issues helmet removal guidelines … Combining carbs to enhance endurance … New NCAA rule protects pregnant athletes … Heart screenings studied at Stanford. Comeback Athlete Jordan Bauman Stratford (Wis.) High School Sponsored Pages

Treating The Athlete

Holes, Macro Results 14 Micro In the past, suffering a chondral defect often meant an end to an athlete’s career. Today, exciting advances in microfracture surgery and rehab are allowing players to come back more explosive than ever. By R.J. Anderson Nutrition

…. And More Choices 23 Choices As the number of nutritional supplements on the market keeps growing, athletes can easily get lost among the choices. Our expert explains how to steer clear of unwanted risks and toward real performance gains. By Michelle Rockwell

Balanced Body

71 52 54 61 62 63 66

Product Pages Product Launch Nutritional Aids Rehab Equipment Knee Products Pilates Equipment Football Conditioning More Products

Advertisers Directory

CEU Quiz For NATA and NSCA members

English, our clientele is growing more diverse by the day. Improving your cultural competence will ensure you are providing the best healthcare possible. By Elicia Leal

Next Stop: Web site

Sport Specific

On the cover: NBA All-Star Amare Stoudemire successfully came back from microfracture surgery on his knee, thanks in part to a carefully planned rehab. Story begins on page 14. Photo: ©GETTY IMAGES TR AINING-CONDITIONING.COM

Optimum Performance

Alignment 31 In Sometimes, an athlete’s toughest opponent is his or her own biomechanical flaws. One way to correct them is through a form of Pilates called Contrology. By Christine Romani-Ruby Leadership

of Faith 38 Leap From Muslim athletes in headscarves to patients who don’t speak

Effort 45 Coordinated At the University of Cincinnati, speed work and a creative approach to building strength are the foundations of the football training program. But just as important is how the coaches coordinate their efforts. By Paul Longo T&C APRIL 2008

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Editorial Board Marjorie Albohm, MS, ATC/L Director of Sports Medicine and Orthopaedic Research, Orthopaedics Indianapolis

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Jon Almquist, ATC Specialist, Fairfax County (Va.) Pub. Schools Athletic Training Program Brian Awbrey, MD Dept. of Orthopaedic Surgery, Massachusetts General Hospital, and Instructor in Orthopaedics, Harvard Medical School Jim Berry, MEd, ATC, SCAT/EMT-B Director of Sports Medicine and Head Athletic Trainer, Myrtle Beach (S.C.) High School Leslie Bonci, MPH, RD Director, Sports Medicine Nutrition Program, University of Pittsburgh Medical Ctr. Health System

Cho-Pat Tennis Elbow Support Secures and supports forearm muscles that are over-exercised or strained during athletic activities. Sizes: Sm – XXL

Dual Action Knee Strap Patented strap provides relief from knee pain caused by degeneration and overuse. Easy to use, comfortable, allows full mobility. Sizes: Sm - XL

Shin Splint Compression Sleeve

Christine Bonci, MS, ATC Asst. A.D. for Sports Medicine, Women’s Athletics, University of Texas Cynthia “Sam” Booth, ATC, PhD Manager, Outpatient Therapy and Sportsmedicine, MeritCare Health System Debra Brooks, CNMT, LMT, PhD CEO, Iowa NeuroMuscular Therapy Center Cindy Chang, MD Head Team Physician, University of California-Berkeley Dan Cipriani, PhD, PT Assistant Professor Dept. of Exercise and Nutritional Sciences, San Diego State Univ. Gray Cook, MSPT, OCS, CSCS Clinic Director Orthopedic & Sports Phys. Ther. Dunn, Cook, and Assoc. Keith D’Amelio, ATC, PES, CSCS Head Strength & Conditioning Coach/ Assistant Athletic Trainer, Toronto Raptors

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

April 2008 Vol. XVIII, No. 3 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 Maria Hutsick, MS, ATC/L, CSCS Head Athletic Trainer, Medfield (Mass.) High School

Circulation Staff David Dubin, Director John Callaghan

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

Art Direction Message Brand Advertising

Allan Johnson, MS, MSCC, CSCS Sports Performance Director Velocity Sports Performance

Production Staff Don Andersen, Director 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

Marketing/Sales Assistant Danielle Catalano

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

Bicep/TricepS Cuff

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. Unsolicited materials will not be returned unless accompanied by a self-addressed, stamped envelope. Periodicals postage paid at Ithaca, N.Y. and additional mailing offices. POSTMASTER: Send address changes to Training & Conditioning, P.O. Box 4806, Ithaca, NY 14852-4806. Printed in the U.S.A.

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Board Lacrosse Helmet Removal Guidelines Released Thanks to the work of the US Lacrosse Sports Science and Safety Committee, the first recommendations for injury-related removal of lacrosse helmet facemasks and chinguards have been released. Until now, athletic trainers have generally applied removal methods from football, but lacrosse helmets are no longer similar enough to football helmets to make shared removal procedures practical. “Lacrosse helmets have really evolved over the past 10 to 15 years from being a helmet that was loose enough to spin around on your head to one that fits tightly,” says Nancy Burke, ATC, Chair of the committee. “In the very beginning, the standard of care when it came to a head or neck injury in lacrosse was to immediately take the helmet off. But that is no longer an acceptable procedure. The best thing to do is remove the facemask and leave the helmet on during transport.” The committee met with each lacrosse helmet manufacturer and developed specific instructions for their current helmet models, which also apply to those manufactured in the past two to three years. Different cutting tools are suggested depending on the helmet design, but Burke says there are some general guidelines that apply to all of them. For removing the screws that secure the facemask to the sides of the helmet, a power screwdriver with a light on it is the best option for all models. Either a flathead or Phillips head will work because lacrosse helmets all contain “combo” screws. Cutting tools, however, are specific to the helmet model—common cutters include the FMXtractor, Trainer’s Angel, and an anvil pruner. “Our hope is that these guidelines get everyone prepared,” Burke says. “There is nothing worse than having an injury happen on the field and not being able to find the necessary tools in your bag. We recommend that athletic trainers practice these removal procedures and review each helmet’s guidelines, because you never know which kinds of helmets will be worn on your field.” The full guidelines can be downloaded by clicking on “Helmet Fitting & Facemask Removal” at: www.uslacrosse.org/safety/index.phtml.

Glucose-Fructose Combo Enhances Endurance A study published in the February issue of Medicine & Science In Sports & Exercise found that consuming a specific blend of glucose and fructose carbohydrates rather than glucose alone improved athletes’ endurance performance by about eight percent. These findings contradict years of re6

T&C APRIL 2008

search saying the human body can burn only 60 grams of carbohydrates per hour. Eight male cyclists, with an average VO2 max of 64.7, ingested a water placebo, a glucose-only solution, or a solution with a 2:1 ratio of glucose to fructose. They then cycled for two hours at 55 percent of maximal aerobic power, followed by a time trial exercise. Expired gases were analyzed throughout and blood samples were taken every 15 minutes. The subjects who ingested the glucose-fructose solution finished the time trial about eight percent faster than the glucose-only group, and about 19 percent faster than the placebo group. The researchers found that combining the two sugars allowed the body to utilize dual transport mechanisms at the same time, thus maximizing carbohydrate use. When ingesting only one simple carbohydrate at a time, the body’s pathway for it eventually becomes saturated, limiting the amount of the carbohydrate available to the body—this is where previous research came up with the 60 grams-per-hour maximum. With the glucose-fructose mixture, the body was able to burn up to 105 grams of carbohydrates per hour. The study, conducted at the School of Sport and Exercise Sciences at the University of Birmingham in England with Asker Jeukendrup, PhD, as lead researcher, is being looked at by sports drink and energy bar companies. At least one company has already announced plans to change its energy bar recipe to include the same glucose-fructose ratio as the solution used in the study. The abstract of the study, “Superior endurance performance with ingestion of multiple transportable carbohydrates,” can be viewed online by visiting: www.ms-se.com and typing “transportable carbohydrates” into the search window.

NCAA Protects Scholarships of Pregnant Athletes An athletic trainer is often one of the first people to learn of a student-athlete’s pregnancy, which can present a dilemma if the athlete wants to keep it a secret for fear of losing her scholarship. Now, however, athletic trainers at NCAA Division I schools can erase that fear. The Division I Board of Directors approved legislation at the NCAA convention in January that will prohibit institutions from reducing or canceling aid to student-athletes because of an injury, illness, or medical condition, including pregnancy, during the scholarship term (the academic year). The rule, which takes effect Aug. 1, applies regardless of whether the condition prevents the student-athlete from playing during the year. TR AINING-CONDITIONING.COM

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Board

Bulletin

“Accountability needs to take place here and now by providing these student-athletes the necessary financial protection,” Rutgers University softball player and National Student-Athlete Advisory Committee member Brittany Loisel told Division I delegates at the convention. “We need to know our institutions are not only committed to us as student-athletes, we need to know our institutions are committed to us as people.”

New Study Analyzes Cardiac Screening In the past two years, the debate over whether to screen athletes for heart abnormalities has heated up. Now, a team of researchers at Stanford University is conducting a multi-year heart screening study to examine whether screening athletes is worth the cost. In Italy, a cardiac screening program for the country’s competitive athletes that includes an extensive physical exam and electrocardiogram (EKG) has been credited with decreasing athletes’ rate of sudden cardiac arrest by 90 percent over a 25-year period. Since these results were published in the Journal of the American Medical Association in 2006, advocacy groups have been calling for more screenings in the U.S. But so far, the American Heart Association has declined to make a recommendation, primarily because of the high cost

of the screenings. For the new study, over 800 Stanford student-athletes volunteered to undergo EKGs in September. Although none of them were found to have hypertrophic cardiomyopathy (the most common cause of sudden cardiac death in young people), a tennis player with a congenital heart defect was

Over 800 Stanford student-athletes volunteered to undergo EKGs in September ... None of them were found to have hypertrophic cardiomyopathy. flagged. While she is not barred from playing, she may undergo surgery in the future to prevent premature heart failure. The researchers will add ultrasounds to the screening next year, and their findings will be presented in two to three years. “Because of all this controversy, people don’t know what to do,” one of the Stanford study’s researchers, Victor Froelicher, MD, Professor of Cardiology and Sports Medicine for the Palo Alto Veterans Affairs Health Care System, told the San Mateo County Times. “We’re feeling we’re the perfect ones to work this out.” ■

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Circle No. 105

Comeback

Athlete

Jordan Bauman Stratford (Wis.) High School BY R.J. ANDERSON

Conventional wisdom says a high school athlete who is undergoing chemotherapy shouldn’t be able to run around a football field helping his team win a state championship. But after watching Jordan Bauman, a junior linebacker and receiver at Stratford (Wis.) High School do just that, Shawn Mullen, LAT, ATC, CSCS, the school’s Head Athletic Trainer, doesn’t put much stock in conventional wisdom. Bauman’s story begins during the 2006-07 wrestling season, when he was diagnosed with iron deficiency anemia. Despite strictly following the prescribed treatments for the condition, which included an improved diet, Bauman went through the next summer feeling weak and listless. Though he consistently ate four meals a day and participated in a vigorous weightlifting program, he lost weight and his lifting numbers declined. Starting the summer at 195 pounds, Bauman had dropped to 187 by the time football preseason camp began in August. He continued to struggle during football workouts. “His performance on the mile run and other measures of fitness were substandard for him,” says Mullen, who is contracted to provide coverage at the school through the Marshfield (Wis.) Clinic Sports Medicine Program. “In the mile, he was probably more than a minute over what he had run the previous year.” Seeing the muscled, six-foot-four Bauman, a second-team all-conference player as a sophomore, lag behind his teammates, Mullen knew something wasn’t right. He became skeptical that iron deficiency was the correct diagnosis for the 17-year-old’s ills. On a Monday, Aug. 27, three days after playing in the team’s first game, Bauman came to practice reporting a slew of new symptoms. “He told me that during the game he felt like he was going to black out and was having problems with his vision,” Mullen recalls. “Then, that day at practice, he again had vision problems, felt like he was going to black out whenever he stood up, and had chest pain when he tried to run. Those are not symptoms you normally associate with iron deficiency.” After performing a short exam that consisted of listening to Bauman’s heart and lungs and feeling around his rib cage, TR AINING-CONDITIONING.COM

While undergoing treatment for Hodgkin’s lymphoma, Jordan Bauman was also making great tackles, helping Stratford (Wis.) High School win a state title. Mullen was concerned it might be a cardiac issue, so he arranged for Bauman to see Team Physician and Marshfield Clinic Medical Director Laurel Rudolph-Kniech, MD, the next day. Rudolph-Kniech performed blood work and did a CT scan of Bauman’s chest, which revealed a large mass. That mass turned out to be one of many tumors in his body. The next day he was diagnosed with Stage III Hodgkin’s lymphoma, in which a malignancy of lymphatic tissue is found in the lymph nodes, liver, spleen, and bone marrow. Stage III refers to the existence of lymph node involvement on both sides of the diaphragm. “The tumor in my chest was taking up a lot of space and putting pressure on my heart and lungs,” says Bauman. “That R.J. Anderson is an Assistant Editor at Training & Conditioning. He can be reached at: rja@MomentumMedia.com. T&C APRIL 2008

Athlete

Comeback

was what made it so hard to breathe and caused me to be lightheaded.” In addition to the tumor in his chest, there were three softball-sized masses in his abdomen. Those tumors stretched from the lower part of his rib cage to his hip, putting pressure on his liver and his spleen.

A couple weeks after his diagnosis, Bauman was working out on his own in the school weightroom. “The doctors told me to lift very light weight because they didn’t know if the tumors could handle anything heavy.” Despite the scary findings, doctors told Bauman that Hodgkin’s lymphoma is treatable and that a full recovery was not out of the question. “I had never heard of the disease before, but when they mentioned it was cancer, my entire life flashed before my eyes,” Bauman says. “But the doctors said if I had to get cancer, this was the best type for me to get.” Doctors initially told Bauman that his high school athletic career was likely over. However, after three rounds of chemotherapy spaced two weeks apart, Bauman began to feel like himself again. “The first three treatments got my blood

counts back up and I started feeling a lot better,” he says. “At that point, we talked about the possibility of playing football my senior year. As my treatments progressed, my prognosis got better and better and I thought maybe I could get back by wrestling season. Then, it seemed possible to get back on the football field in time for this year’s playoffs.” As he improved, Bauman began regaining his strength and conditioning. A couple weeks after his diagnosis, he was working out on his own in the school weightroom. “The doctors told me to lift very light weight because they didn’t know if the tumors could handle anything heavy,” says Bauman, who also started talking to a college athlete who had played his freshman year of high school football while undergoing treatments for Hodgkin’s disease. “The player told me my leg strength would be the first thing to go, so I really concentrated on doing leg work. I kept it real light. For example, I usually did three sets of 15 squats with light weights, and then I would ride the stationary bike for about 25 minutes. I did a few upper-body exercises, but mostly leg stuff at higher repetitions.” During this time, Mullen as well as the entire Stratford football community rallied around their teammate, working to keep his spirits up. “They definitely made me feel like part of the team,” says Bauman. “But they also made sure not to constantly bug me about it. They treated me like nothing was wrong, which was nice.”

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Athlete

Comeback

To cover the port, Mullen cut a donut-shaped pad out of a football tailbone pad. “I took the donut pad and molded a thermoplastic shell over the top of it,” Mullen says. “I applied Leukotape in an X-shaped pattern around his torso to secure the pad over his chemo port. That slipped on right where his shoulder pads ended. It worked perfectly.” Three days after being cleared, Bauman was in uniform for

“During wrestling, the treatments got a lot harder and lasted five or six hours. It would take me two days just to get back to practice, and three days before I could wrestle in a match.” the team’s state semifinal game. “I’ll always remember the way I felt when they called out his name as the starting linebacker,” says Mullen. “Emotions ran so high in that stadium— there weren’t very many dry eyes.” Mullen says the coaches had planned to give Bauman the start, then limit his reps and use him strategically based on how he felt. However, once the game got going, that plan was thrown out the window. “He felt great and ended up playing almost the entire game,” says Mullen, who talked to Bauman every time he came off the field. “I was amazed at his energy.

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Getting stronger and feeling better, Bauman was cleared by his doctors to return to practice and participate in noncontact drills in mid-October, which greatly lifted his spirits. But his participation was limited as he sometimes struggled to bounce back after the chemo treatments, which grew progressively more intense. Bauman spent the first three weeks at practice doing team conditioning drills and running receiver routes, with Mullen keeping a very close eye on him. “I gave him a general rule of thumb to use his energy level and pain tolerance as a guide and to gradually progress every day,” says Mullen. “He was quite winded at first, but he progressed rapidly during those first few weeks. He was very motivated. He was definitely chasing the carrot to get back by the end of the season.” On Nov. 6, with his tumors having shrunk dramatically, Bauman was cleared to return to competition. And his conditioning work had paid off. “By that point, I was feeling better than I’d felt in a year,” Bauman says. “I was probably in as good of shape as everybody else on the team. I felt like I could hang with anybody on the field.” But before he could return to making hits and getting tackled, steps had to be taken to protect the Hickman port used to administer Bauman’s chemotherapy treatments. Located under his rib cage, the port protruded about an inch and a half from his skin and was about the size of a golf ball.

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098707dr

Athlete

Comeback ■ Jordan Bauman Stratford (Wis.) High School Sports: Football, Wrestling Condition: Stage III Hodgkin’s lymphoma, originally misdiagnosed as iron deficiency anemia.

Result: While undergoing chemotherapy treatments, returned two months after diagnosis to help his football team win its fifth straight state championship. Quote from Athletic Trainer: “If you have an instinct that is contradictory to what you’re told, follow up on it,” says Shawn Mullen, LAT, ATC, CSCS, Stratford’s Head Athletic Trainer.

He had 15 tackles, several sacks, and a number of key receptions. He just shut down the other team’s running attack and Stratford won by 30.” The next week, Bauman’s inspired play carried over into the championship game, which Stratford won handily to chalk up its fifth straight Division 6 state title. From football, Bauman moved on to wrestling. And even with the intensity of his chemo treatments rising, he had a stellar season and advanced to the state tournament while wrestling at 215 pounds. “During wrestling, the treatments got a lot harder and lasted five or six hours,” says Bauman. “It would take me two days just to get back to practice, and three days before I could wrestle in a match. So whenever I had a big match coming up, I tried to schedule my treatments at least three or four days before it.” Since his initial diagnosis, Bauman’s weight has risen to 220 pounds. “Normally, they say a patient loses 10 pounds from when they start chemotherapy, but I’ve gained about 30,” Bauman says. This spring, Bauman is finishing up his chemotherapy and will begin radiation treatments shortly thereafter. If all goes according to plan, after four weeks of radiation treatments, he should be tumor-free. He plans to step up his lifting and conditioning during the summer and work toward leading his team to another state championship. After that, he’d like to attend college and play football. Bauman says the time away from the field may have actually made him a better player. Watching his teammates during games and practices allowed him to improve his mental approach to the game. “I treated games and practices like I was a coach,” Bauman says. “I watched film and studied all the positions and thought about what I could have done on a play. I think I’m a better player now because I’m a smarter player.” TR AINING-CONDITIONING.COM

The comeback has also given Bauman a whole new perspective on the opportunities he has. “I know not to take anything for granted, because you never know what could happen,” says Bauman. Mullen admits there are times when he wonders what

“In hindsight, I realize that Jordan was actually playing that first game with an enlarged liver and an enlarged spleen— both of which were essentially protruding from underneath his rib cage. There’s a very real scenario where he could have died right there on the field.” could have happened had he not pushed for a new diagnosis. “In hindsight, I realize that Jordan was actually playing that first game with an enlarged liver and an enlarged spleen—both of which were essentially protruding from underneath his rib cage,” Mullen says. “There’s a very real scenario where he could have taken a shot to either of those organs and died right there on the field. “I count my blessings that didn’t happen,” he continues. “For me it’s a good lesson about moving forward: If you have doubts, trust your instincts and question the answers you’re given. Do it for the sake of the athlete.” ■

To nominate a comeback athlete, please e-mail us at: rja@MomentumMedia.com.

T&C APRIL 2008

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After undergoing knee microfracture surgery in October 2005, followed by a progressive, corrective rehab program, Amare Stoudemire has regained his all-star form.

TREATING THE ATHLETE

Micro Holes,

Macro Results In the past, suffering a chondral defect often meant an end to an athlete’s career. Today, exciting advances in microfracture surgery and rehab are allowing players to come back more explosive than ever.

BY R.J. ANDERSON

hen Phoenix Suns center Amare Stoudemire awoke from anesthesia on Oct. 11, 2005, he heard the word every basketball player dreads: microfracture. Complaining of intermittent knee pain that had been lingering for weeks, Stoudemire had elected to have a diagnostic arthroscopy. He knew ahead of time that the surgeon might find a significant cartilage defect and immediately perform a microfracture procedure. But he was hoping that wouldn’t be the case. Fear of microfracture surgery is very real. Stoudemire undoubtedly recalled the returns of high-profile NBA players Chris Webber, Allan Houston, and Anfernee Hardaway—none of whom recaptured their pre-injury greatness after having the surgery. But thanks to the skills of a premier orthopedic surgeon utilizing the latest microfracture technique, and a carefully designed, full-body rehab program steeped in corrective exercise, Stoudemire did regain his form, earning first-team All-NBA honors at the end of the 2007 season. He also gave athletes with cartilage damage new hope, including 2007 NBA numberTR AINING-CONDITIONING.COM

one draft pick Greg Oden, who underwent the procedure in August. ON THE TABLE Microfracture surgery is performed to restore damaged articular cartilage, sometimes called a chondral defect. Such defects can occur any place cartilage exists, and in the knee they are most commonly found at the tibial condyles, the femoral condyles, or the backside of the patella where it contacts the tibia and femur in the medial compartment. How these injuries develop is not always clear, but they seem to occur either through a twist of a bent knee, a direct blow, or after a series of minor injuries. The goal of the surgery is to bring blood and bone marrow to the defective area through a blood clot that contains tissue-building stem cells. The term “microfracture” refers to the tiny holes a surgeon makes in the patient’s bone that allow the blood and stem cell-containing bone marrow to seep into the area. With proper rehab, the tissue is trained to become healthy cartilage as it heals over the defective area. While this surgery has been around for nearly 20 years, both the procedure and the rehab approach have greatly improved over the last decade.

Before microfracture surgery was considered a viable option for elite injured athletes, those with chondral defects simply lived with the pain, usually experiencing a decline in performance and a shortened playing career. A key part of any microfracture surgery is debriding the calcified “old” cartilage and creating a bed in which the new cartilage can form. Richard Steadman, MD, Orthopedic Surgeon and co-founder of the Steadman Hawkins Clinic in Vail, Colo., who is credited with pioneering knee microfracture surgery in the late 1980s and remains one its most successful practitioners, says completely removing the deepest layer of calcified cartilage is a surgical advance developed in the last five years or so. “If the area where you’re trying to build new cartilage still has a layer of the old cartilage, it resists allowing the new cartilage to form,” says Steadman. “If you don’t remove that layer and create a bed on the bone with edges of stable cartilage surrounding it, we’ve found the chances of success are quite a bit lower. The healthy rim of cartilage R.J. Anderson is an Assistant Editor at Training & Conditioning. He can be reached at: rja@MomentumMedia.com. T&C APRIL 2008

TREATING THE ATHLETE around the bed decreases the amount of pressure shouldered by the new tissue and provides a cushion during the healing process.” After a bed to house the new cartilage is created, a curved surgical awl is used to make microscopic punctures spaced about three or four millimeters apart at the ends of the bone. Steadman says

surgical advances were prompted by his equine work, including the timeframe of his rehab protocol—especially the protective weight bearing phase. Most protocols call for the athlete to spend the first six to eight weeks post surgery in a protective weight bearing environment, and Steadman recommends a full eight weeks.

Over time, Steadman says the procedure has evolved to incorporate shallower holes … “We’ve learned that you don’t have to go very deep, just enough to access the bone marrow. If you go farther than that, the surgery is less likely to be successful.” using the awl allows surgeons to penetrate the subchondral bone while leaving the subchondral plate intact. “The subchondral plate is important for the functioning of articular cartilage, so most cartilage experts feel it is better to leave that plate in place,” he says. Over time, Steadman says the procedure has evolved to now incorporate shallower holes—about three millimeters deep. “We’ve learned that you don’t have to go very deep, just enough to access the bone marrow,” he says. “If you go farther than that, the surgery is less likely to be successful.” After the blood and marrow accumulate in the freshly scraped bed on the bone, the stem cells begin their healing magic, forming a new layer of tissue. This tissue consists mostly of type II collagen, which is the major protein found in cartilage and serves as the “glue” that holds the cartilage together while helping to provide elasticity within the joints. Type II collagen also contains mucopolysaccharides, which help the cartilage to heal itself. “Articular cartilage is type II collagen,” Steadman says. “In a study we did on horses, we were able to take samples of regenerated cartilage and analyze them in several cases, and it turns out 70 percent of the new cartilage is made up of type II collagen— meaning it’s very similar to the original tissue.” The molecular makeup of the regenerated cartilage isn’t the only discovery Steadman credits to the horse study, which he conducted in collaboration with the Colorado State University College of Veterinary Medicine and Biomedical Sciences. He says a number of 16

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“We looked at horses’ cartilage after two weeks, four weeks, six weeks, and eight weeks, and found that eight weeks is when it looked mature enough to take the pressure of full weight bearing,” he says. Another key part of the rehab protocol is to begin continuous motion immediately. “Basically, our theory is that the new tissue needs a mechanical message to tell it what it should become,” explains Steadman. “With cartilage, you’d like a message that tells the new tissue it needs to be smooth and to fill in the defect. You want motion to convince these cells that they want to be-

stimulate the tissue to form a better quality cartilage.” READY FOR REHAB In Stoudemire’s case, the arthroscopy revealed a fairly small lesion—a onecentimeter by one-centimeter chondral defect. Still, Thomas Carter, MD, an orthopedic surgeon at The Orthopedic Clinic Association in Phoenix and Team Physician for the Suns, decided to go ahead with the microfracture surgery, fearing that if left alone, the damaged cartilage would flake off and expand the lesion. During the 30minute procedure, Carter scraped the damaged tissue in the femoral condyle region of Stoudemire’s knee, then made five microfracture holes to trigger the formation of the replacement cartilage. The surgery deemed a success, Stoudemire readied himself for the long, arduous journey back. For the first week, he was at home with his knee completely unweighted, undergoing ice compression treatments and hooked up to a CPM machine. Meanwhile, Suns Head Athletic Trainer Aaron Nelson, ATC, NASMPES, CSCS, was hard at work, drawing up a blueprint for Stoudemire’s rehab. While he had assisted with other microfracture rehabs, this would be Nelson’s first experience with an athlete fresh off of the surgery.

“We’re not positive what caused the cartilage damage, but our plan was to identify and eliminate any type of dysfunction that could cause a problem down the road or that might have contributed to his pre-surgery problems. At the same time we were rehabbing the knee, we wanted to address those other issues.” come cartilage, not bone or muscle or anything else. The constant motion and protective weight bearing are factors that send the right message to those cells.” To provide the motion, immediately after surgery, patients can use a continuous passive motion (CPM) machine. “After about two to four weeks, if the patient is doing well, I’ll allow them to spin on a stationary bike, which gives them that smooth exercise,” Steadman says. “Then they can begin deep water running in which they don’t touch the bottom. Those types of movements

“I started my research by finding out everything I could on other athlete rehabs, and I looked at different surgeons’ protocols,” Nelson says. “Then, Dr. Carter and I had a long conversation about his expectations and what he thought would and should happen throughout the process.” Nelson also consulted with Micheal Clark, DPT, MS, NASM-PES, President and Physical Therapist at the National Academy of Sports Medicine, to design a comprehensive science-based rehab program. “We took what everybody else had done in the past and looked at TR AINING-CONDITIONING.COM

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SMOOTH MOVES When Micheal Clark, DPT, MS, NASMPES, President and Physical Therapist at the National Academy of Sports Medicine, evaluates athletes who are at risk for articular cartilage damage in the knee, these are the most common compensation patterns he sees, which tend to occur when an athlete cuts, lands, or decelerates from a jump: Tibial external rotation: The athlete’s foot turns to the outside during landing and then caves inward. “That causes a shear force of the femur moving across the tibia and creates repetitive microtrauma of the articular cartilage,” says Clark. Trunk flexing forward: When an athlete lands from a jump, instead of keeping their trunk upright and parallel to their lower leg, their chest collapses toward their knees. “When the athlete’s trunk flexes forward, they lengthen the gluteus maximus, which forces the hamstring to eccentrically control the lower leg and the loading of hip flexion,” says Clark. “And if their foot is already turned out into external rotation, they’re facilitating the lateral hamstring, or biceps femoris, which causes stress at the knee.” Limited dorsiflexion in an opposite ankle: “Let’s say it’s the right knee that’s bothering an athlete,” Clark says. “In many cases, we see that the left ankle is restricted. If an athlete jumps for a rebound and lands, the dorsiflexion when landing from a jump needs to be at about 15 degrees. But many NBA players we see only have five degrees of dorsiflexion. “If their ankles don’t bend, their knees must deal with the force,” he continues. “And the next joints up from the knees are the hips, then the spine.

T&C APRIL 2008

When they land, they have to shift the weight over to their right and their right knee takes most of the eccentric load, and you get shear, compressive force on the joint that creates trauma.” Limited motion in the big toe: Clark says his assessments show that a lot of athletes have restrictions in one or both big toes. “If you’re loading eccentrically to jump, you have to get motion at your big toe,” he says. “If a restriction exists and the big toe can’t bend backward, the foot has to flatten out to compensate. When that happens, it lengthens the muscles on the inside of the calf, and then the muscles on the outside of the calf have to work too hard. “If there is an imbalance where one side is pulling harder than the other, the joint will move in the direction of the muscle that’s pulling harder,” Clark adds. “That turns the foot to the inside, and if you jump, land, cut, or do anything with your knees in that position, the femur has to slide across, which creates massive stress.” When rehabbing athletes from a microfracture procedure, Clark recommends athletic trainers and physical therapists go through a proper joint assessment, starting with the big toe and working their way through the ankle and hips, and also testing hamstring length, hip internal rotation, and hip extension. “Those are the primary areas that have to be within a certain range of motion,” Clark says. “If you don’t restore those joint motions when the athlete is rehabbing from microfracture, and they begin bearing weight, they will put increased stress on the microfracture in an early stage, which then creates swelling in the joint and doesn’t allow the cartilage to heal very well. That’s a big problem we’ve seen in a lot of the failed micros of the past.”

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TREATING THE ATHLETE what would be best for Amare, then basically laid out a plan and moved forward,” Nelson says. Determining what would be “best for Amare” began before the surgery, when Nelson evaluated Stoudemire from head to toe. “We did a Kinetic Chain Assessment (KCA) of his overall body strength, flexibility, and mechanics prior to the surgery,” says Nelson. “We’re not positive what caused the cartilage damage, but our plan was to identify and eliminate any type of dysfunction that could cause a problem down the road or that might have contributed to his pre-surgery problems. At the same time we were rehabbing the knee after microfracture surgery, we wanted to address those other issues.” There are a few schools of thought on what triggers a chondral defect, and it’s fairly certain there is no single answer. For example, some experts feel that a bone bruise can cause swelling and lead to microtrauma that worsens over time. There also seem to be some acute cases when an impact instantly tears the cartilage. Regardless, Clark, who provides con-

tinuing education programs to the NBA Athletic Training Association, says his 10-plus years working with athletes who have had microfracture surgery lead him to believe there are usually movement impairments that contribute to the injury. (See “Smooth Moves” on page 18.) He says identifying and correcting those deficiencies is important

When planning the rehab, a major goal was to have Stoudemire’s deficiencies corrected during the protective weight bearing phase. “That was a perfect time for us to hammer out those deficiencies and create activation of those muscles and joints that had been shut off.” to both preventing future injury and compensating for complications during and after rehab. “We try to identify these movement impairments and typically find they are a result of certain muscles that are too short and too tight,” says Clark. “This leads to movement impairment and muscle imbalances that can create trauma at the knee.”

again, he would have symmetrical joint motion and symmetrical muscle activation, which would take as much stress as possible off his knee during rehab.” MAKING CORRECTIONS For the pre-surgery KCA, Stoudemire performed several exercises and movements. Most telling were his compensations during an overhead squat. “If the

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TREATING THE ATHLETE athlete has proper range of motion in the ankles, knees, and hips, and proper muscle activation in the lower leg, hip, stomach, and low back, they’ll be able to squat down while keeping their feet straight with their knees lined up over

had Stoudemire doing single-leg lower-body work with his non-injured leg and workouts on a stationary bike. Increasing the weight he was able to bear was largely facilitated through hydrotherapy. Once his incisions had healed

Many variables determine whether or not an athlete successfully returns from microfracture surgery, but Nelson focuses on three controllable factors. “One, you’ve got to have an experienced surgeon who does a great job. Two, you need the athlete to be motivated and compliant. And three, the athlete has to do everything the rehab team asks.” their second and third toe and their trunk upright,” Clark says. “But what we see with a lot of athletes is that when they squat down, they either pronate, their feet turn out and their knees cave in, or their spine moves into flexion,” he continues. “Those are movement impairments and potential predictive factors of overuse injury at the knee. They can lead to serious articular cartilage damage, which could then necessitate microfracture surgery.” One particular impairment Nelson and Clark discovered in Stoudemire was weakness in his upper gluteus maximus—a deficiency that has far-reaching implications. “When you’re running, at the point when one foot is forward and one foot is back, your opposite arm and lat work together to create that motion,” explains Clark. “If you have weakness in one of your glutes, the opposite lat has to work too hard and that can make it short and tight. If your left glute is weak, your right lat can be tight, and a tight right lat can rotate the right side of your pelvis forward, creating a pelvic imbalance that can cause a variety of complications, including additional stress on the knee.” During the eight weeks of protective weight bearing work, Stoudemire worked with Nelson and Clark for three hours a day, five days a week. He performed foam rolling, stretching, and isolated, non-weight bearing corrective exercise, including plenty of work to strengthen his intrinsic core muscles. Many of the corrective exercises focused on strengthening his upper gluteus maximus. After four weeks, the rehab team 20

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10 days post surgery, Nelson had Stoudemire in the water every day possible. “As he progressed and regained most of his range of motion, after about 10 to 12 weeks, we were able to do more partial weightbearing stuff with him— then he was only in the pool two to three times a week,” says Nelson, adding that Stoudemire still does hydrotherapy as preventative maintenance. From there, Nelson and Clark evaluated Stoudemire’s swelling, quadriceps girth, and range of motion in the knee before progressing. “Every day we measured swelling of the knee joint— which should decrease every day postsurgery. If it went up, we backed the rehab off instantly,” Clark says. “We also looked for increased range of motion every day. If for some reason he lost motion, we backed off. His quad girth also had to increase in order for us to move forward.” Although the rehab was long, Nelson says everything went smoothly. “It’s tenuous and redundant, which is challenging mentally—you do a lot of the same stuff over the different phases,” he says. “But it was my job to reassure Amare and help him fight through the boredom. You have to make the athlete realize that everything is a stepping stone and you’re going one block at a time as you build them up.” A SUCCESS Many variables determine whether or not an athlete successfully returns from microfracture surgery, including the size and location of the lesion, and the athlete’s medical history. But Nelson fo-

cuses on three controllable factors. “One, you’ve got to have an experienced surgeon who does a great job,” he says. “Two, you need the athlete to be motivated and compliant. And three, the athlete has to do everything the rehab team asks.” In Stoudemire’s case, all three were satisfied. He emerged from his rehab more balanced, more flexible, and with greater intrinsic core strength. A strong, healthy knee and a return to explosiveness were the end products of his hard work. Though a success, Stoudemire’s rehab was not without hiccups. He missed nearly one full season of play, and wasn’t back to full strength until midway through the 2006-07 campaign. In the time since the microfracture surgery, he has had two additional arthroscopies—the latest one prior to this season—which his rehab team says may or may not be related to the chondral defect. “They were basic scopes that could have happened regardless of the prior injury,” says Clark. “We can’t make any cause-and-effect conclusions about those procedures.” So far during the 2007-08 season, Stoudemire’s knee has been strong. “Knock on wood, there has never been a swelling issue with his knee,” says Nelson. “He gets a little stiff from time to time, but nothing significant. It’s normal wear and tear that even nonsurgically repaired knees have.” Since Stoudemire’s successful return to the court, Nelson and Clark have fielded numerous requests from colleagues looking to obtain similar results with athletes who have chondral defects. “When we talk to other people conducting microfracture rehabs, we don’t really go into detail about the actual knee rehab because everybody is doing a good job there,” says Nelson. “We focus more on making sure they look at the entire body—trying to identify any imbalances that may overstress the knee,” he continues. “We also tell them to focus on core, balance, and functional training—not just isolated knee rehab.” “From my perspective, the take-home message is that it’s not a mysterious injury—we just have to look at what deficiencies are causing it,” says Clark. “Typically, muscles, ligaments, and cartilage from each leg should be the same strength, and if a deficiency exists, it can be the proverbial straw that breaks the camel’s back.” ■ TR AINING-CONDITIONING.COM

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Choices…And More Choices BY MICHELLE ROCKWELL ast year, I was sitting in my office with an elite-level swimmer—a former and likely future Olympian—who was in the midst of her most intense training phase of the year. She was telling me about how she had stopped using all types of sports drinks, sports bars, and recovery shakes, and had even thrown away the multivitamin, vitamin C, glucosamine/chondroitin, and omega-3 fatty acid supplements she had been taking as part of our performance nutrition plan. Since the plan had helped her record a tremendous season the previous year, I was very surprised. The change was spurred by a presentation she’d heard at a recent training camp about the risks of supplement

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As the number of nutritional supplements on the market keeps growing, athletes can easily get lost among the choices. Our expert explains how to steer clear of unwanted risks and toward real performance gains.

one could repay him those two lost years of competing. That story was enough to make my swimmer swear off everything—even her Gatorade. It’s true that the supplement world can involve considerable risks and plenty of unknowns, including—though certainly not limited to—contamination. But it’s also true that when used responsibly, supplements can help ath-

contamination. An athlete had discussed his experience being banned from competition for two years after testing positive for a steroid, even though he had never taken steroids: He had unknowingly used contaminated nutritional supplements. The athlete ultimately won a lawsuit against the manufacturer, but no

Michelle Rockwell, MS, RD, CSSD, is a private sports nutrition consultant based in Durham, N.C. She works with athletes and teams throughout the country ranging from recreational to professional. She also offers sports nutrition consulting and workshops through RK Team Nutrition, at: www.rkteamnutrition.net. T&C APRIL 2008

NUTRITION letes achieve their performance goals. The problem is athletes often have a hard time separating fact from fiction and legitimate claims from marketing hype. And the ever-growing whirlwind of aggressive advertising, confusing research, and anecdotal peer experience does little to help. That’s where you come in. In this article, I’ll discuss how to evaluate nutritional supplements so that you can provide meaningful advice to your athletes when it comes to choosing safe,

banned by a sports governing body. The NCAA and International Olympic Committee (IOC) each maintain lists of banned substances, as do most professional sports leagues. The lists are updated as new products hit the market, so always make sure you’re using the most current version when checking on the permissibility of an ingredient or a supplement. Purity: In studies evaluating large numbers of over-the-counter dietary supplements, it is consistently shown that 15 to 25 percent of products test-

At minimum, it’s important to discuss with an athlete what the supplement’s desired effect is, and whether that desire is consistent with his or her performance, body composition, and health goals. legal, and effective products. I’ll also review some popular supplements and suggest natural dietary alternatives. BREAKING IT DOWN Today’s nutritional supplement marketplace is largely a “buyer beware” environment. Supplements are not regulated by the Food and Drug Administration (FDA), so there is no required testing for safety and effectiveness before a product hits the shelves. And many supplement makers see athletes as a prime target, as claims about boosting energy, reducing body fat, and building strength and power find an eager audience among those looking for a competitive edge. Let’s say an athlete comes to you with a supplement brochure, a printout from the Web, or a bottle of some supplement they’re interested in taking. They want your advice. What do you do? I recommend breaking the evaluation process down into four key criteria. Legality: It may sound obvious, but the first thing to look at is whether a supplement is legal. You probably know, for instance, that anabolic steroids are illegal to purchase in the U.S., but they can easily be found online. Androstenedione (“andro”) and other prohormones (sometimes called “testosterone precursors”) have been illegal since the passage of the Anabolic Steroid Control Act of 2004. Other substances, such as ephedrine, may be legal to purchase over the counter, but their sale is regulated by the FDA. Beyond actual laws, there’s also the question of whether a supplement is 24

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ed contain ingredients not listed on the label. Some of those ingredients are banned by the NCAA and/or the IOC. Ingredients found in supplements but not listed on labels often include prohormones or actual steroidal ingredients, stimulants, or even heavy metals such as lead. And unfortunately, “I didn’t know the supplement was tainted” is rarely an acceptable excuse if a drug test comes back positive. Sometimes the contamination of a supplement is deliberate, and sometimes it’s simply the result of poor manufacturing practices. For instance, if a company makes multiple products, some of which contain banned ingredients, contamination can occur if the mixing machines are not properly cleaned between manufacturing runs. How do you know if a manufacturer can be trusted? To address concerns about the purity of commercially available products, independent labs and certification bodies have been created to evaluate supplements and verify that their labels are complete and accurate. Supplements certified by these groups are more trustworthy than those that have not been submitted for independent testing. (See “Resources” on page 28 for links to these groups’ Web sites.) Safety: I recently worked with a high school football player who was referred to me after a scary experience. During practice, he had developed a severe headache and a rapid heart rate and had to be rushed to the emergency room. His physicians felt the symptoms were related to stimulant supplements and

NO2 (an arginine-based product). Supplements can raise safety concerns for several reasons. In this case, I believe the effects from the supplements were compounded by poor hydration. Most athletes don’t know that musclebuilding supplements often increase the body’s fluid needs, and some stimulants have been shown to increase the risk of heat stress. Add in the fact that athletes often use these products during periods of heavy activity, and the risk for dehydration and heat illness is very real. Another serious concern is interaction between different supplements, or between supplements and medications an athlete may be taking—both prescription and over the counter. In some cases, a supplement can enhance the effect of a medication or vice-versa. In other cases, the effectiveness of one or both substances is reduced. For example, dietary supplements containing St. John’s Wort, a popular ingredient used to treat depression, may negate the effects of some antibiotics and birth control pills. Willow bark (the herbal equivalent of aspirin) in dietary supplements typically enhances the effects of other ingredients, especially stimulants such as caffeine, guarana, and synephrine. Stimulants and prohormone supplements may interact with antidepressants and anti-anxiety drugs, and with medications taken for learning disabilities. Ginseng, ginkgo, and high doses of vitamin E have bloodthinning effects and may be hazardous to athletes set to undergo surgery. The best way to avoid potentially harmful interactions between dietary supplements and other drugs is to bring a physician into the picture. Make sure athletes disclose any medications they are taking before you recommend a supplement, and check with their doctor or a team physician about the risk of any unwanted side effects. Efficacy: How do you know if a supplement will deliver on its promises? That’s a difficult question, since many products—even effective ones—have not undergone the controlled experiments necessary for ironclad conclusions. And athletes’ own experience may be colored by the placebo effect (they expect it to work, so they believe it is working). At minimum, it’s important to discuss with an athlete what the supplement’s desired effect is, and whether that desire is consistent with his or her TR AINING-CONDITIONING.COM

NUTRITION performance, body composition, and health goals. Remarkably, athletes often take a dietary supplement without being able to say exactly what they hope it will do for them. Athletes should also understand that people respond to supplements differently. Some individuals, for example, are very sensitive to caffeine, while others feel little effect from it. Sensitivity can also vary by day, diet, activity level, or hydration status. A popular example of this phenomenon involves creatine: It increases muscle phosphocreatine levels for some people, but not for others. If an athlete tries a supplement and doesn’t experience the desired effect, it may simply not be the right fit for their biochemistry or lifestyle. GETTING SPECIFIC Keeping up with every new supplement that comes out is a tall order. But it’s important to be well versed on those that are most popular with athletes right now. Below I will discuss these categories of products and offer a few suggestions on when (or if) they are appropriate to recommend.

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Creatine, now available in many formulations, remains a very popular seller with athletes. It has been shown to increase some people’s levels of muscle phosphocreatine, a substance that breaks down to produce adenosine triphosphate (ATP, an energy source).

vide a standard supplemental dose of creatine without the supplement. Poultry is lower in creatine, so athletes who always choose chicken and turkey should be encouraged to diversify their menus. Vegetarians eat few creatine-containing foods, so they may benefit most from

Beta-alanine is a newer supplement that’s very popular right now. It is involved in carnosine production … and promises “decreased muscle burn” and delayed fatigue during high-intensity exercise. Theoretically, higher phosphocreatine stores help speed recovery, improve high-intensity performance, and build lean body mass, and those results have been found in numerous studies. Many athletes don’t realize that creatine occurs naturally in food. Beef, pork, and fish such as salmon and cod all contain about one gram of creatine per eight ounces—about a third of the recommended daily dose for supplementation. Thus, eating three eight-ounce servings of these foods per day can pro-

creatine supplementation. Here’s another key nutritional note: The phosphocreatine system only contributes to energy production in the first few seconds of muscle activation. After that, carbohydrates become the primary fuel source. Thus, if dietary carbohydrate intake is insufficient, creatine’s benefits will be short-lived. Who should avoid creatine supplementation? Because it leads to increased fluid needs, it’s a bad choice for athletes who are prone to cramp-

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NUTRITION ing, heat illness, or easy muscle pulls. Athletes working out in hot environments and those who sweat excessively should also steer clear of creatine. Protein and amino acids are commonly used by athletes seeking to gain weight. Recently, there has been a focus

long exercise periods when muscle protein is oxidized for fuel. Protein supplements are a convenient choice for athletes who don’t get enough protein through their normal diet. The American Dietetic Association and American College of Sports

Many athletes say they like the way nitric oxide makes them feel before and during workouts … But a growing number of sports medicine professionals have observed troubling side effects from NO and NO2 supplementation. on the source of protein used in supplements (whey vs. casein vs. soy vs. egg), as some researchers feel whey protein leads to greater lean body mass gains, but this has not been conclusively established. Athletes have used amino acid supplements for years, though there is little research to support their benefits. Two possible exceptions are glutamine, which some studies show improves immune function and recovery, and branched-chain amino acids (BCAAs), which may be beneficial during very

Medicine (ACSM) recommend a protein intake of 1.2 to 1.7 grams per kilogram of body weight per day, and most athletes can achieve this through eating meat, poultry, fish, dairy products, eggs, nuts, seeds, beans, and grains. Consistently selecting a variety of protein sources helps ensure adequate levels of all amino acids. Glutamine and BCAAs in particular are plentiful in many types of foods, especially dairy products and red meat. Beta-alanine is a newer supplement

that’s very popular right now. This specific amino acid is involved in carnosine production, which plays a role in buffering acid in muscle cells. Consequently, these supplements promise “decreased muscle burn” and delayed fatigue during high-intensity exercise. There are now some studies supporting those claims, but this supplement warrants further research before its benefits (and any potential risks) are clearly established. The advertised benefits of beta-alanine can be achieved more reliably through dietary changes. Athletes who experience excessive muscle burn during activity are often underhydrated, so they simply need to drink more before, during, and after exercise. And the consumption of quality carbohydrates before workouts will delay fatigue considerably. Suggest that athletes try these solutions before turning to a supplement that has some question marks. Nitric oxide (NO or NO2) is derived from the amino acid arginine. These supplements are marketed as enhancing “muscle pump,” vasodilation, and blood and nutrient delivery to muscles. Many athletes say they like the way ni-

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tric oxide makes them feel before and during workouts. But a growing number of sports medicine professionals have observed troubling side effects from NO and NO 2 supplementation, such as extreme headaches, lightheadedness, and increased blood pressure. There is currently very little research to support the purported benefits or assess the risk of side effects. Until that changes, I discourage athletes from using these supplements. Good hydration and adequate intake of vitamins and minerals are critical for proper nutrient delivery to muscles. If an athlete is tempted by the claims of nitric oxide, try evaluating their hydration habits and vitamin and mineral intake instead, and they may experience surprising performance benefits. Energy supplements come in many forms: drinks, pills, powders, bars, and even special gums and candies. They promise to enhance energy and boost metabolic rate, thereby leading to fat loss. Some contain substances such as synephrine, bitter orange, citrus aurantium, and zhi shi, all of which are banned by the NCAA. Other products contain stimulants that are permissible in limited does, such as caffeine, guarana, and green tea extracts. Untitled-2 Some research supports the use of caffeine for enhancing athletic performance, but it affects individuals differently—some experience dehydration, rapid heartbeat, jitteriness, and laxative effects from caffeine and other stimulants. Why are athletes drawn to this “artificial” energy boost? It’s often a sign of inadequate caloric intake, low glycogen stores, poor hydration habits, not enough sleep, iron deficiency, overtraining, or possibly a mental health issue. You should help athletes consider all those areas before thinking about an energy supplement—if one of them is the underlying cause, addressing it will have more lasting effects than a stimulant. If you do want to recommend an energy supplement, I suggest very measured experimentation with caffeine prior to exercise. Start small—maybe just a cup of coffee, iced tea, or a soft drink before workouts—and then adjust the dose depending on the athlete’s response. However, individuals under 18 and those with high sensitivity to stimulants should avoid these products.

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NUTRITION

RESOURCES Below are some excellent information sources that can help you evaluate dietary supplements.

Thirsty?

www.naturaldatabase.com This site includes information on specific dietary supplements and their individual ingredients. It also discusses physiological benefits, reported side effects, and potential drug/supplement interactions. Pharmacists regularly update the data. I personally use this resource often when evaluating dietary supplements. The subscription cost is under $100 per year. www.drugfreesport.com The National Center for Drug Free Sport provides information, printable documents, and other resources aimed at educating athletes about how to use dietary supplements safely. Athletes and sports medicine professionals can anonymously call or e-mail staff members for information about supplement legality. Many services are free.

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www.consumerlab.com This resource conducts unbiased testing of various dietary supplements to evaluate purity and ensure that ingredient lists are accurate. I feel much more comfortable recommending a supplement that has passed a Consumerlab test. The cost is under $35 per year. dietary-supplements.info.nih.gov This free resource from the National Institutes of Health’s Office of Dietary Supplements includes extensive supplement information, links to published studies, and product fact sheets. www.nsf.org The National Sanitation Federation provides programs through which companies can pay to submit their products for quality and purity testing. Dietary supplements with NSF approval are recognized as being pure and are more likely to be approved by sports governing bodies. www.informed-choice.org Informed-Choice is a not-for-profit partnership between supplement companies and HFL, a prominent anti-doping laboratory, created to help athletes, coaches, parents, and athletic trainers make sound choices about supplements. Informed-Choice has analyzed more samples for banned substances than any other lab in the world.

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www.ncaa.org/health-safety k click on “Nutrition & Performance” The NCAA’s Nutrition & Performance gateway page includes links to helpful information for athletic trainers, athletes, coaches, parents, and athletic administrators. Click on the “Student-Athlete” link for access to the association’s most up-to-date list of banned substances. www.wada-ama.org k click on “Prohibited List” The World Anti-Doping Agency was created by the International Olympic Committee (IOC) to combat drug use in sports, and maintains the IOC’s list of prohibited substances.

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NUTRITION grocery store contains dietary supplements with these claims on their labels: • “Increase power output five-fold” • “Lose weight faster” • “Rapidly boost MUSCLE PUMP” • “Recover 10 times faster” With enticements like those, who wouldn’t be tempted? The bad news for athletes is that a promise on a supplement label doesn’t always mean much. But the good news, which is equally important to share, is that athletes can experience the benefits they seek from supplements through an approach anchored in sound sports nutrition. As a sports dietitian, I have guided athletes to huge improvements in their performance, body composition, and overall health by changing their diet, hydration practices, and fueling habits before, during, and after exercise. In many cases, even small interventions have made a very big difference. It’s vital to communicate that supplements, as their name implies, are intended to supplement diet and lifestyle factors—not provide a shortcut or “magic bullet.” Athletes need to understand that supplementation should always be secondary to nutritional strategies in helping them reach their goals. If an athlete asks you about a caffeine-based supplement because they want more energy during practices and games, first find out if they’re eating enough carbohydrates in preactivity meals. If they want to use an herbal product that promises to speed recovery, ask whether they’re eating appropriate meals after workouts to replace muscle glycogen stores. If they want to take a weight loss supplement, have them first keep a food diary for a week and evaluate whether they’re consuming too many empty calories or high-fat foods. I receive many phone calls from high school-age athletes and their coaches and parents wanting to know which creatine supplement is best, how many cans of energy drink are safe, or how much protein powder per day is recommended. The fact is, the American Academy of Pediatrics (AAP) and the ACSM discourage the use of musclebuilding supplements, protein supplements, and stimulants by individuals under 18. However, I worry that responding with a flat “no” to these inquiries will

only push athletes to other, less reliable sources of information. Instead, I talk about the athlete’s performance goals and about nutrition strategies that can provide a natural solution. I also explain why groups like the AAP and ACSM make their recommendations, and note that the science behind them far outweighs anything an athlete or parent will read on a supplement label. The bottom line is that as long as athletes are driven to run faster, outmuscle their opponents, and go the extra mile—literally and figuratively—di-

etary supplements will appeal to them. Armed with the right information and evaluation strategies, you can help steer them clear of danger and toward a smart approach to sports nutrition that optimizes performance without introducing unwanted risks. ■

The author would like to thank Susan Kundrat, MS, RD, CSSD, (www.nutritiononthemove.net) for her contributions to this article.

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OPTIMUM PERFORMANCE

In Alignment Sometimes, an athlete’s toughest opponent is his or her own biomechanical flaws. One way to correct them is through a form of Pilates called Contrology. BY CHRISTINE ROMANI-RUBY

n 1934, Joseph Pilates wrote, “Incorrect habits are responsible for most of our ailments, if not all of them. Through proper education it is possible to replace bad habits with good ones.” The creator of the Pilates exercise system, Joseph Pilates devoted a major part of his life to the scientific study of the body. Part of his work involved helping athletes to improve their performance through a method called Contrology, which is just as relevant today. In Pilates’s own words, Contrology is “the conscious control of all muscular movements of the body. It is the correct utilization and application of the leverage principles afforded by the bones comprising the skeletal framework of the body. It is a complete knowledge of the mechanism of the body and a full understanding of the principles of equilibrium and gravity as applied to the movements of the body in motion, rest, and sleep.” Today, we would simply refer to this as good biomechanics. More specifically, it is the connection between motor control and musculoskeletal function, and the effects both have

Christine Romani-Ruby, MPT, ATC, is an Associate Professor in the Exercise Science Program at California University of Pennsylvania. She is also the owner of PHI Pilates and can be reached at: cruby@phipilates.com. TR AINING-CONDITIONING.COM

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OPTIMUM PERFORMANCE on the pattern of muscle use and the shapes of the bones and joints. As we closely examine athletes’ biomechanics in an effort to prevent injury and enhance performance, Pilates can be a very useful tool. Because of its emphasis on a balanced and controlled body, Contrology specifically can assist the athletic trainer or strength coach to uncover biomechanical flaws and help the athlete work toward correcting them.

Figure One: The Pilates V position

Figure Two: Pilates footwork in the V position on the reformer

Figure Three: Frog exercise with ring on the reformer 32

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BIOMECHANICAL FORCES Both static and dynamic forces can lead to improper biomechanics. Static forces involve the effects of gravity on muscles, joints, and bones. For example, athletes naturally stand in a sway back posture, with their pelvis forward of the line of gravity. This posture is very common in swimmers and weight lifters because of a lengthened external oblique and shortened rectus abdominis. It leads to a decreased demand on the hip extensor muscles and results in significant atrophy of the gluteus maximus, setting the athlete up for stress to the hip and spine. Static forces can also alter the shape of bones and joint surfaces. An athlete who presents with genu recurvatum (knee hyperextension) has a downward slope to the articular surfaces of the tibia, a displacement of the femur anterior to the tibia, and an inferior position of the patella. This alignment changes the stresses across the cruciate ligaments and leads to a weakening of the anterior cruciate ligament (ACL). Improper static alignment continues to cause biomechanical problems when dynamic forces are introduced by creating moments that cause joint malalignment. These moments—as well as frequent patterns of movement—can become factors in movement system imbalance, as they can lead to changes in the recruitment pattern of muscles. This in turn can alter muscle performance and cause a change in the pattern of joint movement, and also create micro trauma to tissue from compensatory movements. The good news is that these compensatory movements can be eliminated by practicing frequent and deliberate healthy movement patterns in an optimal posture. Contrology offers athletes a variety of apparatuses and exercises to accomplish optimal posture and balanced movement. Two of the main benefits documented in research are improvement in motor control (because of the emphasis on spinal stability) and the recruitment of the deep abdominal and pelvic floor muscles. Pilates equipment offers a variety of ways to apply progressive overload in a non-weight bearing position, which can be an invaluable tool in re-training reactions to dynamic forces. One of the keys to Pilates exercises is one-on-one attention from a coach who can focus on proper execution and alignment. Visual and verbal cueing is essential to the program in order to provide the necessary stimuli for change. Repetitions are low and the exercises are layered to provide overload. Specific breathing patterns are incorporated into each motion, and we emphasize exhalation for the recruitment of the deep abdominal muscles. Just like other bad habits, faulty movement patterns can be re-trained with persistence. However, the athlete needs undivided attention and practice to change the biomechanical flaw. With collaboration by the coach and the athlete, the result can be the prevention of future injury or a reduction and resolution of current pain. TR AINING-CONDITIONING.COM

OPTIMUM PERFORMANCE CASE STUDY One example of successful Contrology use with an athlete involved a 20year-old female soccer player with a history of insidious onset right medial knee pain. While being observed, her static posture revealed medial rotation of the right femur and right tibial varum. When standing, her right patella faced medially and she supinated her right foot when it was in a forward position. The condition worsened when she performed a single-leg stance, with additional medial rotation of the femur. When she was sitting, medial rotation of the femur was again noted. When she went from a sitting to a standing position, she demonstrated a medial collapse of the right knee.

ties and can provide verbal and tactile cues to reposition the limbs so the athlete has optimal alignment. As the athlete practices footwork on the reformer, resistance can be modulated from very light to heavy, and can be set to target either core or limb strengthening. First, the athlete performed the footwork in the Pilates V position, as this provides the most tactile feedback. (See Figure Two on page 32.) The motion involves not only knee flexion, but also ankle dorsiflexion against the

spring resistance. This slow and progressive motion with feedback begins to build a new motor pattern, while also developing strength and flexibility that will create the necessary relationship for muscle balance in the lower extremities. Next, she progressed to the same movement in a neutral stance, but with her feet still slightly turned out. Again the coach encouraged proper alignment with verbal and tactile cues. The next phase involved each of these exercises using a single-leg stance. This

Two of the main benefits documented in research are improvement in motor control (because of the emphasis on spinal stability) and the recruitment of the deep abdominal and pelvic floor muscles. This athlete’s introduction to Contrology began with a discussion of where her foot should be when standing. She had significant tibial torsion, and when she aligned her foot to the front, it would exacerbate the varus force. Therefore, we taught her to stand using a Pilates V, in which the feet are slightly turned out. This practice also requires the contraction of the deep outward hip rotators to create a sensation of “zipping and wrapping the legs together” to eliminate any light between the thighs. (See Figure One on page 32.) Footwork: This body alignment was reinforced with Pilates footwork on the reformer apparatus. In these exercises, the spine is placed in alignment against the stable carriage of the reformer. The carriage or bed of the reformer allows constant proprioceptive feedback for the athlete to hold the neutral position of both the spine and the pelvis while performing the footwork with his or her lower extremities. The coach literally has a bird’s eye view of the lower extremiCircle No. 122 TR AINING-CONDITIONING.COM

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Figure Four: Standing work on the reformer

Figure Five: Articulating bridge with ring between ankles

often takes a while to progress to, and with varus alignment it is important to also address weight shift for the single-leg stance. As the weight is shifted from both to one lower extremity, it is important that the pelvis remains stable from the control of the gluteus medius and the pelvic floor. Any resultant hip rotation or lateral tilt of the pelvis will contribute to stress at the knee. The reformer provides the necessary environment to teach this effectively by introducing the single-leg stance in a supine position with reduced resistance. Not only does the athlete have the proprioceptive feedback of

the reformer carriage, but he or she has the advantage of the feedback from the coach. Frog Exercise: In addition to footwork, the athlete performed the frog exercise with the ring on the reformer. For this exercise, the athlete remains supine, but places the feet in the Pilates loops. The loops are connected to ropes that pull the carriage against the springs, so the athlete can work against resistance with the feedback of the carriage movement. This exercise is neither open chain nor closed chain. It is what we call â&#x20AC;&#x153;controlled open chainâ&#x20AC;? because the movement is guided by the ropes.

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OPTIMUM PERFORMANCE In the frog exercise, the athlete holds the ring between the ankles with the hips in external rotation and the spine in a neutral position. Then she performs a plié motion while suspended in the ropes. (See Figure Three on page 32.) This works the hip external rotators throughout the entire range of hip flexion. It also combines several other challenges: flexibility of the hip internal rotators, stability of the core, and strength of the hip extensors throughout the entire range of hip flexion. In the beginning, the athlete usually has a great deal of difficulty holding the ring and the coach needs to provide additional encouragement.

diately and included performing an articulating bridge with the ring first between the ankles and then around the outside of the knees. With the ring between her ankles, the athlete was encouraged to keep the patella over the second toe. (See Figure Five on page 34). When the ring was around her knees, the athlete was encouraged to abduct gently into the ring. (See Figure Six on page 36.) For exercises like these, it is important that the athlete be taught to do pattern breathing with each exercise to help engage the

deep abdominal muscles. We told her that each exercise should be performed eight times daily. The third home exercise was challenging, so we waited until the pain had subsided to introduce it. For this one, the athlete wore the ring around the outside of her lower thighs, just above her knees. The goal was to maneuver from sitting to standing and back without losing the ring. We told the athlete to place her feet in the newly aligned outward position, but to have her knees aligned straight ahead.

For many athletes, the problem is not flexibility or strength, but a lack of focus or control. Sometimes the athlete just needs to learn how to position him- or herself to avoid pain. Standing Work: Our soccer player also performed standing exercises on the reformer with resistance to hip abduction. For these exercises, we have the athlete stand in hip outward rotation with one foot on the stable surface and one foot on the moving carriage. The athlete simultaneously abducts both legs while holding a neutral pelvis and spine to open and close the carriage with control. (See Figure Four on page 34.) After eight repetitions, the athlete changes to the other side. In this same position, the athlete is asked to hold the carriage closed and performs pliés against very light resistance. The knee flexion is limited to the range available without pain. At Home: For a home and travel program, the soccer player was given a Pilates ring and instructed in three exercises. The first two began imme-

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OPTIMUM PERFORMANCE For many athletes, the problem is not flexibility or strength, but a lack of focus or control. Sometimes the athlete just needs to learn how to position him- or herself to avoid pain. This happens quickly—in some cases after just one session.

Figure Six: Articulating bridge with ring outside knees She was encouraged to perform up to eight repetitions of this exercise daily. The results of the Contrology method were rapid. Our soccer player had a resolution of her knee symptoms in just one week.

To read a previous T&C article by Christine RomaniRuby on using Pilates with football linemen, visit: www.Training-Conditioning.com and type “Pilates on the Line” into the search window.

INCORPORATING CONTROLOGY Adding Contrology to your workout offerings does not require extensive study or buying a lot of new equipment. Mainly, it just means understanding that identifying the mechanical cause of an athlete’s pain is a more important step in correcting problems than alleviating the pain. It’s about changing the way you approach pain and looking further into an athlete’s biomechanics to recognize and then solve problems. It also means realizing that the athlete’s focus is the one main component necessary for success. As Joseph Pilates said, “The acknowledgement of Contrology evidently throws the responsibility for health, efficiency, and happiness upon the individual, where it should belong.” ■ References: McMillan, Proteau, and Lebe. “The effect of Pilates-based training on dancers’ dynamic posture.” Journal of Dance Medicine & Science 2, no. 3 (1998): 101-107. Pilates and Miller. Your health. Philadelphia: BainBridge Books, originally published in 1934, reprinted in 2000. p. 20, 63. Sapsford and Hodges. “Contraction of the pelvic floor muscles during abdominal maneuvers.” Archives of Physical Medicine and Rehabilitation 82 (2001): 1081-1088.

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Pilates and the Hamstrings: You’ve seen it a hundred times, and from an athletic trainer’s standpoint it’s never easy to watch. A batter flies up the base path, crosses first and pulls up lame. A point guard races down the court, makes a crossover dribble and suddenly collapses on the floor. The culprit? Hamstrings. It is no secret that hamstrings (the semimembranosus, semitendinosus and biceps femoris muscles in the back of the upper leg) are a common source of injury and pain in athletes, and a headache to athletic trainers and conditioning coaches. Hamstring injuries occur most often in sports when they are stretched eccentrically at a high speed. Track and field and running contact sports like football and basketball are prime examples. In addition, sports such where the knee is fully extended during injury (like waterskiing), can also lead to hamstring injuries. These injuries primarily occur proximally and laterally and the severity of injury can be classified by the following grades: Grade 1 is a mild strain with few muscle fibers being torn. Grade 2 is a moderate strain with a definite loss in strength. Grade 3 is a complete tear of the hamstrings. They also take a long time to heal. A recent study cited on eMedicine.com’s Web site involving 47 football players with hamstring injuries reported an average of 14 days of convalescence before return to play. That’s a lot of time off the field.

in motion. So, with Pilates you can actually retrain your athlete’s body to move in safer, more efficient patterns of motion. They can learn to move with strength and control in larger range of motion, thus helping to avoid injuries to the hamstrings and other areas. And the by-product of all of that will be increased performance.” Pilates develops a strong core (the deep abdominal muscles along with the muscles closest to the spine) with exercises and stretches that integrate the trunk, pelvis and shoulder girdle. It also emphasizes proper breathing, correct spinal and pelvic alignment and smooth flowing movement. This allows athletes to access each part of the body individually, and become familiar with the functional mechanics. “A strong core helps with everything – and that definitely includes the hamstring. With a strong core you’ll have strong glutes and that’s important because it is the primary mover for hip extension, says Naymick-White. “From there you can start to get your athlete’s hamstrings and glutes to work together. The more that happens the more you can see it helping the quads, or at least being able to withstand the pressure that the quads exert. It really is an ideal tool for any athletic trainer or strength and conditioning coach to have in their arsenal.” Two Pilates Mat Exercises and One Mat Stretch for the Hamstrings and Surrounding Areas Exercises

The most common cause of hamstring injuries, by far, is a muscular imbalance, in this case an imbalance between the quadriceps muscles and the hamstring muscles. Because the quadriceps are used to perform an everyday activity like leg extension they can become very strong, particularly in athletes. This puts a tremendous amount of tension on the hamstrings. If the hamstring is weak, tired or inﬂexible, an injury is almost a sure bet. The best preventative measures involve a consistent program of both stretching and strengthening exercises. Pilates is an absolutely ideal adjunct to any athlete’s conditioning program for this purpose, since it creates an even symmetry throughout the body and eliminates muscular imbalances.

1. Pelvic Tilts/Bridge Marching Exercise sequence: Begin with both feet on the floor with the heels hip width apart and the knees bent. Press the hips up, articulating the spine until the hips are a handwidth or more off the floor. Lift one foot off the floor at a time maintaining the level of the hips. Imagery and Cueing: Imagine the hips are suspended in a hammock as each leg floats up. If one hip drops as the leg lifts, engage the gluteals to keep the hip level with the opposite hip. To increase the challenge, place a foam roller, ball, or other unstable object under the standing leg. Used for: Strengthening the hamstrings and gluteals and increasing lumbopelvic stability.

is comfortable. Keep the head in line with the spine. Exhale and lower the torso back down to the mat with control. Imagery and cueing: Lift up into the back extension from the torso, not the arms. Keep the abdominals engaged throughout (no sagging stomachs). Keep the spine as elongated as possible and the shoulders down and wide. (Press into the mat with the whole hand to widen the space between the shoulder blades). Lengthen the leg along the mat and activate the posterior side of the leg. Used for: Improving back extension and scapular stability, strengthening back extensors, hamstrings and gluteals. Stretch 1. Single Straight Leg Stretch Exercise sequence: Lie on the back with the head and upper body rounded oﬀ the mat with one leg reaching toward the ceiling and the other leg reaching toward the wall. Lower the leg only as far as you can without disturbing the stability of the low back and pelvis. Place the hands as far

Single Straight Leg Stretch - Hands on

up the leg as they can easily reach but not directly behind the knee. Inhale and engage the abdominals and draw the leg closer to you. Exhale and switch the legs, keeping the torso still, the low back in place and the shoulders down with the elbows wide. Imagery and cueing: Keep your torso still - imagine you are holding a glass of your favorite drink on your abdomen and don’t spill it. Keep

Single Straight Leg Stretch - Hands off

Robyn Naymick-White is a personal trainer and Pilates instructor who has worked and trained with athletes for over 20 years. She has seen many hamstring injuries and feels that Pilates is not only great for rehabilitating hamstring injuries but avoiding them altogether. “I’ve seen a lot of injuries created by a lack of strength or flexibility in the hamstring. Pilates helps strengthen our eccentric phase in movements. On a flexibility note, it’s dynamic – meaning that it’s developing flexibility while we are moving. This is ideal since athletes are constantly

2. Swan Exercise sequence: Lie prone with the palms of the hands on the mat, the palms level with the shoulders and the elbows bent. Legs are as close together as is comfortable for the lower back. Inhale and engage the abdominals, slide the shoulder blades down the back and lift the upper body into extension as you press the hands into the mat. Press the hips into the mat at the beginning of the exercise to take pressure oﬀ the low back if needed. Keep the shoulders away from the ears and rise up only as far as the low back

the head and upper body in the same position throughout the exercise. Imagine you are holding an orange between your chin and your chest. Challenges: Hands oﬀ the Leg - reach the arms along the torso as the legs move. Used for: Developing pelvic stability and core control, strengthening the abdominals and increasing the ﬂexibility of the hamstrings. Ken Endelman is the Founder and CEO of Balanced Body, Inc. www.pilates.com

LEADERSHIP

©GETTY IMAGES

Leap of Faith

BY ELICIA LEAL

football player on your high school team seems to have contracted bronchitis and you instruct him to see a physician immediately. When you check back with him two days later, he admits that he hasn’t seen a doctor, but says his grandmother gave him some medicinal herbs to help him get better. Working in a hospital’s sports medicine clinic, you are assigned to provide rehab to a construction worker who is suffering from back pain. His case looks fairly straightforward and you plan an efficient half hour with him. But when you meet face to face, you learn he barely speaks any English. Your track and field coach refers a female freshman athlete who seems to have shin splints to the athletic training room. She is bundled up from head to toe, apparently due to the cold. But she is reluctant to answer your questions, and when you ask her to roll up her sweatpants so you can examine her legs, she says she cannot—she is Muslim and not allowed to bare her legs in public. 38

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From Muslim athletes in headscarves to patients who don’t speak English, our clientele is growing more diverse by the day. Improving your cultural competence will ensure you are providing the best healthcare possible. As the American population grows more diverse and athletic trainers continue to broaden their role in healthcare delivery, understanding cultural, ethnic, and religious differences has become a must in our profession. Along with knowing physiology and the latest treatments, the need to develop our cultural competence is a top professional priority. WHAT IS CULTURAL COMPETENCE? As athletic trainers, we pride ourselves on treating every patient as an individual. We care about the fourth-string lineman as much as the starting quar-

terback. We understand that there are no one-size-fits-all protocols and different athletes respond to treatment in different ways, so we remain flexible and modify our plans accordingly. We also pride ourselves on going out of our way to help an athlete, even if it is not our direct area of responsibility. We advocate for athletes who confide in us. We follow up after referring an athlete to an outside professional. However, these efforts can sometimes fall flat if we don’t also understand how a patient’s cultural background affects Elicia Leal, MEd, LAT, ATC, is the Head Athletic Trainer at McKinney North High School in McKinney, Texas. She is the District 6 Representative to the NATA’s Ethnic Diversity Advisory Committee and serves as the Chair of the Southwest Athletic Trainers’ Association’s Ethnic Diversity Committee. A former member of the Advisory Board of Athletic Trainers for the State of Texas, she is also the Director of the Permian Basin Student Trainer Workshop. She can be reached at: eleal@mckinneyisd.net. TR AINING-CONDITIONING.COM

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LEADERSHIP our interactions with him or her. To be truly effective in our roles, we need to realize why an athlete might refuse to see a doctor who practices Western medicine, how to bridge a language barrier, and what it means to hold certain religious beliefs while participating in athletics. Cultural competence is the ability to effectively serve culturally diverse pop-

describe various opposing physical conditions of the body. Some African approaches to medicine believe spirits can cause illnesses and as treatment use herbs selected for both symbolic significance and medicinal effect. In the African-American community, some patients harbor feelings of distrust for the medical profession, especially when participating in medi-

It is important to show respect, sensitivity, awareness, and understanding of the different perspectives that may exist. You must also convey to the patient your desire to understand his or her viewpoint. ulations. It is a realization that a patient’s beliefs can affect their response to treatment and shape the way they view us as healthcare providers. And it is a commitment to working through any differences. BELIEFS & PRACTICES The first step to becoming culturally competent is to understand that there are many beliefs about healthcare that do not fit what we learned in school. Every individual has their own frame of reference for what it means to be healthy, how to stay that way, how to label and categorize various symptoms, what type of treatment to seek for illness or injury, how to respond to medical advice, and so on. One’s cultural background usually plays a strong role in defining these beliefs. Therefore, it is important as healthcare professionals to be aware of the various attitudes and habits of ethnic groups in our community in order to better meet their needs. For example, a traditional Native American belief about health is that it reflects living in total harmony with nature. For this group, medical care is concerned less with treating a disease and more with restoring an individual’s connectedness to the community and spirit of nature. Symbolic healing rituals are often used to prepare the body for cleansing and treatment can sometimes take weeks to complete. Chinese medicine also teaches that health is a state of spiritual and physical harmony with nature. Traditional Chinese healthcare often combines the use of medicinal herbs, acupuncture, food therapy, massage, and therapeutic exercise. The terms yin and yang are used to 40

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cal research or clinical trials. Much of this distrust originates from incidents like the Tuskegee study, in which African-Americans were deliberately denied treatment for syphilis in order to study the progression of the disease. In the Hispanic community, physical illness can sometimes be associated with a condition called susto, which means fright. Traditional healers are known as curanderos (folk healer), sobadoras (masseuse), and alborarios (herbalist). Many Muslims adhere to strict religious rules that may determine how they would like to receive treatment. These include fasting during the month

When a patient receives Westernstyle treatment that conflicts with their cultural beliefs, it can create an inner struggle. The patient often feels compelled to make a choice: Embrace Western medicine and neglect the beliefs they are comfortable with, or forego Western medicine and continue with their traditional practices. A progressive athletic trainer, however, can help patients bridge the gap between the two. Often, it is possible to integrate some traditional or culturespecific treatments with Western medicine. At the very least, we can hear the patient’s concerns about why the treatment may conflict with their beliefs. How do you do this? First, it’s important to ask the patient if he or she is comfortable with your treatment plan. Then, carefully listen and ask follow-up questions. Be open to whatever the patient tells you, even if you believe their ideas to be bad medical practices. Next, try to integrate their cultural practices into the treatment you’d like to provide. If the patient is eager to see an herbalist, ask them to bring you the suggestions from the herbalist and see how that advice can work with your ideas. If the patient wants to get acupuncture, you may decide to help them do so. Even if you’re skeptical of any of their suggestions, remember that if a patient believes an herbal remedy or alternative therapy is key to their well-

With high school and college athletes, understand that their life may be a constant challenge of assimilating while respecting their family’s traditional beliefs. Help them to talk and work through their decisions. of Ramadan and some other dietary restrictions. Rules requiring women to dress modestly in public—which some sects interpret as covering nearly the entire body—and a preference to be treated by a member of the same sex also have medical implications. Some patients, regardless of background, follow alternative forms of medicine that borrow from several different cultures or come from religious groups that place limitations on medical treatment. For instance, Jehovah’s Witnesses have restrictions against blood transfusions and many Buddhists will refuse narcotic pain killer medications that interfere with cognition.

being, incorporating it with your treatment can help make them comfortable and lead to a better outcome. OPEN TO DIFFERENCES The second important element of cultural competence is being constantly aware that a patient’s experiences and beliefs can conflict with many aspects of Western healthcare, and thus you need to be ready to address these roadblocks. You also need to realize that an insensitive comment regarding ethnic and cultural beliefs may damage your relationship with the patient. Barriers can be lack of knowledge about Western healthcare, embarrassTR AINING-CONDITIONING.COM

LEADERSHIP ment over a physical exam or being touched by strangers, belief that some illnesses are untreatable, and fear of medical equipment. It is important to show respect, sensitivity, awareness, and understanding of the different perspectives that may exist. You must also convey to the patient your desire to understand their viewpoint. Some tactics for raising mutual awareness and building trust include the following: • Ask the patient if they’ve ever met with an athletic trainer before. If they haven’t, take the time to explain your role in the medical community and ask them to tell you a bit about their past experience with Western healthcare. • Ask them what other forms of healthcare they practice, and be accepting of whatever they tell you. • Explain why you are doing everything you do. If you are probing or palpating an area, first describe why it is necessary for you to touch them. If they are uncomfortable with you touching them, ask if they’d like someone else (for instance a member of their own gender) to perform the exam. • If English isn’t their first language, ask if they need an interpreter. If one is not available, you may need to use pictures and very simple descriptions. Ask them to stop you when they don’t understand what you’re saying, and remember to speak slowly. • Encourage them to ask questions. This is a great way to find out what might be behind a hesitation they have. • Never criticize a medical practice they describe. Ask them more about it and how it helps. • See the illness or injury from the patient’s point of view. If the patient feels an injury is due to not living in harmony with nature, understand that restoring this balance will need to be a part of his or her healing. • With high school and college athletes, understand that their life may be a constant challenge of assimilating while respecting their family’s traditional beliefs. Help them to talk and work through their decisions. • Understand the challenges Muslim females face in playing sports if they choose to wear a headscarf and keep their bodies covered. This is becoming more prevalent, with leagues enacting rules to allow uniform modifications that comport with religious requirements.

AN EXERCISE In my efforts to increase my own cultural competence within the athletic training profession, I have devised an activity that can help a staff discuss and better understand this topic. All it requires is a few bags of M&M candies and a willingness to think outside one’s comfort zone. I start by giving each participant a small bag of M&Ms and a piece of paper that has a six-pod diagram on each side. The pod diagram has one large circle with lines that lead to five

smaller circles. One side of the paper is marked Side One, and the other Side Two. On Side One, individuals are asked to randomly number the circles from one to six. Next, we open our M&M packages and in a blank area on Side Two, each person records the total number of M&Ms of each color (e.g., yellow = 6, brown = 5, and so on). Now each individual creates an identity profile of a patient using six different categories. We start with ethnic/racial identification and I pass out

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LEADERSHIP the following chart: Yellow =African-American Red=Asian-American Orange=Native American Blue=Hispanic Green=Caucasian Brown=Other Whatever color of M&M was most prevalent in the person’s bag is the patient’s ethnic/racial identification and it is written in the center circle on Side Two.

SAMPLE PODS Side One: Athletic Trainer’s Identity

CHRISTIAN

CAUCASIAN

MODERN MEDICINE CLINIC SETTING

Then we define the job setting for our identify profile. The color of M&Ms that had the second highest number defines the job setting where the patient is seeking treatment and is written in one of the small pods/circles: Yellow=High School Red=Industrial Orange=College/University Blue=Professional Green=Military Brown=Clinical

SINGLE, The color of M&Ms that finished third determines the patient’s religion: Yellow=Muslim Red=Non-Catholic Christian Orange=Other Blue=No affiliation Green=Catholic Brown=Jewish

HETEROSEXUAL

The fourth most common color establishes healthcare preference: Yellow=Modern/Allopathic Red=Natural Orange=Holistic Blue= Traditional Folk Green=Complementary Brown=Alternative

Side Two: Patient’s Identity CATHOLIC

CLINIC SETTING

HOLISTIC HEALING ASIAN-AMERICAN

MARRIED, HETEROSEXUAL

BACK PAIN

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Next comes sexual and marital identity: Yellow=Married, heterosexual Red=Single, heterosexual Orange=Single, gay/lesbian/transgender Blue=Domestic partner, gay/lesbian/ transgender Green=Domestic partner, heterosexual Brown=Widowed/Divorced And finally, the color of M&M occurring least frequently in their bag denotes the patient’s healthcare concern: Yellow=ACL tear Red=Ankle sprain Orange=Tendinitis Blue=Back pain Green=Low energy levels Brown=Asthma TR AINING-CONDITIONING.COM

LEADERSHIP To add some fun, I usually have participants eat each color of M&M after they’re finished with that category. Then, as a group, we talk about the biases, stereotypes, and barriers that may be associated with each characteristic on their sheets. People should be encouraged to speak freely and offer their expertise, observations, and experiences related to each identity characteristic. Participants are then instructed to turn their paper over to Side One and fill in the pods with their own personal information, using the numbers they already put down to determine which trait goes in which pod: 1=Ethnicity 2=Job setting 3=Religion 4=Healthcare preference 5=Sexual and marital status 6=leave blank Once both sides are filled out, individuals compare and contrast their own personal profile with the identity profile of the patient, discussing the differences between them. For example, on Side One, the largest pod may have contained religion while on Side Two it will

or other obstacles may affect this patient’s overall treatment. During this activity, encourage participants to come up with more questions for group discussion. For example, how might the policies and procedures at your particular job setting affect this patient, and what changes can or should be made to assure that he or she is receiving optimal treatment? How do you and your staff approach healthcare in your athletic training room or clinic and how culturally competent are you?

In today’s world, cultural competence is not optional for athletic trainers. The NATA has an explicit mission to enhance the quality of healthcare for athletes and those engaged in physical activity, and to advance the profession of athletic training through education and research in the prevention, evaluation, management, and rehabilitation of injuries. By embracing cultural competence, athletic trainers can better fulfill their mission while improving the lives of people from different backgrounds. ■

How might the policies and procedures at your particular job setting affect this patient, and what changes can be made to assure he or she is receiving optimal treatment? FEELS LIKE SKIN … ACTS LIKE MUSCLE always be ethnicity/race. We might talk about the fact that most individuals assume they are being identified or categorized by their ethnicity, when in fact someone may identify them primarily by another category. Often, bringing our own assumptions and biases to a situation can greatly affect how we treat our patients or how we ourselves seek healthcare. The next discussion centers on how the athletic trainer’s cultural competence can impact the way they work with patients. Using their own identity profile from Side One, they should imagine a patient with the profile defined on Side Two. They can then discuss how to approach this patient’s healthcare and how any biases, preconceptions, prejudices,

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SPORT SPECIFIC

Coordinated W Effort

BY PAUL LONGO

At the University of Cincinnati, speed work and a creative approach to building strength are the foundations of the football training program. But just as important is how the coaches coordinate their efforts.

Putting an emphasis on speed training helped the Bearcats run an aggressive defense—and post their best record in over 50 years.

BRETT HANSBAUER

TR AINING-CONDITIONING.COM

hen I arrived at the University of Cincinnati with new Head Football Coach Brian Kelly after the 2006 season, he and I had high expectations. We came from Central Michigan University, where we had turned the football program around in three short years, going from 4-7 in 2004 to 6-5 in 2005 (the program’s first winning record in a decade) to 10-4 in 2006. In that last season, we claimed the Mid-American Conference title and won the Motor City Bowl—the team’s first bowl appearance in 12 years. Our first year with the Bearcats didn’t disappoint. The team had its first 10win season since 1951, and finished in the Associated Press Top 25 poll for the first time ever (at number 17). And with a strong class of incoming players, we’ve set our sights even higher for next season. I’ve been in the strength training profession long enough to see—and borrow from—virtually every type of coach and philosophy. The main lesson I’ve learned over the years is that there’s no single best approach to football development. My program is a constantly changing hybrid of many kinds of training, as I adjust to address players’ specific goals, correct weaknesses or deficiencies, and provide enough variety to keep the athletes engaged and challenged. I like to think of my approach as 50 percent science and 50 percent art. For that reason, this article doesn’t contain detailed lists of exercises, weight training progressions, and the complete framework for my football workouts. Instead, I’ll explain our program’s top training priorities and discuss how they’ve helped Cincinnati football reach a higher level. Paul Longo, CSCS, CSCCa, is the Head Strength and Conditioning Coach at the University of Cincinnati. He has over 20 years of NCAA Division I experience, with stints at Central Michigan University (2004-06), the University of Iowa (19882004), and the University of Wisconsin (1987-88). He can be reached at: Paul.Longo@UC.edu. T&C APRIL 2008

SPORT SPECIFIC THE “THIRD COORDINATOR” From a strength and conditioning perspective, the foundation of our team’s success isn’t any unique workout I’ve devised or any secret I’ve figured out to make players stronger and faster. I believe the biggest key has been Coach Kelly’s philosophy for how I fit into the program. I call it the third coordinator model.

the off-season. Strength coaches spend far more hours with the football team than anyone else throughout the year. Of course, I’m not a member of the football staff, and NCAA rules prohibit me from actually having a coordinatorlevel position with the team. I oversee strength and conditioning for all 18 Bearcat sports, and I work with coaches

Because the players see me as a leader and not just a lifting coach, they buy into every activity I put them through and understand that my primary goal is the same as theirs: to win football games. Too often, the strength coach is seen as a member of the support staff—an athletic department employee like the sports information director or equipment manager. But in reality, every strength coach knows we actually play a much larger role than that. Football player development, especially at the NCAA Division I level, is a year-round process, and the football coaching staff has only limited access to the players in

and athletes from all of our programs. But I take a special leadership role in our football players’ development. Under Coach Kelly’s direction, they see me right next to the offensive and defensive coordinators on our program’s totem pole. What does this really mean? On a daily basis, it means I’m not just a guy in the weightroom who tells them how to lift. I follow the football team closely and build personal relationships with

the players, so I fully understand the team dynamics and the buttons to push to get individual players motivated. I know who the team leaders are, and the players know that I communicate regularly with the coaching staff about their performance during our strength and conditioning sessions. For instance, if a second stringer works his tail off in the weightroom because he wants to challenge for a starting spot, he knows he’s not toiling in obscurity. And if a player is slacking off, he knows I have the authority to hold him accountable. I see who our hardest workers are, and my input to Coach Kelly and his assistants is reflected in playing time decisions. Everything we do in our football strength program is colored by that approach. Because the players see me as a leader and not just a lifting coach, they buy into every activity I put them through and understand that my primary goal is the same as theirs: to win football games. Coach Kelly’s third coordinator model gives me the credibility I need, and our success on the field speaks for itself.

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B E S T

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A G I L E

A L L

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C H E S T

N E W

D R I V E

S L E D

RogersAthletic.com

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SPORT SPECIFIC FOOTBALL FAST We run a spread offense and an aggressive defense, so nothing is more important in our strength and conditioning program than speed. I’m not just talking about 40 times—being football fast is about explosiveness, force production from the ground, foot agility and quickness, and the ability to change di-

from the base to the top, and it’s fairly steep (I estimate the average grade to be around 45 degrees). The work volume varies depending on the type and intensity of the players’ other activities in practice and the weightroom that day, and during most sessions I prescribe intervals of varying effort. A typical ses-

My favorite speed exercise is hill running because it uses gravitational resistance, requires the athletes to generate force as they plant each foot, and trains totalbody coordination during the running movement. rection on a dime. I don’t believe there are any magic techniques for speed development. My favorite speed exercise is hill running because it uses gravitational resistance, requires the athletes to generate force as they plant each foot in the ground, and trains total-body coordination during the running movement. And best of all, when performed as a group, it taps into players’ natural competitiveness. The hill we use is about 30 yards

sion might consist of five runs at 70 percent of max effort, five runs at 80 percent, and five runs all-out. Maximizing team speed also means evaluating players’ body composition. I did just that shortly after arriving and found we needed to improve in this area. Our heaviest linemen had an average body fat percentage between 23 and 25 percent, which is too high for a team that prioritizes speed up front. I set 18 percent as the maximum

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body fat percentage for our players, and they’re all at or below that level today. For our purposes, body fat percentage is a better metric than body mass index (BMI), which does not distinguish between muscle mass and fat mass. It’s also better than body weight, because in most cases I didn’t want the players to actually lose weight—I wanted them to replace fat with lean muscle, which makes them faster and more powerful on the field, and also helps ensure they’re in shape to remain fast for all four quarters. To assess whether our speed program is succeeding, we put players through an NFL-style combine test twice a year. Their 40 times and shuttle run performances give us some indication of where the athletes are at, but that’s just a starting point. I know the top players in a straight-ahead dash or a cone drill aren’t always the ones who play fastest on game days. There’s no substitute for watching players play football, so I often look at practice drills and game performance when evaluating players’ progress in developing football speed.

SPORT SPECIFIC FROM THE GROUND UP There are many ways to build strength in football players, and every strength coach has his preferences. Some like a high-intensity machine-based program. Some focus on the big squats and big benches. At Cincinnati, I’ve gravitated toward ground-based training, especially Olympic lifts and explosive movements. Today, 75 to 80 percent of our weightroom work is done on a platform. The main reason I like platform work and Olympic lifts is that they force the athletes to activate multiple key muscle groups at the same time. These lifts typically incorporate 80 percent or more of the athletes’ total muscle fiber, and to do each lift successfully, the athlete must apply force in a specific sequence of short, burst-style movements. So while they’re getting stronger, they’re also developing muscle coordination that maximizes transfer to the demands of football. Most of the players at Cincinnati hadn’t done much platform work before I got here, so it felt like I was working with 90 freshmen. As I taught and demonstrated the Olympic lifts, I always kept in mind that there’s a big difference

between impeccable technique and acceptable technique. If you’re lucky, maybe 20 percent of your football players will perform the lifts impeccably—but that doesn’t mean the rest should move on to another type of strength training. I evaluated each player’s lifting mechanics individually, and as long as they were

erything, including traditional farmer’s walks, tire flipping, log presses, and carrying heavy rocks, sand bags, and other oddly shaped implements. In addition to being a great way to increase work volume, strongman exercises offer several key benefits. They promote total-body muscle coordination by forc-

Throughout the year, I periodically turn to a training phase that I call building our “coat of armor.” This is when we address any weaknesses or strength deficiencies that may leave players more prone to injury. activating the right muscle groups, not risking injury due to a mechanical flaw or compensation, and making adequate progress on a weekly and monthly basis, I didn’t micromanage their lifting. Never forget that weightlifting is a means for football players to increase their strength and explosiveness, not an end in itself. Off the platform, my favorite strength training activity is strongman work. I like to get creative for our strongman sessions, so we have done just about ev-

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ing the athletes to use their core, extremities, and stabilizer muscles to maintain balance while carrying a heavy, awkward object. Most weightroom work involves predictable straight-line up/down or push/pull movements, but strongman activities provide a more dynamic stimulus: The athletes have to think and react with their muscles during the walks, lifts, and movements, much like they have to during football games. Another benefit is that strongman ac-

SPORT SPECIFIC tivities lend themselves to competition between the players, so they push each other to work harder. Any time I can make a strength activity competitive, I know the athletes will give it everything they have. COAT OF ARMOR In the last two years—my final season at Central Michigan and this past season at Cincinnati—my football players haven’t suffered any major injuries. In both seasons, we started the same 22 guys at the beginning and end of the year. Obviously there’s an element of

luck in avoiding major injuries, but it’s also due to a specific emphasis in our strength program. Throughout the year, I periodically turn to a training phase that I call building our “coat of armor.” This is when we address any weaknesses or strength deficiencies that may leave players more prone to injury. Nine times out of 10, the biggest deficiency I need to correct is in the posterior chain. Quite simply, too many players come out of high school thinking that football strength training is all about the bench press and squat. They come in

with underdeveloped hamstrings, glutes, calves, and lower-back muscles, and they’re often unfamiliar with the exercises that will strengthen these areas. To address posterior-chain weakness, I frequently prescribe straight-leg deadlifts, king deadlifts, glute-ham developers, and partner leg curls. These are all fairly easy to teach and very effective in targeting the deficient muscle groups. Strengthening the posterior chain not only prevents injuries, but many athletes are surprised to find it also increases their speed, quickness, and vertical jump. Another common area of weakness that’s central to the coat of armor is the shoulders, particularly the rear deltoids. The deltoids are a smaller muscle group, so they are frequently overlooked by high school strength programs that only emphasize bench pressing for upper-body development. To address weakness in the deltoids, I like to use L-flys and lying flys. Throughout our coat of armor phase, I observe the athletes during certain lifts to identify movement deficits that may make them injury prone. For instance, an overhead squat provides a great opportunity to evaluate ankle mobility, and this is an area where many athletes are lacking. I have used several tricks to address this, including having them wear work boots or lifting shoes, and even putting weights under their heels before a lift. In some cases, I’ll also refer players to our athletic trainer for remedial ankle flexibility work on wobble boards and other instability devices. TOTAL TEAM EFFORT That brings me to my final point, which is the importance of open communication with all the other parts of our football program. Our Head Athletic Trainer, Bob Mangine, PT, ATC, is an outstanding resource who has been working with athletes even longer than I have. We frequently consult each other when evaluating players in the weightroom, and I can rely on him for advice on virtually any aspect of our strength and conditioning program. And, like I explained at the outset, my communication with the football coaching staff is the foundation for my ability to do my job. I am in tune with all the coaches and I regularly adapt my training itinerary based on their input and concerns. By building around this philosophy, I know we’re getting the most from our athletes every day. ■

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REHAB EQUIPMENT Ball Dynamics International 800-752-2255 www.fitball.com The new FitBALL Peanut is a balance and core-training tool for beginners who are anxious about training or doing rehab on a standard FitBALL exercise ball. The FitBALL Peanut rolls in one direction at a time and is more easily controlled by the user. The longer shape of the Peanut allows two people to sit on the ball. The FitBALL Peanut is burst-resistant, latex-free, and available in sizes from 30 to 70 centimeters. Circle No. 513 Shuttle Systems by Contemporary Design Co. 800-334-5633 www.shuttlesystems.com The Shuttle Balance functionally trains the neuromuscular systems of

athletes and seniors alike. It has long been recognized that the body’s ability to negotiate unpredictable changes in force direction and placement in space at the neuromuscular level are critical building blocks for performance and skill development. The Shuttle Balance provides a safe platform for individuals to develop and hone proprioceptive responses while performing a variety of activities. Circle No. 514

strengthening needs. It is the complete transition tool for bridging the gap between injury and full functional movement. From a basic bilateral press to the advanced activity of jumping, you will not find a better therapy device. Circle No. 515

Facilitate a safe, speedy, and functional recovery for a wider variety of patients with the Shuttle 2000-1. Countless therapists worldwide have discovered that the 2000-1 allows treatment of virtually any lower-extremity injury early in rehab. It effectively addresses patients’ trunk and upper-body rehabilitation, along with

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REHAB EQUIPMENT a specially designed lift made of three 1/8-inch layers of neoprene rubber and a leather top cover. The layers can be removed to get the right height in the shoe. The leather layer makes this more of a lift than a pad. The Adjusta-Lift is available in three sizes to accommodate most individuals. Circle No. 516 Gebauer Co. 800-321-9348 www.gebauer.com Gebauer’s Instant Ice® non-prescription skin refrigerant can be used like ice for minor pain and swelling from sprains, strains, bruising, contusions, and minor sports injuries. Gebauer’s Instant Ice is ideal for facilities that restrict the use of flammable components. It is available in a mist spray or stream spray aerosol

can, and can be purchased directly from Gebauer by calling the company or visiting its Web site. Circle No. 517

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

Gebauer’s Spray and Stretch® topical anesthetic skin refrigerant replaces Gebauer’s Fluori-Methane, which has been discontinued. Use Gebauer’s Spray and Stretch fine stream spray in conjunction with the spray and stretch technique to effectively manage myofascial pain, restricted motion, trigger points, muscle spasms, and minor sports injuries. The product is nonflammable and available only by prescription. It can be purchased through your medical supplier or wholesaler, or directly from Gebauer. Circle No. 518

The new Thera-Band® Rehab and Wellness Station is designed for strength, balance, and core training. It features TheraBand clip-connect resistance tubing, stability trainers, and the new Pro Series SCP™ exercise ball. It provides three planes of movement for upper- and lowerextremity strength training. Slide tracks with one-hand lockdown capability provide significant flexibility for user setup, charting, and documentation. Circle No. 519

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REHAB EQUIPMENT Thera-Band®/Hygenic Performance Health 800-246-3733 www.thera-bandacademy.com Hygenic Performance Health has announced the introduction of a newly designed category of exercise balls providing advanced security, comfort, and performance: The TheraBand Pro Series SCP Exercise Ball. This ball was developed with customengineered compression deflection to provide the most comfortable and responsive exercise experience available. The wall surface is up to twice as thick as standard exercise and rehabilitation balls. It’s highly durable and

provides slow deflation if accidentally punctured. It’s also smoother than traditional anti-burst exercise balls for outstanding ease of use. Circle No. 520

Mettler Electronics 800-854-9305 www.mettlerelectronics.com

Perform Better 800-556-7464 www.performbetter.com To strengthen muscles and ligaments in the wrist, elbow, and shoulder girdle, Perform Better suggests these Indian Clubs. They allow for circular weight training that’s not possible with other equipment. Training with them regularly helps maintain joint flexibility and improve range of motion, grip, wrist strength, and fore-

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arm strength. See them in the 2008 Perform Better catalog in 12-ounce and two-pound sizes. Circle No. 521

Mettler Electronics is pleased to introduce Polar Frost Cold Spray for the temporary relief of pain and swelling from sprains, contusions, and minor injuries. The skin is instantly chilled to quickly reduce pain when Polar Frost Cold Spray is applied to an injury or muscle spasm. This is followed by the longerlasting cooling relief of menthol. To find

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REHAB EQUIPMENT out more about Polar Frost Cold Spray, call Mettler Electronics or go online. Circle No. 522 Mettler Electronics has released the new Sonicator Plus 940 four-channel combination unit. Therapeutic ultra-

letic trainers. Each of the 18 electrodes delivers stimulation, which is drawn to the optimal treatment point within an area. Use it strapped onto an extremity during dynamic function or as an unattended treatment before or after rehab. It’s an excellent option for knee, elbow, and ankle injuries. Circle No. 525 NExTT Solutions, LLC 574-233-6695 www.nexttsolutions.com

sound is 1 and 3 MHz. Stimulation waveforms include interferential, premodulated, Russian, EMS, highvoltage, TENS, microcurrent, and DC. There are 61 preset and 80 userdefined protocols. The membrane panel and back-lit LCD touch screen make the selection of treatment parameters quick and easy. Circle No. 523 Neuro Resource Group 877-314-6500 www.nrg-unlimited.com The InterX Professional Sport is dedicated to your success. Handheld and battery-operated, it is one of the most convenient products on the market today. It’s an effective and userfriendly way to deliver pain relief and increased range of motion to keep your athletes out of the athletic training room and in the game. The InterX is easy to incorporate into all your usual treatment programs, and is used by the athletic trainers for several professional and collegiate teams. Go online for more details. Circle No. 524 The new Dual Flex Array electrode from Neuro Resource Group is used with the InterX Professional Sport device and offers completely new treatment options for ath-

NExTT Injury Management© software has been servicing athletic training rooms for more than 24 years, incorporating methods and styles from a variety of staffs. This first-hand working knowledge is the foundation of the program and what sets NExTT Solutions apart from the competition. With quick filter views, a single-page treatment log, and an interactive episode history calendar, this software operates just like a real day in the athletic training room. Circle No. 526 OPTP 800-367-7393 www.optp.com The Stretch Out Strap delivers the benefits of partner-assisted stretching without a partner. The multiple-position grips allow deep, gradual stretching of major muscle groups. The strap comes rolled in a 16” x 20” laminated poster with 20 stretches for various areas of the body. This strap and other products are available from OPTP. Call or go online for a free catalog. Circle No. 527

Virtually all professional teams use the VERTEC to improve lower body power and jump reach.

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REHAB EQUIPMENT PROTEAM by Hausmann 888-428-7626 www.proteamtables.com PROTEAM by Hausmann has released the new model A9098 Back Saver Crank Hydraulic Hi-Lo Taping Table. This table has a durable crank hydraulic system that allows for easy adjustment of the table height from 32 to 42 inches. Your back will thank you. The table also features spacious storage for supplies and a heavy-duty 500-pound weight capacity. It comes in natural oak laminate and your choice of 12 PROTEAM vinyl colors. Go online to see this product and a wide selection of modular taping stations, treatment tables, cabinets, and lockers. Circle No. 528 PROTEAM by Hausmann offers athletic trainers a complete line of laminate treatment furniture designed to enhance the functional capacity and appearance of the athletic training room. PROTEAM Modular Taping Stations are available in a wide variety of sizes and with many options. The individual taping units are finished on all sides and can be easily repositioned to fit your needs now and in the future. Go online to see the company’s wide selection of quality products. Circle No. 529 Stromgren Supports 800-527-1988 www.stromgren.com Looking for affordable protection for ankle sprains? Stromgren’s model 329 Ankle Support offers heel-lock ankle protection without tape. Permanently attached heel-lock straps help control severe eversion and inversion of the ankle complex. The Spandex™ sock 58

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applies comfortable compression to the entire foot complex. It’s easy to put on, not bulky, and fits comfortably inside the shoe. This support stays cool and dry because of its moisture-wicking material. For a free sample, call Stromgren or e-mail barb@stromgren.com. Circle No. 530 WaterRower 800-852-2210 www.waterrower.com Universally recognized as a highly effective therapeutic exercise, WaterRower provides a unique hybrid of cardio

aerobic and low-impact, non-load bearing resistance. The patented WaterFlyWheel provides an added restorative dimension with the soothing sound of water as the patient rows. WaterRower, a Rhode Island-based designer and manufacturer of commercial and residential fitness rowers, was one of the first companies in the rehab industry to offer rowing seminars and training to clinicians on the benefits of rowing. These benefits include cardiovascular conditioning, core stabilization, and strengthening of atrophied muscles. Circle No. 531 The WaterRower design features dual-rail construction and a comfortable seat at the proper height, which

provides an area for closed-chain exercises, stretching, and upper-extremity protocols. By keeping patients engaged with an enjoyable exercise, they remain enthusiastic and willing to progress through common plateaus in rehabilitation. Included with the equipment purchase, WaterRower provides a professional in-service on-site by an exercise physiologist to review rowing technique and specific clinical applications for broad patient populations. Circle No. 532 Watkins, Inc. 507-457-3300 www.JRWatkins.com For 140 years, Watkins has been America’s pioneer in natural living, utilizing the finest natural ingredients in its products. To this day, Watkins adheres strictly to the same quality standards set forth by company founder J.R. Watkins. Through its topical analgesics, first aid, and natural personal care offerings, Watkins continues to provide products that are good for the earth, good for others, and good for you. Circle No. 533 Antibody, Inc. 877-546-2639 www.antibodywear.com Antibody offers the custom-made double shoulder sleeve. It is designed to have a shorter arm on the existing (less severe) injury that covers only the shoulder itself, and a normal longer arm on the new (more severe) injury. It includes an abduction strap for the longer arm, and the compression ratio is increased on the shorter arm to compartmentalize the entire shoulder joint. Circle No. 534

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NExTT Solutions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 ONS Performance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 OPTP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Outdoor Boss . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 Perform Better . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Perform Better (seminars) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 Power Lift . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Power Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 PROTEAM by Hausmann. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . IBC Rogers Athletic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .47 Samson Weight Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Save-A-Tooth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 Shuttle Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Sports Imports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 SPRI Products . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Stromgren . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 Thera-Band®/Hygenic Performance Health® . . . . . . . . . . . . . . . . . . . .7 Townsend Design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Training Sweeps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 TurfCordz/NZ Mfg. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Waterboy Sports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 WaterRower . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Watkins, Inc.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .IFC Wilson Case. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

PRODUCTS DIRECTORY CIRCLE COMPANY NO.

512 . . . 511 . . . 534 . . . 535 . . . 544 . . . 543 . . . 573 . . . 546 . . . 545 . . . 501 . . . 513 . . . 564 . . . 504 . . . 536 . . . 568 . . . 567 . . . 502 . . . 575 . . . 505 . . . 506 . . . 516 . . . 517 . . . 518 . . . 569 . . . 500 . . . 537 . . . 548 . . . 549 . . . 561 . . . 538 . . . 539 . . . 508 . . . 507 . . . 522 . . . 523 . . . 570 . . . 551 . . . 565 . . .

8-Ball Nutrition (Gator Whey) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-Ball Nutrition (Recovery Mix) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Antibody (double shoulder sleeve) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Antibody (knee brace) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . APT Pilates (Elite Series Reformer). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . APT Pilates (Precision Club) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Aqualift/Sports Innovations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Balanced Body (Allegro Tower of Power) . . . . . . . . . . . . . . . . . . . . . . . . . . . Balanced Body (EXO Chair) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ball Dynamics (FitBALL Deluxe Board). . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ball Dynamics (FitBALL Peanut) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . California University of Pennsylvania . . . . . . . . . . . . . . . . . . . . . . . . . . Cera Products . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Cho-Pat . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . CorTemp™ HQ, Inc. (Long Range RF System) . . . . . . . . . . . . . . . . . . . . . . CorTemp™ HQ, Inc. (CorTemp™ system) . . . . . . . . . . . . . . . . . . . . . . . . . . Cramer Products . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Creative Health Products . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . CytoSport (Cytomax) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . CytoSport (Muscle Milk Collegiate Bars) . . . . . . . . . . . . . . . . . . . . . . . . . . . . G&W Heel Lift . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Gebauer (Instant Ice) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Gebauer (Spray and Stretch) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Hydrate, LLC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Keiser . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Kneebourne Therapeutic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Lebert Equalizer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Lebert Equalizer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . MAXX Football . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . McDavid (Dual Disc hinged knee brace) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . McDavid (Protective Knee Brace) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . MET-Rx (Metamyosyn XXL) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . MET-Rx (RTD Nutrition Shake). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Mettler Electronics (Polar Frost Cold Spray) . . . . . . . . . . . . . . . . . . . . . . . . Mettler Electronics (Sonicator Plus 940) . . . . . . . . . . . . . . . . . . . . . . . . . . NASM (Corrective Exercise Specialist) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NASM (Performance Enhancement Specialist) . . . . . . . . . . . . . . . . . . . . . . . . NCCPT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

T&C APRIL 2008

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525 . . . 524 . . . 526 . . . 509 . . . 547 . . . 527 . . . 566 . . . 510 . . . 521 . . . 550 . . . 554 . . . 553 . . . 556 . . . 555 . . . 528 . . . 529 . . . 558 . . . 503 . . . 557 . . . 559 . . . 560 . . . 571 . . . 515 . . . 514 . . . 572 . . . 563 . . . 540 . . . 530 . . . 520 . . . 519 . . . 541 . . . 542 . . . 552 . . . 574 . . . 531 . . . 532 . . . 533 . . . 562 . . .

Neuro Resource Group (Dual Flex Array). . . . . . . . . . . . . . . . . . . . . . . . . . Neuro Resource Group (InterX) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NExTT Solutions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ONS Performance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OPTP (Pro-Roller Pilates Essentials) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OPTP (Stretch Out Strap) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Outdoor Boss (Coil Boss) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Outdoor Boss (Stadion Plus) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Perform Better (Indian Clubs) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Perform Better (Sled Dawg Elite) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Power Lift (Full Body Squat) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Power Lift (Spinning Bike) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Power Systems (Outdoor Agility Poles) . . . . . . . . . . . . . . . . . . . . . . . . . . . . Power Systems (Premium Speed Sled) . . . . . . . . . . . . . . . . . . . . . . . . . . . . PROTEAM (Hi-Lo Taping Table) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PROTEAM (Modular Taping Stations) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Rogers Athletic (Combo Passing Net) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Rogers Athletic (Cougar Drive Sled) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Rogers Athletic (Drive Sled) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Samson (Belt Squat) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Samson (Combo/Decline Bench). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Save-A-Tooth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Shuttle Systems (2000-1) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Shuttle Systems (Balance) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Sports Imports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . SPRI Products . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Stromgren (190SP Knee Protector) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Stromgren (329 Ankle Support) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Thera-Band®/Hygenic Performance Health® (SCP Exercise Ball) . . . Thera-Band®/Hygenic Performance Health® (Rehab Station) . . . . . . Townsend Design (Premier) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Townsend Design (Rebel Series) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TurfCordz/NZ Mfg. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Waterboy Sports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . WaterRower . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . WaterRower . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Watkins, Inc.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Xvest (TurboBells) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

57 57 57 52 62 57 66 53 56 63 63 63 64 63 58 58 64 59 64 64 64 66 54 54 67 64 61 58 56 55 61 61 63 67 58 58 58 64

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KNEE PRODUCTS Antibody, Inc. 877-546-2639 www.antibodywear.com The Bodyguard Open Patella Compression Knee Brace is designed to add comfort, stability, and performance enhancement to the sprained or bruised knee while taking direct pressure off the kneecap itself. In the uninjured knee it reduces the incidence of sprains/strains and bruises from impact trauma while adding stability and performance enhancement. As with all Bodyguards, it provides compression, support, muscle and tendon heat circulation, strain distribution, and impact absorption. Circle No. 535 Cho-Pat 800-221-1601 www.cho-pat.com Knees really take a beating. Cho-Pat’s patented Dual Action Knee Strap continues to be a leading tool for athletic trainers to help relieve knee pain and discomfort. It applies pressure on the patella tendon below the knee to reduce subluxation and improve tracking and elevation. It also adds pressure on the patella tendon above the knee to further strengthen and provide extra support and stability for the joint. It’s easy to apply, comfortable to wear, allows full mobility, and is available in various sizes to provide specific and effective results. Circle No. 536 Kneebourne Therapeutic 866-756-3706 www.eliteseat.com The Elite Seat by Kneebourne Therapeutic is a portable knee-extension device designed for the non-operative treatment of degenerative knee conditions. By evenly distributing force across the leg, the Elite Seat provides effective full-knee hyperextension and reduces pain in bent knees caused TR AINING-CONDITIONING.COM

by any of these conditions: acute ACL injury; inadequate post-operative rehabilitation after ACL reconstruction; total-knee arthroplasty; arthrofibrosis; deconditioned knee with a flexion contracture; and arthritis. Circle No. 537 McDavid 800-237-8254 www.mcdavidusa.com The McDavid Dual Disc hinged knee brace offers advanced support with polycentric hinges. The 3/16inch thick neoprene material provides thermal therapy and firm compression. A horseshoe buttress provides added support for the patella. The brace adjusts via two Velcro™ straps. Available in sizes S through 2XL, the brace fits both the right and left knee. Circle No. 538 The McDavid Protective Knee Brace provides maximum protection from impact. A geared, polycentric aluminum hinge dissipates force for increased knee stability. The open construction provides greater joint line clearance and ease of movement. Constructed of 100percent CR neoprene, this knee brace is available in regular and tall sizes. Circle No. 539 Stromgren Supports 800-527-1988 www.stromgren.com Need affordable MCL injury prevention for your linemen? For more than 20 years, the 190SP Knee Protector from Stromgren Supports has been helping college and professional football

teams reduce injuries to the MCL ligament. It absorbs and dissipates blows to the lateral side of the knee complex, helping to reduce lateral pressure on the MCL. The slotted pivot points allow a full range of motion for lateral movements, and the Lycra® straps secure the brace so there is no downward migration. The knee protector weighs seven ounces and fits either the left or right leg. Call Stromgren for more information, or visit the company online. Circle No. 540 Townsend Design 800-432-3466 www.townsenddesign.com Townsend Design’s number one custom knee brace, the Premier, features ultra lightweight, rigid carbon graphite shells. Premier braces are fabricated with patented Townsend Motion Hinges that replicate the roll-and-glide movement of the knee, and Townsend’s patented Synergistic Suspension Strap, backed by a nomigration guarantee. This is the ideal brace for ligament injuries, contact sports, and prophylactic protection. Call or go online to learn more. Circle No. 541 Townsend’s Rebel Series knee braces feature rigid aircraft aluminum shells and Townsend’s patented hinge motion and brace suspension technology. These braces can be ordered custom, “customized,” and in standard sizes. The “customized” models are made from three leg measurements, so the brace fits like a custom brace for the cost of a pre-sized brace. No other brace manufacturer offers this service. Circle No. 542

T&C APRIL 2008

PILATES EQUIPMENT APT Pilates 866-384-0823 www.aptpilates.com

Pilates Reformer the new standard of excellence. Its frame and structural components are ruggedly constructed

of premium aircraft-grade alloy aluminum. The Elite Series Reformer utilizes the same construction, but has the added feature of fine Amish hand-crafted hard wood cabinetry. These products are manufactured and assembled with pride in the USA. Call or go online for more equipment options. Circle No. 544

Balanced Body’s Allegro Tower of Power provides your athletes with a complete full-body Pilates workout, keeping them on the field and performing at the highest level. A three-in-one exercise system with a Reformer, mat station, and Tower, it easily folds down for quick storage. Find out why some of the world’s top athletes make the Allegro Tower system a crucial part of their training regimen. Circle No. 546

Balanced Body, Inc. 800-PILATES www.pilates.com

OPTP 800-367-7393 www.optp.com

Balanced Body has introduced the perfect athletic training tool: the EXO Chair. It’s the only Pilates chair in the industry with attachments for resistance bands, and it lets your athletes do many exercises formerly possible only on a Reformer—in a fraction of the space. The EXO Chair improves strength, balance, flexibility, and agility, all of which are paramount for improving athletic performance and decreasing injury. Circle No. 545

Gain additional body awareness and develop better posture while challenging core strength with ProRoller Pilates Essentials. This illustrated 37-page booklet teaches more than 30 Pilates exercises to increase strength and flexibility using the Pro-Roller. It’s just one of the many resources available from OPTP. Call or go online for a free catalog. Circle No. 547

APT Pilates has proudly introduced its Precision Club and Elite Series Reformers. Designed by a medical

equipment manufacturing company to exacting standards of quality, ease of use, and durability, these reformers set a new standard of excellence. Features include ultra-smooth gliding motion, push-button selection of spring resistance, six springs for more versatility in workouts, self-centering pulley ropes, improved foot bar adjustment, and a large foot plate. Circle No. 543 A balance between tradition and modern design innovations makes the APT

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Circle No. 145 T&C APRIL 2008

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Your athletes are counting on you!

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FOOTBALL CONDITIONING Lebert Fitness, Inc. 905-785-0626 www.lebertequalizer.com The Lebert Equalizer trains athletes for strength, agility, plyometrics, and so much more. Originally developed for portable body weight compound strength training exercises, this product has many outstanding functions. For instance, when used in cardiovascular training, the Equalizer works great for circuits and interval training. In a circuit, the participants can move from one of 75 different strength training and cardio exercises to another to get their heart rate way up. In an interval setting, a coach can have athletes break in two groups, with one doing Equalizer pull-ups and the other doing jumping jacks or Equalizer agility drills. Circle No. 548 When it comes to athletic conditioning, most coaches agree that athletes should master body weight training before external loading. The Lebert Equalizer is the perfect tool for compound body weight exercises like chin-ups, push-ups, and dips. Using their own body weight, athletes can adjust the level of difficulty (usually by a simple change in foot placement) to suit their needs. The Equalizer is perfect for everyone from beginners to pro athletes. Made of long-lasting steel, the Equalizer is portable, versatile, and easy to store. It is a leading tool for sports teams, boot camps, and athletes everywhere. Circle No. 549 Perform Better 800-556-7464 www.performbetter.com If football is your focus, note that the Sled Dawg Elite has added push handles for powerful hip and leg drive exercises. Its multi-point harness attachment TR AINING-CONDITIONING.COM

allows for even load distribution during pulling, while the rear handles are great for pushing. It is designed with heavyduty 11-gauge steel and welded construction to create an extra-strong frame. The plate mount allows for standard or Olympic plate use. This product is in the 2008 Perform Better catalog. Call today or go online to request your copy. Circle No. 550 NASM 800-460-6276 www.nasm.org/pes Outperform the competition with the updated Performance Enhancement Specialist (PES) advanced specialization. Learn cuttingedge performance assessment techniques and sportspecific program design. The course content is now delivered 100-percent online, with a brand new NASM look and feel. Course materials and the exam can be purchased separately, and an optional Print On-Demand manual and Burn On-Demand CDROM are now available at additional costs with the course purchase. Circle No. 551 NZ Mfg. 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

chain- and beltdrive version. The belt-drive version allows the user to pedal backward with resistance. Standard features for both bikes include dual-sided pedals with a clipless system on one side and toe cages on the other, adjustable seat height and forward/back position, and adjustable handlebar height and forward/ back position. Circle No. 553 Power Lift’s Full Body Squat is the latest addition to its lower-body strength training equipment line. The design of the Full Body Squat allows for a broader range of motion through the hip than traditional leg presses. Users can perform explosive movements due to the low inertia created by the four-bar linkage design. Adjustable shoulder pads let users of all heights properly align themselves in the unit. Single-leg movements can be performed as well, by lowering the single-leg isolator to the proper position. Standard features include weight storage, four-weight loading horns, band attachments, a single-leg isolator, and an oversized angled footplate. Circle No. 554 Power Systems 800-321-6975 www.power-systems.com

Olympians train with TurfCordz for explosive start drills, power-building footwork, and simulated play action to enhance performance through resistance. TurfCordz offers both safety and reliability, enabling athletes to overcome physical and mental barriers. For more information on NZ Mfg.’s extensive product line, call today or go online. Circle No. 552 Power Lift 800-872-1543 www.power-lift.com Power Lift is excited to introduce its new Spinning Bike. The Power Lift Spinning Bike is available in both a

With its S-shaped design, the new Premium Speed Sled from Power Systems generates less friction for faster runs. Improve acceleration and increase stride length by incorporating it into sprint training drills on a track or other outdoor surface. The angled tray holds up to three 45pound plates and keeps the sled stable by directing force downward. The unit includes dual leads for a straighter pull and a shoulder harness or waist belt. Circle No. 555 T&C APRIL 2008

FOOTBALL CONDITIONING Power Systems 800-321-6975 www.power-systems.com

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

Designed specifically for training outdoors, Outdoor Agility Poles from Power Systems have six-inch stakes that drive into the ground to hold the poles securely in place. Metal springs add flexibility so they return to an upright position when athletes make tight cuts. Outdoor Agility Poles come in a set of six 66-inch poles with high-impact stakes. A carrying bag is included for easy transport to the field. Circle No. 556

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 while still making it 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. 559

Rogers Athletic Co. 800-457-5337 www.rogersathletic.com The new Drive Sled from Rogers is the only drive sled that puts the hands in the correct inside position to train stamina, quickness, and power. Multiple grips work different muscle groups and accommodate athletes of various sizes. Two urethane weight horns are standard for additional weight/resistance—just add your plates. Drill two athletes at a time by harnessing one up front and having the other push on the back to train quickness. This product is safe for use on turf. Circle No. 557 The Combo Passing Net from Rogers Athletic is two nets in one: a drop-in net to sharpen fade routes, and a target net with three adjustable targets for passing rep training. The target net adjusts in height for high-release training. This unit has a full floor for transporting balls, practice gear, and training aids, a hitch for towing, and a handle for one-person towing. The wheels are foam-filled for “never flat” technology. Circle No. 558 64

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The Samson Combo/Decline Bench is one of the newest and most comprehensive utility benches on the market today. This revolutionary new addition to Samson’s bench line gives your athletes the ability to perform a decline press by making a few simple adjustments. Perform the bench press, incline, military, decline, and even sit-ups all from the same bench. The unit is constructed of 2 1/2” x 2 1/2” steel square tubing, and all flat surface welds are ground and polished to a smooth finish. Outfit your weightroom with the best in quality and design from Samson Equipment. Circle No. 560 MAXX Football 800-294-4654 www.maxxfootball.com This off-season, while your opponents are lifting, you will be putting the intensity of football into your workouts. MAXX provides a lifelike dummy and a durable weight machine with state-

of-the-art computer technology. The LED board gives your players instant feedback on their speed off the ball and the power of their punch while they work to increase strength and perfect football technique. Circle No. 561 Xvest 800-697-5658 www.thexvest.com Adjustable Xvest TurboBells are a new product from the maker of Xvest. They replace a room full of dumbbells and are engineered so the weights can be adjusted from five pounds to 60 pounds in just seconds, giving athletes complete control of their workout. The economical Xvest TurboBells have large easy-grip rubberized handles and come with a specially designed stand. The manufacturer is offering them at an introductory price of $349, plus free shipping—saving you more than $270. Circle No. 562 SPRI Products 800-222-7774 www.spriproducts.com Todd Durkin says, “I am honored to work with SPRI to further develop the sports conditioning category. I love working with a great company that is always striving to bring its customers more.” Because of this focus on sports conditioning, SPRI has developed the new Todd Durkin SpeedCord Plus. Through contrast training, the TD SpeedCord Plus develops strength and power while the athlete is running—specifically during the acceleration phase. Circle No. 563

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TESTIMONIAL

Calling Cards

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

Supplying the professional market since 1991. www.fitball.com

Shuttle Systems excels at delivering closed-chain and plyometric resistance training. www.shuttlesystems.com

The newest Web resource for all your fitness rubber needs. www.fitnessrubber.com

A premier publisher of sports books and DVDs. www.humankinetics.com

Maker of the original FlexBand exercise equipment since 1980. www.jumpstretch.com

MET-Rx provides collegiatecompliant products, including the new Brownie Bar, to schools across the country. www.met-rx.com

World-class manufacturer of adjustable, portable taping and treatment tables. www.oakworks.com

Supplier of quality tools and resources for more than 30 years. www.optp.com TR AINING-CONDITIONING.COM

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

Created for the extreme demands of high-level athletic training. www.nzmfg.com

Featuring collegiate-compliant, certified nutritional products. www.onsperformance.com

Athletic trainer’s cases that are tough, mobile, and organized. www.wilsoncase.com

Make Strength Training and Flexibility Work More Effective with Bands “I have used Jump Stretch’s Flex Bands in each of my six years as Head Baseball Coach at Youngstown

State University, and I have been very pleased with how they’ve aided our strength training, flexibility, and injury recovery. We use the Flex Bands every day, and I tell our players that their bands are their most important piece of equipment. “We have had a number of pitchers make significant increases in their velocity, and I attribute much of it to the use of Flex Bands. We’ve had several pitchers drafted (including one current major leaguer), and that was not a regular occurrence before we started using the bands. Flex Bands have helped tremendously by increasing our players’ flexibility and arm strength. “Decreased rehab time is probably the most significant effect of the bands. Sprained ankles that normally take three to four weeks to recover from now take only three to four days, thanks to Flex Bands and tractioning. And pulled muscles are pretty much a thing of the past. “I feel Flex Bands are a must for any organization looking to maximize player performance.” Mike Florak Head Baseball Coach Youngstown State University

Jump Stretch, Inc. 1230 N. Meridian Rd. Youngstown, OH 44509 800-344-3539 Fax: 330-793-8719 www.jumpstretch.com T&C APRIL 2008

MORE PRODUCTS 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 continues 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. 564 NCCPT 800-778-6060 www.NCCPT.com The National Council for Certified Personal Trainers is a company that certifies personal trainers both nationally and internationally. The NCCPT curriculum focuses on preparing students to succeed and excel in the commercial environment. The council offers home-study courses as well as two-day seminars to prepare students to sit for the exam. The NCCPT is currently looking for qualified individuals to instruct those twoday courses. Call, go online, or e-mail info@nccpt.com for details. Circle No. 565 Outdoor Boss 888-463-5699 www.outdoorboss.com It’s no wonder why Outdoor Boss is a leader in water drinking systems for sports teams. Look what the company has designed now. The new Coil Boss drinking system has all the great features at 66

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an unbelievable price. The specially designed coil is like no other. The Coil Boss lid will fit almost any cooler. Check it out online. Circle No. 566 CorTemp™ HQ, Inc. 941-723-4197 www.hqinc.net Early intervention to rapidly and accurately assess core body temperature on the field is necessary for the proper prevention, evaluation, treatment, and management of exertional heat stroke. Research indicates that external methods of monitoring core temperature have not been proven valid under conditions of intense exercise in the heat. The CorTemp™ system, featuring the CorTemp ingestible temperature pill, provides an easy, affordable approach to monitoring core temperature on the field and gauging the effectiveness of cooling methods on the sidelines. This FDA-cleared product is used by professional and collegiate teams nationwide. Circle No. 567 HQ, Inc., manufactures the CorTemp ingestible temperature pill and has been a leader in core body temperature monitoring for more than 20 years. The CorTemp Long Range RF System accessories now feature Bluetooth technology, making it even easier to remotely monitor your athletes from the sidelines. CorTemp data recorders coupled with remote transceivers wirelessly transmit data from the field to the RF base station on the sidelines. The PDA software shows individual temperatures for each athlete and features built-in temperature alarms. The system transmits data over a line-of-sight distance of up to 300 feet. Circle No. 568

Hydrate, LLC 407-694-1034 www.hydrate1.com The HydrateCart by Hydrate is a 50gallon hydration system that allows up to eight players to quickly and easily replenish vital fluids lost during practice and competition. The cart has a built-in hitch for easy transportation and is protected by a lifetime warranty. With newly improved drinking nozzles, a quickdrain tank, and no assembly required, it saves athletic trainers and coaches valuable time, so they can be on the field with their athletes. Circle No. 569 NASM 800-460-6276 www.nasm.org/ces 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 post-rehabilitation 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. Circle No. 570 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 TR AINING-CONDITIONING.COM

MORE PRODUCTS 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. 571 Sports Imports 800-556-3198 www.sportsimports.com Virtually all professional and college sports teams and the NFL Scouting Combine use the Vertec jump-training system, distributed by Sports Imports. It is one of the best ways to evaluate and improve jump reach and lower-body explosive power. The Vertec jumptraining system challenges athletes to improve their vertical leap through instantaneous feedback and recognition. The process is simple, offering a true vertical target, visual motivation,

and an immediate, accurate measure of success and growth. A wall-mounted version is now available. Circle No. 572 Sports Innovations 800-288-3954 www.sportsltd.com Every athlete needs water, and the Aqualift portable drinking system delivers—for children on the playing field and professionals in the NFL alike. Aqualift is one of the finest hydration systems on the market, and is made with only top-quality materials. It continues to be the hydration unit of choice for many pro, college, and high school athletic teams worldwide. Each 10-gallon Aqualift includes four drinking hoses (with stacking capabilities), plus a battery with a charger. Circle No. 573

WEB NEWS Comprehensive Fitness Site Offers Extensive Product Selection Fitnessrubber.com is a unique new fitness Web site offering an opportunity for training and conditioning professionals to purchase all their fitness equipment at “Manufacturer Direct Pricing”. That’s right—no middle man. The company has one of the largest and ever-expanding selections of fitness products, from rubber flooring to free weights. Some of its major brands include Kraiburg Solid Rubber Olympic Bumper Plates, Kraiburg-Sportec Rolled Rubber Flooring, FLEXGARD Interlocking Fitness Tiles, FLEXGARD EVA Dojo Interlocking Mats, and FLEXGARD Rubber-Coated Cast Iron Olympic Weight Plates, to name a few. If you are looking for a one-stop shop to purchase your rubber flooring, free weights, racks, barbells, and bars, Fitnessrubber.com has exactly what you need. In addition to excellent savings, log on now to receive a $20 discount on your initial Web site order over $100.

www.fitnessrubber.com Wilson Makes a Convincing Case on Its Web Site At Wilson Case’s Web site, you can view all the standard athletic trainer’s cases and get very detailed information about them. The site is full of dimensional information and photos of athletic trainer’s cases. You can order online, request a free quote, download a brochure, request information, and explore many stock and custom cases at the site. There’s even a gallery full of pictures of custom cases. Check out Wilson Case online today.

www.wilsoncase.com

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Waterboy Sports, Inc. 888-442-6269 www.waterboysports.com Waterboy Sports offers an extensive line of fans, misters, tents, and hydration units designed to meet the price demands and specific needs of the athletic training community. Visit the company online to see its complete product line. All Waterboy Sports products are built to withstand the punishment of constant use and any abuse an angry athlete can exhibit. Call today to find out more about how Waterboy Sports can provide your team’s hydration and climate-control solutions. Circle No. 574

CATALOG SHOWCASE Creative Health Products, Inc. 800-742-4478 www.chponline.com Since 1976, Creative Health Products has been a leading discount supplier of rehabilitation, fitness, exercise, and athletic equipment, as well as health, medical, and fitness testing and measuring products, all 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. Circle No. 575 T&C APRIL 2008

CEU QUIZ

T&C April 2008 Volume XVIII, No. 3

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 70) that represents the best answer for each of the questions below. Complete the form at the bottom of page 70, include a $25 payment to MAG, Inc., and mail it by June 30, 2008 to the following address: MAG, Inc., ATTN: T&C 18.3 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. Comeback Athlete (pages 9-13) Objective: Hear the comeback story of a Wisconsin high school football and wrestling athlete diagnosed with Hodgkin’s lymphoma his junior year. 1. According to this article, Stage III Hodgkin’s lymphoma refers to: a) The existence of lymph node involvement on both sides of the diaphragm. b) Small masses on both sides of the thyroid. c) Hyperthyroidism with malignancy. d) Low white blood cell count.

Micro Holes, Macro Results (pages 14-20) Objective: Learn about the latest advances in microfracture surgery and how to rehab athletes after such surgery. 2. Microfracture surgery is performed to do what? a) Repair damaged articular cartilage. b) Speed recovery from type I Salter fractures. c) Promote the healing of stress fractures. d) Replace the old technique of O.R.I.F. procedures. 3. What does the term “microfracture” refer to? a) The initial stages of a stress fracture. b) The tiny holes a surgeon makes in the bone that allow the blood and stem cell-containing bone marrow to seep into the area. c) The small fractures that are found in a bone from repetitive trauma. d) The small fractures that are created in the bone to increase the blood flow to the bone and promote healing. 4. A key part of microfracture surgery involves: a) Debriding the calcified old cartilage and creating a bed in which the new cartilage can form. b) Leaving a layer of the old cartilage intact to allow for stability during the healing phase. c) Minimizing the time the joint is open during the procedure. d) Creating microscopic punctures at least five millimeters deep in the subchondral bone. 5. According to Steadman, articular cartilage is: a) Very slow to heal. b) Prone to stress fractures. c) Type I collagen. d) Type II collagen.

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6. In a horse study, what percentage of new cartilage did Steadman find to be composed of type II collagen? a) 30. b) 40. c) 50. d) 70. 7. According to Steadman, activities such as _____ stimulate the tissue to form a better quality cartilage. a) Weight shifts and closed chain activities. b) Resistive exercises. c) CPM or spinning on a stationary bike. d) Open chain resistive exercises. 8. Clark feels that _____ contribute to a chondral defect. a) Movement impairments. b) The athlete’s weight. c) Training intensity. d) Hydration levels.

Choices … and More Choices (pages 23-29) Objective: Help your athletes understand what their choices are when it comes to nutritional supplements— how to safely use them and what they should avoid. 9. The Anabolic Steroid Control Act of 2004 made what illegal? a) Prescription vitamin supplements. b) Cold and cough medications. c) Testosterone precursors. d) Iron supplements. 10. In studies evaluating large numbers of over-the-counter dietary supplements, it has consistently been shown that what percentage of products contain ingredients not listed on the label? a) 5-10. b) 10-14. c) 15-25. d) 30-40. 11. Creatine has been shown to increase a substance that: a) Breaks down to produce adenosine triphosphate. b) Increases lactic acid buildup. c) Depletes glycogen stores. d) Depletes adenosine triphosphate stores. 12. Athletes who are prone to _____ should avoid creatine. a) Irritable bowel syndrome. b) Heat related problems or those who sweat excessively. c) Ligament sprains. d) Lightheadedness or migraines.

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13. The American Dietetic Association and the American College of Sports Medicine recommend a protein intake of how many grams per kilogram of body weight per day? a) 1.2 to 1.7. b) 1.6 to 2.0. c) 2.2 to 3.7. d) 2.0 to 3.0. 14. Beta-alanine supplements advertise: a) Lean muscle gains. b) Strength gains. c) Decreased muscle burn. d) Enhanced vasodilation. 15. Sports medicine professionals are observing side effects consisting of extreme headaches, lightheadedness, and increased blood pressure from what supplementation? a) Creatine. b) Beta-alanine. c) Amino acid. d) Nitric oxide. 16. The American Academy of Pediatrics and the American College of Sports Medicine _____ the use of muscle-building supplements by individuals under the age of 18. a) Encourage. b) Monitor. c) Discourage. d) Have not commented on.

In Alignment (pages 31-36) Objective: See how a form of Pilates called Contrology can not only strengthen athletes’ bodies, but can also help correct a biomechanical flaw. 17. We now refer to Contrology as simply: a) Good biomechanics. b) The involved process of correcting biomechanical flaws. c) The correct utilization and application of leverage principles afforded by bones to allow for full equilibrium. d) Self control, body awareness, and inner peace. 18. Static forces involve: a) Momentum forces. b) Effects of gravity. c) Eccentric muscle contractions. d) Concentric muscle contractions. 19. One main documented benefit of Pilates is: a) Unique, state of the art equipment. b) Significant strength gains in a short period of time. c) The recruitment of deep abdominal and pelvic floor muscles. d) Pain resolution.

20. One important key to Pilates exercises is: a) High repetitions. b) Slow, shallow breathing. c) One-on-one attention from a knowledgeable coach. d) Daily sessions lasting 90 minutes.

Leap of Faith (pages 38-43) Objective: Learn what it means to be culturally competent and how you can apply it to your healthcare services. 21. Cultural competence is: a) Knowing about all athletes’ cultures. b) The ability to speak multiple languages. c) The knowledge of various thinking processes. d) The ability to effectively serve culturally diverse populations. 22. _____ are terms used to describe various opposing physical conditions of the body in Chinese medicine. a) Yong and ying. b) Yin and yang. c) Chi and Yin. d) Chai and yong. 23. One element of cultural competence discussed in this article is: a) Being open to differences. b) Teaching all of your athletes about Western medicine before the season begins. c) Educating athletes and their families about athletic training. d) Sticking with what research says works.

Coordinated Effort (pages 45-50) Objective: See how one strength coach fits into the football program at his school, and how he helped the team to its best record in over 50 years. 24. This article discusses the: a) Second coordinator model. b) Third coordinator model. c) Ability of strength coaches to coach on the field. d) NCAA rules allowing a strength coach to hold a coordinator-level position. 25. What is one drawback of using the body mass index? a) Charts do not go high enough for collegiate football players’ weights. b) The process to calculate BMI is time consuming. c) It does not distinguish between muscle mass and fat mass. d) Height is not computed into the calculation.

Answer sheet is on page 70 TR AINING-CONDITIONING.COM

T&C APRIL 2008

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 18.3 Quiz, 31 Dutch Mill Road, Ithaca, NY 14850, no later than June 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.

Comeback Athlete

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Micro Holes, Macro Results

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2. 3. 4. 5. 6. 7. 8.

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Choices … and More Choices

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9. 10. 11. 12. 13.

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14. 15. 16.

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In Alignment

17. 18. 19. 20. Leap of Faith

21. 22. 23.

Coordinated Effort

24. 25.

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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 18.3 Quiz” on check) ❏ Visa

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❏ Discover

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

T&C APRIL 2008

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NEW Product Launch Keiser Power Rack Platform Unique features: • Low-profile platform reduces trip hazards and improves appearance • Trimmed in steel tubing with cast rounded corners to reduce athletic injury • Inch-thick construction topped with first-grade maple that’s sanded, sealed, and triple-varnished

FitBALL Deluxe Board Unique features: • Extra-large surface: 19.5” x 27” • Fulcrum height of five inches and multi-directional bases

Beneﬁts for the user: • Impact-absorbing rubber separated from the woodwork to significantly reduce noise • Space to add a team or club logo

Beneﬁts for the user: • Ample room for full-body training and leg strengthening exercises • The heavy-duty plastic construction is perfect for highuse fitness and rehab facilities • Offers balance challenges for both beginners and advanced users

Keiser www.keiser.com 800-888-7009

Ball Dynamics International, LLC www.fitball.com 800-752-2255

Circle No. 500

Active Ankle Volt Ankle Brace Unique features: • Newly engineered gliding hinge • Carbon-reinforced frame

Circle No. 501

Cougar Drive Sled Unique features: • Two urethane weight horns standard for additional weight/resistance • Slide pan standard on the bottom of the runner to allow for use in sand/dirt pits • Eyebolts standard for attaching pulling harness

Beneﬁts for the user: • Allows for more fluid motion and reduced bulk so athletes can perform at their personal best

Beneﬁts for the user: • Engineered to allow for multiple grips • Approved for use on artificial turf • Backpedal drills allowed by frame’s forward design

Cramer Products, Inc. www.cramersportsmed.com 800-345-2231

Rogers Athletic Co. www.rogersathletic.com 800-457-5337

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Circle No. 503

T&C APRIL 2008

OVERTIME

Next Stop: Web Site

KIRBY LEE | IMAGE OF SPORT

Our editorial continues on www.Training-Conditioning.com Here is a sampling of what’s posted right now:

Our current monthly feature examines the concept of a “runner’s high.”

WEEKLY BLOGS

MONTHLY FEATURES

Nutrition Case Study

Runner’s High Theory Gains Traction

Michelle Rockwell, MS, RD, CSSD, continues her article in this issue (“Choices,” on page 23) with a case study on advising an athlete about whether to use creatine.

While the concept of a “runner’s high” has been debated for years, a recent study indicates that running and other aerobic activities can indeed elicit a ﬂood of endorphins in the brain. In this feature, we examine the inﬂuence exercise can have on human emotions.

Living the Dream Ryan Johnson, CSCS, Strength and Conditioning Coach at Wayzata High School in Plymouth, Minn., shares his take on the challenges facing high school strength and conditioning professionals.

Baseball & Softball Injury Analysis Regular contributor Dawn Comstock, PhD, gives readers an inside look at her recent studies on injury rates and trends for high school baseball and softball players.

A Sharp Facility Herb Rhea, ATC, Head Athletic Trainer at Jenks (Okla.) High School, talks about the health and ﬁtness center that was recently constructed at his high school. The project came to fruition thanks to a partnership with a local hospital.

www.training-conditioning.com/features.html

www.training-conditioning.com/blogs.html

WWW.TRAINING-CONDITIONING.COM

Circle No. 148

IN HERE IT’S ABOUT RESULTS. YEAH, WE ARE TOO. You expect it from your equipment manufacturer, your uniform provider and everything else that goes into making your athletic program a success. So why compromise on your nutrition? Don’t settle for imitations or pretenders. Give them Muscle Milk® Collegiate.

Available in Calorie Replacement Powder, Ready-to-Drink formula, and now Bars! 707 747-3377 / www.cytosport.com

Circle No. 149