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Circle No. 100

October 2008, Vol. X VIII, No. 7

CONTENTS

15 4

8

13 49 55 57 59 56

Bulletin Boards An improved test for testosterone doping … Why athletes shouldn’t wear flip-flops … The ACC addresses injury reporting … Study finds a predictor for amenorrhea.

Comeback Athlete Max Baumann St. Xavier High School Cincinnati, Ohio Sponsored Page Q&A with Dr. Nicholas DiNubile Product News Pain Management Hot & Cold More Products Web News Advertisers Directory

61

CEU Quiz For NATA and NSCA Members

64

Next Stop: Web Site

23 42 Optimum Performance

15

The ZZZ Factor Chronically sleep-deprived athletes probably don’t realize all the ways they’re hampering their performance. This article presents research on sleep’s many physical and mental benefits.

By Art Horne Nutrition

for Battle 23 Preparing The yearly training cycle for wrestlers includes three distinct phases, and an optimal nutrition strategy should target specific goals for each one.

By Susan Kundrat Treating the Athlete

Pains 30 Groin Whether you call it a sports hernia or athletic pubalgia, recurring pubic-area pain can be a major hindrance for athletes. These authors devised a specialized training program for the Cornell University men’s hockey team aimed at addressing and preventing groin injuries.

By Dr. Paul Geisler & Ed Kelly Leadership

For the Record

37 From helping you lobby for more resources to protecting your program against lawsuits, a top-notch medical record keeping system offers many benefits. Does yours?

By Jon Almquist Sport Specific

On the cover: The Cornell University men’s hockey team saw a dramatic reduction in lower-body injuries last season after implementing a new training program designed to prevent athletic pubalgia and sports hernias. Story begins on page 30. Photo by Patrick Shanahan.

TR AINING-CONDITIONING.COM

Finishing Strong

42 A college track coach—who also designs strength programs for some of the world’s top runners—explains how good things happen when strength training and track and field embrace each other.

By Danny Brabham T&C OCTOBER 2008

1

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Jon Almquist, ATC Specialist, Fairfax County (Va.) Pub. Schools Athletic Training Program

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

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Editorial Staff Eleanor Frankel, Director Greg Scholand, Managing Editor R.J. Anderson, Kenny Berkowitz, Abigail Funk, Kyle Garratt, Mike Phelps, Dennis Read

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

Cynthia “Sam” Booth, ATC, PhD Manager, Outpatient Therapy and Sportsmedicine, MeritCare Health System

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

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Christine Bonci, MS, ATC Asst. A.D. for Sports Medicine, Women’s Athletics, University of Texas

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Gary Gray, PT, President, CEO, Functional Design Systems

Boyd Epley, MEd, CSCS Director of Coaching Performance, National Strength & Conditioning Association Peter Friesen, ATC, NSCA-CPT, CSCS, CAT, Head Ath. Trainer/ Cond. Coach, Carolina Hurricanes Lance Fujiwara, MEd, ATC, EMT Director of Sports Medicine, Virginia Military Institute Vern Gambetta, MA, President, Gambetta Sports Training Systems P.J. Gardner, MS, ATC, CSCS, PES, Athletic Trainer, Colorado Sports & Spine Centers

Ellyn Robinson, DPE, CSCS, CPT Assistant Professor, Exercise Science Program, Bridgewater State College Kent Scriber, EdD, ATC, PT Professor/Supervisor of Athletic Training, Ithaca College Chip Sigmon, CSCS Strength and Conditioning Coach, Carolina Medical Center Bonnie J. Siple, MS, ATC Coordinator, Athletic Training Education Program & Services, Slippery Rock University Chad Starkey, PhD, ATC Visiting Professor, Athletic Training Education Program, Ohio University Ralph Stephens, LMT, NCTMB Sports Massage Therapist, Ralph Stephens Seminars 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

Administrative Assistant Sharon Barbell

Pat Wertman (607) 257-6970, ext. 21 T&C editorial/business offices: 31 Dutch Mill Road Ithaca, NY 14850 (607) 257-6970 Fax: (607) 257-7328 info@MomentumMedia.com Training & Conditioning (ISSN 1058-3548) is published monthly except in January and February, May and June, and July and August, which are bimonthly issues, for a total of nine times a year, by MAG, Inc., 31 Dutch Mill Rd., Ithaca, NY 14850. T&C is distributed without charge to qualified professionals involved with competitive athletes. The subscription rate is $24 for one year and $48 for two years in the United States, and $30 for one year and $60 for two years in Canada. The single copy price is $7. Copyright© 2008 by MAG, Inc. All rights reserved. Text may not be reproduced in any manner, in whole or in part, without the permission of the publisher.

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Bulletin

Sponsored by

Board A Better Doping Test University of Utah scientists have developed a new test to identify athletes who have taken testosterone to enhance performance. By using mass spectrometry to measure levels of both testosterone and the closely related epitestosterone in a urine sample, researchers were able to detect doping more quickly and accurately than with other existing methods.

Testosterone and epitestosterone levels vary widely among individuals, but the two hormones are normally present in the body at nearly equal levels. If an athlete takes additional testosterone or drugs that boost testosterone production, the test will detect an artificial imbalance in the testosteroneepitestosterone ratio. The World Anti-Doping Agency considers a ratio of 4:1 or higher to indicate doping.

Testosterone-epitestosterone tests are already used in some settings—in one famous example, Floyd Landis was stripped of his 2006 Tour de France title after his ratio was measured at 11:1. But the tests have been difficult to perform and required specialized procedures.

This new mass spectrometry test can be performed using standard lab equipment and is more sensitive than other methods, because it increases the number of usable “diagnostic qualifier ions,” which are markers that indicate doping.

As a result, it may make testing for testosterone doping more widely available. “Our system means that we can determine the testosterone-epitestosterone ratio in a sample with greater confidence, and therefore be in a better position to spot doping violations without falsely accusing innocent athletes,” Jonathan Danaceau, MD, Preventive Medicine Specialist at the University of Utah Hospital, said in a press release.

“Quantitative confirmation of testosterone and epitestosterone in human urine by LC/Q-ToF mass spectrometry for doping control” was published in the July 2008 issue of the Journal of Mass Spectrometry. The journal can be found online at: www.uclibs.org/PID/839.

Flip-Flops & Athletes: A Bad Combination It’s not hard to imagine why flip-flops can be bad for your feet, since they offer very little cushioning and virtually no arch support. But now, research from Auburn University’s Department of Kinesiology provides specific data about how flip-flops can affect athletes who wear them.

“There’s plenty of anecdotal information out there that says flip-flops can cause problems,” says graduate student Justin Shroyer, MA, CSCS, who co-wrote Auburn’s flip-flop study with Professor Wendi Weimar, PhD. “We wanted to look at them scientifically to see what effects they have.”

4

T&C OCTOBER 2008

In the study, researchers analyzed the way 39 college-age men and women walked while wearing flip-flops, then compared it to the way they walked in athletic shoes. With flip-flops, subjects took shorter strides, hit the ground with less vertical force, and increased the “attack angle” of their ankles during the leg’s swing phase. When participants switched to sneakers, some of the gait changes remained, causing discomfort.

The study raises questions that Shroyer and Weimar would like to answer with further research: How do muscle recruitment patterns differ when wearing flip-flops versus athletic shoes?

Does the shortened stride put athletes at risk for injury? How much energy do foot muscles have to use to grip the flip-flop?

Does the flip-flop step cause muscles to work harder?

Shroyer stops short of drawing too many conclusions from the initial study, and hasn’t yet tossed his own flip-flops. But he does caution athletes against wearing them all day long.

“Flip-flops were made for the beach, the pool, and the shower, and that’s where they should be worn,” he says. “There are some great things about flip-flops: They’re easy to take off and put on, and they help keep feet cool. But they’re not the best choice for everyday footwear.

“If athletic trainers are trying to provide an optimal environment for their athletes, they’ll want to eliminate anything counterproductive,” adds Shroyer. “If athletes want to keep wearing flip-flops, they should look for ones with more arch support and a thicker cushion. And they should replace them every three or four months. If they have to break out the duct tape, they’ve gone way too far.”

Injury Reporting Revised in the ACC This season, the Atlantic Coast Conference (ACC) is adopting the NFL model for reporting football injuries. The new guidelines state that head medical personnel for each team, rather than coaches, will report every Monday during the season which players are scheduled for surgery or are out for the season. On Thursday, within 90 minutes of the end of practice, teams will release a list classifying each player as definite, probable, questionable, doubtful, or out. Teams won’t release any injury information on Tuesday or Wednesday.

ACC schools used to release a full injury report on Monday, as is standard practice in most other conferences. The new policy was adopted to give teams more time to evaluate the status of players, and to keep coaches from having to answer media questions about medical issues.

“We’re not doctors, athletic trainers, or medical personnel,” says North Carolina State University Head Football Coach Tom O’Brien. “This policy gets us out of the business of answering questions about injuries. Trying to get an injury report out on Monday after a Saturday game is almost impossible, because you can’t really tell at that point if someone will TR AINING-CONDITIONING.COM

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Bulletin

Board be able to make it or not.”

O’Brien says he’ll work with athletic trainers and team physicians in much the same way he did before, but now, they will be able to provide more accurate information to the media and the public. This reporting process will also keep coaches from having to worry about violating the Health Insurance Portability and Accountability Act (HIPAA), which protects the privacy of personal health information.

The new injury reporting system is voluntary, with no penalties for deviating from the agreed upon protocols. No other conferences are currently planning to follow the ACC’s lead, though Head Football Coach Mack Brown of the University of Texas (a Big 12 Conference member), has expressed interest in adopting the system.

Study Finds Hormonal Link to Amenorrhea A study from Harvard University has found a possible predictor for amenorrhea (the absence of menstruation in females of reproductive age) among teenage female athletes. The hormone ghrelin, which normally stimulates appetite, was found to be at elevated levels in amenorrheic athletes.

Madhusmitra Misra, MD, a pediatric endocrinologist at Harvard-affiliated Massachusetts General Hospital, studied 21 teenage athletes with amenorrhea alongside 19 normally

menstruating teenage athletes and 18 menstruating teenage non-athletes. The non-menstruating athletes had significantly higher average levels of ghrelin and lower levels of a corresponding hormone called leptin than the other two groups.

The amenorrheic athletes also had lower bone density and lower levels of estrogen, which is essential for bone growth.

Misra’s study says amenorrhea affects as much as 25 percent of the high school female athlete population, compared with two to five percent of teenage females overall. The higher rate is usually linked to energy deficits caused by high-intensity exercise and low caloric intake.

This most recent research helps clarify the role hormones play, and may be a step toward identifying who is at greatest risk for amenorrhea and the female athlete triad in general. “These findings suggest that hormonal disorders may explain why amenorrhea occurs in some but not all adolescent athletes,” Misra said during a presentation at the Endocrine Society’s June 2008 meeting. “In addition, ghrelin may be an important link between an energy deficit state and the hormones that regulate menstrual function.”

An abstract of Misra’s presentation, “Reproductive and Bone Health in the Female Athlete,” can be found on the Endocrine Society’s Web site at: www.abstracts2view.com/endo.

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Circle No. 105

ComebackAthlete

Max Baumann St. Xavier High School, Cincinnati, Ohio

BY R.J. ANDERSON

After his team was blown out in the 2006 Ohio Division I football regional finals by archrival Colerain High School, St. Xavier High School junior right guard Max Baumann was as low as he’d ever been. With both knees and a shoulder wrapped in large bags of ice, Baumann struggled to understand how his season had ended in the worst possible way: The team’s dream of defending its state title was dead and his left knee was shredded.

While pulling on a blocking assignment five minutes into the fourth quarter, the 6-foot-2, 275-pound Baumann was blindsided. His left knee buckled awkwardly, and he heard a pop.

Later, an MRI revealed he had torn the ACL, MCL, and medial meniscus—arguably the most feared triad of knee injuries.

There’s an old saying that “bad things come in threes.” For Baumann, that turned out to be a very unfortunate reality. In addition to the injuries to his left knee, Baumann tore his right posterior labrum in the fourth game of the season, and two games after that he tore the medial meniscus in his right knee.

St. Xavier Team Physician Robert Heidt, Jr., MD, an orthopedic surgeon at Wellington Orthopaedic & Sports Medicine, told Baumann that by limiting his practice reps and managing the injuries properly he could play through them. But Heidt, also the Team Physician for the Cincinnati Bengals, told him the injuries would require surgery at season’s end.

“He was mentally prepared to go through surgery for the first two injuries, but the third one, which turned out to be the most serious, left him in a state of shock,” says Michael Gordon, ATC, Head Athletic Trainer at St. Xavier. “My heart broke for him because I knew how hard he had worked to play through all the pain from his previous injuries. To have another surgery added to the lineup was very tough on him.”

Baumann’s rehab began as he sat in the locker room draped in ice and disappointment. Seeing that he was hurting emotionally as well as physically, Gordon put on his “sports psychologist” and “motivator” caps and sat down next to him. “I prayed with him and told him we were going to help him get through it,” Gordon says. “I told him it wasn’t going to be easy, but that everything happens for a reason. I said, ‘You have to work your tail off to get back out there for your boys next season.’”

It didn’t take long for Baumann to set his sights on the long road that lay ahead. With a goal of returning for the first game of the 2007 season, he prepared for his first surgical proce8

T&C OCTOBER 2008

Max Baumann (no. 65) underwent three surgeries after the 2006 season to repair his shoulder and both knees. In 2007, he helped lead St. Xavier High School to a state title. dure. “We wanted to get him ready mentally and physically because he was facing some long, hard months,” Gordon says.

“So we prehabbed him and had him do a lot of quad strengthening work to minimize atrophy before the surgery.”

The surgery on his left knee took place Dec. 7, three weeks after St. Xavier’s last game, with Heidt performing an autograft procedure using a piece of Baumann’s patellar tendon to reconstruct the torn ACL. During the first four weeks after surgery, Baumann was on crutches and followed what Gordon describes as a typical ACL rehab, doing continuous passive motion work and quad tightening, as well as increasing his knee’s range of motion and overall flexibility. At the same time, Baumann prehabbed for his upcoming shoulder surgery using the strengthening program he had begun during the season, which included band work, internal and external rotations, front raises, and some light shrugging.

Baumann did his initial physical therapy at Wellington with John Brehm, MEd, ATC, an athletic trainer at the clinic and an Assistant Athletic Trainer at St. Xavier. During his school R.J. Anderson is an Assistant Editor at Training & Conditioning.

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

TR AINING-CONDITIONING.COM

ComebackAthlete lunch periods, Baumann visited Gordon in the athletic training room to complete many of his home exercises for getting range of motion back. There, his work included using a continuous passive motion machine with polar care and performing heel slides, wall slides, hamstring and calf stretching, and quad strengthening exercises.

By Jan. 25, 2007, having learned to ambulate on one crutch, Baumann underwent the procedure to repair the torn labrum.

At this point in his rehab, the hobbled high schooler was a walking medical supply closet. “For a couple weeks he was in the sling and on one crutch, with braces on both knees,” Gordon says. “If it wasn’t so sad, it would have been comical.”

On Feb. 9, Heidt performed the medial meniscus procedure on Baumann’s right knee, putting him back on two crutches. By mid-February, with the surgeries behind him, Baumann was rehabbing three body parts, working three hours a day for three days a week.

In addition to physical therapy at the clinic for his knees and shoulder, Baumann was also working with Gordon after school. During those sessions, he concentrated on core strength. “We worked really hard on his core because that was all we could really do then, strength-wise,” Gordon says. “We knew strengthening his abs, low back, and hip flexors would help get the ball rolling for when he could ratchet up his other strengthening work down the road, like leg extensions and curls.”

By April, Baumann had completed his work at Welling-

Speed

Agility

ton and was doing all his rehab with Gordon and Brehm at St. Xavier. To keep the sessions lively, Gordon implemented sport-specific exercises whenever possible. “It’s not always interesting or fun to continually do straight-leg raises or ride the bike,” he says. “For instance, when we did balance exercises that incorporated tosses, we used a football. Also, we put him in his lineman’s stance whenever we could and utilized a lot of ladders and foot-high hurdles that trained him to chop his feet like linemen do in their position drills.”

The hours, days, and months of repetitive rehab often left Baumann drained—physically and mentally. To keep him focused, Gordon introduced visualization exercises. “We’d say, ‘Imagine yourself on the podium, holding up that state championship trophy,’” Gordon explains. “Or, ‘Imagine making a pancake block against Colerain, and putting your arms around your teammates knowing you worked your tail off to get there.’

“It was amazing to watch him stay motivated,” Gordon adds. “I wouldn’t say every day was a great day, but every day was definitely a progressive day.”

One of the more unusual aspects of Baumann’s recovery was not what he gained, but what he lost during the rehab process. With Baumann weighing 270 pounds at season’s end, Gordon knew the hulking lineman had to drop some weight in order to reduce the stress on his surgically repaired knees.

“Usually, when bigger guys undergo surgery—and I’ve seen this at the high school, college, and professional levels—they gain weight because they’re not active and they

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T&C OCTOBER 2008 2/6/08 2:36:06 PM

9

ComebackAthlete don’t really watch what they eat,” Gordon says. “I didn’t want that to happen with Max, so we spent a lot of time talking about the importance of a proper diet after his surgeries.”

Baumann heard the message loud and clear. “Right away, Max was really proactive about changing his eating habits, and he actually lost weight during his rehab,” Gordon says.

“His parents were great about changing the family’s meals.

They cut out fatty, fried foods and concentrated on eating salads, lean meats, and other proteins.”

Throughout the rehab, Gordon watched as Baumann’s body became more and more lean. By the start of the team’s summer strength and conditioning sessions, he was down to 240 pounds. “He didn’t lose it all at once—it was a slow progression,” Gordon says. “I monitored him to make sure he wasn’t losing more than two pounds a week. I didn’t want him to eventually put it all back on.”

In the spring, when Baumann’s rehab began to include functional training, Gordon and Carlo Alvarez, CSCS, Head Strength and Conditioning Coach at St. Xavier, worked together to design a program that addressed his weaknesses and improved strength imbalances without interfering with his progress. They incorporated a lot of proprioception and balance work and used the school’s swimming pool for lowimpact hydrotherapy exercises. They also kept Baumann away from heavy upper- and lower-body presses.

“We never put him on the bench press or leg press and challenged him to max out to gauge how strong he was,” Gor-

Max Baumann St. Xavier High School, Cincinnati, Ohio Sport: Football Injury: Torn ACL, MCL, and medial meniscus in left knee; torn medial meniscus in right knee; torn posterior labrum in right shoulder.

Result: After having three surgeries in less than two months, Baumann successfully rehabbed and led his team to a state championship.

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ComebackAthlete don says. “Instead, we wanted to see how he looked bilaterally—was he as strong on his left side as he was on his right?”

When football practices rolled around, Baumann was back on the field, and 236 days after his ACL surgery he participated in the team’s first scrimmage. Despite adding five pounds of lean muscle over the summer, he was still 25 pounds under his 2006 playing weight. Freed from the extra weight as well as the knee and shoulder injuries that dogged him during his junior season, he felt quicker and stronger.

Baumann was named a team captain and started every game of the 2007 season. Though he was able to play—and play well—he had significant soreness after most games. “He was still only eight months removed from an ACL surgery, which can take a year or two to fully recover from,” Gordon says. “Max basically lived in the athletic training room and got treatment every single day—sometimes four, five, or six times.

But week after week, he toughed it out.”

To reduce the pounding on Baumann’s repaired knees and shoulder, Gordon kept his practice load light. “Max was able to do some hitting in a controlled environment, but we kept him out of most contact drills,” Gordon says. “And if he was really sore, I told the coaches, ‘You might not get him for even one day this week. Let’s take him to the pool and stay away from pounding his body.’”

Baumann says his comeback was complete when his team capped an undefeated 2007 season by winning the Ohio Division I championship game. Standing on the awards podium

afterward, one of the visualization exercises from the early days of his rehab came to life. “I was standing on that stage holding the trophy with the other captains,” says Baumann, who was named to the 2007 all-Ohio Division I first team. “As I looked out at my teammates and our screaming fans, I knew that all my hard work had paid off.”

Since graduating from St. Xavier, Baumann has lost 25 additional pounds, bringing him down to 220. A freshman studying finance at the University of Cincinnati, he turned down several offers to play college football. “I talked to scouts who said he could have gotten a full ride at a mid-level to major NCAA Division I program,” Gordon says. “It’s not that he lost the desire to play football, I think he was just physically worn out and realized it would be very tough to keep playing week after week for another four or five years. I also think he was completely fulfilled by his experience playing with his friends and teammates at St. Xavier and didn’t need to keep playing just so he could say he played college ball.”

But that doesn’t mean Baumann is ready to retire to a life on the couch. “Through this process, Max has seen the benefits of healthy eating and being smart about his body,” Gordon says. “He really appreciates how good it feels to be physically fit and healthy and realizes he has a long life ahead of him.”

Baumann concurs. “I will definitely miss playing football,” he says. “But I’ll also be grateful when I’m 40 years old and can walk without limping.” ■

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Q&A

SPECIAL ADVERTISING FEATURE

With Nicholas DiNubile, MD

Using Supplements To Promote Joint Health

W

hen you hear the words “arthritis” or “bone and joint pain,” you probably picture an aging man or woman with gray hair shuffling by. Certainly the incidence of arthritis goes up with age, but the truth is, young and mobile athletes zipping around the court, rink, or field are also subject to these conditions. In fact, Nicholas DiNubile, MD, an orthopaedic surgeon specializing in sports medicine with expertise in knee surgeries, says one out of three patients diagnosed with arthritis is under the age of 40.

But there are steps these athletes can take to help reduce their chances of serious aches and pains down the road. DiNubile, author of the best-selling book, FrameWork: Your 7-Step Program For Healthy Muscles, Bones, and Joints, who also serves as Orthopaedic Consultant to the Pennsylvania Ballet company and the NBA’s Philadelphia 76ers in addition to his private practice in Havertown, Pa., addresses common questions surrounding joint pain and arthritis in scholastic-age athletes in this interview.

Why should athletes be concerned about joint pain and arthritis?

When most people think of arthritis or osteoarthritis, we think of our grandparents or an older relative. But the reality is that we’re seeing joint damage in younger and younger patients—myself included, from an old high school football injury that has caught up with me.

That’s partly because of athletic kids playing on multiple travel teams or even playing on two or three teams in the same sport yearround. Traditionally, people think of arthritis as our bodies getting old and our joints wearing out. But athlete years are like dog years, and when an athlete tears his or her ACL or meniscus or even just comes down hard and knocks a piece of their joint surface off, that sets the stage for progressive early deterioration of that joint. Just because these athletes are young and feel invincible doesn’t mean they can ignore joint health and protection.

Can joint supplements play a role?

Absolutely. I recommend them quite often in my office practice.

Also, for many of the patients I do knee surgery on, whether it’s microfracture, a chondrocyte transplant to rebuild a damaged joint surface, or just someone with arthritis seen at the time of an arthroscopy, I absolutely insist they take these supplements.

Glucosamine and chondroitin are the building blocks of your joint surface.

Joint supplements aren’t for everyone, however. If an athlete has joint pain, they need to know the reason for it. If it’s a meniscus

tear or a muscle strain or some tendonitis, a joint supplement will not help. But if an athlete has arthritis or early osteoarthritis, I’m a big believer in the use of glucosamine and chondroitin sulfate to help counteract that. There is a lot of science behind the use of joint supplements with glucosamine and chondroitin in them.

What are the positives?

Glucosamine and chondroitin are naturally occurring substances in the body, so you don’t get all the issues that you have with NSAIDs (non-steroidal anti-inflammatory drugs) like stomach ulcers, gastric bleeding, and even more serious complications. It’s nice to have a more natural option that has a tremendous safety profile.

Another interesting thing about joint supplements is that they may also have something called a chondroprotective effect, which means they may actually slow down or help stop the progression of osteoarthritis. Arthritis medicine is really just aimed at controlling symptoms like inflammation, whereas there is some early evidence that those patients who take joint supplements have less progression of their arthritis. Joint supplement pills or drinks are the only things you can put in your mouth that have actually been shown to possibly alter the course of the disease in a positive way, that is they may be disease modifying, rather than only symptom controlling.

Any words of caution?

There are no real negative side effects that we know of. If anything, we’re used to taking a pill and feeling better, but joint supplements are slow-acting so you’ve got to give them about a twomonth trial. Athletes also want to be careful to get a good quality brand product.

What else can athletes with joint pain or arthritis do?

You can’t treat damaged joints or arthritis in a vacuum. Taking joint supplements has to be part of a comprehensive program that includes things like activity modification, dietary changes, weight control, and a good strengthening and exercise program. Joint supplements are one piece of the puzzle, but a very important piece.

The other thing to remember is that once an athlete damages a joint they will never ever get it back to where it was, so it’s important to do everything they can from a preventive standpoint. Whether it’s conditioning, smart training programs, injury prevention programs, or the right kind of diet, all those things will help.

Prevention is the key.

Joint Supplement Pills vs. Liquid Form Pills may be easier to take on the road, but the supplements are more absorbable in liquid form.

Procter & Gamble has done research that says when taking a pill with food and water, only about 77 percent is absorbed, but in liquid form, 93 percent is absorbed. There tends to be a better rate of compliance with patients who take joint supplements in liquid form as well, likely because unlike pills, it doesn’t have to be ingested at multiple time intervals throughout the day.

– Michelle St John, Elations Company For more information, go to www.elations.com. Free shipping and professional discounts available.

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OPTIMUM PERFORMANCE

The ZZZ Factor Chronically sleep-deprived athletes probably don’t realize all the ways they’re hindering their performance. By explaining sleep’s many physical and mental benefits, you can help them put the issue to rest.

BY ART HORNE

I

n the past decade, recovery has become one of the hottest buzzwords in the athletic performance world. Athletes today go to great lengths to ensure that their post-workout habits help them recover optimally after practices, weightroom sessions, and competitions—whether that means following a special nutrition program, performing a carefully planned cooldown routine, or even using modalities such as hydrotherapy or yoga. With so much time and money spent on recovery aids like these, it’s ironic that so many athletes overlook the most easily accessible, affordable, and time-tested recovery booster of all: sleep.

But the value of sleep isn’t limited to recovery. Its important role in athletic performance and overall health is well documented, and few things are as intuitive as the need for a good night’s rest. Yet how many athletes in your setting truly take advantage of it? If you’ve ever looked around a team bus and seen heads bobbing up and down as athletes doze off during even short trips, it’s obvious that many are sleep deprived.

By educating athletes and coaches, you can help them realize that better sleep habits—or “sleep hygiene,” as our team physician Gian Corrado, MD, has called it—can be a secret weapon to improve performance and recovery. The latest research on how sleep affects mental and physical ability suggests that the time athletes spend on the pillow can be just as important as the time they spend in the weightroom and the gym.

SLEEP 101 Let’s begin with a short primer on exactly how sleep works.

Every human brain has a built-in clock called the suprachias-

© GETTY IMAGES

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Art Horne, MEd, ATC, CSCS, is Associate Director of Sports Medicine and Strength and Conditioning Coach for men’s basketball at Northeastern University. He can be reached at: a.horne@neu.edu.

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OPTIMUM PERFORMANCE matic nucleus (SCN), which regulates our circadian rhythm. The SCN is located in the brain’s hypothalamus, just above where the optic nerves cross— and that’s important, because light ex-

mal physical and mental health, and in an ideal world, it’s the goal everyone should strive for.

What exactly goes on during those hours? Analysis of brain activity during

Each stage of sleep has its own function, and stages three and four—deep sleep—are of particular importance to athletes. This is when the natural physical and mental processes of restoration are at their peak, and when growth hormone secretion occurs. posure is one factor that can greatly affect circadian rhythms and feelings of sleepiness or alertness.

If you could remove all the external elements of daily life that affect sleep patterns, including stress, schedule demands, alarm clocks, and nextdoor neighbors’ barking dogs, research indicates that most adults would sleep for about eight hours a night (slightly more according to some studies), and teenagers and college-age people would sleep for approximately nine hours.

This amount of sleep produces opti-

sleep reveals that it can be broken into five unique stages. Stages one and two comprise what is commonly referred to as light sleep, and stages three and four constitute deep sleep. The fifth stage, rapid-eye movement (REM) sleep, is the dreaming stage, and in most cases it occurs only after we have passed through the first four stages. During a typical night of undisturbed sleep, we complete a full cycle through the stages of sleep roughly every 90 minutes.

Each stage has its own function, and stages three and four—deep sleep—are

of particular importance to athletes.

This is when the natural physical and mental processes of restoration are at their peak, and when growth hormone secretion occurs. Growth hormone is essential for building and rebuilding muscle and other body tissue, so when an athlete doesn’t sleep long enough to complete several cycles of deep sleep, they deprive themselves of key physiological benefits.

SLEEP DEBT & PERFORMANCE Anyone who has pulled an all-nighter while studying for an exam is familiar with the concept of “sleep debt.”

When the body fails to get an adequate amount of shut-eye, everything from mood to cognitive function to motor skills can suffer. But what about athletic performance in particular?

From a clinical perspective, the actual definition of sleep debt is still up for debate. Several researchers have attempted to set parameters for it and quantify its effects, while others have questioned whether the concept is scientifically valid at all. For this discussion, we’ll define sleep debt as what happens when “how

Fibula Tibia Posterior inferior tibiafibular ligament

Anterior talofibular Talusligament Anterior inferior tibiofibular ligament Talus

Posterior talofibular ligament

Calcaneofibular ligament

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OPTIMUM PERFORMANCE much a person should sleep” and “how much they actually do sleep” are different enough that physical and mental effects can be observed.

For athletic performance, both the physical and mental dimensions are important. On the physical side, sleepdeprivation studies have shown that the primary negative effect of sleep debt is a decrease in time to exhaustion during activity. In prolonged performance tests, subjects who have gotten less sleep consistently tire more quickly than those who have gotten more.

Other key physical parameters, such as power output and aerobic and anaerobic performance, are not usually impacted by a mild to moderate lack of sleep. However, ratings of perceived exertion (RPE) are almost always affected when a significant sleep debt is present: Athletes feel they are working harder when sleep deprived, even if performance metrics say otherwise.

Some study authors have attributed this to a self-fulfilling prophecy, since tired athletes expect physical activity to

be more strenuous and difficult due to their tiredness.

The mental effects of sleep debt, meanwhile, are much more pronounced. And for competitive sports, in which decisions must be made in the blink of an eye and concentration is at a premium, this subject is worth exploring.

Research has shown that reaction time, stress level, alertness, irritability, and overall energy level or vigor are all negatively affected by sleep deprivation.

Some studies in this area have looked at extremes, such as three consecutive sleepless nights (which even the busiest student-athlete is unlikely to experience), but others have found that even a relatively mild sleep debt, over time, takes a clear mental toll.

For example, after subjects in one study were limited to four to six hours of sleep per night over a two-week period, their performance in cognitive tests was comparable to that of other subjects who were kept awake for more than 48 hours straight. Another study found that chronically sleep-deprived

people were outperformed on a reaction time test by well-rested people—who also happened to be above the legal alcohol intoxication limit for driving at the time.

Findings like these reveal the cumulative nature of sleep debt: If an individual consistently doesn’t sleep enough over an extended period, the negative effects are compounded. Four to six hours of sleep a night is common for many high school and college students, so these results are significant.

Sleep debt can also wreak havoc on another key process for athletes: motor learning. It’s well known that practicing a given skill leads to improved proficiency, and that the passage of time after practicing further enhances the gains—this is one of the concepts behind “muscle memory.” But a recent landmark study suggests it’s not the passage of time itself that makes the difference, but rather time spent asleep that causes additional proficiency gains to occur.

In the study, two groups were tested

TIME TRAVEL It’s the opportunity of a lifetime: One of your teams has been invited to play in a tournament in Hawai’i, or is finally taking that trip to Italy the coach has talked about for years. After months of planning, anticipation, and excitement, the plane touches down and the athletes can’t wait to put on their uniforms and compete. But when they meet for their first morning practice, they’re groggy, out of sync, and tiring much more quickly than usual. Jet lag has set in.

Adjusting to a new time zone can be a major challenge for teams that do long-distance travel, and unless there’s some advance planning, a dream trip can turn into a performance nightmare. Here are some pointers for making a smooth transition: • Whenever possible, adjust practice and workout times to accommodate athletes’ internal clocks. For instance, if you usually practice at 3 p.m. in Boston and you’re traveling to Rome (which is six hours ahead), try holding your first practice at 9 p.m. As your schedule allows, gradually move practices, workouts, and even scheduled games “backward” to ease players into the new time zone and minimize circadian rhythm disruption.

• Athletes may be tempted to take long naps the first few days after arriving if they’re tired out by

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jet lag, but this should be discouraged. It will only delay adaptation to the new time zone, as the body attempts to stick to the sleep schedule it’s used to back home. If a player must nap, a short doze of around 10 minutes can have some restorative effects without delaying time zone adaptation.

• Departure and arrival times can play a major role in jet lag, so try to schedule flights that will allow players to get a full night’s sleep their first night in the new time zone.

• Tell athletes to avoid caffeinated foods and beverages on the plane if the team is arriving at its destination in the evening. Caffeine affects individuals differently, but for many, it can make falling asleep difficult for several hours after consumption.

• Remember that jet lag is worst when flying eastward, so a trip to Europe will require greater adjustment than a trip to Hawai’i, even if the actual difference in hours is the same. That’s because you “lose” hours when you travel east, winding the clock forward instead of backward. A westward trip may even afford an opportunity for players to resolve minor sleep debts by using the “gained” hours to get a great night’s sleep upon arrival.

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OPTIMUM PERFORMANCE in a specific motor skill, and then retested in the same skill 12 hours later. Members of the first group were initially tested at 10 p.m. and went to sleep shortly afterward. Members of the second group were initially tested at 10 a.m. and did not sleep afterward. When the groups were re-tested, those who had slept showed a statistically significant improvement in performance, while those who had not slept showed no improvement. However, it’s interesting to note that after 24 hours, once members of the second group had gotten a night’s sleep, their performance at the skill improved significantly as well.

Scientists can’t explain precisely why this phenomenon occurs, but something happens within the brain during sleep that causes us to process movements and skills we’ve learned through practice in a way we can’t when we’re awake. This fact should be very interesting to anyone who takes foul shots, kicks field goals, executes volleyball serves, or performs countless other athletic activities that rely on precision and learned movement patterns.

Several studies have shown that test subjects who suffer cognitive and motor impairment due to a sleep debt are often unaware of their decreased ability … They don’t realize how much it may be hampering their alertness, mental processing speed, reaction time, and other skills essential to athletic success.

Perhaps most interesting of all, several studies have shown that test subjects who suffer cognitive and motor impairment due to a sleep debt are often unaware of their decreased ability. This might help explain why athletes don’t take sleep habits as seriously as they should—they don’t realize how much it may be hampering their alertness, mental processing speed, reaction time, and other skills essential to athletic success.

BETTER NIGHTS AHEAD If you could improve athletes’ sleep habits simply by summarizing the research in this article and then telling them to hit the hay, I could stop here. But in reality, most sleep-deprived athletes got that way because they don’t know exactly what they’re doing wrong.

The first priority to address is time devoted to sleep. The aforementioned goal of nine hours per night for teens and college students will seem unrealistic to many, but the closer they can come to that number, the better they’ll feel and the more they’ll enjoy the health, recovery, and performance benefits of sleep.

Consistency in sleep time is valuable as well. Going to bed and waking up at the same time every day takes maximum advantage of the body’s natural circadian rhythm, while having different bedtimes and wake-up times every day can throw off the internal clock. Once a routine is established, athletes will find they are able to fall asleep more quickly and sleep more soundly through the night.

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OPTIMUM PERFORMANCE

ADDRESSING APNEA Sometimes, an athlete’s sleep problems aren’t caused simply by stress, neglect, or a busy schedule. Sleep apnea is a serious and possibly even fatal condition in which a person stops breathing while asleep, usually because their airway is obstructed. It can affect anyone, but three of the main risk factors are being male, being overweight, and having a large neck circumference—all of which describe most football linemen to a ‘T.’

Wind says the mild cases can be treated more simply, through weight loss and teaching the athletes to avoid sleeping on their backs.

A 2003 study in the New England Journal of Medicine made headlines when it looked at 300 NFL players and found that 34 percent of the linemen suffered from sleep apnea. Awareness was further raised the following year when 13-time all-pro Reggie White died unexpectedly in his sleep, and the medical examiner’s report said apnea may have been a contributing factor.

“If a kid sleeps for three or four years with apnea and doesn’t do anything about it, eventually his heart is going to wear out. He can pass a physical and appear to be in great shape, but over time, his heart is just not capable of handling the load it’s given,” says former MTSU Head Athletic Trainer Joe-Joe Petrone, who recently moved to Auburn University. “The two athletes who are now on the [CPAP] machines have reported that they feel better during the day, and that they’re more alert in the classroom and during lifting and running.”

So when Middle Tennessee State University Athletic Director Chris Massaro proposed earlier this year that Head Football Coach Rick Stockstill send some of his linemen to participate in a sleep apnea study, it didn’t take much convincing. “Some of my friends had been tested for sleep apnea, so I was familiar with it,” says Stockstill. “I thought it would be a great idea for our bigger guys to get tested.”

The Sleep Centers of Middle Tennessee selected 16 MTSU linemen who displayed physical characteristics consistent with elevated sleep apnea risk. After analyzing their breathing during sleep, researchers led by Clinical Director Brian Wind, MD, found that two of the linemen suffered from severe sleep apnea, and 10 others had borderline or mild cases.

Sleep apnea causes the neck muscles to relax during sleep, allowing the soft tissue in the back of the throat to collapse and block the airway. This can halt breathing for 10 seconds or more, often causing the sleeper to snore loudly or wake up gasping for breath. These frequent interruptions in sleep can lead to daytime fatigue, morning headaches, and reduced blood oxygen levels. Untreated apnea can lead to high blood pressure, irregular heartbeat, and increased risk of stroke, heart disease, and even type 2 diabetes.

For treatment, the linemen diagnosed with severe sleep apnea were given Continuous Positive Airway Pressure (CPAP) machines, which use a mask or nasal tube to continually force air into the throat to keep the airway open.

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“We feel pretty good about being able to step in and help these guys,” says Wind. “The two athletes with severe cases most certainly would have had long-term consequences in both health and quality of life.”

How do you decide who in your program should be tested for sleep apnea? “The two big screening questions are, ‘Do you snore?’ and ‘Are you sleepy during the day?’” explains Wind. “There are other signs as well. If you have a 19- or 20-year-old with high blood pressure, that’s a major red flag that they should be checked out.

“In putting players through the screening process, if nothing else we’re educating them about sleep apnea,” Wind continues. “I’d be willing to bet that 80 to 90 percent of these guys will have sleep apnea to a severe degree when they are done playing football. Ex-football players often see their weight shoot up once they stop playing and working out. By testing them, at least a seed has been planted so that when the symptoms kick in later in life, they say, ‘I remember learning about what this might mean.’”

Stockstill believes sleep apnea testing—which is fairly inexpensive and available at many sleep centers and clinics around the country—should become standard practice for athletic programs. “If you deal with bigger guys, you’re crazy if you don’t perform sleep apnea tests,” he says.

“It’s not only good for them as athletes, it’s also an opportunity to impact their whole lives in a positive way. You might even save someone’s life.”

—Kyle Garratt

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OPTIMUM PERFORMANCE

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to time zone changes, see “Time Travel” on page 18.)

MUCH TO GAIN Serious athletes will do whatever they can to get better at their sport. That’s why they come early to practice and stay late, wear themselves out in the weightroom, and spend countless hours on their own in the gym or on the field, honing their skills to gain even the slightest edge against future opponents.

It’s your job to help them realize that devoting more time to sleep isn’t being lazy or slacking off—it’s enlightened self-interest.

Luckily, the research suggests that a moderate sleep debt can be cured with just a few consecutive nights of prolonged sleep, and once athletes develop better sleep habits, the performance advantages should show themselves fairly quickly. Well-rested athletes may soon find they’re recovering faster after workouts, performing sport skills with greater accuracy and proficiency, enjoying improved cognitive and motor function, and feeling better all day long. ■

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before going to bed. Remember that interrupted sleep can deprive you of the deeper stages of the sleep cycle, which have so many crucial benefits.

• Engage in progressive relaxation activities as you prepare to go to sleep. Being very physically active late at night, exposure to bright light right before bed (for instance from a computer monitor or television), or eating less than two hours before bedtime can delay “sleep latency,” making it harder to fall asleep and robbing you of total sleep time.

• Set the room at a cool, comfortable temperature for sleep. Some people prefer warmer sleep environments than others, so when your team travels, try to find a roommate with a similar temperature preference.

Speaking of travel, this can raise several challenges for athletes’ sleeping patterns, especially when a trip involves crossing multiple time zones.

It may take several days for circadian rhythms to adjust to the new daylight hours and sleep/wake times of a different time zone, so teams should take this into account when planning trips.

(For some specific advice on adapting

Remember how the suprachiasmatic nucleus is located near the optic nerves? Even small amounts of light can affect levels of melatonin, the major hormone that regulates sleepiness, and that’s just one example of why creating the right sleeping environment must be a priority as well. This can be difficult for student-athletes, particularly college students living in dorms, so here are some helpful tips to pass along: • Eliminate as many light sources as possible when going to bed. This means turning off computer monitors, using dark curtains over dorm windows, and even rolling up a towel and putting it at the base of the door to block light from the hallway. If these steps are not possible, try using a sleeping mask to cover your eyes.

• Try wearing soft foam earplugs to eliminate nighttime noises that might interrupt your sleep. Or, if you’re used to some ambient noise at night, use a fan, humidifier, or other appliance that creates “white noise” to make you more comfortable.

• Turn off the ringer on your phone(s)

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NUTRITION

Preparing for Battle Wrestlers from the University of Illinois and Northwestern University compete at left. Both teams benefit from this author’s sport-specific approach to nutrition counseling.

STEPHEN CARRERA

The yearly training cycle for wrestlers includes three distinct phases, and an optimal nutrition strategy should target specific goals for each one.

BY SUSAN KUNDRAT t first glance, wrestling seems like such a simple sport: It’s just you, your opponent, and the mat, and the objective is very straightforward. But anyone who has worked with wrestlers knows it’s much more complicated than that. Success depends on a special combination of strength, power, agility, quickness, coordination, endurance, mental toughness, and tactical skill.

Nutrition planning for wrestlers has a very similar dynamic—what seems basic can actually be quite complex. To support optimal performance, a wrestling nutrition program must be versatile enough to account for different phases of the training year—“bulking up” versus “leaning out”—and managed closely enough to deliver desired

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weight loss without sacrificing valuable lean muscle.

In my 15 years of experience planning nutrition programs for wrestlers at successful NCAA Division I programs, I have developed strategies to help wrestlers go into every match well nourished, well hydrated, and fully energized. In this article, I’ll lay out my goals for each phase of the training year, explain what dietary adjustments can be made to achieve them, and provide some sample menus and meal ideas that have worked well for my athletes.

OFF-SEASON: BULKING UP During the off-season and the months leading up to fall workouts, wrestlers generally focus on making strength gains by maximizing lean muscle mass.

They typically spend fewer hours on the mat and more in the weightroom. From a nutrition perspective, that means they must consume enough total calories to support muscular hypertrophy, with a special emphasis on protein consumption every day.

Susan Kundrat, MS, RD, CSSD, LDN, is President of Nutrition on the Move, Inc., based in Urbana, Ill., and consults with athletes from the University of Illinois, Northwestern University, and Bradley University. She and sports dietitian Michelle Rockwell, MS, RD, CSSD, recently launched RK Team Nutrition (www.rkteamnutrition.net), providing sports nutrition handouts, training, and workshops for health professionals who work with athletes.

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NUTRITION Let’s take a closer look at the top priorities for this time of year: Calories. When looking to add muscle, wrestlers should take in at least 500 calories per day above their standard maintenance needs. For example, if a wrestler is training two hours per day in the off-season, he would require at least 20 calories per pound of body weight per day (3,300 calories for a 165-pound wrestler). Add 500 to that for lean muscle building, and you get a total of 3,800 calories per day.

An intense strength training program typically results in a robust appetite, so this energy intake goal shouldn’t be difficult for most wrestlers to achieve. I recommend eating several small meals throughout the day, and supplementing with snacks before and after workouts to maximize lean muscle gains.

Protein. Wrestlers can benefit from up to one gram of protein per pound of body weight per day when training to add strength. Protein consumption should be spread throughout the day to maximize muscle building, with the greatest attention paid to foods eaten before and after hard workouts—con-

suming protein at these times minimizes natural protein loss and maximizes muscle recovery.

Including proteins from a wide variety of whole food sources ensures that athletes take in a broad spectrum of amino acids, creatine (which occurs naturally in many foods), and other key nutrients. Some excellent protein sources are eggs, milk products, red meats, white meats, beans, peas, nuts, seeds, and whole grains.

Carbohydrates. Wrestlers should consume at least 50 to 55 percent of their energy in the form of carbohydrates (2.0 to 2.5 grams of carbs per pound of body weight per day), especially during periods of heavy training. For a 165pound wrestler eating 3,800 calories per day, this means a minimum of 1,900 calories of carbs (475 grams) on a daily basis. There are many well-known and healthy sources of carbs, including whole wheat pasta, fruits and vegetables, lean dairy products, and legumes.

Fat. During strength building, wrestlers should get at least 15 to 20 percent of their energy from fat—for our 165-pound wrestler, that means 63 to

84 grams of fat and 570 to 760 calories from fat per day. With an adequate training volume, this amount won’t lead to unwanted fatty weight gain, but it will support optimum muscle growth and overall health. Foods high in omega-3 fatty acids are the best choices, since they can help decrease inflammation (which may result from heavy training) and aid in muscle recovery.

Some good examples include salmon, tuna, walnuts, and flax seeds.

Phase One in the “On the Menu” box on page 26 shows a sample day’s meal plan that would allow a typical 165pound wrestler to meet all the nutrition goals I’ve outlined for muscle building.

Note that protein-rich choices are included pre- and post-workout, and that I’ve added “extra water” with each meal to emphasize proper hydration.

PRESEASON: LEANING OUT In the two months or so before the start of the competitive season, it’s critical for wrestlers who need to lose weight to follow a practical, sound plan for dropping body fat. This should begin with an initial weigh-in and body

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Circle No. 118

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NUTRITION

ON THE MENU At right are sample menus for two different phases of a wrestler’s year: muscle building, which typically occurs in the off-season; and weight loss, which, if necessary, should occur in the two months leading up to the start of the competitive season.

Phase One: Muscle Building

The menu for Phase One contains roughly 3,800 calories, 550 grams of carbohydrates, and 100 grams of fat. The menu for Phase Two contains roughly 2,550 calories, 380 grams of carbohydrates, and 45 grams of fat.

Both menus contain about 165 grams of protein or one gram of protein per pound of body weight (these were prepared for a 165-pound wrestler), since consistent protein intake is a key to building and protecting lean muscle.

Breakfast:

Dinner:

2 whole wheat bagels with peanut butter 1 small banana 2 cups of 100 percent orange juice Extra water

High-Protein Salad Dinner* 2 slices of whole grain bread 2 chocolate chip cookies Extra water

Lunch:

2 cups of whole grain cereal 1 cup of skim milk Extra water

3 soft tacos 1 side of beans 1 side of rice Extra water

Pre-Workout Snack: 1 cup of homemade trail mix with nuts, seeds, dried fruit, and granola Extra water

Post-Workout Snack:

Snack:

*High-Protein Salad Dinner: 3 cups baby spinach salad + 4 boiled egg whites + ½ cup cooked chicken breast + 1 cup mandarin oranges + 1 cup shredded carrots + 2 tablespoons fatfree Italian dressing.

1 recovery shake (250-300 calories) Extra water

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Circle No. 121

NUTRITION

Phase Two: Weight Loss Breakfast:

Snack:

Egg Scramble Breakfast* Extra water

Peach smoothie: 2 cups skim milk + ½ cup light frozen yogurt + 1 cup unsweetened frozen peaches + ice Extra water

Lunch: 1 grilled hamburger on a bun 1 single-serving bag of baked chips 1 apple Iced tea or water

Pre-workout snack: 1 light yogurt cup 1 small banana Extra water

Post-workout: 1 recovery shake (250-300 calories) Extra water

Dinner: “Super” Vegetable Soup Dinner** Extra water

*Egg Scramble Breakfast: 1 cup egg substitute + 2 cups chopped green peppers, onions, and tomatoes + 1 slice whole grain toast with jam + 1 cup fresh strawberries. **“Super” Vegetable Soup Dinner: 1 can (2 cups) low-fat vegetable bean soup + 2 cups canned green beans (added to soup) + 1 mini whole grain bagel, toasted with 1 ounce mozzarella cheese + 4 ounces shaved deli turkey + 1 orange.

composition analysis. Based on the athlete’s starting weight, you can then set specific goals and benchmarks that can help ensure safe weight loss.

The most important thing to monitor for wrestlers’ weight management is the rate of loss: An athlete should never lose more than 1.5 percent of their body weight per week. Shedding pounds faster than that can raise serious health concerns, and once the season begins, both the NFHS and the NCAA have rules prohibiting weekly weight loss beyond 1.5 percent. There are also limits in both high school and college for minimum body fat percentage: High school wrestlers at NFHSgoverned schools cannot drop below seven percent overall body fat during the season, and NCAA wrestlers must stay at or above five percent.

Returning to our 165-pound wrestler, let’s assume his body composition analysis reveals 12 percent body fat.

Since he is a college student, he wants to be near the NCAA minimum of five percent, which would set his minimum weight at 153 pounds. By losing between one percent and 1.5 percent of

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27

NUTRITION his body fat per week over an eight-week preseason, he could easily achieve his goal and compete in the 157-pound class.

One important note: Five percent is the minimum healthy body fat percentage for college-age wrestlers, but that doesn’t mean it’s the goal most wrestlers should strive for. Many find they have more energy and perform better at a higher body fat percentage—in fact, one study of NCAA champion wrestlers found their average body fat to be around 8.5 percent. Rather than focus on a set minimum, it’s much better to talk with athletes regularly about their energy level, their overall performance, and how they feel while they’re losing weight. This can help them find their own optimal body fat percentage.

So how can a wrestler safely lose weight? The goal is to drop adipose tissue (fat) while retaining muscle mass and lean tissue, so the best strategy is to lower caloric intake but maintain adequate protein consumption. Using the formula introduced earlier, the 165-pound wrestler would need 3,300 calories for maintenance—but now, instead of adding calories for muscle growth, we’ll take some away for weight loss. Subtracting 750 calories per day, for a total of 2,550, would result in about 1.5 pounds of weight loss per week. Over the course of two months, that would bring our athlete down to his legal minimum of 153 pounds.

The calorie reduction should come from adjustments to carbohydrate and fat intake, with protein consumption holding steady at about one gram per pound of body weight per day. In addition to preventing lean muscle loss, protein also enhances feelings of satiety, making the athlete less likely to feel chronically hungry as he scales back his daily caloric intake.

Phase Two in the “On the Menu” box on page 27 is a sample day’s meal plan for fat loss. Post-workout fueling remains unchanged, since a quality recovery shake at this time can help protect lean muscle mass.

IN-SEASON: MAKING WEIGHT During the season, wrestlers can optimize their nutrient stores and perform at a higher level by avoiding large fluctuations in weight. Because hydration status accounts for most weight change in a typical week, athletes should aim for consistency in hydration at all times.

Short-term weight loss (“weight cutting”) through dehydration causes losses in glycogen and lean muscle tissue, which can have several negative health and performance effects—it may take 24 to 48 hours after a period of dehydration to replenish muscle glycogen and body fluid levels. This is another area where governing bodies have stepped in to help keep athletes safe: At both the college and high school levels, weigh-ins must occur when the wrestler is in a hydrated state as measured by a urine test of specific gravity.

It’s easy to teach athletes to self-assess hydration status by monitoring their urine throughout the day. Frequent trips to the bathroom and relatively clear urine is good, while infrequent trips and darker color is a sign they need to drink more fluids. Encourage wrestlers to drink on a schedule before and during workouts, as fluid loss through sweat may exceed two liters per hour during hard exercise. Carrying a water bottle to classes and refilling it throughout the day is one simple and effective way to improve hydration habits.

Aside from consistent hydration status, weight maintenance should be the primary goal for in-season wrestlers. Addressing any weight issues in the preseason eliminates the burden of attempting weight loss during competitive cycles, so the athlete can focus simply on avoiding unwanted weight gain or loss.

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NUTRITION ery performance or body goal the atherally hundreds of products available One of the best ways to maintain lete wants to take a supplement for can on store shelves and over the Internet weight consistency during the season be achieved more naturally through a claiming to offer a shortcut to fat loss, is to avoid binge eating, so I encoursound dietary plan. bigger muscles, and extra energy. So age wrestlers to eat smaller meals sevIn most cases, once athletes see their when talking to wrestlers about their eral times a day. In addition to helping performance improving after making nutrition and performance goals, supprevent overeating, this strategy maxiappropriate nutritional changes, the plements and their risks should always mizes available energy for workouts allure of supplements becomes much be part of the discussion. and matches. It also enhances recovless of a problem. With a comprehenNutritional supplements raise conery, especially if the athlete is working sive nutritional strategy tailored for cerns ranging from safety to effectiveout (training, competing, or otherwise each phase of wrestlers’ yearly calness to contamination, but for a wrestler being physically active) more than once endar, they’ll find themselves fueled, looking for fast results, the marketing a day. Going into every workout with energized, and ready to perform at hype may be difficult to resist. Your fuel on board is essential for optimal their best. ■ message needs to be clear: Virtually evperformance, and that can be achieved by eating a snack or small meal every three hours or so throughout the day.

Another way to promote weight consistency is by adjusting the energy den800,000 teeth are knocked out each year during sports! sity of an athlete’s meals. Wrestlers are very physically active during their sport Is your dental kit ready? season, so they may be tempted to turn those frequent, smaller meals into frequent, larger ones. To avoid excess calorie consumption, you can help them find ways to boost total food volume without piling on too many calories.

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Circle No. 125

Groin Pains Whether you call it a sports hernia or athletic pubalgia, recurring pubic-area pain can be a major hindrance for athletes. These authors devised a specialized training program for the Cornell University men’s hockey team aimed at addressing and preventing groin injuries.

PATRICK SHANAHAN

TREATING THE ATHLETE

BY DR. PAUL R. GEISLER & ED KELLY n the past few years, the term “sports hernia” has shown up with growing frequency in both athletic medicine circles and mainstream media coverage of sports injuries. For those of us in the business of treating athletes, the sudden surge in popularity leads to one obvious question: Are more athletes suffering this type of injury than in the past, or have we simply developed a new term for an old condition?

Unfortunately, there is no simple answer. For one thing, despite how often the term is used, there’s no universally accepted definition for a sports hernia.

It’s sometimes applied as shorthand for virtually any condition affecting an athlete’s lower abdominal region and groin area, though some researchers believe there are specific symptoms and pathologies that must be present to warrant the diagnosis. Furthermore, there’s a basic misnomer involved—in a clinical examination, no actual “hernia” by common medical definition (the trademark bulge of tissue through muscle) is usually found. A more appropriate term is athletic pubalgia, though this is much less frequently heard.

Whatever you call it, the condition can pose serious problems for athletes.

When a rash of athletic pubalgia struck the Cornell University men’s hockey team two seasons ago, we decided to take the opportunity to design and implement a proactive approach to treat the injuries, and more importantly, reduce the likelihood they’d crop up again in the future. As you’ll see, we achieved significant success, and in the process, we learned much about this poorly understood area of sports medicine.

I

NOT EASILY DEFINED Various researchers have complicated the subject of athletic pubalgia in published literature by defining it strictly in terms of the anatomical structures and precise pathology involved, often contradicting each other’s definitions and creating much confusion. For instance, one study describes a sports hernia as a TR AINING-CONDITIONING.COM

“spectrum of pathology” involving the conjoined tendon, inguinal ligament, fascia transversalis, and internal and external oblique muscles, caused by a disruption of the inguinal canal without a clinically detectable hernia. Another describes it as a weakening of the posterior inguinal wall without an inguinal hernia detectable during a physical exam.

Numerous other authors have added to the disorder by introducing their own terms, such as “hockey hernia,” and listing specific body parts or symptoms that must be involved for the diagnosis to apply. For instance, varying definitions for a sports hernia may include or exclude the presence of a palpable hernia, and some incorporate the ilioinguinal nerve, while others ignore it.

So where is the common ground, and what do we really mean when we say an athlete has a sports hernia or athletic pubalgia? Despite the conflict over details, authors usually agree that a sports hernia involves a combination of injuries affecting both the groin area and the abdominal region. It’s actually more of a syndrome than a specific injury, encompassing several conditions that can be difficult to differentiate.

It has been theorized that athletic pubalgia is the result of chronic shearing forces across the pubic symphysis generated by repetitive adductor muscle activity. Over time, pubic symphysis forces indirectly cause progressive micro-stress to the posterior abdominal wall, causing a separation of the transversalis fascia and internal oblique aponeurosis from the inguinal ligament. This leads to the pain that we typically associate with pubalgia or a sports hernia.

Recently, a leading specialist who surgically treats this condition has attempted to create a more focused working definition for athletic pubalgia. According to William C. Meyers, MD, it consists of chronic inguinal or pubic area pain in athletes that is exertional only and not explainable by a palpable hernia or other medical diagnosis. Thus, since true athletic pubalgia (by this definition)

does not include an occult internal-ring hernia, Meyers has called for the term “sports hernia” to be discontinued when dealing with conditions that don’t directly involve the inguinal rings.

CLINICAL PRESENTATION Research into athletic pubalgia has shown the greatest incidence among soccer, football, and ice hockey players.

For instance, Meyers’s study of 157 athletes who required surgery for pubalgia found that 75 percent played one of those three sports. It’s also not uncommon for the pain to affect both sides of the abdominal-groin region—in Meyers’s study, 43 percent of the athletes presented with bilateral abnormalities.

The primary reason why clinical evaluation, diagnosis, and treatment for pubalgia are so challenging is that several contributing or co-existing factors have been reported in the literature as being associated with the condition (see Table One on page 34). Also, several differential diagnoses must be considered before concluding that athletic pubalgia is the cause of an athlete’s pain (see Table Two on page 34 for the most common examples).

By all accounts, the diagnosis of athletic pubalgia is clinically difficult because no condition-specific test exists, and there is no one clear indicator that can confirm the diagnosis. Many factors may contribute to pain in the hip, groin, and abdominal regions, and the list of Paul R. Geisler, EdD, ATC, is an Assistant Professor and Director of Athletic Training in the Department of Exercise & Sport Sciences at Ithaca College, and has over 20 years of experience as an athletic trainer and sports performance specialist working with high school, college, and professional athletes. He can be reached at: pgeisler@ithaca.edu. Ed Kelly, MS, ATC, is in his 14th season as Athletic Trainer for the Cornell University men’s hockey and sprint football teams. He can be reached at: erk2@cornell.edu.

T&C OCTOBER 2008

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TREATING THE ATHLETE

ThermaSplint Splint Material Heating Unit

historical findings and clinical signs and symptoms is also quite extensive (see Table Three on page 34 for examples).

Nonetheless, there are a few key things we know for sure about pain and stress to this area of the body. The pubic symphysis functions as a pivot point for force transfer between the lumbo-pelvic and femoracetabular joints. As it is subjected to chronic strain and shearing forces, this can lead to micro-tears of the rectus abdominis muscle or its tendon at the pubic insertions.

Movement of the femurs during athletic activity, and subsequent activation of the adductor muscles, may add to the stress.

Conceptually, there is a “chicken or egg” phenomenon in considering whether adduction forces affect the pelvis, or if pelvic forces affect the femoral adduction component. Either way, however, tears of the tendinous insertion of the rectus abdominis will undoubtedly alter the function of the pelvis, which then impacts femoral adductor function.

In addition, poor core stability can cause excessive anterior pelvic tilt, increasing tension in the adductor compartment Figure One: The neutral pelvic positioning shown below was used to assess eccentric hip flexor and rectus abdominis strength. Exercises based on this position were also central to our prevention-based training program.

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TREATING THE ATHLETE and the femur. Likewise, poor adductor strength or flexibility will place increased stress on the pubic symphysis, thus hampering the pelvic girdle’s function and affecting various muscle attachments of the pelvis, including the obliques, rectus, and transversalis muscles, as well as the conjoined tendon.

THOROUGH SCREENING During the 2006-07 season, the Cornell men’s hockey team suffered what you might call an outbreak of athletic pubalgia. There were five confirmed cases, a rate that far exceeded historical trends within the program. Surgery is the gold standard for resolving athletic pubalgia symptoms, but because the return-to-play timeline for surgical repair is typically 10 to 12 weeks, the sports medicine team decided a renewed focus on prevention was needed.

In the spring of 2007, we developed a specialized screening tool to look for historical markers and any other factors that might increase a player’s athletic pubalgia risk. To begin, each athlete completed an injury questionnaire that focused on the past and current health of the lumbar, abdominal, pelvic, and femoral areas. Specifically, we wanted to know who had a history of pain or soreness in the lower back, abdomen, or groin areas, and who had sustained musculoskeletal strains of the abdominal, hip flexor, adductor, or hamstring muscles.

We also conducted a clinical assessment of each athlete’s core stability, hip flexibility, and strength, and took abduction/adduction muscle strength ratios with a handheld dynamometer. For core stability, the athletes performed a series of timed movements in the quadruped position while maintaining a neutral pelvis (contracting the transverse abdominals, lumbar multifidii, and abdominal obliques to do so). Eccentric muscle strength of the rectus abdominis and hip flexors was assessed with a max time contraction test (see Figure One at left), and hip range of motion was assessed manually with a goniometer, a Thomas test, and a rectus femoris tightness screening. Hip muscle strength was measured with a handheld dynamometer. Finally, each athlete completed Gray Cook’s Functional Movement Screen, which we videotaped for in-depth analysis.

Since we had already reviewed the literature on orthopedic concerns for high-level hockey players, we weren’t TR AINING-CONDITIONING.COM

surprised by most of the evaluation results. Several athletes had histories of muscle strains in the abdominals, hip flexors, and adductors. Chronic episodes of lower-back pain, as well as peripubic and lower-abdominal tenderness, were common as well.

We did observe a few interesting trends. Specifically, the movement

algia have yet been published.

The available research, our clinical experience, and the evaluations we performed with the hockey team led us to a few conclusions. First, it’s clear that the hip adductors, hip flexors, and lumbopelvic stabilizers are part of an intricate functional relationship that controls the position and movement of the lumbar

Muscle strains heal via scar tissue that decreases tensile strength and elasticity, so the treatment and rehabilitation of those injuries is paramount for maintaining the dynamic relationship between muscles in the lumbo-pelvic region. screen and other tests revealed a high incidence of restricted abdominal and hip flexor flexibility, poor core stability, hip abduction/adduction strength imbalances (with the abductors stronger than the adductors), and poor eccentric strength in the hip flexors and rectus abdominis. All five athletes with confirmed athletic pubalgia had a history of at least two of these markers.

Our findings suggested that muscle imbalances and functional deficiencies were part of an acquired pattern for elite hockey players—and these problems challenged the dynamic balance between the lumbo-pelvic and femoracetabular joints and muscles. Given the physical demands of hockey, especially the biomechanics of movement and specific muscular stresses involved in the sport, this was hardly surprising. The data we collected helped us set priorities for the new program we would now begin to design.

TRAINING FOR PREVENTION Although there has been very little high-quality research to date on treatment and rehabilitation programs for athletic pubalgia, authors who have tackled the subject have focused mainly on the active tissues involved. For instance, one study showed that an active pelvic stabilization program was effective for treating adductor tendinopathy, while another revealed that rest and trunk stability exercises were effective in treating chronic groin injuries. And multiple studies have found that strengthening the pelvic floor and transverse abdominal muscles results in faster recovery and return to play. Still, no quality randomized and controlled studies or systemic reviews looking at non-surgical treatment of athletic pub-

spine, pelvis, and femur. Imbalances between the control (timing), strength, endurance, and flexibility of these muscles directly impact the type and magnitude of forces on the pubic symphysis, femoracetabular joint, lumbar spine, posterior abdominal wall, and pelvic floor.

In addition, long-term participation in sports like hockey, soccer, and football tends to create certain muscle imbalances due to repetitive activity. If these are not addressed in a training program, the resulting concentric and eccentric strength and flexibility imbalances can leave an athlete more prone to lower abdominal and groin injuries, including athletic pubalgia.

Hip flexor and adductor strains are also very common in sports that require cutting and quick acceleration and deceleration movements. Muscle strains heal via scar tissue that decreases tensile strength and elasticity, so the treatment and rehabilitation of those injuries is paramount for maintaining the dynamic relationship between muscles in the lumbopelvic region. Anatomical and postural abnormalities, such as increased lumbar lordosis or kyphosis and hip anteversion or retroversion, can also affect this dynamic functional relationship and increase athletic pubalgia risk.

To translate these conclusions into a training program, we decided to isolate several key weaknesses or movement limitations, then set training priorities that would correct them. With this approach, we hoped to address the most important factors that predispose an athlete to athletic pubalgia and other related injuries. Below is a list of the key factors, followed by the exercise focuses we used to address them: Poor core stability. For athletes with this deficiency, we sought to improve T&C OCTOBER 2008

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TREATING THE ATHLETE

Table One: Co-Existing Factors for Athletic Pubalgia History of abdominal muscle pathology Hip flexor and/or adductor strains Adductor tendinopathy Pubic symphysitis or osteitis pubis Lower abdominal, adductor, and hip flexor muscle imbalances Adductor/abductor strength ratio under .80

Table Two: Differential Diagnosis Considerations Pubic symphysitis or osteitis pubis Adductor tendinopathy Obturator/ilioinguinal neuropathy Inguinal hernia (direct/indirect) Femoracetabular intra-articular lesions Femoracetabular impingement syndrome Legg-Calve-Perthes disease Avascular necrosis of the femoral head Osteoarthritis Labral pathologies Slipped capital epiphyses Osteochondritis dissecans Pubic bone/femoral stress fractures Testicular pathology Intra-abdominal/pelvic floor pathology (genitourinary, reproductive, gastrointestinal systems)

Table Three: Common History & Symptom Complaints Lower abdominal pain with exertion Distinct mechanism w/exertion often not recalled Pain w/coughing, sneezing, or Valsalva maneuver Pain in inguinal canal near rectus abdominis insertion on pubic symphysis Pain absent/minimal at rest Pain progresses from unilateral to bilateral over time Pain with resistive adduction and/or hip flexion reported in the lower abdominals, inner thigh, and/or testicular areas Failed response to conservative treatment History of multiple hip, low back, and/or pelvic pathologies Inguinal tenderness Pain with resistive hip adduction Pain with resistive trunk flexion Peripubic tenderness Adductor longus insertional tenderness Direct pubic symphysis tenderness Lower abdominal tenderness Testicular pain Absence of palpable inguinal mass 34

T&C OCTOBER 2008

control and endurance of the transverse abdominals, abdominal obliques, lumbar multifidii, and quadratus lumborum muscles through a comprehensive core stabilization program. To be effective, core stabilization concepts needed to be incorporated throughout the athletes’ entire strength and conditioning program.

This meant going back to the basics of teaching athletes to maintain a neutral pelvis and spine, and activating the transverse abdominals in simple supine, sitting, and standing positions. We then gradually progressed toward more functional exercises utilizing these essential principles. We incorporated exercises with progressive resistance using plyo balls, tubing, and a physio ball with rotational and diagonal movements as well as other functional patterns. We also added lateral and prone plank exercises with hip abduction, flexion, and extension perturbations to reinforce neutral pelvic and lumbar positioning.

Poor eccentric strength of the hip and trunk flexors. We discontinued concentric hip and abdominal flexion exercises for these athletes in an attempt to address the flexibility and eccentric strength imbalances, which we theorized were partly caused by concentric training. We then prescribed exercises that focused on building eccentric strength and improving control of the hip and trunk flexors, using slow, controlled movements and sometimes a four-way hip machine.

To ensure maximum benefit, we were careful to not allow anterior or posterior pelvic tilting during the exercises.

We were concerned that such tilting might excessively activate the powerful hamstrings and hip flexors, thus overpowering the local fine-control muscles such as the transverse abdominals and external obliques.

Weak hip adductor muscles. We focused on building hip adduction strength (eccentric and concentric), and de-emphasized concentric hip abduction exercises until the athletes’ abduction/adduction ratio approached 1:1.

This was accomplished using a standard four-way hip machine, but we also could have used exercises incorporating pulleys, cables, and even therapeutic exercise bands or cords.

History of lumbo-pelvic and femoracetabular muscle strains. We worked individually with these athletes on the specific muscles that were most vulnerable to strain, exhibited the greatest TR AINING-CONDITIONING.COM

TREATING THE ATHLETE inflexibility, or were most in need of recruitment. In some cases, athletes were instructed to focus more on flexibility of the adductor, iliopsoas, and/or rectus femoris muscles with side lying or supine stretches. For others, a clinicianassisted manual approach was required to address personal limitations. A few athletes had to incorporate trunk flexibility and mobility exercises into their workouts, such as prone press-ups and torso rotational patterns.

POSITIVE RESULTS One year after implementing our program, we are pleased with the trends we have seen thus far, specifically a decrease in the number of soft-tissue injuries to the lumbo-pelvic-femoral region.

The team enjoyed a 40 percent reduction in hip flexor and adductor muscle strains, and an associated 58 percent drop in days lost to injury during the 2007-08 season. There was a 17 percent reduction in lower-back pain episodes, with an associated 64 percent drop in lost days. And there were no new cases of athletic pubalgia.

Three players did suffer mild abdomi-

nal strains during the season, but each case was resolved with a conservative care program that re-emphasized the exercises that had been prescribed as part of the prevention program. Overall, we noted a significant reduction in the number of lumbo-pelvic-femoral related complaints, and saw improved returnto-play timeframes for minor strains and pain throughout the season.

So what did we learn by designing and implementing this program? First, athletic pubalgia is a complex condition involving several interrelated factors.

Often confused with other orthopedic problems or lumped in with the general and poorly defined term “sports hernias,” it is in fact a specific condition unto itself, and effective prevention and rehab exercise programs must address all the right components.

Whenever an athlete experiences groin pain, several anatomical structures and biomechanical models may be in play. Because of the proximity of this area to vital parts of the digestive, reproductive, and genitourinary systems, you must take care to ensure that other potential diagnoses are ruled out before

treating the condition as athletic pubalgia. It’s always a good idea to bring a physician into the picture if a correct diagnosis is elusive.

To prevent this type of injury in the first place, exercise programs should focus on individual injury histories involving the lumbar spine, abdomen, and hip joints, and also address functional core stability, which is crucial for protecting the lumbo-pelvic region. Building or restoring functional eccentric and concentric strength and flexibility balance between the hip flexors/extensors and abductors/adductors must be priorities as well. Above all, because the risk is so individualized, training programs should be specifically crafted to address each athlete’s risk factors and their underlying causes. With that approach, you can help your athletes avoid this painful and debilitating condition. ■ The authors wish to thank Thomas Howley, MS, CSCS, Cornell’s Assistant Director of Athletics for Athletes Performance, for his assistance with this article.

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LEADERSHIP

For the Record

BY JON ALMQUIST hink back to your days in an athletic training education or internship program, and try to remember what you were taught about note taking and record keeping. When I was a student almost 30 years ago, this meant learning how to take SOAP notes (subjective, objective, assessment, and plan) and using the HOPS format (history, observation, palpation, special tests), and many from my generation probably remember the same. To this day, SOAP and HOPS continue to be part of the curriculum approved by the Commission on Accreditation of Athletic Training Education, and for some programs, that’s where information management begins and ends.

T

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From helping you lobby for more resources to protecting your program against lawsuits, a top-notch medical record keeping system offers many benefits. Does yours?

Athletic trainers have widely varying opinions on record keeping. Some consider it a necessary evil or a “required waste of time,” adding to our already daunting workload and taking time away from the treatment of athletes. Others acknowledge its importance, but don’t agree on exactly what information should be kept, how to ac-

complish the task most efficiently, or how to use the data gathered over time.

And some have embraced it wholeheartedly, implementing elaborate computerbased record systems or home-grown database programs, “syncing” them with handheld devices for instant updates, and finding ways to synthesize all the information into monthly, quarterly, or annual reports detailing everything from man-hours to injury rates to how much they spent on supplies.

In my own setting as the Athletic Jon Almquist, ATC, is the Athletic Training Administrator for Fairfax County (Va.) Public Schools. He can be reached at: Jon.Almquist@fcps.edu.

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LEADERSHIP Training Administrator for a public school system, we have made record keeping a priority, and it has paid off for us in several ways. In this article, I’ll outline the benefits of a complete and well-organized information management system, and explain how it has helped us improve the care we provide for athletes every day.

WHY IT MATTERS There are some key reasons why certified athletic trainers should document every action we perform within our scope of practice. The most basic is that if we want to be considered credible

of an athlete’s injury, what our obligation was to provide a certain level of care, and whether there was any breach of that duty. By being able to review our files and say, “Our written records show that the chain of events was X, Y, and Z,” I’m sure we have nipped several potential lawsuits in the bud.

Communication. Anyone who works in high school or college athletics is familiar with the potential for miscommunication between athletic trainer and athlete, athlete and parent, athlete and coach, athletic trainer and parent, and so on. A good record keeping system can streamline the sharing of

Analysis of your injury data can help you set priorities ...

A spike in ACL injuries among your female basketball players might spur you to talk to the coach about adding preventive exercises to their warmup routine. healthcare professionals, we must acknowledge that thorough record keeping is the standard of practice in today’s medical world. Everyone from physicians to physical therapists to dentists maintains complete records of their evaluations and treatments, and athletic trainers should be no exception.

There are other crucial reasons for record keeping as well. They include all of the following: Legal liability. If an athlete feels they were not treated correctly, they or their parents need only pick up a phone and call an attorney to begin a sequence of events that can make any athletic trainer miserable. Anyone who has been on the receiving end of a lawsuit will tell you that accurate and complete records are the best defense. If you have documentation showing what happened each time the athlete was under your care, proving you acted appropriately is as simple as finding the right folder or computer files.

Without complete records, it is your word against the athlete’s, and key details of past treatments can be difficult to nail down. If your records don’t “tell a story” from the initial evaluation through the release to participate without restriction, you could be taking a serious risk if someone ever questions what you did.

Our school system has been contacted several times by attorneys’ offices to inquire about an athlete’s treatment.

When lawyers are deciding whether to file suit, they first investigate the extent 38

T&C OCTOBER 2008

information, help prevent miscommunications, and resolve problems more quickly when they occur.

For instance, a parent may contact the school with concerns about how their child was treated. Maybe they received incomplete information from a coach, or their son or daughter left out some key details when describing what happened. If you can say definitively that the athlete was given certain directions, or that messages were left on the voicemails of two phone numbers in an attempt to contact the parent, their attitude often does a complete 180.

Parents today want to take a more active role in their children’s activities, especially in matters of health and safety. With the proliferation of cell phones and e-mail, athletic trainers must be prepared to maintain a higher level of communication, and to thoroughly document what athletes and their parents have been told.

Proof of worth. In the high school setting, some administrators still think of certified athletic trainers as a luxury.

In college, many departments are understaffed and not given all the resources they need. The best way to correct these problems is to have a comprehensive record of all the ways athletic trainers add value to an athletic program.

Keeping excellent records allows you to generate detailed reports for administrators and school boards illustrating the true impact athletic training has on

the student body. For example, Fairfax County Public Schools is now the 12th largest school system in the nation, with over 170,000 students. Each of our 25 high schools has two certified athletic trainers (one full-time and one associate who also teaches). Our record keeping system allowed us to complete a recent analysis showing that our football players alone suffered a total of 24,207 injuries and 4,276 time-loss injuries over one five-year span, for an average of 3.93 injuries per 1,000 athlete exposures.

Whenever resources are being allocated, putting hard data like this in the hands of decision makers presents a much more compelling case than anecdotes, testimonials, and complaints of being understaffed. A professional summary of athletic training activities can also help you advocate for new equipment or a larger facility. Even administrators who don’t view athletics as a top priority can be convinced when they see that treatment from on-site athletic trainers reduces classroom time missed by student-athletes.

Finally, analysis of your injury data can help you set priorities in the athletic training services you provide. A spike in ACL injuries among your female basketball players might spur you to talk to the coach about adding preventive exercises to their warmup routine. Or a sudden drop in lower-body injuries on your football team might validate the new ground-based training program the strength coach is using. The possibilities for putting the data to use are endless.

WHAT TO RECORD & HOW Here’s the simplest possible summary of what thorough record keeping really means for today’s athletic trainers: Every problem or injury that’s brought to your attention should be represented in your files by its own record, containing information about the initial evaluation, the mechanism of injury and any pre-existing or contributing factors, and what treatments and other interventions were provided to resolve the situation. For problems or injuries that require more than a one-time intervention, the record should document all evaluations, treatments, and progress made until the return to full function.

Sounds simple enough, right? But if you tried following the above guidelines without some careful front-end planning, you’d quickly find yourself spending most of your day taking notes or sitting at your TR AINING-CONDITIONING.COM

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LEADERSHIP computer. Before long, you’d adjust by taking briefer notes, or perhaps limiting your records only to injuries that result in time loss. But this shortcut leaves you vulnerable—if what at first seemed like a minor injury or condition takes a turn for the worse, you’re already behind in your records and some pertinent information about early symptoms and treatments has been lost.

Clearly, one of the biggest keys to effective record keeping is finding a way to fit it into your daily tasks and schedule efficiently. I’ve found that a computerized record management program is by far the easiest solution for achieving this goal.

Whether you purchase a software package dedicated to medical record keeping or develop your own database or spreadsheet-based system, given the many advantages, there’s no reason to not be using a computer to manage your records.

Computer-based electronic medical record (EMR) systems usually include point-and-click options with dropdown menus, which make it easier to create consistent records because you use the same format to input data for each entry. Most systems also have note

fields where narratives and comments can be added as needed.

Drop-down menus make up the foundation of some computer systems, and they’re a great way to ensure that entries are uniform and thus can be used to compile trend data. The menus are often very detailed, covering everything from clinical impressions and mechanisms of injury to amount of pain reported by the athlete and various treatment options. Based on the selections you make from the menus, a program will create reports with summaries of injuries and injury rates, types of injuries sustained most frequently by sport, average number of treatments provided per injury or type of injury, and so on.

If you have a computer-based system, some simple logistics planning can make it as user-friendly as possible. For instance, at our schools we’ve found it very helpful to set up a computer right in the athletic training facility, with the keyboard and mouse at countertop height.

This allows easy access for entering information, so it often takes as little as 10 or 20 seconds to record routine treatments. Our athletic trainers can even fill

out some parts of the form as the athlete answers questions. We’ve learned from experience that if the only available computers are at desks with chairs, there’s a tendency to wait until “after the rush” to input information—and in the interim, important details can be forgotten.

Simple ongoing treatments, such as the application of special pads or routine taping and bracing, need just a short note in the athlete’s file stating what was done, when, and any relevant context information (for instance, whether a treatment was provided before or after practice). Re-evaluations of existing injuries, such as when you’re determining an injured athlete’s participation status, should take a minute or two as you provide notes on the evaluation results, injury progress, and new status. Evaluations of new injuries generally take the most time to document, so you may find it’s best to take brief (but detailed) notes during or immediately after your time with the athlete, and write up a full account later on when you’re less busy.

Some athletic trainers have found that documenting everything right as it happens is the best way to ensure the records

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LEADERSHIP leave no holes. This method, known as real-time record keeping, can help improve accuracy, but it does force athletes to wait as you complete notes from the previous patient. Others take a break to update their files after every two or three athletes they treat. However you decide to structure your record keeping schedule, remember that the shorter the time between when treatment is provided and when it is recorded, the better.

IN MY SETTING When I started at Fairfax County Public Schools in 1983, I was one of the first people hired through a school board initiative aimed at bringing in certified athletic trainers for each of the 23 high schools we had at the time. We were full-time teachers who received a stipend to provide athletic training services after school hours. As it became evident that one athletic trainer per school was not enough, we added an associate position for each school in the late ’80s.

Back then, we compiled injury stats using data from our paper-and-pencil records, and we used those stats to develop an event coverage policy based on

each sport’s injury frequency and severity. Our policy was often challenged by administrators who would see one injury in a low-risk sport and instantly decide it should be a higher priority.

The statistics we had compiled helped us defend our policy, but doing so was very time- and labor-intensive.

In 1997, we began using a computerbased EMR program. Each school compiled its own data, and uploaded the information to our Sports Injury Monitoring System (SIMS) for district-wide analysis. This was a huge leap forward in making our information management more effective and less burdensome, and before long, we were putting the results to use.

In 2001, we had 24 high schools and the two athletic trainers at each school both had teaching responsibilities. We proposed converting one position for each campus to full-time athletic trainer with no teaching duties—something we definitely needed, but which carried a $1.3 million price tag. Thanks to our record keeping system, we were able to lay out concrete facts to support our proposal.

We noted that student-athletes in our

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system incurred over 3,800 time-loss injuries and 8,100 minor injuries per year based on data collected over a threeyear period. We also explained that our athletic trainers conducted more than 82,000 treatments and rehab sessions over that time span, a figure that clearly demonstrated the need for a full-time athletic healthcare provider.

That first attempt didn’t succeed, but we kept compiling the data and presenting more and more facts and figures documenting the athletic training workload. Finally, in 2005, the restructured athletic trainer position was funded and implemented. That taught us two key lessons: Don’t give up, and use all available data to your advantage when making your case.

You didn’t become an athletic trainer because of your love for spreadsheets, medical note taking, or software programs that analyze trend data. But I have learned through experience that in athletic training, the old axiom “information is power” is truer today than ever. Excellent record keeping takes time, but with so many benefits, it’s definitely a wise investment. ■

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SPORT SPECIFIC

Finishing

STRONG A college track coach—who also designs strength programs for some of the world’s top runners—explains how good things happen when strength training and track and field embrace each other.

BY DANNY BRABHAM aving coached track and field for 35 years, I have seen the sport change and evolve in many ways.

One of the most exciting progressions has been the integration of strength training into our athletes’ workouts.

A traditional fear of bulking up and the difficulty of working with strength coaches who primarily focus on the school’s football squad have long kept track and field athletes out of the weightroom. In addition, as track coaches, we like to control every aspect of our athletes’ training and don’t necessarily want to turn one part of it over to a coach who doesn’t specialize in our sport.

But over the past decade, I have had the opportunity to work with three strength coaches here at Baylor University who have helped me develop

H Running the anchor leg in the men’s 4x400m relay, Jeremy Wariner struck gold for the U.S. at the 2008 Olympics in Beijing.

AP PHOTOS/PETR DAVID JOSEK

42

T&C OCTOBER 2008

Danny Brabham is Assistant Head Coach for Men’s and Women’s Track and Field at Baylor University and has served as strength coach for 400-meter Olympic champions Michael Johnson and Jeremy Wariner. He can be reached at: Dan_Brabham@baylor.edu.

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SPORT SPECIFIC

JOHNSON 2000 The following is a sample workout developed for Michael Johnson as he was training for the 2000 Olympics. He rested 30 to 60 seconds between sets and one to two minutes between exercises.

specific training protocols for track athletes. I’ve also served as strength coach for two of our nation’s premier 400meter runners, Michael Johnson and Jeremy Wariner. My work with them has helped me to develop a specific strength training program for long sprinters, which can be used by runners at any competitive level.

Monday Bench

2x8

1 @ 75 percent, 1 @ 80 percent

Squat machine

4x5

Begin at 150 lbs., progress in 50 lb. increments

Front raises

2x6

10 lb. dumbbell

Leg extensions/curls

2x6

Single leg, 60, 30 lbs.

Pull-downs

2 x 10 150, 160 lbs.

Running curls

2 x 20 Quickly, with 20 lb. dumbbells

Flexor pulls

1 x 10 Quickly, with half-inch exercise band

Switches

2 x 20 Quickly, leg at 90 degrees, one minute rest

Flat dumbbell

2x8

65-70 lbs.

Incline dumbbell

3x5

Single arm, 40, 45, 40 lbs.

Lateral raises

4x5

10 lb. dumbbell

Pec deck

3x5

Begin at 100 lbs., progress in 10 lb. increments

Dumbbell curls

3x5

30, 35, 30 lbs.

Ad/ab band

1 x 15 half-inch exercise band, each leg

Horizontal arm/leg lifts

1 x 45 5 lbs. in each hand

Upright rows

2x8

Back raises-hamstrings

1 x 20 25 lbs.

Bench

3x8

Sit-ups

3 x 25 2 flat, 1 float

Wednesday

90 lbs.

145 lbs., regular/wide/narrow grips

Thursday

44

Bench

1 x 10 175 lbs.

Dumbbell rolls

2x5

30 lbs.

Leg extensions/curls

2x8

Double, 110, 50 lbs.

Curls

3x5

Standing, 25 lbs. each + bar

Push-downs

4x6

50, 60, 80, 70 lbs.

Six-stage flys

1 x 15 Standing, quickly, with 10 lbs.

Running curls

1 x 20 20 lbs.

Pull-downs

1 x 15 140 lbs.

Medicine ball twists

1 x 20 To wall, each side, 12 lb. ball

T&C OCTOBER 2008

A LITTLE HISTORY When I began my coaching career at Baylor (after coaching at the high school level for 16 years), there was no effective means for our athletes to perform any sort of strength training.

There was only a small, cramped, hot room at the end of the track where our athletes trained on outdated machines.

After some time we were allowed to use the football weightroom, and as an afterthought one of the strength coaches was assigned to work with our team.

But the coach seemed to give us very generic workouts and rarely spoke to our athletes one-on-one or even as a group.

In 1999, however, LeBaron Caruthers arrived as Baylor’s Head Strength and Conditioning Coach. Not only was he an NSCA national strength coach of the year (1992), but he was also a former track and field athlete (two-time All-American in shot put). He brought sport-specificity to the weightroom and opened the doors to our team.

He understood the importance of listening to what the sport coach was hoping to achieve. From the first time we talked about our goals for the track and field team, he was receptive to our ideas.

Although he was hired by our football coach, LeBaron found time to design workouts for different track and field events, even tweaking programs based on the goals of each individual athlete.

Just as important, he actively worked with our athletes when they were in the weightroom. One of the main points we discussed was developing a relationship with our team members, letting them know that he was genuinely interested in what they accomplished both on and off the track. This really paid off as the athletes began to trust him.

The program we implemented was not fancy. We began our lifting regimen by concentrating on flexibility, warmup, and strength gain. The first six weeks of training were designed to get the athletes strong enough to avoid injuries once we began event work. We lifted three days a week, with two of those days conTR AINING-CONDITIONING.COM

SPORT SPECIFIC centrating on Olympic lifts, snatches, cleans, deadlifts, and squats (both front and regular). A dumbbell circuit was included in these workouts, as were numerous body weight exercises. The third day was designed to improve speed and flexibility by doing such lifts as step ups with a bar on the back, fast cleans, accelerated overhead dumbbell pulls from the floor, hamstring and quadriceps work, and bench presses.

We then gradually moved from a strength phase to different event phases. The athletes were able to adapt without much of the soreness and negative thoughts that had previously been associated with the weightroom.

After LeBaron left, we were assigned another strength coach, Torre Becton (who has since moved on to Iowa State).

He, too, was extremely focused on what our athletes achieved in the weightroom and during competition. From there, Milton Leal took over and he has been

helping to coach them as undergraduates, I have had the pleasure of serving as personal strength coach for both of them since they’ve graduated.

The programs I’ve designed for them have not been elaborate. In our sport, so much energy is needed for workouts on the track that strength training must never overload the athlete. My focus has been to specifically target all the muscle groups these athletes use in their event, concentrating on strength gain without much body weight gain.

One key has been to develop a routine

that balances all the muscle groups associated with the athlete’s racing in order to reduce injury risk. We also look specifically at the athlete’s injury history and try to correct any imbalances.

When I began training Michael, we did exercises that would essentially develop all the opposing muscle groups.

Most of the squat work was done on squat machines or simply with his body weight. Very seldom would we load heavy weight on his shoulders because he had issues with lower-back stability and alignment. This proved very success-

I relay the above thoughts for two main reasons. One is so that strength coaches know why track and field athletes and coaches often aren’t big fans of the weightroom.

The other is to help strength coaches understand that if you do give our sport some attention, we will respond. another great weightroom partner. My thanks to them for enabling our athletes to compete at the highest level possible.

I relay the above thoughts for two main reasons. One is so that strength coaches know why track and field athletes and coaches often aren’t big fans of the weightroom. The other is to help strength coaches understand that if you do give our sport some attention, we will respond to it.

FOCUS ON THE 400 Baylor University is nicknamed “Quarter Mile U” because it has produced some of the nation’s and even the world’s top 400-meter runners. Alumni Michael Johnson and Jeremy Wariner have been the top 400-meter athletes in the world for the past two decades. Along with Circle No. 134 TR AINING-CONDITIONING.COM

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SPORT SPECIFIC

WARINER 2008 The following workout was performed by Jeremy Wariner in preparation for the Beijing Olympics, where he won silver in the 400. We placed a lot of emphasis on alignment and core strength.

Monday Seated ball leg lift

1 x 40

Each leg

Bench

2x8

145, 155 lbs.

Squat machine

3x5

Begin at 150 lbs., progress in 50 lb. increments

Front raises

2x6

Right up, left up: 25 lbs.

Leg extensions/curls

2 x 6/3 x 4 Each leg: 60, 30 lbs.

Running curls

1 x 30

Quickly, with 15 lbs.

Flexor pulls

1 x 25

At 45 degree angle, with half-inch exercise band

Flat dumbbell

3x6

45, 50, 55 lbs.

Short stroke push-down

2 x 25

1 minute rest

Incline dumbbell

3x4

Both arms: 35, 40, 35 lbs.

Lateral raises

3x5

15 lbs.

Pec deck

2x6

100, 110 lbs.

Curls-standing

2x8

1 in, 1 out: 25 lbs.

Horizontal arm/leg lift

1 x 30

5-10 lbs.

Ad/ab band

1 x 10

Each leg in/out, front/back

Upright rows

2x5

Each hand, with 35 lb. dumbbell

Back raises

1 x 20

25 lbs.

Bench

2 x 10

Regular/wide, 135 lbs.

Sit-ups

2 x 25

1 flat, 1 float

Bench

2x8

155, 175 lbs.

Dumbbell rolls

2x6

15 lbs.

Leg extensions/curls

2x8

Double, 110, 60 lbs., toes in/out

Push-downs

3x5

100, 110, 120 lbs.

Six-stage flys

2x8

Seated on stability ball, 10 lbs.

Running curls

1 x 30

15 lbs.

Pull-downs

3x6

90, 110, 130 lbs.

Bodyweight squats

2 x 50

To 90 degrees, 1 minute rest

Wednesday

Thursday

46

T&C OCTOBER 2008

ful, and also helped him avoid injury. In addition, we worked with Dale Smith, a physical therapist based in Dallas.

Another key with Michael was for me to explain the reasoning behind each of the exercises and what exactly they would do for his racing strategies. Michael was always willing to work extremely hard to excel in his sport, and knowing the why behind the work really motivated him.

The table titled “Johnson 2000” (on page 44) details the workouts Michael did in preparation for the 2000 Olympics, at which he won a gold medal in the 400 meters. Most of the bench workouts are based on percentages of his bench max, which we tested approximately three to four times per season.

At the time of this workout, Michael’s bench max was 315 pounds.

Monday’s workout focused on the chest, triceps, and shoulders. Wednesday’s workout was for the chest, biceps, and pecs. And Thursday was about the chest, triceps, and shoulders again. Every day also included work on the legs.

Some of the leg work, such as leg extensions and curls, involved both singleleg and double-leg exercises. On the double-leg workouts, we would push a hard toe in/toe out and do straight extensions to load the quads and hamstrings in different planes. This helped us avoid injury. (Michael was 33 years old at this point in his career—in a sport plagued by leg injuries.)

These specific workouts were conducted one month prior to the Olympic trials. As we got closer to the trials and then the Olympic Games, he only did one set of each exercise. One week prior to the Olympics, he performed just the Monday and Wednesday workouts with a reduction in sets.

In 2004, I began to work with Jeremy, and we progressed through the same basic scenario that Michael had. For Jeremy, however, we also wanted to address some imbalances. He had a weak core that caused alignment problems and could potentially lead to injury. Our physical therapist in Dallas helped diagnose his weaknesses and make sure the strength program addressed the problems.

We added stability ball and band exercises in order to stabilize his weaker core muscles. We also worked on strengthening his hip flexors, adductors, abductors, abdominals, and the smaller muscle groups along his back by doing horizontal arm/leg lifts with five- to 10TR AINING-CONDITIONING.COM

SPORT SPECIFIC pound plates in each hand. This solved most of his alignment problems, and it was great to see both sides of his body begin to work together more efficiently.

The table titled “Wariner 2008” (at left) details Jeremy’s program in the month before this summer’s Olympics.

When the preliminary heats in Beijing were two weeks away, we reduced the workouts to two days a week. The week he competed, he did just one day of maintenance work and reduced the bench weight to 155 pounds.

THE SPECIFICS Doing an exercise correctly, of course, is key to making it effective. While many of our exercises are self explanatory, there are some I’d like to provide specifics on.

Seated Ball Leg Lifts. The athlete sits upright on a stability ball with arms across his chest and feet together, facing a mirror. He is instructed to keep his shoulders level and head aligned with no movement. The athlete lifts one leg off the floor with the last contact coming from the heel. The knee moves to about 10-20 degrees past horizontal. At this

point the foot returns to the floor for the next rep. This is done until one leg has completed the proper number of reps.

Then the opposite leg does the exercise.

Front Raises. The athlete takes a dumbbell in each hand and stands on one foot. He then raises each dumbbell, one at a time (alternating arms), bring-

Another key with Michael was for me to explain the reasoning behind each of the exercises and what exactly they would do for his racing strategies. Michael was always willing to work extremely hard to excel in his sport, and knowing the why behind the work really motivated him. ing it up to shoulder height for the assigned number of reps. The exercise is repeated on his other foot.

Running Curls. The athlete takes the dumbbell in one hand and lifts it up until there is a 90 degree angle in his arms.

Performing a running motion, he moves the dumbbell from behind his hip to shoulder height, repeating until he has done the assigned number of reps. The reps are then performed with his op-

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posite arm. The emphasis should be on maintaining the 90 degree angle during the entire sequence of reps.

Flexor Pulls. The athlete attaches a half-inch rubber resistance band to the top of his foot at floor level. He then places a stationary object, such as a bench or rail, far enough away to stretch

the band to three or four times its length.

Leaning at 45 degrees, he then moves through a running motion, keeping the ankle of the drive leg above the knee of the leg on the floor. He does each leg for the assigned number of reps. Keeping the 45 degree angle is key.

Short Stroke Push-Downs. This exercise is done with a two-inch resistance band through four planes: front, right side, left side, and reverse pull. The band

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SPORT SPECIFIC is placed on a stationary object approximately seven to eight feet high. The athlete holds the band with both hands and stands back until it is at a 45 degree angle. He then pulls the band straight down until his arms are also at a 45 degree angle. With a very fast motion, he pushes down until the number of reps is reached. The distance of the push-down should not exceed one inch.

To complete the exercise on the right and left sides, he shifts his feet to 45 degrees with the shoulders rotating back to be parallel with the wall. He then

pulls to the outside of the hip across his body. To do a reverse pull, he turns around and pushes down while facing away from the machine or wall to which the band is secured.

Horizontal Arm/Leg lifts. The athlete lies on his stomach on top of a stability ball, with his hips in the middle of the ball and weights in each hand. He lifts his right arm and left leg to parallel. He then repeats on the opposite side until the proper number of reps is reached.

Some of these exercises are done with a five-second hold on top, while others

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Ad/Ab Band. Using a half-inch resistance band, the athlete attaches the band to a stationary object at floor level and then to one of his feet. With the shoulders parallel to the band, he walks out to three or four times the band length. He then pulls the band across his foot until the band is at least one foot length past the foot on the floor.

He does this exercise pulling the band both in front of and behind the stationary foot. Once the assigned reps are done, he switches to the other foot.

Dumbbell Rolls. Lying on his back on a bench or stability ball, the athlete takes a dumbbell in each hand. Beginning with the dumbbells straight up above his shoulders, the athlete alternately rolls the weight until one is touching his thigh and the other is at shoulder level overhead. The weights switch posi-

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We worked on strengthening his hip flexors, adductors, abductors, abdominals, and the smaller muscle groups along his back ...

This solved most of his alignment problems, and it was great to see both sides of his body begin to work together more efficiently. tions until all reps are completed.

Six-Stage Flys. Standing with his feet together, dumbbells in each hand and to the side, the athlete takes the weight on both sides up until his arms are straight out and even with his shoulders. He then takes the weight to the front, even with his shoulders. Next, his arms go straight up until both are overhead, then back to the front, sides, and down to his legs.

That is one rep, and the athlete repeats until all reps are completed. There is one full minute between reps on this exercise. This can also be done while sitting on a stability ball with feet together.

Whether working with a track and field team or one elite athlete, I have found strength training to be critical for reaching goals. Track coaches can be hesitant to let you into their circle, but if you show that you’ll listen and work with them, the rewards are great. â–

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PAIN MANAGEMENT Cho-Pat 800-221-1601 www.cho-pat.com Cho-Pat’s newest product, the Bicep/ Triceps Cuff, affords protection from overuse injuries for individuals performing repetitive lifting in activities such as weight training. This patentpending device applies dynamic circumference pressure to the upper and lower portions of the biceps and triceps muscles, particularly at the tendon attachments. This action spreads out the stress and direct pull on the muscle attachments, which helps reduce the likelihood of developing bicipital and tricipital tendonitis or tendonosis.

Circle No. 500 Clinton Industries, Inc. 800-441-9131 www.clinton-ind.com The Clinton Classic Wood Taping Station features the beauty of real wood in four popular finishes, famous Clinton durable construction, and desirable standard features— like leg extensions that save valuable space and comfortable adjustable back rests. With more than 14 available options, this product is sure to be on every athletic trainer’s wish list. Plus, Clinton’s modular design, available in four depths, allows the units to be configured to fit large or small sports training facilities.

Circle No. 501 Clinton’s Style Line Laminate Taping Station is packed with value for large and small athletic training rooms. With easy-clean laminates in 15 standard colors and custom laminates to match your school colors, Clinton’s Style Line Laminate Taping Station can complement any facility. Standard features TR AINING-CONDITIONING.COM

include leg extensions and adjustable back rests. The units are available with 14 options, four depths, and a modular design allowing multiple stations to be joined in a row.

Circle No. 502 Dynatronics 800-874-6251 www.dynatronics.com The Dynatron X5 is a highly effective treatment for both acute and chronic pain. This remarkable machine features two independent channels and six treatment modes, and it includes both large and small treatment probes. It features four frequency sweeps, frequency ranges from 0 to 200 Hz, a conductance meter, and a two-year warranty.

The X5 is lightweight and affordable.

Feeling is believing—for a free demonstration, contact your Dynatronics dealer or call the company directly.

Circle No. 503 Let Dynatronics furnish your athletic facility with individual taping stations, cabinets built to your specifications, and units with your team logo debossed in the Naugahyde color of your choice.

Dynatronics manufactures tables in beautiful, durable hardwoods to fit every need. With 30 years of experience, Dynatronics offers outstanding craftsmanship and design, with sturdy construction, reinforced stress points, and great long-term performance. Go online to learn more.

Circle No. 504 Elations 513-321-4072 www.elations.com/professional Elations is a fruit-flavored glucosamine and chondroitin drink that is more absorb-

able than pills and designed to improve joint health and reduce joint discomfort.

Elations’ unique formula includes a patented, more absorbable form of calcium and boron to help minimize soreness and stiffness due to exercise and overly strenuous daily activities. A professional discount program and a profit program are available at the company’s Web site. With Elations, there will be no more pills to swallow.

Circle No. 505 Hygenic Performance Health Products 800-246-3733 www.biofreeze.com Applied generously, Biofreeze painrelieving gel and roll-on effectively relieve pain from heel injuries, sore arches, muscle spasms, strains, sprains, and tendonitis, and will help minimize next-day aches and pains. Use it up to four times a day. It’s available in a 16-ounce spray bottle and 16-ounce, 32-ounce, and gallon gel pump bottles. Also available is a gravity dispenser box with 100 five-gram single-use application packets for clinical settings.

Circle No. 506 Jump Stretch, Inc. 800-344-3539 www.jumpstretch.com “Don’t Ice that Ankle Sprain!” by Jump Stretch founder Dick Hartzell and Dr. Michael Shimmel will introduce you to the FlexBand Ankle & Strengthening Traction Technique, which is designed to reduce pain and swelling and to speed recovery time from ankle injuries. You will never deal with a sprain the same way again. This 85-page book includes a companion DVD, and covers horizontal traction, vertical traction, deferred pain, and more. It also includes testimonials from athletes and healthcare professionals.

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PAIN MANAGEMENT HydroWorx International, Inc. 800-753-9633 www.hydroworx.com HydroWorx pools with the InstaFit option offer a convenient, plug-in answer for sports professionals who need immediate access to the benefits of aquatic therapy. The 500i and 600i units leave the company’s workshop skirted, prepackaged, and ready to perform. The 500i is up and running after being set in place and connected to an electrical source at its rehab and exercise destination. The 600i can be carried through a standard doorway and quickly assembled and plumbed on site, so it can fit into virtually any spot too confined for the 500i.

Circle No. 508 Kustomer Kinetics 800-959-1145 www.kustomerkinetics.com Pain Blocker is an effective topical pain-relieving lotion. This product from Jay Alan, a division of Kustomer Kinetics, will ease the discomfort associated with muscle soreness, muscle spasms, strains, sprains, exercise overuse, tendonitis, bone and joint pain, and arthritic pain. It is formulated with potent analgesics and skin-softening emollients in a soothing lotion. Apply Pain Blocker generously to trouble spots for quick relief. Call for more information.

Circle No. 509 Multi Radiance Medical 800-373-0955 www.multiradiance.com Multi Radiance Medical has introduced the new FDA-cleared LaserStim emitter for the TerraQuant laser device.

The new technology allows therapists to identify inflammation areas and provide highly targeted treatment.

The LaserStim is a patented hybrid emitter that combines phototherapy and e-stim in one device. With the LaserStim, powered by Multi Radiance 50

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technology, clinicians can now receive insurance reimbursement for this attended combination modality. The product provides 25,000 mW of superpulsed laser peak power, resulting in rapid pain relief with no risk of burning tissue. The results have been proven by numerous clinical studies.

Circle No. 510 The TQ Solo Laser from Multi Radiance Medical is the only handheld portable device with exclusive Multi Radiance technology, which synergistically incorporates four proven radiances to provide the ultimate phototherapy environment for relieving pain: a super-pulsed laser, infrared light, red light, and a static magnetic field. With up to 18 hours of battery power, the TQ Solo’s pain-relieving power is there when you need it. There are no side effects and the product is easy to use. It is used by pro athletes worldwide.

Circle No. 511 Oakworks 800-916-4603 www.oakworks.com Strong, stable, and remarkably durable, PowerLine treatment tables are in a league of their own, with a massive 500-pound weight capacity. The solid hardwood construction with heavyduty hardware ships partially assembled, resists humidity, and will continue to promote your professional image year after year. Choose a 27-inch or 30-inch wide H-brace, and a flat rectangular or manual back rest top with an optional storage shelf and 20 upholstery colors.

Circle No. 512 With a 500-pound weight capacity, the Oakworks Portable Taping Table is one of the strongest and most durable taping tables on the market. Fully portable, this table provides an ideal sideline evaluation and taping station both at home and on the road. Plus, with independently adjustable legs and unique field feet, the Portable Taping Table can handle

any uneven surface or rugged terrain without a problem.

Circle No. 513 OPTP 800-367-7393 www.optp.com Kinesio Tape is a high-quality elastic athletic tape specifically designed to be worn for an extended period of time as well as during strenuous exercise or hydrotherapy.

The heat-activated adhesive will not leave residue when removed. Kinesio Tape is latex-free and has an elasticity of 140 percent, matching the basic elasticity found in skin and allowing it to work with the body. Call or go online to request a free OPTP catalog.

Circle No. 514 The original McKenzie® night roll from OPTP is designed to compensate for poor sleeping positions by supporting the spinal structures and maintaining proper lumbar posture while an individual sleeps on their side or back.

The user can easily tie the night roll around their waist, and the exclusive tapered ends allow comfort and freedom of movement without loss of support. Request your free OPTP catalog online or by phone today.

Circle No. 515 PRO Orthopedic Devices, Inc. 800-523-5611 www.proorthopedic.com The PRO 180 Dr. “M” Patella Brace has become the time-tested, successful, conservative approach to patella problems.

Designed with several unique features, it’s so revolutionary that it’s patented. A buttress of orthopedic felt in a horseshoe configuration is positioned underneath the sleeve, taking advantage of the compression of the sleeve over the buttress. This ensures proper positioning and control of patella movement.

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PAIN MANAGEMENT The PRO 110 standard knee sleeve from PRO Orthopedic is the classic knee sleeve that spawned a revolution in the treatment of knee problems and created a whole new industry. The time-proven design is made from the highest grade 1/8inch neoprene rubber and features a nylon outer cover for durability. Measuring 13 inches in length, the outer oval pad helps control sleeve stretch and fit while increasing the concentration of heat over the patella area. The PRO 110 is helpful for arthritis, strains, and post-operative knee problems. It is comfortable and effective.

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Sprint Aquatics 800-235-2156 www.sprintaquatics.com Sprint Aquatics has been supplying the aquatics world with aquatic therapy products for more than 36 years. The company’s combination of quality, price, and customer service makes Sprint an industry leader. The company has brought a myriad of

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PROTEAM by Hausmann 888-428-7626 www.proteamtables.com PROTEAM by Hausmann now has the ability to dress up your athletic training room by adding your team logo to your taping station back rests, Untitled-5 seats, or table tops.

Your logo can be embossed in multi-colored raised panels that really make your athletic training room pop, or you can deboss a monochrome logo into the upholstery for a more subtle look. Go online to see images of some of the company’s recent work.

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innovative and thought-provoking products to the market over the years—products that have altered the course of aquatic therapy and helped set the pace for the entire field.

Circle No. 520

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PROTEAM by Hausmann offers 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 options. The individual taping units are finished on all sides and can be easily re-positioned to fit your needs now and in the future.

Visit the company online for a wide selection of treatment tables, split-leg tables, cabinets, and stadium lockers.

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Call For FREE ‘08 Catalog • 800-752-2255 • www.fitball.com Circle No. 138

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PAIN MANAGEMENT Watkins, Inc. 507-457-3300 www.jrwatkins.com

Swede-O, Inc. 800-525-9339 www.swedeo.com

Chattanooga Group 800-592-7329 www.chattgroup.com

For 140 years, Watkins has been America’s pioneer in natural living, utilizing the finest natural ingredients in its products, including topical analgesics.

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.

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Swede-O has launched the patented Thermoskin Heel-Rite for effective daytime treatment of plantar fasciitis.

The innovative tension support straps lift and support the arch to provide compression to the plantar fascia for pain relief. The lightweight, low-profile design fits easily into most footwear to provide pain relief during normal everyday activity. The Heel-Rite applies effective support to relieve tension and pain on the plantar fascia during the day, when athletes need it most.

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The economical Opti-Ice helps reduce athlete pain and swelling and speed rehabilitation. Its motorized, eight-quartcapacity system provides continuous, consistent cold therapy for up to seven hours through the patented semi-closed loop system. OptiIce has an easy-to-use external console and thermometer to help maintain an accurate, safe water temperature.

Instructions are printed on the lid for easy referral, and the fill line is molded inside the cooler for accurate filling.

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Keffer Development Services 888-328-2577 www.athleticsoftware.com The Athletic Trainer System (ATS) is a multi-team, multi-sport system designed to assist athletic trainers in tracking and reporting information related to athletes and injuries.

This information ranges from evaluations and rehabilitations to drug testing and purchase orders. New features are reviewed by the company’s advisory council of athletic trainers. ATS consists of three modules: ATS Core, ATS Smartphone, and ATS Web Portal.

All three modules share information without the need to synchronize.

Circle No. 522 NExTT Solutions, LLC 574-233-6695 www.nexttsolutions.com NExTT Injury Management is a leading provider of electronic medical recording for sports organizations. The software provides a simple and efficient way for athletic trainers, doctors, and other medical professionals to easily enter, manage, and share important medical information on behalf of the entire organization. The system is designed for multi-sport and multi-site consolidation and serves as accurate documentation for all insurance and legal purposes. Take the NExTT step.

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BSN Medical, Inc. 800-537-1063 www.bsnmedical.com Lightplast Pro is a lightweight stretch tape that’s ideal for all-purpose taping and strapping of ankles, wrists, and fingers. It’s easy to tear and unwinds consistently for smoother, faster wrapping. It even holds securely in the presence of moisture. This tape is available in black or white.

Circle No. 525 Coverlet adhesive bandages by BSN Medical are made to absorb liquid quickly. In addition, each Coverlet features an extra-large wound pad capable of absorbing 10 times its weight in water. The 360-degree adhesive surrounding the island pad helps seal the afflicted area against dirt and contamination, keeping wounds clean and providing an environment conducive to healing. Coverlet bandages are available in 13 different shapes and sizes, making them perfect for use on knees, elbows, chins, noses, knuckles, and other hardto-bandage areas. The elastic fabric moves with the curves and contours of the skin and the body, sticking with athletes wherever they go.

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Chattanooga Group, a DJO company and one of the world’s largest manufacturers of rehabilitation equipment, was recently awarded “Best in Show” at the NATA Annual Meeting in St. Louis for its Intelect TranSport® Combo. The TransPort® Combo, a portable device that delivers both electrotherapy and ultrasound, was voted tops in the electrotherapy category.

“We’re very excited to receive this distinction,” says Jeff Gephart, National Sales Manager for Chattanooga Group.

“The Intelect TranSport is one of our most innovative and popular products because it was designed with the athletic trainer in mind.”

Circle No. 528 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 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.

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COMPANY Q&A

Understanding the Benefits of Dynamic Stretching In your opinion, is stretching beneficial? If so, do you recommend it before or after a workout?

Some studies indicate that stretching before a workout either has no effect on performance or may actually impede performance. To some extent, I would agree with that, because the stretching done in most of these studies is static, which is a complete waste of time. Instead, we recommend dynamic stretching, which can be appropriate before, during, and after a workout.

Carl LaRosa, son-in-law of FlexBand inventor Dick Hartzell, is the chief instructor for the FlexBand Training Seminars, held bimonthly at the Jump Stretch Fitness Center in Youngstown, Ohio. He currently serves as the CEO, helping Jump Stretch to grow in the U.S. and around the world.

At our gym, we use FlexBands by Jump Stretch to perform a controlled dynamic stretch. This is more of a

brings blood flow to the area, helping to improve range of motion, which translates into increased stride length and greater running speed.

Is there any risk of injury with this type of stretching?

We’ve never had an injury stretching this way. Rarely do teams that correctly use the FlexBands suffer injuries.

The idea that dynamic stretching can cause injury originated with a study done on inactive people in a nursing home, not a population of athletes. I have, however, seen athletes do a static stretch and then go into a dynamic activity and get hurt. Why a person would do a static stretch before going into a ballistic or dynamic activity like running or kicking is beyond me.

Who else can benefit from FlexBands?

“real world” stretch and simulates the way an athlete’s body works. Muscles extend and flex in microseconds when running. One muscle lengthens while its antagonist muscle shortens, and this happens quickly.

An interesting study done at the University of Wisconsin-LaCrosse showed that phase III cardiac rehab patients who used FlexBands to perform dynamic stretches showed increases in hamstring and lower-back flexibility

Can you give an example?

At Jump Stretch, we do three rounds of stretching on the hamstring. Round one is a moderate stretch of approximately 10 leg raises with the bands, keeping the knee straight and the toe pointed back. Next, we grasp the band up high, take a small bend to the knee, and lock out for 10 reps. For rounds two and three, we repeat the sequence of 10 leg raises and 10 bends, bringing the leg back a little further each time.

This activity “re-educates” the Golgi tendon behind the knee to improve flexibility in the long run.

Jump Stretch 1230 N. Meridian Rd. Youngstown, OH 44509 800-344-3539 Fax: 330-793-8719 www.jumpstretch.com TR AINING-CONDITIONING.COM

The way we teach the hamstring stretch, the leg moves through a full range of motion, with the athlete controlling the intensity of the stretch. This

versus those who did traditional nonresistance static stretches. On average, the FlexBand group improved flexibility from the 30th percentile to the 60th by the end of the study.

Since it has been shown that the use of FlexBands is safe, effective, and an innovative method of improving lowerback and hamstring flexibility for cardiac rehab patients, it is not a far stretch (pun intended) to assume that it could also help prevent and rehabilitate injuries in the lower-back and hamstring areas of athletes.

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CASE STUDY

More Reasons to Not Treat Athletic Pain with NSAIDS

By Mark C. Faulkner Mark C. Faulkner has spent more than 20 years in the business of biomedicine. After working in diagnostics for Abbott Labs, he co-founded Aegis Analytical Laboratories, Inc., and focused largely on athletic doping control (analysis for banned drugs).

After 10 years, he shifted from testing for illegal supplements to researching and manufacturing safe and legal performance-enhancing supplements.

When an athlete is injured, you want to get him or her back into competition as quickly as possible. That means managing the pain so the athlete can start working out once his or her body can handle the activity. Many athletes turn to non-steroidal anti-inflammatory drugs (NSAIDs), like ibuprofen or aspirin, for help at these times, hoping the drugs will control their pain and get them on the fast track to recovery.

According to recent research, this is like taking two steps forward and one step back. A growing body of evidence says NSAIDs can raise serious problems for athletes who use them.

The FDA has long warned of liver, kidney, and stomach damage from popular pain relievers such as acetaminophen, ibuprofen, and aspirin, and the medical community cautions that too many people take these drugs habitually. Now, the sports medicine community is learning that there are even more reasons to be wary of NSAIDs. At the Fifth World Congress on Sports Trauma, Drs. Bjorn Dimmen

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and H. Alfredson reported on a study showing that drugs that inhibit or block cyclooxygenase pathways (COX-2) also interfere with tendon, bone, and cartilage repair. Alfredson said that NSAIDs not only inhibit COX-2, but also inhibit tenocytes—thus virtually blocking protein synthesis in muscle.

This means athletes who take NSAIDs to control pain and inflammation so they can work out may actually be undermining their own effort. Two steps forward, one step back.

The counterproductive effects of NSAIDs may be greatest for athletes recovering from broken bones. In his presentation, Dimmen noted that “the COX-2 enzyme is critical for fracture and bone healing and it is especially involved in repair during the first three weeks after a fracture. NSAIDs and COX-2 inhibitors impair fracture healing.” For this reason, he recommended avoiding NSAIDs and other COX-2 inhibitors in all cases of fracture or cartilage damage.

Other recent research on NSAIDs has revealed more concerns. Dr. Steven McAnulty of Appalachian State University and colleagues found that using NSAIDs may be bad for muscles, even in cases where there is no damage initially. In their recent study, runners who took ibuprofen as a prophylaxis before strenuous exercise reported more soreness the following day than runners who didn’t take the drugs.

Oxidative stress is another problem for athletes who use NSAIDs. Analysis of blood and urine samples has revealed remarkable differences in the levels of protein carbonyls (PCs) between people who took NSAIDs and people who didn’t. These results indicate that oxidative stress is much more prevalent among NSAID users.

Oxidative stress can lead to toxic effects ranging from cell damage to atherosclerosis, Parkinson’s Disease,

Alzheimer’s Disease, and other neurodegenerative conditions.

Fortunately, there are safer and healthier options for athletes in today’s marketplace. Over the past six years, research conducted at the medical centers of the University of Missouri and the University of Nebraska have shown that the new compounds found in StayActiv® (formerly known as AminoActiv®) can effectively relieve pain without the toxicity or impedance to healing.

Necropsy studies reveal that even supertherapeutic doses have no effect on blood chemistry or organ profiles. In addition to being safe, these compounds contain no banned substances as defined by the NCAA, NFL, IOC, and other sports governing bodies.

The compounds rely on natural anti-inflammatories, not synthetic chemicals with potentially harmful side effects. They do not inhibit the COX-2 enzyme, but instead reduce prostaglandin release from cells using a different mechanism called mitochondrial membrane stabilization. As an added benefit, they are also known to have anti-oxidant properties.

Research shows that these new compounds are just as effective as the leading NSAID (ibuprofen) in slowing the production and release of prostaglandin from cells, which essentially means the products have similar analgesic and anti-inflammatory effects. But unlike NSAIDs, they actually enhance the rate of tissue recovery after over-exertion or common athletic damage. That means pain isn’t just being masked—it’s actually being relieved, while recovery is actively promoted.

Imagine, healthy pain relief and unimpeded recovery: That’s a muchimproved prognosis. It’s two steps forward, without any steps back.

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HOT & COLD Pro-Tec Athletics 800-779-3372 www.injurybegone.com Experience the benefits of direct, active ice massage with the Ice Up portable ice massager. It offers effective treatment in just five to seven minutes, and quick deep-tissue relief for ligament, tendon, and muscular injuries. Ice massage increases treatment effectiveness and speeds recovery. The Ice Up has a leak-proof design to keep your sports bag dry. A portable carry cooler keeps the Ice Up stick frozen for up to 12 hours, so it can be taken anywhere for pre- or post-activity ice massage.

Circle No. 530 Pro-Tec Athletics’ Hot/Cold Therapy Wrap has gotten even better. The new XL form-fitting shoulder wrap offers the same great dual strapping system that allows for even, effective compression of the entire target area, but with wider (4.5-inch) straps. Advanced gel technology packs remain flexible during application and retain cold or heat longer— and now there are two of them. The addition of a second pack allows for greater coverage and treatment to both sides of the shoulder.

Circle No. 531 Therapy Innovations, LLC 541-550-7347 www.therapyinnovation.com Therapy Innovations has introduced its new portable Smart Heat system.

This system is a true heat therapy modality that can be used anywhere. Internal thermal controls guarantee accurate temperatures every time.

Simply plug the unit into a standard electrical outlet (120 volts), and the pads will be ready to use in less than seven minTR AINING-CONDITIONING.COM

utes. The therapy pads are extremely flexible and durable. They come with washable covers and a travel bag for a completely portable modality.

Circle No. 532 Whitehall Mfg., Inc. 800-782-7706 www.whitehallmfg.com Whitehall’s complete line of moist heat therapy units is designed for easy and convenient use.

The Thermalators are available in five sizes. The two-, four-, six-, eight, and 12-pack Thermalators come with high-quality heating packs, locking casters, and coved bottoms, and they are UL-listed.

Circle No. 533 The Hydrolift from Whitehall Mfg. is essentially two whirlpools in one, allowing you to treat lower and upper extremities with the same unit.

The heavy-gauge tubular stainlesssteel lift raises the whirlpool three feet for easy and safe treatment. The Hydrolift is available with 10-, 15-, and 22-gallon whirlpools.

Circle No. 534 The Polar Pool 617-480-7683 www.thepolarpool.com The Polar Pool cryotherapy spa offers cold water therapy, hot water therapy, and saltwater therapy--all in one. It’s completely portable, so you can provide athletes with state-oftheart treatment and pain relief without installing new plumbing or redesigning your entire facility. Users can sit or kneel in the pool, and the purification and sanitization systems keep the water clean while the solidstate cooling system maintains the temperature you want.

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A Popular Choice for Explosive Drills and More TurfCordz™ are used in high-level athletic training by professional football, baseball, hockey, and basketball teams. They’re great for explosive start drills, power-building footwork exercises, and simulated play action.

Here are just a few satisfied TurfCordz users: Arizona Cardinals Cincinnati Reds Colorado Avalanche Denver Broncos George Washington University Indiana University Kenyon College McMaster University Ohio State University Pennsylvania State University Purdue University Stanford University University of California University of Denver University of Notre Dame U.S. Air Force U.S. Marine Corps U.S. Olympic Swim Team U.S. Olympic Speed Skating Team Texas Rangers Contact NZ Manufacturing to request a free catalog.

NZ Manufacturing, Inc. P.O. Box 2146 Stow, OH 44224 800-886-6621 Fax: 866-320-3653 www.nzmfg.com T&C OCTOBER 2008

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131 . . . Athletic Trainer System (Keffer Development). . . . . . . . . . . . . . . . . . . . . . . 40

136 . . . NCCPT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .47

103 . . . Biofreeze®/Hygenic Performance Health® . . . . . . . . . . . . . . . . . . . . . .5

130 . . . NExTT Solutions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

129 . . . BSN Medical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

128 . . . Oakworks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

132 . . . BushwalkerBags . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41

122 . . . OPTP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

109 . . . Chattanooga Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11

106 . . . Perform Better . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9

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

137 . . . Power Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

102 . . . Clinton Industries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3

123 . . . PRO Orthopedic Devices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

119 . . . Concentra . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

115 . . . Pro-Tec Athletics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

141 . . . CytoSport . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . BC

114 . . . PROTEAM by Hausmann. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17

140 . . . Dynatronics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . IBC

134 . . . Samson Weight Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

120 . . . Egg Whites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

124 . . . Save-A-Tooth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

138 . . . FitBALL USA (Ball Dynamics) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51

133 . . . Shuttle Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

142 . . . Flexall . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41

139 . . . Speed to Win . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51

121 . . . G&W Heel Lift . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

118 . . . Sprint Aquatics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

116 . . . Gebauer Company . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21

127 . . . TerraQuant (Multi Radiance Medical) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

112 . . . Glyc’N Go (Lifexpand) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14

107 . . . The Polar Pool . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

105 . . . Hibiclens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7

117 . . . TheraBand®/Hygenic Performance Health® . . . . . . . . . . . . . . . . . . . 22

110 . . . Jump Stretch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12

135 . . . Therapy Innovations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .47

108 . . . Kustomer Kinetics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

125 . . . TurfCordz/NZ Mfg. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

113 . . . Medi-Dyne Healthcare Products . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16

100 . . . Watkins, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .IFC

104 . . . NASM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6

126 . . . Whitehall Manufacturing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

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506 . . . Biofreeze®/Hygenic Performance Health® . . . . . . . . . . . . . . . . . . . . 49

513 . . . Oakworks (Portable Taping Table) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

526 . . . BSN Medical (Coverlet) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

512 . . . Oakworks (PowerLine treatment tables) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

525 . . . BSN Medical (Lightplast Pro) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

514 . . . OPTP (Kinesio Tape) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

528 . . . Chattanooga Group (Intelect TranSport®) . . . . . . . . . . . . . . . . . . . . . . . . . 52

515 . . . OPTP (McKenzie® night roll) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

527 . . . Chattanooga Group (Opti-Ice) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

543 . . . Perform Better (Elite) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

500 . . . Cho-Pat . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

544 . . . Perform Better (Tiger Tail). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58

502 . . . Clinton Industries (Laminate Taping Station) . . . . . . . . . . . . . . . . . . . . . . . . 49

545 . . . Power Systems (Airope) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58

501 . . . Clinton Industries (Wood Taping Station) . . . . . . . . . . . . . . . . . . . . . . . . . . 49

546 . . . Power Systems (X-Ladder) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58

551 . . . Concentra . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

517 . . . PRO Orthopedic (PRO 110) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51

538 . . . Creative Health Products . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

516 . . . PRO Orthopedic (PRO 180). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

503 . . . Dynatronics (Dynatron X5) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

530 . . . Pro-Tec (Ice Up) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

504 . . . Dynatronics (taping stations) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

531 . . . Pro-Tec (shoulder wrap) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

505 . . . Elations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

519 . . . PROTEAM (Modular Taping Stations) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51

539 . . . Fitnessrubber.com . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

518 . . . PROTEAM (team logo) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51

508 . . . HydroWorx . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

547 . . . Save-A-Tooth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58

507 . . . Jump Stretch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

537 . . . Shuttle Systems (Balance) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

522 . . . Keffer Development (Athletic Trainer System) . . . . . . . . . . . . . . . . . . . . . . . 52

536 . . . Shuttle Systems (Shuttle MVP) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

529 . . . Kneebourne . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

548 . . . Speed to Win . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

509 . . . Kustomer Kinetics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

520 . . . Sprint Aquatics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51

549 . . . Lifexpand (Glyc’N Go) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

524 . . . Swede-O. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

550 . . . Lifexpand (Lyte’N Go) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

535 . . . The Polar Pool . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

542 . . . Medi-Dyne Healthcare Products . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

541 . . . Thera-Band®/Hygenic Performance Health® . . . . . . . . . . . . . . . . . . 57

510 . . . Multi Radiance Medical (LaserStim) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

532 . . . Therapy Innovations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

511 . . . Multi Radiance Medical (TQ Solo Laser) . . . . . . . . . . . . . . . . . . . . . . . . . . 50

521 . . . Watkins, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

552 . . . NASM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

534 . . . Whitehall Manufacturing (Hydrolift). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

540 . . . NCCPT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

533 . . . Whitehall Manufacturing (Thermalators) . . . . . . . . . . . . . . . . . . . . . . . . . . 55

523 . . . NExTT Solutions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

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MORE PRODUCTS Shuttle Systems 800-334-5633 www.shuttlesystems.com Used by 26 NFL teams, 20 NBA teams, 14 MLB teams, and counting, the Shuttle MVP helps you develop explosive functional power while reducing impact on the ankles, knees, hips, and spine. The patented Horizontal Rebounding Technology, shuttle glide, and padded kickplate give you a smooth, controlled exercise experience. Use sport-specific protocols with the MVP to increase functional power and muscle memory. Increase your athletes’ performance and prolong their athletic careers with the MVP. Circle No. 536 The Shuttle Balance from Shuttle Systems 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. 537 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 TR AINING-CONDITIONING.COM

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. 538 Fitnessrubber.com 888-894-0204 www.fitnessrubber.com Fitnessrubber.com is a new Web fitness resource that offers Manufacturer Direct Pricing for all your weight training needs. Check out the Flexgard brand of rubber-coated cast iron weight plates, available from 2.5 to 45 pounds.

The Grip collection features a three-handle grip design on all weight plates, even the 2.5- and five-pound weights. If you are looking for a one-stop shop to purchase your weight training equipment, including weights, racks, bars, and dumbbells, Fitnessrubber.com has exactly what you need. In addition to the already excellent savings, log on now and receive a $25 discount on your initial Web site order over $100.

Circle No. 539 NCCPT 800-778-6060 www.nccpt.com The National Council for Certified Personal Trainers is the only personal trainer certification company that compensates its members for referrals.

Members of the NCCPT receive up to 20-percent discounts on select products and services while receiving commissions on membership dues and referrals four levels deep. The NCCPT has been in business since 1995 and provides personal trainers with the tools to succeed in their field. Many companies recruit directly from the NCCPT. Call or go online for details.

Circle No. 540 Thera-Band/Hygenic Performance Health 800-246-3733 www.thera-band.com The new Thera-Band® Rehab and Wellness Station is designed for

strength, balance, and core training.

It features Thera-Band clip-connect resistance tubing, stability trainers, and the new Pro Series SCP™ exercise ball. It provides three planes of movement for upper- and lowerextremity strength training. Slide tracks with onehand lockdown capability provide significant flexibility for user setup, charting, and documentation.

Circle No. 541 Medi-Dyne Healthcare Products 800-810-1740 www.medi-dyne.com StrengthRite™ provides an innovative, proactive solution for the prevention and rehabilitation of ankle, shin, calf, and Achilles tendon injuries.

StrengthRite’s patent-pending design enables you to adjust the tension for varying levels of resistance and focus.

No other product on the market allows you to strengthen the muscles controlling all four planes of ankle motion this easily. StrengthRite provides one of the most cost-effective, complete anklestrengthening solutions on the market.

Circle No. 542 Perform Better 800-556-7464 www.performbetter.com Perform Better’s specially constructed Elite molded foam roller lasts up to three times longer than traditional white foam rollers. It will not break down or flatten out. Use it for self-myofascial release and alignment, and use the half-round version for balance and stabilization.

These rollers improve alignment and mobility while increasing core flexibility.

Request your 2008 Perform Better catalog by calling the company or going online today.

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MORE PRODUCTS Perform Better 800-556-7464 www.performbetter.com

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

New in the 2008 Perform Better Catalog, the Tiger Tail deep-pressure trigger-point massage tool relaxes, loosens, and soothes sore muscles and helps increase blood flow to massaged areas.

Designed with a neoprene rolling surface that helps relieve tightness and increase flexibility, it is available in 18- and 22-inch sizes. Request your 2008 Perform Better catalog by phone or online today.

Circle No. 544

Revolve to evolve. All athletes can intensify their workouts with the new Airope. With handles like a jump rope and soft PVC balls on the ends, this weighted rubber rope creates swing resistance, intensifying cardio conditioning and recruiting the upper body.

Perform traditional jump rope actions, incorporate it into sport-specific drills, or combine it with other equipment. It’s available in original and pro models—the pro has a thicker rope for increased resistance.

Circle No. 545 The X-Ladder from Power Systems features three separate sections for setting up multiple configurations, so

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athletes can perform forward, backward, and lateral movement patterns in the same run. Two sections measure 67 inches and one measures 158 inches. They attach together with buckles. The ladder has high-impact round PVC rungs that stay fixed and provide instant feedback when stepped on. The X-Ladder comes with its own carrying bag.

Circle No. 546 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

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MORE PRODUCTS degenerated cells. The patented basket and net container are designed to protect tooth root cells.

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

Circle No. 547 Speed to Win, Inc. 866-324-9282 www.speedtowin.com Speed to Win provides on-campus sports performance training centers for schools and athletic sites. The pro-

gram is delivered to your campus, so the whole team can train and improve together. Your on-site center comes with everything you need, from a worldclass curriculum accessed with Webbased software to state-of-the-art training equipment called SpeedStations, which are scalable to train both small and large teams. The Speed to Win training curriculum leverages years of experience training professional athletes such as Jamal Lewis, Osi Umenyiora, J.J. Hickson, and many others.

Circle No. 548

Lifexpand 866-399-5433 www.lifexpand.com

Concentra 800-232-3550 www.concentra.com

Glyc’N Go is a revolutionary new food supplement shown in controlled clinical trials to truly increase levels of nitric oxide and enhance blood flow to exercising musculature. This product also contains the only form of carnitine that is able to shuttle fatty acids into the mitochondria to serve as an energy source. Glyc’N Go is available in tasty chewable tablets, which provide a significantly faster dissolution rate than standard capsules.

Circle No. 549

Concentra is currently seeking certified athletic trainers for positions in its onsite occupational health clinics and medical centers.

As a leading provider of healthcare to the American workforce, the company operates more than 260 on-site facilities in 39 states and more than 320 medical centers in 41 states. You can earn a competitive salary and enjoy access to a complete benefits package. Visit Concentra online for more details on available positions and to submit your resumé.

Circle No. 551

Lyte’N Go from Lifexpand is a convenient, tasty, chewable electrolytereplacement tablet. In addition to electrolytes, allnatural Lyte’N Go contains vitamins and minerals that research has shown to be important for athletic performance, including vitamins B3, B5, B6, B12, and C, folic acid, zinc, chromium, and calcium. Several studies have found that these ingredients can reduce oxidative stress, boost energy, and aid in recovery after strenuous physical activity.

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 CD-ROM are now available at additional costs with the course purchase.

Circle No. 552

WEB NEWS Check Out Elite Resistance Products on NZ’s Site TurfCordz resistance products by NZ Manufacturing meet the demands of high-level athletic training. Leading professional sports teams and international Olympians train with TurfCordz for explosive start drills and power-building footwork to enhance performance through resistance. Visit the company’s Web site to view NZ’s extensive line of TurfCordz, StrechCordz, and MediCordz resistance products. You can purchase products, request a catalog, access usage guide brochures, receive overstock item discounts, and get free UPS Ground shipping to the contiguous U.S. on any order placed through the site (certain restrictions may apply).

SPRI’s Web Site Offers Valuable Free Videos The most popular features on SPRI’s Web site are probably the free exercise videos. SPRI offers more than 350 exercise videos, categorized by product, which you can view and also download to your computer or a video-enabled device, such as an iPod. The videos are great for adding exercise ideas to any workout routine or learning how to better utilize a new product you are interested in purchasing or have already purchased. The videos are used by personal trainers, coaches, and active individuals on a daily basis. Go online today to check them out for yourself.

www.spriproducts.com

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TESTIMONIAL

TESTIMONIAL

TESTIMONIAL

Develop Explosive Power While Protecting the Joints

Olympians Benefit from Top-Notch Treatment Tables

Four Products That Ease Athletes’ Pain

To develop explosive power, there is no substitute for jumping. However, jumping from a gravity-induced position can be risky. By training athletes from a horizontal position, the Shuttle MVP helps reduce the negative impact of load on the ankle, knee, hip joints, and spine.

The patented Horizontal Rebounding Technology, shuttle glide, and padded kick plate provide a smooth and controlled exercise experience.

“The Oakworks therapy tables supplied to the U.S. Olympic track and field team in Beijing performed

That’s why 26 NFL teams, 20 NBA teams, and 14 MLB teams use the MVP: New York Giants New England Patriots Buffalo Bills Miami Dolphins New England Patriots New York Jets Baltimore Ravens Cincinnati Bengals Indianapolis Colts Tennessee Titans Denver Broncos Oakland Raiders San Diego Chargers Dallas Cowboys Philadelphia Eagles Washington Redskins Chicago Bears Green Bay Packers Minnesota Vikings Atlanta Falcons Carolina Panthers New Orleans Saints Tampa Bay Buccaneers Arizona Cardinals St. Louis Rams San Francisco 49ers Seattle Seahawks New Jersey Nets Philadelphia 76ers Chicago Bulls Cleveland Cavaliers Indiana Pacers

Boston Celtics Los Angeles Lakers San Antonio Spurs Atlanta Hawks Orlando Magic Washington Wizards Minnesota Timberwolves Oklahoma City Thunder Portland Trail Blazers Utah Jazz Golden State Warriors Los Angeles Clippers Sacramento Kings Houston Rockets Memphis Grizzlies Toronto Blue Jays Cleveland Indians Minnesota Twins Chicago White Sox Oakland Athletics Los Angeles Angels Seattle Mariners Washington Nationals Philadelphia Phillies Milwaukee Brewers Chicago Cubs Pittsburgh Pirates Cincinnati Reds Los Angeles Dodgers

Shuttle Systems by Contemporary Design P.O. Box 5089 Glacier, WA 98244 800-334-5633 Fax: 360-599-2171 info@shuttlesystems.com www.shuttlesystems.com 60

T&C OCTOBER 2008

beautifully. With the incredibly high level of repeated use, with a variety of techniques and modalities, the Oakworks tables held up better than ever. With portability and table height adjustability, the Oakworks tables were able to accommodate every sports medicine professional. Thank you, Oakworks, for your contribution of high-quality therapy equipment to the U.S. Olympic effort.”

Benny Vaughn, ATC, LMT, CSCS Beijing, China, 2008

“I’ve found Pro-Tec products to be a great addition to my patient care, as they are very patient-compatible.”

Jim Whitesel, MS, ATC Former Seattle Seahawks Head Athletic Trainer (1976-1998) President, Whitesel Pro Therapy, Inc., Kirkland, WA “I have found the Iliotibial Band Wrap to offer unmatched effectiveness in alleviating conditions of iliotibial band syndrome. We are recommending it for our patients.”

Dr. Shintaro Ohtake Aim Treatment Center “Finally, because of the Shin Splints Compression Wrap, I feel no pain in my shins during strenuous activity.”

Lisa Duke Ballerina and Runner

Since 1977, Oakworks has been setting industry standards for quality and innovation, resulting in some of the finest portable, stationary, and electric-lift treatment tables and positioning devices in the marketplace.

The company’s products provide the basis for a wide range of treatment applications and procedures for the athletic training, physical therapy, medical imaging, spa, and massage therapy market sectors. Oakworks’ leadership, innovation, and work ethic truly set the company apart.

“Thanks to the Arch Pro-Tec, the plantar fasciitis in my foot has completely disappeared.”

Christina Cambra 3rd-Place Finisher, Ironman Austria

Oakworks 923 E. Wellspring Rd. New Freedom, PA 17349 800-916-4603 Fax: 877-562-4787 www.oakworks.com

Pro-Tec Athletics 2743 152nd Ave. N.E. Redmond, WA 98052 800-779-3372 pro-tec@injurybegone.com www.injurybegone.com

“With Ice Up, the benefits of ice massage are ready for me anytime, anywhere.”

Scott Jurek, PT Seven-Time Champion, Western States Ultra 100-Mile Marathon

TR AINING-CONDITIONING.COM

CEU QUIZ

T&C October 2008 Volume XVIII, No. 7

Training & Conditioning is pleased to provide NATA and NSCA members with the opportunity to earn continuing education units through reading issues of the magazine. The following quiz is based on articles that appear in this issue of Training & Conditioning. By satisfactorily completing the quiz and mailing it 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 63) that represents the best answer for each of the questions below.

Complete the form at the bottom of page 63, include a $25 payment to MAG, Inc., and mail it by November 30, 2008 to the following address: MAG, Inc., ATTN: T&C 18.7 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.

Bulletin Board (pages 4-6) Objective: Read summaries of the latest sports medicine news, research, and published studies.

1. What ratio of testosterone to epitestosterone does the World Anti-Doping Agency consider to indicate doping? a) 1:1. b) 2:1. c) 3:1. d) 4:1.

2. The Health Insurance Portability and Accountability Act: a) Helps protect the privacy of personal health information. b) Increases the speed of reporting. c) Helps delay the release of injury reports until Thursdays. d) Shifts responsibility to athletic directors.

3. A study from Harvard University has found that an elevated level of _____ may be a predictor for amenorrhea. a) Ghrelin. b) Progesterone. c) Testosterone. d) Leptin.

Comeback Athlete (pages 8-12) Objective: Follow the comeback story of a high school football player who had three surgeries in the same off-season.

4. What specific method was used to help the athlete in this article stay motivated? a) Positive feedback. b) Visualization exercises. c) Strengthening exercises. d) Two days off per week from rehabilitation.

The ZZZ Factor (pages 15-21) Objective: Learn about the importance of sleep for athletic performance and how to get athletes to make “sleep hygiene� a higher priority.

5. What regulates our circadian rhythm? a) Supraspinal nerves. b) Suprachiasmatic nucleus. c) Optic nerve. d) Circle of Willis.

6. The article indicates that approximately _____ hours of sleep per night produces optimal physical and mental health for teenagers and college-age people. a) Seven. b) Eight. c) Nine. d) 10.

7. Sleep stages three and four constitute: a) The doze-off stage. b) Light sleep. c) Deep sleep. d) REM. 8. The fifth stage of sleep is _____ sleep. a) Arousal. b) Light. c) Deep. d) REM. 9. It takes approximately how many minutes to complete one cycle through the sleep stages? a) 30. b) 60. c) 75. d) 90.

10. Growth hormone secretion occurs during which stage? a) The first. b) Light sleep. c) Deep sleep. d) REM. 11. Studies have shown that the primary physical effect of a sleep debt is: a) An altered ego. b) Flattened affect. c) A decrease in the rate of perceived exertion. d) A decrease in time to exhaustion during activity.

12. A landmark study indicates that additional skill proficiency gains occur after time is spent: a) Sleeping. b) Reading. c) Receiving coaching instruction. d) Static stretching.

Answer sheet is on page 63 TR AINING-CONDITIONING.COM

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61

CEU QUIZ Preparing for Battle (pages 23-29) Objective: See how a nutrition consultant works with wrestlers to create the best nutrition plan for yearround training.

13. During the wrestling off-season, wrestlers should take in how many extra calories per day for lean muscle building? a) 500. b) 100. c) 200. d) 1,000.

14. The author recommends that wrestlers consume _____ gram(s) of protein per pound of body weight per day when training to add strength during the off-season. a) One. b) 1.5. c) Two. d) 2.5.

20. It may take up to how many hours after a period of dehydration to replenish muscle glycogen and body fluid levels? a) 12 to 16. b) 16 to 24. c) 24 to 48. d) 48 to 72.

21. One of the best ways to maintain weight throughout the season is to: a) Consume protein shakes. b) Eat several small meals throughout the day. c) Use nutritional supplements. d) Drink more water.

Groin Pains (pages 30-35) Objective: Get an inside look at a college hockey team’s specialized training program for treating and preventing groin injuries.

15. Wrestlers should consume at least what percentage of their energy in the form of carbohydrates during the off-season? a) 25-45. b) 45-50. c) 50-55. d) 60-70.

22. William C. Meyers, MD, reports that what percentage of athletes requiring surgery for athletic pubalgia played soccer, football, or ice hockey? a) 25. b) 50. c) 75. d) 95.

16. During strength training, a 165-pound wrestler should consume _____ grams of fat per day. a) 43-53. b) 63-84. c) 90. d) 90-94.

23. _____ is the gold standard for resolving athletic pubalgia symptoms. a) Surgery. b) Rest. c) Stretching. d) Strengthening.

17. Weight loss should never exceed what percentage of an athlete’s body weight per week? a) .5. b) .75. c) 1.0. d) 1.5.

24. After experiencing a high rate of athletic pubalgia, the Cornell University men’s hockey team implemented a training program to address key weaknesses or movement limitations.

One year later, the team had: a) A 50-percent decrease in incidence. b) No new cases of athletic pubalgia. c) Only two new cases of athletic pubalgia. d) An 83-percent drop in days lost to soft-tissue injury.

18. High school wrestlers at NFHS-governed schools cannot drop below _____ percent overall body fat during the season. a) Seven. b) Eight. c) Nine. d) 10.

19. One study of NCAA champion wrestlers found their average body fat percentage to be: a) Five. b) Seven. c) 8.5. d) 10.2.

For the Record (pages 37-41) Objective: Understand how best to keep records on athletic injuries and learn how to put the information you collect to good use.

25. The most basic reason certified athletic trainers should document every action performed is that: a) Follow-up should be consistent. b) Multiple athletic trainers work in most athletic training rooms. c) Thorough record keeping is the standard of practice in the medical world. d) It promotes professionalism.

Answer sheet is on page 63 62

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TR AINING-CONDITIONING.COM

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 18.7 Quiz, 31 Dutch Mill Road, Ithaca, NY 14850, no later than November 30, 2008. Readers who correctly answer 70 percent of the questions will receive 2.0 BOC Athletic Training and 0.2 NSCA (two hours) CEU’s, and will be notified of their earned credit by mail within 30 days.

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

❏ $25 check or money order (U.S. Funds only) payable to: MAG, Inc. (please note “T&C 18.7 Quiz” on check) ❏ Visa

❏ Mastercard

❏ Discover

❏ American Express

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

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63

OVERTIME

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

WEEKLY BLOGS Lightning Safety

MONTHLY FEATURES Finding a Rhythm

While spring may be the time of year most often associated with thunderstorms, there’s plenty of action—and danger—in the skies during the fall. Numerous college and high school football games were delayed or ended early by lightning this season. Now is a good time to review the basics of lightning safety and some of the new technology that can help keep your athletes safe.

With school back in session, there is no shortage of headlines about automated external defibrillators (AEDs). This month, T&C examines AED news from around the country.

Back From Beijing

Spending most of their time working behind the scenes, athletic trainers rarely receive the kind of recognition their work deserves.

When they do make headlines, we like to spread the word with a selection of links to articles featuring athletic trainers in action.

David Andrews, ATC, Athletic Trainer at Gig Harbor (Wash.)

High School and Northwest Sports Physical Therapy, is back in Washington after spending the summer in Beijing as the Head Athletic Trainer for the U.S. men’s Olympic soccer team. In this interview, Andrews talks about preparing for the Olympics, making tough choices, and the difference between working with high school and Olympic athletes.

www.training-conditioning.com/blogs.php

www.training-conditioning.com/features.php ©2003| HAROLD EDENS

Athletic Trainers in the News

Check out the weekly blog on lightning safety for a review of the most up-to-date storm warning technology.

WWW.TRAINING-CONDITIONING.COM

Introducing. . .

DYNATRON X5™

Hear What Athletic Trainers Are Saying About Soft-Tissue Oscillation Therapy “The results are impressive. We notice immediate reductions in acute edema and joint stiffness.

“My athletes love the X5 unit. It is user friendly and allows us to treat both acute and chronic injuries with amazing success. The ability to treat multiple athletes with the dual channels is vital during preand post-practice treatments. You can actually see immediate results following treatment and more importantly, my athletes notice the difference.”

David Gable, MS, ATC, LAT, CSCS Associate Director of Sports Medicine Head Football Athletic Trainer Texas Christian University

The student-athlete’s response to the X5 has been highly positive. Our athletes are impressed by the immediate decrease in joint stiffness after treatment of an acute injury.”

Mike Cembellin, ATC Director of Sports Medicine Santa Clara University

“The X5 has been a huge addition to the way I treat my patients. I typically do not use modalities with my patients. However, after trying the X5 for a few weeks, I was convinced that it would become a permanent part of my treatment plan. Most patients feel the improvements in motion and pain immediately after the first treatment. The best part is, it lasts and the improvements are built upon each session. I’m glad that I added this to my bag of tricks.”

Mike Dixey PT, Cert. MDT, NASM-PES, CSCS Clinic Director Ortho Rehab Specialists, Inc. Eden Prairie, MN

Feeling is Believing!

Call Dynatronics for a Free Demo

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Circle No. 140

TIMING IS EVERYTHING.

When it comes to sport nutrition, timing is crucial.

Getting enough fuel to make it through another day of training, class, practice and studying can be difficult for today’s time-constrained student-athlete.

That’s where Collegiate branded products from CytoSport can help.

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Providing a combination of glucose, fructose, Polylactate , and electrolytes – Cytomax fuels and hydrates like no other sport drink today.

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Complex carbohydrates • Multi-source proteins • Advanced lipid complex

Muscle Milk® Collegiate nutritional shakes, powders and bars help athletes re-fuel after grueling workouts, practices and games. Muscle Milk Collegiate taken immediately post-workout helps stimulate glycogen replenishment along with muscle recovery and repair.

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©2008, CYTOSPORT, Benicia, CA 94510

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