July/August 2009 Vol. XIX, No. 5, $7.00
Taking the Lead
Proactive strategies for preventing heat illness Sports Chiropractic Treatment Recovery Recommendations
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July/August 2009, Vol. XIX, No. 5
contents
15 31 Bulletin Boards 5 North Carolina considers high school ATC requirement … New research on softball pitchers’ injury risk … Helping athletes with asthma … Cereal and milk: a simple recovery booster.
Comeback Athlete Jim Dray Stanford University
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Sponsored Page Fitness Anywhere
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Special Section 51 Supplier Web Site Directory Product News 59 Heat Stress Prevention 60 Aquatic Therapy 62 Ankle & Foot Care 64 Web News 65 More Products
68 Advertisers Directory CEU Quiz 69 For NATA and NSCA Members
72 Next Stop: Web Site On the cover: The University of Oklahoma’s Jermaine Gresham (pictured) is kept safe from heat illness through the efforts of athletic trainer Scott Anderson, who joins in a roundtable discussion on the topic beginning on page 20. Photo by AP Photos, Matt Slocum TR AINING-CONDITIONING.COM
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Treating the Athlete
Healing Hands
Sports chiropractic medicine is gaining broader acceptance as a remedy for joint instability, soft tissue dysfunction, and many other orthopedic problems. By Dr. Jim Kurtz Special Focus
the Lead 20 Taking A proactive approach and careful planning are critical for protecting
your athletes from heat illness. Here, experts weigh in with the latest advice on beating the heat. By Abigail Funk Optimum Performance
Rest of the Story 31 The Success-driven athletes push themselves harder and harder in the
weightroom, on the practice field, and in every other aspect of their lives. It’s up to you to teach them that rest and recovery are essential parts of the performance equation. By Dr. Terry Favero Leadership
39 If you understand HIPAA’s Privacy Rule and how it applies in your A Private Matter
setting, there’s no reason it should be a barrier to athletic training communication, a source of administrative headaches, or a cause to fear legal action. By Kenny Berkowitz Sport Specific
46 Mental acuity, reflex awareness, balance, and functional muscle Swing Theory
control are the key ingredients of a great golf swing. By Robert Mottram
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Editorial Board Marjorie Albohm, MS, ATC/L Director of Sports Medicine and Orthopaedic Research, Orthopaedics Indianapolis
Joe Gieck, EdD, ATR, PT Director of Sports Medicine and Prof., Clinical Orthopaedic Surgery, University of Virginia (retired)
Jon Almquist, ATC Specialist, Fairfax County (Va.) Pub. Schools Athletic Training Program
Brian Goodstein, MS, ATC, CSCS, Head Athletic Trainer, DC United
Brian Awbrey, MD Dept. of Orthopaedic Surgery, Massachusetts General Hospital, and Instructor in Orthopaedics, Harvard Medical School
Christopher Ingersoll, PhD, ATC, FACSM Director, Graduate Programs in Sports Medicine/Athletic Training University of Virginia
Leslie Bonci, MPH, RD Director, Sports Medicine Nutrition Program, University of Pittsburgh Medical Ctr. Health System
Allan Johnson, MS, MSCC, CSCS Sports Performance Director Velocity Sports Performance
Cynthia “Sam” Booth, ATC, PhD Manager, Outpatient Therapy and Sportsmedicine, MeritCare Health System Debra Brooks, CNMT, LMT, PhD CEO, Iowa NeuroMuscular Therapy Center Cindy Chang, MD Head Team Physician, University of California-Berkeley Dan Cipriani, PhD, PT Assistant Professor Dept. of Exercise and Nutritional Sciences, San Diego State Univ. Gray Cook, MSPT, OCS, CSCS Clinic Director Orthopedic & Sports Phys. Ther. Dunn, Cook, and Assoc. Keith D’Amelio, ATC, PES, CSCS Head Strength & Conditioning Coach/ Assistant Athletic Trainer, Toronto Raptors Bernie DePalma, MEd, PT, ATC Head Athl. Trainer/Phys. Therapist, Cornell University Lori Dewald, EdD, ATC, CHES Health Education Program Director, Salisbury University Jeff Dilts, Director, Business Development & Marketing, National Academy of Sports Medicine David Ellis, RD, LMNT, CSCS Sports Alliance, Inc. 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
Publisher Mark Goldberg
Maria Hutsick, MS, ATC/L, CSCS Head Athletic Trainer, Medfield (Mass.) High School
Jim Berry, MEd, ATC, SCAT/EMT-B Director of Sports Medicine and Head Athletic Trainer, Myrtle Beach (S.C.) High School
Christine Bonci, MS, ATC Co-Director of Athletic Training/Sports Medicine, Intercollegiate Athletics, University of Texas
July/August 2009 Vol. XIX, No. 5
Gary Gray, PT, President, CEO, Functional Design Systems
Editorial Staff Eleanor Frankel, Director Greg Scholand, Managing Editor R.J. Anderson, Kenny Berkowitz, Abigail Funk, Kyle Garratt, Mike Phelps, Dennis Read Circulation Staff David Dubin, Director John Callaghan
Tim McClellan, MS, CSCS Director of Perf. Enhancement, Makeplays.com Center for Human Performance
Art Direction Message Brand Advertising Production Staff Maria Bise, Director Jim Harper, Neal Betts, Natalie Couch
Michael Merk, MEd, CSCS Director of Health & Fitness, YMCA of Greater Cleveland Jenny Moshak, MS, ATC, CSCS Asst. A.D. for Sports Medicine, University of Tennessee
Business Manager Pennie Small Special Projects Dave Wohlhueter
Steve Myrland, CSCS Owner, Manager, Perf. Coach, Myrland Sports Training, LLC, Instructor and Consultant, University of Wisconsin Sports Medicine
Administrative Assistant Sharon Barbell
Mike Nitka, MS, CSCS Director of Human Performance, Muskego (Wis.) High School
Advertising Materials Coordinator Mike Townsend
Bruno Pauletto, MS, CSCS President, Power Systems, Inc.
Marketing Director Sheryl Shaffer
Stephen Perle, DC, CCSP Associate Prof. of Clin. Sciences, University of Bridgeport College of Chiropractic
Marketing/Sales Assistant Danielle Catalano
Brian Roberts, MS, ATC, Director, Sport Performance & Rehab. Ctr. Ellyn Robinson, DPE, CSCS, CPT Assistant Professor, Exercise Science Program, Bridgewater State College Kent Scriber, EdD, ATC, PT Professor/Supervisor of Athletic Training, Ithaca College Chip Sigmon, CSCS Strength and Conditioning Coach, Carolina Medical Center Bonnie J. Siple, MS, ATC Coordinator, Athletic Training Education Program & Services, Slippery Rock University Chad Starkey, PhD, ATC Visiting Professor, Athletic Training Education Program, Ohio University Ralph Stephens, LMT, NCTMB Sports Massage Therapist, Ralph Stephens Seminars 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
Advertising Sales Associates Diedra Harkenrider (607) 257-6970, ext. 24 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© 2009 by MAG, Inc. All rights reserved. Text may not be reproduced in any manner, in whole or in part, without the permission of the publisher. Unsolicited materials will not be returned unless accompanied by a self-addressed, stamped envelope. Periodicals postage paid at Ithaca, N.Y. and additional mailing offices. POSTMASTER: Send address changes to Training & Conditioning, P.O. Box 4806, Ithaca, NY 14852-4806. Printed in the U.S.A.
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Boils: tender, red lumps that swell and get pimple-like white heads. Boils can form on oily or moist skin such as neck, armpits, groin, and buttocks. Small red bumps that look like spider bites or ingrown hairs. Pain out of proportion to skin conditions. If you notice any of the below symptoms (or any abnormal skin conditions), , it could be a matter of life or death.
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Board N.C. Considers High School ATC Requirement After five North Carolina high school student-athletes died from catastrophic injuries this past school year, two bills intended to make high school athletics safer were introduced in the state legislature. One would require each of the state’s public high schools to employ a certified athletic trainer, and the other calls for the creation of a sports injury task force to study injury prevention and treatment options. The North Carolina Athletic Trainers’ Association (NCATA) pushed legislators to introduce the first bill. James Scifers, PT, SCS, LAT, ATC, President of the NCATA and Associate Dean of the College of Health and Human Services at Western Carolina University, says it is getting a lot of support from the athletic training community, school officials, coaches, and parents, but many are worried about funding. “We’ve estimated a $21 million price tag, and North Carolina, like many other states, is running a huge deficit right now,” Scifers says. “So while this bill is certainly timely due to the unfortunate deaths we’ve had, our economic situation is posing a real challenge. There are also logistical questions the NCATA is working on, like whether there are enough certified athletic trainers to fill the need.” The second bill would create a new task force made up of 14 members, including a sports medicine doctor, an athletic trainer, a high school coach, a high school athletic director, and a representative from the North Carolina High School Athletic Association. The group would be charged with studying prevention and treatment of sports injuries at the high school and middle school levels. Both bills have been introduced in the state house and senate, and await committee readings. In North Carolina, three committee readings are required before a bill can be sent to the floor for a vote. To view status updates on the bills, visit the North Carolina General Assembly Web site at: www.ncleg.net. Click on “Legislation/Bills,” then “Bill Look-Up” and search “H 1006” for the athletic trainer bill or “H 536” for the task force bill.
Windmill Pitching Carries Injury Risk An overwhelming majority of studies on the underhand throwing motion of softball pitchers say that it rarely results in injury. But some new research is challenging that conclusion, suggesting that the “windmill” pitch actually subjects the thrower’s biceps muscles to high forces and torques that pose significant injury risk. TR AINING-CONDITIONING.COM
The study, which appeared in the March 2009 issue of the American Journal of Sports Medicine, analyzed muscle firing patterns of three collegiate and four professional women’s softball pitchers. The authors used motion analysis and surface electromyography, which detects electrical potential generated by muscle cells when they contract. The data showed that unlike in a traditional overhand baseball pitch, where the maximum force occurs when a pitcher’s arm is cocked, the maximum force in a windmill delivery occurs when the arm circles from the nine o’clock position to the six o’clock position. It was also found that the biceps, not the elbow, receives the most stress. Lead researcher Nikhil Verma, MD, a sports medicine specialist at the Rush University Medical Center in Chicago, cautions that overuse injuries are a real concern for softball players and should not be ignored. “Competitive female pitchers often pitch in every game during a weekend tournament—the equivalent of 1,200 to 1,500 pitches in as little as three days,” he told Medical News Today. “This is the opposite of the baseball world, where pitchers receive three to four days of rest before returning to the mound.” To view the abstract of the study, “Biceps Activity During Windmill Softball Pitching,” go to: ajs.sagepub.com, click on “Archive,” then click on “March 2009.” To read an article from Training & Conditioning on overuse injury risks associated with windmill pitching, search “Checking the Windmill” at www.training-conditioning.com.
Helping Athletes With Asthma Are college athletic trainers lagging behind when it comes to managing asthmatic athletes? A study from Ohio State University revealed that few athletic trainers at NCAA institutions follow the asthma guidelines established by the National Institutes of Health (NIH). The study, published in the April 2009 issue of Medicine & Science in Sports & Exercise, was based on survey responses from 541 athletic trainers at NCAA schools. Slightly more than 20 percent of the respondents reported having asthma management protocols in place, while almost 40 percent said they do not require that a rescue inhaler be available at all practices, and more than 40 percent said an inhaler is not required at games. All three are recommended by the NIH. While almost one quarter of survey respondents reported having a pulmonologist on staff, only 17 percent said their athletes are screened for exercise-induced bronchospasm (EIB). Lead researcher Jonathan Parsons, MD, Associate T&C july/august 2009
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Bulletin
Board Director of the Ohio State University Medical Center’s Asthma Center, said athletes often ignore the symptoms of EIB, assuming that wheezing, coughing, and shortness of breath are signs of being out of shape. He also emphasized that preparedness is key when it comes to asthmatic athletes. “Evidence has shown that outcomes are better when … the proper help is available,” Parsons said in a press release. “Since it’s impossible to predict an asthma attack, we need to be prepared for when it happens.” To view the abstract of the study, “Management of ExerciseInduced Bronchospasm in NCAA Athletic Programs” go to: www.ms-se.com, click on “Archive,” and select “April 2009.”
Fueling For Recovery—With Breakfast Most people remember being told as children at the breakfast table to eat their cereal. According to research from the University of Texas, athletes can benefit from that same advice after workouts. The study, appearing in the May 2009 issue of the Journal of the International Society of Sports Nutrition, compared two groups of cyclists: One6/19/2009 that drank sports drink, and Nolaro24_TC_071009flatB.pdf 11:20:49aAM
another that ate whole grain cereal with nonfat milk, both following moderate exercise sessions. Researchers found that both methods helped initiate muscle recovery equally. A dozen trained cyclists (eight men and four women) cycled at a moderate pace for two hours, then consumed either a sports drink with 78.5 grams of carbohydrate or a bowl of cereal and skim milk with 77 grams of carbohydrate, 19.5 grams of protein, and 2.7 grams of fat. Blood samples were taken before the workout and at 15-minute intervals for one hour after the workout, and showed similar glycogen and muscle protein levels in both groups. “Our goal was to compare the whole grain cereal plus milk, which are ordinary foods, and sports drinks after moderate exercise,” Lynne Kammer, MA, exercise physiologist and lead researcher for the project, said in a press release. “We wanted to understand their relative effects on glycogen repletion and muscle protein synthesis for the average individual. Cereal and nonfat milk are a less expensive option than sports drinks … making this an attractive recovery option for those who refuel at home.” To view the abstract of the study, “Cereal and Nonfat Milk Support Muscle Recovery Following Exercise,” go to: www.jissn.com, click “Browse articles,” then “May 2009.”
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ComebackAthlete
Jim Dray Stanford University By R.J. Anderson
It was a play Jim Dray had made countless times before. While covering a punt midway through the 2007 season, the Stanford University redshirt sophomore ran downfield hunting the Texas Christian University return man. Out of the corner of his right eye, he saw a Horned Frog blocker lining him up for a blindside hit. Dray reacted quickly, planting his left leg into the grass and lowering his right shoulder to initiate contact and beat the defender to the punch. As the two players collided, the force of the hit flowed through Dray’s shoulder and down the rest of his body, twisting his core and shifting most of the weight to his left leg. With his left foot still planted in the ground, his knee buckled and his thigh kept shifting to the left. “That’s when I heard tendons and ligaments ripping and popping,” recalls Dray. “I crumpled to the ground. The pain was excruciating.” Remarkably, Dray was able to get to his feet and limp to the sideline under his own power before collapsing. Stanford Head Football Athletic Trainer Steve Bartlinski, ATC, PTA, made his way to the injured player. “Jim was yelling, ‘my knee, my knee!’ So we got him on a sideline athletic training table,” says Bartlinski. “It was obvious he had multi-ligament instability. Based on how loose the knee felt, I figured he had multiple torn ligaments.” An MRI revealed even more damage than that. In addition to tearing his anterior cruciate ligament (ACL), medial collateral ligament (MCL), lateral collateral ligament (LCL), and meniscus, Dray had ruptured his popliteus and distal biceps femoris—he had essentially shredded his knee and ripped his hamstring from the bone. It was a devastating injury. “I’d heard about similar incidents, but I had never seen anything like it,” Bartlinski says. “In most cases I’ve read about, it took years of rehab and usually the guy never made it back to his pre-injury ability, or he didn’t make it back to the field at all.” The diagnosis hit Dray hard. “I knew what an ACL was, but I didn’t know anything about the other stuff—it all sounded pretty bad,” he says. “I freaked out for a minute, but once our team physician sat me down and explained all the options, I calmed down. He told me something like this could take TR AINING-CONDITIONING.COM
A torn ACL, MCL, LCL, and meniscus cut tight end Jim Dray’s 2007 season short, but he returned in 2008 and caught touchdowns in two of his first three games post-injury. two years to come back from, but he’d put me on a plan that would get me back faster than that.” True to his word, Team Physician and Orthopedic Surgeon Jason Dragoo, MD, and the rehab team had Dray back on the field the following season. After two surgeries, countless hours of hard work, and a complete team effort, Dray reclaimed his position as the starting tight end, was a huge contributor to the Cardinal offense and special teams, and even scored a touchdown in his second game back. Along the way, Dray’s rehab did more than rebuild his knee—it also united a rehab team that began the 2007 season on relatively unfamiliar ground. That January, Bartlinski had been named Head Football Athletic Trainer after spending a year caring for the school’s track and field teams, and Dragoo had moved into a new role as Head Team Physician for the football program. At the same time, Stanford also hired Head Football Coach Jim Harbaugh, who in turn brought along Shannon Turley, CSCS, as the team’s Strength and Conditioning Coordinator. Along with Director of Athletic Training and Rehabilitation Moira Jamati, ATC, PT, CSCS, Bartlinski, Dragoo, and Turley R.J. Anderson is an Assistant Editor at Training & Conditioning. He can be reached at: rja@MomentumMedia.com. T&C JULY/AUGUST 2009
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ComebackAthlete
Jim Dray Stanford University Sport: Football Injury: Torn anterior cruciate ligament, medial collateral ligament, lateral collateral ligament, and meniscus; ruptured popliteus and distal biceps femoris. Result: Returned to the field nearly a year after his injury and soon regained his starting tight end position. Quote from Athlete: “Fixing so many things in such a short time was incredible. [The rehab team] had never seen an injury like mine, but it didn’t seem that way. They were always in sync with one another, and I owe them a lot of gratitude.”
formed the core of the football program’s rehab team, and Dray’s case marked the first major injury that would require an intensive group effort. Coordinating their roles in rehabbing such a multi-layered injury kick-started an expedited feeling-out process based on trust and frequent communication. “After Jim got hurt, Dr. Dragoo and I had twice-a-day conversations about the surgeries and how Jim was progressing,” says Bartlinski. “Once he started his rehab, our entire team—physical therapy, athletic training, and strength and conditioning—met almost daily and exchanged lots of e-mails and phone calls to update each other.” Dray underwent surgery on Oct. 18, five days after he sustained his injuries. During that procedure, Dragoo repaired the LCL, biceps femoris, and popliteus. “Once we realized he had muscle damage, we concluded that needed to be fixed first,” says Bartlinski. Dray emerged from the surgery with an eight-inch incision on a left leg that required complete immobilization. For the next month, he rested and allowed the incision to heal. 10
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A week before the second surgery, Dray began seeing Bartlinski and Jamati multiple times a day to prehab for the procedure to repair his ACL. During that time, they worked on very basic range of motion increases and inflammation control. “That was a very tricky period because we needed the hamstring and LCL to heal and keep those surgical repairs as stable as possible, so we couldn’t really push the envelope,” Bartlinski says. Unable to get aggressive prior to and just after the second surgery, Bartlinski used continual passive motion and oscillation therapy to promote lymphatic drainage. “We had considerable success with oscillation therapy to decrease swelling,” he says. “The device we used looks like a stim unit with two pads. I put one pad on Jim and one on myself to complete a circuit, and then massaged the injury as low-level electrical currents surged through both our bodies. “We had just gotten the device when Jim was injured, so he was one of the first patients I used it on,” continues Bartlinski. “We’ve had great results with it. We’ve done girth measurements while we treat athletes and have seen reductions in swelling of two to three centimeters per treatment.” Once his incisions healed, Dray began what Bartlinski describes as a standard ACL rehab that was initially focused on managing swelling, restoring ROM, and improving lateral and anterior stabilization. Six weeks post-surgery, Dray met Dragoo’s goal of having 90 to 110 degrees of ROM in his knee. But because the hamstring repair was still healing, Dray was prohibited from doing upper-body lifts. “When guys do lifts like the bench press, they tend to dig their feet into the ground, and we didn’t want him to activate that hamstring while it was still healing,” Bartlinski says. “So during that time he only did very basic lower-body work, like the straight-leg extension lift series, glute activation, and shortarc quad work.” By week 12 after the second surgery, the goal was for Dray to achieve full ROM—a goal he narrowly missed and still hasn’t reached, but that didn’t impede his progress. For the next six weeks he performed stationary bike work, core and upper-body lifts, and more aggressive lower-body work, including partial weight-bearing unilateral and full weightbearing bilateral closed-chain exercises. The goals for week 18 were for Dray to perform a singleleg squat to 60 degrees and progress to closed-chain, multiplane exercises, while also advancing his proprioception and strength work. During this phase, he began right lowerextremity lifting as well as elliptical and Stairmaster work. By week 24, Dray was doing straight-line running drills and select lower-extremity lifts. Throughout those first six months, Dray became a fixture in the athletic training and physical therapy facilities. “I saw Jim every day, sometimes four times a day,” says Bartlinski. “Sometimes the session was a 20-minute ice and stim between classes, and other times he’d be here for an hour and a half doing rehab exercises.” Through all the monotonous, grinding work, Dray never missed an appointment. “Jim stayed here during all his TR AINING-CONDITIONING.COM
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ComebackAthlete breaks from winter through summer—he even got treatment here on Christmas Day,” says Bartlinski. “I would like to say we had a huge role in motivating him, but he did that all on his own.” In June, Dray was released to do all of his strength and conditioning work in the weightroom, which decreased his
“When he scored, we all just stopped for a second and time stood still,” recalls Bartlinski. “Then I turned to Coach Turley and said, ‘Job well done.’ We shook hands and hugged. Moments like that are why we do what we do.” time in the physical therapy and athletic training facilities. He quickly grew stronger and regained the 25 pounds he’d lost due to inactivity. When the team began its training camp in August, Dray was a spectator, but he was feeling stronger by the day. On Sept. 3, he was cleared to return to the practice field for noncontact football activities. That’s when Bartlinski knew his patient was close to full strength. “The team had a day off, but Coach Turley, myself, and my six-year-old son had Jim out on the practice field doing a passing route progression and he looked great,” Bartlinski
says. “I remember that day, because my son looked at me and said, ‘Why are we here? He doesn’t look like he’s hurt.’ We all laughed about it, but my son was right—Jim looked completely healthy.” Two weeks later, Dragoo released Dray to begin contact drills in practice. On Sept. 20, after practicing for a week without limitations, he took the field against San Jose State University for about 15 plays. The next week, against the University of Washington, he was in for 20 plays and caught a touchdown pass. It was an emotional six points for Dray and his rehab team. “When he scored, we all just stopped for a second and time stood still,” recalls Bartlinski. “Then I turned to Coach Turley and said, ‘Job well done.’ We shook hands and hugged. Moments like that are why we do what we do.” As the season rolled on, so did Dray. He didn’t miss a game, practice, or training session, and never had to take any plays off because of knee soreness. He was functioning virtually as though he’d never been injured. By his third game back, he regained the starting spot he’d held as a freshman and sophomore. This season, Dray hopes to maintain his starter status and contribute to the team any way he can. And although he is healthy, he continues to do supplemental rehab to maintain stability and build up the muscles around the injury site. In addition to the team strength and conditioning program, he performs short arc work, step-down progressions, balance
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ComebackAthlete progressions, and single-leg exercises. Bartlinski calls Dray’s story the best comeback he’s ever been involved in. “It was a big team effort, but ultimately it came down to his will,” Bartlinski says. “The physician can only repair the injury, and the physical therapist and athletic trainer can only direct the rehab—the patient is the one who determines how well it turns out. The real keys to Jim’s return were his hard work and positive attitude.” Dray says his motivation stemmed from his love of the game and his dream of playing in the NFL. Throughout his comeback, thinking about a friend and teammate’s career-ending neck injury helped him keep everything in perspective. “I wasn’t ready for my career to end,” says Dray. “When things got tough, I would think about my friend who was forced to quit the game after breaking his neck, and how disappointed he is not to be playing anymore. I knew if I worked hard, I would be able to play again, and that one day I’ll be able to leave the game on my own terms.” Dray also credits the time and effort Bartlinski and the rest of the rehab team dedicated to him. “They were as invested in the process as I was,” Dray says. “They came up with a great blueprint and I tried to follow it as closely as possible. “Fixing so many things in such a short time was incredible,” Dray adds. “They’d never seen an injury like mine, but it didn’t seem that way. They were always in sync with one
another, and I owe them a lot of gratitude.” In addition to the team approach and Dray’s hard work, Bartlinski credits Dragoo’s surgical touch and rehab strategy. “He drew up an integrated program that incorporated athletic training, strength and conditioning, and physical therapy,” Bartlinski says. “He gave us a nine-month timeline from the completion of the second surgery and guidelines like, ‘At week 10, I want unilateral closed-chain exercises to 60 degrees of flexion.’ He pointed us in the right direction, then opened it up for our input in terms of choosing therapies and exercises, and trusted us to do our jobs.” Bartlinski says that trust is something he tries to incorporate into his own practice. “I approach sports medicine’s relationship with strength and conditioning as a cooperative,” he says. “When an athlete is cleared back into strength and conditioning, there is some advisement from me, the physical therapist, and the physician, but Coach Turley is allowed to do his job and design workouts that contribute to the rehab program.” Aside from Dray’s return to the field, the lasting legacy of his rehab, Bartlinski says, is the open communication that developed among all members of the sports medicine team. “We have weekly meetings between physical therapy, strength and conditioning, and athletic training about all of our rehabs,” he says. “Jim’s case brought us together and helped set the tone for the way we do things today.” n
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Sports chiropractors including Dr. Jim Kurtz (at right) provide care for athletes at the Cascades Edge Triathlon in Washington.
Ming Ming Su-Brown
HEALING HANDS
By Dr. Jim Kurtz
W
hen many people think of chiropractors, they picture a group outside of mainstream medicine, relying on a pseudo-science based on spine cracking, joint “adjusting,” and other practices of dubious benefit. In fact, in the 1960s, the American Medical Association called chiropractic “an unscientific cult whose practitioners lack the necessary training and background,” and went on to say it was “a hazard to rational health care … because of its substandard and unscientific education of its practitioners.” But as both chiropractic and traditional medicine have evolved, more and more physicians are realizing the genuine value that today’s chiropractors can add to programs for performance enhancement and injury prevention and treatment. In the athletics world in particular, the benefits of modern chiropractic care have spoken for themselves, and it’s now common to find chiropractors treating athletes at virtually all levels, from high school to the NFL to the Olympics to the Senior PGA Tour. So what exactly do sports chiropracTR AINING-CONDITIONING.COM
Sports chiropractic medicine is gaining broader acceptance as a remedy for joint instability, soft tissue dysfunction, and many other orthopedic problems. Is it time to adjust your perception of this emerging field? tors do, and how can they benefit your athletes? In this article, I’ll answer those questions and provide an overview of this progressive and often misunderstood branch of sports medicine. I’ll also tell you how to identify chiropractic specialists who have the training to make a truly positive difference for your athletes. IMBALANCES & INJURIES A chiropractor’s approach to sports medicine is typically concerned with two main facets of orthopedics: joints (both in the spine and the extremities) and soft tissue. When a sports chiropractor examines an athlete’s body, he or she is typically looking for any type of dysfunction that can be addressed with treatment.
Joints. There are three main types of joint dysfunction that chiropractors can treat. Hypomobility occurs when the joint has an inadequate or abnormally limited range of motion. Hypermobility is just the opposite, when the joint has too much motion or laxity. Aberrant mobility can include elements of both other types, and refers to any abnormal movement patterns within a joint—this is often seen in athletes with degenerative joint conditions. Joint hypomobility often develops after a sports injury and commonly produces symptoms of pain and reduced function. Hypomobility can also result after immobilization of a joint following an injury or surgery. The term subluxation is sometimes used by chiropractors to describe limited joint motion with soft tissue changes and possibly nerve irJim Kurtz, DC, DACRB, CCSP, CSCS, CES, PES, is clinic director for NW Sports Rehab in Federal Way, Wash., and was Team USA’s chiropractor for the 2008 Paralympic Games. He serves as a consultant to college and pro athletes in several sports, and can be reached at: jkurtz@nwsportsrehab.com. T&C JULY/AUGUST 2009
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TREATING THE ATHLETE ritation. Soft tissue conditions can also cause joint dysfunction, or joint dysfunction can cause soft tissue changes. Hypermobility is commonly seen after an injury such as a sprain or a tear of
and over time results in a breakdown of the cartilage, which can lead to arthritis or osteoarthritis. Athletes don’t typically present with aberrant mobility until their 30s or 40s, depending on ac-
There are neurophysiological benefits as well. These come primarily from changes in the activity of the mechanoreceptors within the joint capsules, and include relaxation of muscle hypertonicity and facilitation of inhibited muscles. a ligament, especially in highly mobile joints like the knee. In the spine, hypermobility is most common in the lumbar and lower cervical regions, where there is more movement and a higher risk for repetitive overstress injuries. Repetitive overuse stretches the ligaments in these areas and results in ligament laxity and pain with activity. Aberrant mobility is often the end result of incomplete or improper rehab following a joint laxity problem. The excessive movement causes increased shear forces across the joint cartilage
tivity level—for example, many soccer players experience degenerative changes in the foot and ankle by their early 30s due to a history of ankle sprains. Likewise, pro golfers may see degenerative changes with aberrant mobility in their lower lumbar spine due to years of repetitive rotational forces. Soft tissue. The most common soft tissue injury in athletics is a muscle strain. Medical imaging studies have shown that most muscle strains occur at a muscle-tendon junction or tendonbone junction, and muscles that cross
two different joints are especially prone to strains. Athletes who participate in sports that require quick bursts of speed, such as football, basketball, and soccer, are at highest risk for muscle strains. Strains and other muscle injuries are painful and can be debilitating. But just as troublesome, they can also lead to chronic muscle tightness and, eventually, muscle imbalances. Czech physician Vladimir Janda researched and wrote extensively about muscle tightness and shortening, and was a pioneer in the treatment and rehabilitation of soft tissue conditions. He was among the first to recognize and study the relationship between joint dysfunction and muscle imbalances, and he wrote seminal papers on how as the non-contractile elements of a muscle shorten, the muscle spindle adapts to this new length, and the muscle then becomes hyper-excitable. According to his analysis, the hyperexcitable or facilitated muscle then begins to fire when it’s not supposed to, leading to overuse and further tension. This increased tension, in turn, leads to inhibi-
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TREATING THE ATHLETE tion (lack of full firing) of the corresponding antagonist muscle. Let’s explore an example of how this concept applies to a common sports injury. When a soccer player strains a hip flexor during activity, or the hip flexor begins tightening due to overuse, the flexor muscle shortens and reflexively inhibits its antagonist, the gluteus maximus. Because the gluteus maximus isn’t firing completely, the athlete becomes susceptible to pain in the knee, hip, and low back, since the hip flexor or psoas muscle attaches to the lumbar spine and hip. When the muscle is too tight or in a shortened position, it can create joint dysfunction in the lumbar spine, sacroiliac joint, or hip joint. Furthermore, with the gluteus maximus not firing properly, a host of other biomechanical problems may result. If the hip and pelvis are not stabilized adequately by the gluteus, this can further increase loading on the low back, hip, and knee joints. A gluteal weakness can also increase pronation in the foot and internal rotation of the leg, resulting in knee valgus (inward pointing or “knock-knees”). Depending on the athlete and the length of time they have this dysfunction, the iliotibial band may tighten due to the knee valgus and overpronation, which can exacerbate other conditions and lead to iliotibial band syndrome. In the end, an athlete who began with a simple strained hip flexor can end up with dysfunction and pain in the low back, hip, and knee joints. All told, this may result in decreased performance, overuse injury, and significant prolonged pain and discomfort. CHIRO INTERVENTION A sports chiropractor can not only address dysfunctions like those described above through hands-on manipulation, but also assess and treat muscle imbalances and prescribe exercises and stretches to correct the imbalances and prevent them from returning. Chiropractors have a thorough understanding of proper joint function, biomechanics, soft tissue flexibility, movement patterns, and rehabilitation protocols, and this comprehensive approach to orthopedic care is essential for optimizing outcomes. Chiropractors are traditionally associated with spinal and extremity manipulation or adjustment, and indeed, this is one of the profession’s primary tools. The main purpose of manipulation is to correct joint dysfunction or hypomobility, which mechanically restricts the movement of a joint and can lead to increased strain on the tissues that move the joint and those that must compensate for the lack of movement. Manipulation helps to remove mechanical restrictions, increase range of motion, and eliminate excessive strain. Usually, several treatments are needed to achieve lasting results and longterm pain relief. In addition to the mechanical effects of manipulation, there are neurophysiological benefits as well. These come primarily from changes in the activity of the mechanoreceptors within the joint capsules, and include relaxation of muscle hypertonicity and facilitation of inhibited muscles. Another neurophysiological benefit is the stimulation of mechanoreceptors, which helps block pain impulses and thus increases patient comfort. These effects can be produced through direct manual chiropractic treatment or with any number of adjusting instruments. The instruments are handheld devices placed on the patient that deliver a series of short, quick thrusts at varying speeds to stimulate the mechanoreceptors and produce moveTR AINING-CONDITIONING.COM
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LOOKING FOR A CHIROPRACTOR? Whether you’re looking to add a sports chiropractor to your program, or are simply interested in referring an athlete to a chiropractor for help with a specific condition, the resources listed below are excellent starting points for further information. • The American Chiropractic Association’s Sports Council: www.acasc.org • The American Chiropractic Board of Sports Physicians: www.acbsp.com • The American Chiropractic Rehabilitation Board: www.acrb.org • Active Release Techniques: www.activereleasetechniques.com • Graston Technique: www.grastontechnique.com • Sound Assisted Soft Tissue Mobilization: www.sastm.com • International Federation of Sports Chiropractic: www.fics-sport.org • Your state chiropractic organization
ment in the restricted joints. Chiropractors are like most other healthcare providers—the best ones have a large toolbox of techniques they can apply in response to problems they encounter. In addition to many varieties of manual adjustments and various adjusting instruments, there are also several different types of adjusting tables that can assist in an athlete’s care. One of the most popular is the flexion distraction table, which is frequently used to assist with flexing the spine during spinal adjustment. This table has a hinge that allows the half supporting the patient’s lower body to be flexed downward, essentially placing a traction on the spine. This stretches the lower back muscles and provides a gentle distraction force to make the adjustment process easier on the patient and the chiropractor. Another common apparatus, the drop table, has several hinged pieces— typically under the sections supporting the middle back, lower back, and pelvic area. The chiropractor can raise those sections up independently to make adjustments easier and more efficient. It also allows smaller chiropractors to deliver adjustments to larger patients with less effort and force. For manipulating soft tissue, chiropractors use many types of manual therapy, including Active Release Tech18
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niques (ART), the Graston Technique (GT), and sound-assisted soft tissue mobilization. These are used successfully to encourage suitable scar formation, mobilize soft tissue after acute and overuse injury, and eliminate, reduce, or stretch adhesions. They can also reduce abnormal cross-linkages,
to initiate the active care phase of the athlete’s recovery. The rehab exercises are an important part of successful chiropractic intervention—they help to restore proper firing patterns and further break the cycle of muscle imbalance and joint dysfunction. Daily activation of inhibited muscles, stretching, and the use of aids such as foam rollers can mobilize the hypertonic or facilitated muscles and improve overall muscle function. This active care phase of rehab is critical in developing strength, flexibility, endurance, proprioception, and balance following acute and chronic injuries. Without it, even the most skilled chiropractor’s manual adjustments won’t produce maximum results, as lingering muscle imbalances and the inevitable return of joint dysfunction will leave the athlete at risk for further injury. Many sports chiropractors have good working relationships with physical therapists, athletic trainers, and others who carry out the rehab phase of care, and some even work together in the same offices. FORMING A PARTNERSHIP If you’re thinking of adding a sports chiropractor to the treatment offerings in your program, it’s important to familiarize yourself with the extensive “alphabet soup” of credentials and
Rehab exercises are an important part of successful chiropractic intervention—they help to restore proper firing patterns and further break the cycle of muscle imbalance and joint dysfunction. Daily activation can mobilize the hypertonic or facilitated muscles and improve overall muscle function. eliminate or reduce pain-induced tissue reaction, remove chemical irritants and waste products by improving circulation and lymphatic drainage, promote muscle balance and proprioceptive input, and stretch and improve the flexibility of muscle and fascia. Soft tissue manipulation techniques are most commonly used on overly facilitated muscles to aid in inhibiting them, and on shortened muscle groups to lengthen them and help restore muscle balance. In a typical injury treatment, a sports chiropractor might begin by addressing soft tissue, then adjust any hypomobile joints, and finally recommend rehab exercises and stretches
continuing education that exists in the field. Finding a qualified chiropractor with specific knowledge of how to treat athletes is usually not difficult, but you have to know what you’re looking for. DC stands for Doctor of Chiropractic, and this is the degree all chiropractors receive after completing their education. Most DCs have a bachelor’s degree or complete a BS shortly after entering chiropractic college, since most schools require at least three years of pre-med studies before a prospective student enrolls. Chiropractic college is typically a four-year professional training program. For chiropractors who want to work TR AINING-CONDITIONING.COM
TREATING THE ATHLETE in sports, the most common credential you’ll see is the CCSP, or Certified Chiropractic Sports Physician. This involves a 120-hour postgraduate course in sports injury diagnosis, treatment, and rehabilitation. A DC with this credential has passed a written exam and must complete 12 continuing education unit hours each year. This is considered the minimum standard of postgraduate education in chiropractic sports injury care. The next credential to look for is the DACBSP, which denotes a Diplomate of the American Chiropractic Board of Sports Physicians. This credential is more advanced, requiring at least 320 hours of postgraduate study, plus written and practical exams, practical experience, and publishing a paper in a peer-reviewed journal. In addition, the DACBSP must complete 24 CEUs a year in sports injury care and maintain current CPR certification. The chiropractic profession has several diplomate programs in rehabilitation, orthopedics, nutrition, neurology, pediatrics, radiology, and other specialties. For instance, both the DACRB (Diplomate of the American Chiropractic Rehabilitation Board) and the DABCO (Diplomate of the American Board of Chiropractic Orthopedics) programs contain extensive training in the management of sports injuries and rehab. When looking for a sports chiropractor, you may also see the designations ART (Active Release Techniques), GT (Graston Technique), and CKTP (Certified Kinesiotaping Provider). Many sports chiropractors also possess the well-known CSCS, NASM-CES, and NASM-PES credentials. Professionals who have earned these certifications show a commitment to athlete care that goes beyond the borders of chiropractic medicine, and they would be a valuable asset to any sports medicine program. Beyond these established credentials, the U.S. Olympic Training Center recently added a new sports medicine fellowship program for chiropractors. The center continues to run a sports medicine volunteer program for chiropractors and other healthcare providers, offering additional experience in sports medicine and multidisciplinary teamwork. For this past summer’s Olympic Games, the U.S. Olympic Committee selected four chiropractors to join the U.S. Olympic medical staff to serve the
athletes in Beijing. Also, for the first time, the USOC selected a sports DC to serve on the U.S. medical team for the Paralympic Games in Beijing. Today, sports chiropractors are part of the medical staffs for most teams in the NFL, NBA, MLB, NHL, and MLS, and also provide services to the PGA Tour, Senior PGA Tour, ATP Tour, USA Track and Field, the X-Games, Ironman triathlons, and many other sporting endeavors. Sports chiropractic is an emerging field and is becoming an integral part
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of sports medicine and rehabilitation in countless settings. Our hands-on approach to care is valuable for correcting faulty biomechanics caused by joint dysfunction, assessing and correcting muscle imbalances, and helping athletes successfully return to play following injury. Having access to a qualified sports DC, on staff or on a referral basis, can add a new dimension to your department, helping to improve athletic performance, prevent and manage injuries, and expand the overall quality of care your athletes receive. n
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SPECIAL FOCUS The University of Oklahoma protects football players like Jermaine Gresham from heat illness with measures ranging from preseason screening to sideline cold water immersion.
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TAKING THE
LEAD A proactive approach and careful planning are critical for protecting your athletes from heat illness. Here, experts weigh in with the latest advice on beating the heat.
By Abigail Funk
I
t’s a nightmare scenario: During a hot, humid afternoon of two-aday preseason practices, a sudden silence falls over the football field. No yelling, no helmets crashing together—everything stops. Your heart drops as you race to the collapsed player on the sideline. Almost immediately, you recognize the signs of heat stroke. Virtually all athletic trainers worry about keeping athletes safe from the heat. Though there are plenty of proactive measures to take—immediate cooling devices, heat policies, emergency action plans—there is always a lingering concern that one of your athletes could be next. What are the most important precautions to implement in your program? How do you effectively educate your coaches about heat-related dangers? When can an athlete return to play? How do you separate heat illness fact from fiction? We asked some of the field’s leading heat illness experts to answer those questions and more. They also shared their latest research and provided their
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take on the recent legal proceedings in Kentucky, where a high school football coach is being criminally charged in the death of one of his players. All the experts agree on one thing: The more educated you are about heat illness, the better equipped you are to guard against it. What are the main things every program should do to protect athletes from heat illness? Michael Ferrara: You need to take readings so you know what type of environment your teams are practicing in. At the University of Georgia, we’ve done one of the few studies that looked at the relationship between the environment and exertional heat injury. One of the trends that emerged suggests that the risk for exertional heat illness increases as soon as the wet bulb globe temperature reaches 82 degrees Fahrenheit. That data has held true for the college football players we’ve studied for five years now. Sandra Fowkes-Godek: Athletes need
structured acclimatization. You can’t just start practicing two or three times a day in August, because players’ bodies are not ready for that. The acclimatization process will be different in different areas of the country. Kids in Florida, who live in 90-degree heat all the time, are much more acclimated to that weather than a kid in the northeast who only sees those conditions for two months out of the year. Jon Almquist: There needs to be an immediate cooling mechanism on the field. You can’t rely on having players take off their equipment and sit in the shade. We have a tarp that you can find at any hardware store for a few bucks. When we need it, we unfold it, have the kid lie down with his equipment off, have a few coaches gather up the ends, and pour ice water on him so he is submerged. It’s not a fancy cooling tub, but we don’t have to fill it and clean it out Abigail Funk is an Assistant Editor at Training & Conditioning. She can be reached at: afunk@MomentumMedia.com. T&C JULY/AUGUST 2009
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OUR PANEL Jon Almquist, ATC, is the Athletic Training Program Administrator for Fairfax County (Va.) Public Schools. He serves as Chair of the Athletic Training Advisory Board with Virginia’s Board of Medicine and is a member of the Sports Medicine Advisory Committee for the Virginia High School League (VHSL). He took the lead in developing heat illness prevention guidelines for both Fairfax County Public Schools and the VHSL.
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Scott Anderson, ATC, is Head Athletic Trainer at the University of Oklahoma. He is a member of the NATA Inter-Association Task Force on Safety in Football and former Co-Chair of the NATA InterAssociation Task Force on Sickle Cell Trait in Athletes.
Doug Casa, PhD, ATC, FACSM, FNATA, is Director of Athletic Training Education and a Professor in the Department of Kinesiology at the University of Connecticut. He is also the Associate Editor of the Journal of Athletic Training and was a writing group member of both the ACSM and NATA position statements on exertional heat illnesses.
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Michael Ferrara, PhD, ATC, FNATA, is Director of the Athletic Training Education Program and a Professor of Kinesiology at the University of Georgia. He is on the Board of Certification’s Board of Directors and a member of the NATA Research and Education Foundation Research Committee.
NO-DRIP DRINKING CART
Sandra Fowkes-Godek, PhD, ATC, is a Professor and the Medical Coordinator for the Department of Sports Medicine at West Chester University. She is also Director of the school’s HEAT (Heat Illness Evaluation Avoidance and Treatment) Institute, which aims to provide athletes and athletic trainers with unbiased information on thermoregulation and fluid and electrolyte balance.
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SPECIAL FOCUS every day and it has the same effect. The other thing everyone should have in place is some type of policy approved by the school system saying that when the humidity and temperature reach a specific level, there will be some sort of change in practice. Maybe that means no equipment, or helmets only, or more frequent breaks, but there has to be some accommodation for weather conditions. Doug Casa: Educating coaches, athletes, and parents is paramount. With parents especially, you have to throw the risks out there. They need to communicate with the athletic trainer if their kid has been sick with the flu for two days. Or if their child has sickle cell trait they are more susceptible to heat stroke, so they must tell the athletic trainer at the beginning of the year. You want the parents on board completely.
has been criminally charged in the heat-related death of a player? Ferrara: It certainly brings the issue of exertional heat illness to the forefront. I think all coaches should be certified in CPR and first aid, since coaches are on the front lines if a catastrophic injury occurs. You always want something positive to come out of a bad situation like this, so I hope we can learn from it. Casa: I think we’re going to see a lot more coaches held liable for their actions in the future. I also think the state legislature acted in a very poor manner
after the incident. They focused on requiring medical training for coaches instead of addressing the real issue, which is the need for more athletic trainers to provide competent healthcare. You don’t want a coach to be the one treating a child on the sideline in a life-or-death situation. Coaches don’t want anything to do with medical work. It’s unfortunate the legislature couldn’t be a little bolder and say that all schools in the state need to employ athletic trainers instead. Fowkes-Godek: Coaches have a re-
How has the standard of care for heat illness changed in recent years? Scott Anderson: There’s a greater trend toward cold water immersion as the treatment of choice. Here at Oklahoma, we
“Heat stroke is 100 percent survivable if the person is cooled right away, and yet we still lose people every year. It’s gut wrenching to find out someone died when it could have been avoided.” have implemented on-field immersion with a cold water tank. If there is any question at all about an athlete suffering from heat stroke, we can cool them immediately instead of having to transport them to the athletic training room. Casa: We’re still fighting the same battles we’ve fought for years. Heat stroke is 100 percent survivable if the person is cooled right away, and yet we still lose people every year. It’s gut wrenching to find out someone died when it could have been avoided if they’d been diagnosed and treated immediately. I think we’ve been very slow to progress, not just with heat illness, but also in the broader landscape of guarding against all sudden deaths. What is your take on the criminal case involving Kentucky high school football coach David Stinson, who
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SPECIAL FOCUS sponsibility to adjust practice by having their players wear less equipment, and they need to monitor athletes for behavior or symptoms that indicate a health problem. But for a coach to be held responsible for the medical care of an athlete is ridiculous. Yes, they need to be educated, but they are not trained the way an athletic trainer is, and shouldn’t be expected to make medical decisions.
How do you educate coaches about heat illness? Almquist: We take a proactive approach through mandatory education sessions. We also give our athletic trainers a lot of information on heat illness to share with coaches. The information is discussed with athletes as well, and that’s important. If a kid understands the warning signs and can say to an athletic trainer,
“With parents especially, you have to throw the risks out there. They need to communicate with the athletic trainer if their kid has been sick with the flu for two days. Or if their child has sickle cell trait they are more susceptible to heat stroke, so they must tell the athletic trainer at the beginning of the year.” They need to hand it off to an athletic trainer, period. Anderson: As athletic trainers, we have to be attentive to the potential legal issues involved with our jobs, but that can’t determine the way we do things. We need to make decisions based on what’s best for the athletes under our charge.
“Hey, this guy’s not looking so good,” the athletic trainer can intervene immediately, and that’s incredibly valuable. We’ve made great progress with our coaches. I no longer hear coaches boasting about how they never had water on the field back when they were playing. If they’re saying that at all, it’s to acknowledge that we’ve come a long way
and now know we must have water available for the kids. Anderson: I don’t think information about heat illness can be shared often enough. During two-a-days, there are 105 football players on the field, and I only have one set of eyes. If I’ve educated the coaches and players, that’s a lot more eyes that can recognize a potential problem at an early stage. Casa: Coaches care most about performance, so I’ve found it works best to explain that their athletes will perform better if they’re cool, hydrated, and able to recover between sessions. The athletic trainer has to get and keep the respect of coaches by allowing them to work their butts off trying to win the state championship, but also by keeping their athletes safe along the way. What is the best way to take environmental readings? Almquist: We use a wet bulb thermometer, which takes into account the air temperature and humidity, but not the impact of the sun. We’re located in Virginia, where if it’s humid it’s also hazy, so we don’t really have direct sun we need to account for.
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SPECIAL FOCUS Fowkes-Godek: In a perfect scenario, you’d have an intestinal sensor in everybody, but we know that won’t be the case for most schools. One way is to use weight charts, where you put athletes on a scale before and after practice to make sure they are rehydrating and replenishing between sessions.
But that doesn’t hold true everywhere. In places like Arizona, where it’s very sunny, a wet bulb globe thermometer is the best choice. Whatever method you use, I’m a big advocate of having the temperature monitored right on the practice field, because the field could be 10 degrees warmer—or 10 degrees cooler—than what your
“A specific ingredient in an energy drink or supplement may not be a problem by itself, but in combination with things like a really high glycemic load, ephedra, and intense exercise, it could pose a risk.” local radio station tells you. Casa: I definitely recommend a wet bulb globe over just the heat index, because it takes into account the impact of radiation from the sun. The guidelines on what that temperature means, however, are different depending on where you are. People in Mississippi and Louisiana can handle much higher temperatures than people in Maine.
But weight charts can be deceiving if you don’t know what to look for. It might seem like eight pounds is a lot of weight to lose during practice, but as long as the athlete comes back the next day at his regular weight, it’s fine. Another athlete, however, may only lose four pounds during practice, but if he doesn’t come back the next day weighing what he did before, that’s something to worry about.
How can you effectively monitor athletes for heat illness?
Energy drinks have recently surged in popularity with athletes. Can
these products contribute to heat illness risk? Almquist: We need to make sure people understand all the possible adverse effects of some of these products, including heat illness problems. We don’t really know all the effects those chemicals can have yet. It’s a problem we’re struggling with in our district—in fact, we recently banned energy drinks in athletics completely. Casa: We could pull 10 energy drinks off the shelf at random, and eight of them might be totally fine and two could pose a problem. It’s hard to group them all together in one category. We do know that caffeine can actually improve performance, and if taken in normal doses, it does not dehydrate the body. I’d prefer that athletes who are looking for a boost just get a set amount of caffeine that’s not in combination with a million other substances like you might find in an energy drink. Fowkes-Godek: I worry not just about energy drinks, but also about the supplements kids are taking. We really don’t have all the information on these products yet. A specific ingredient in an
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TREATING THE ATHLETE energy drink or supplement may not be a problem by itself, but in combination with things like a really high glycemic load, ephedra, and intense exercise, it could pose a risk. When an athlete asks me if a certain product would be bad for them to take, I don’t lie and say, “Yes, it’s bad, don’t take it.” I say, “Well, I’m not really sure, but my gut feeling is that a lot of the ingredients in here won’t do anything for you anyway, and there is potential to hurt your body, so let’s not go there.” When can an athlete who has suffered from heat illness return to play? Casa: With something like heat exhaustion, I would keep the person out for the rest of the day, and with the recommendation of a physician, consider having a modified practice the next day. With heat stroke, it’s a completely different story. We generally recommend that those athletes refrain from activity for a week. They need to see a physician for clearance to begin an extensive rehab process to return to activity. I’m talking about light exercise indoors, then heavier exercise indoors, then heavier exercise indoors with equipment on before even going outside. They can slowly work up their fitness level and acclimatize that way.
“One player might lose 10 times more sodium than another player during the same workout session ... We’ve been customizing replenishment programs for our salty sweaters, and we’ve been very successful with some of the adjustments we’ve made.” Almquist: It will always be on a case-by-case basis with a lot of close monitoring, but you need to know why he suffered from heat illness in the first place. Is it just because he’s out of shape? Has he been sick? If so, has he been sick for less than 24 hours, or longer than that? If he had a bad bout with some food last night, he might be okay to play sooner than if he’s been dehydrated for a week. We ask athletes to provide urine samples so we can test their hydration level. This can work really well in conjunction with your wrestling program in particular, since high schools across the country now need to keep track of their wrestlers’ hydration to comply with new safety regulations. What new heat illness research should athletic trainers be aware of? Fowkes-Godek: What I’m writing and revising right now has to do with the wide range of sodium losses that occur in athletes. One player might lose 10 times more sodium than another player during the same workout session. As part of my work with the Philadelphia Eagles and the Philadelphia Flyers, we’ve been customizing replenishment programs for our salty sweaters, and we’ve been very successful with some of the adjustments we’ve made. Ferrara: In the near future, we’re going to be expanding our research on piecing together the relationship between the environment and the rate of injury. Here in Georgia, 25 high Circle No. 122 TR AINING-CONDITIONING.COM
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SPECIAL FOCUS
Thirsty?
schools have signed on and received top-of-the-line wet bulb globe thermometers to take temperature readings over the next year while also keeping track of heat illnesses. We hope to see if the same trends we saw in the college population hold true for high schools. Anderson: Screening for sickle cell trait at birth is required across the U.S., but in a recent survey, only 37 percent of
“Environment and hydration are certainly factors, but people get too caught up in those areas alone. They create a false sense of security by thinking that as long as their athletes hydrate they’re in the clear.” parents with a child who has it reported they were told of a positive test. Overall, the rate of athletes with sickle cell trait who don’t know they have it is extremely high. Of the 18 football players we found to have sickle cell trait through screening here at Oklahoma, only two of them knew they carried it.
Hydration is our only Passion. It’s everything we do!
There’s also a perception that athletes will always have visible, obvious stages prior to heat stroke, but the initial signs and symptoms can actually be very subtle. A small change in an athlete’s mental status, like confusion or an odd behavior response, can easily be missed or misinterpreted. Fowkes-Godek: Many athletic trainers think a certain core temperature—104
What misconceptions about heat illness need to be cleared up? Anderson: Not everyone understands that exertional heat illness is more about exertion than anything else. Environment and hydration are certainly factors, but people get too caught up in those areas alone. They create a false sense of security by thinking that as long as their athletes hydrate they’re in the clear, when in fact the issue is multi-faceted.
degrees Fahrenheit, for example—means an athlete has heat stroke. But a lot of people actually deal quite well with a core temperature that high and may be completely asymptomatic. There is no cut and dried answer for what constitutes an unsafe core temperature. Almquist: Too many physicians say that heat illness deaths are always avoidable. Yes, we can do a lot to prevent them, but even if we have all the precautions in place—wet bulb thermometers on every field, certified athletic trainers at every practice, a heat policy—a kid who’s been sick for a week and is extremely dehydrated could still come to practice and want to impress the coach, work too hard, and collapse. I would love to say that we’ll never have a heat death, but I just don’t know that for sure. n
RESOURCES ACSM The American College of Sports Medicine’s consensus statements on heat illness and hydration are available by searching “heat illness” at: www.acsm.org. CDC The Centers for Disease Control and Prevention has a Web site devoted to extreme heat and its effects. A prevention guide, the signs and symptoms of heat illness, and extreme weather tips can be found at: www.bt.cdc.gov/disasters/extremeheat. NATA The NATA’s position statement and tips for recognizing, preventing, and treating heat illness can be found by searching “heat illness” at: www.nata.org.
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NCAA You can download the NCAA Sports Medicine Handbook, which contains the association’s guidelines and protocols for heat illness, by going to: NCAAPublications.com and clicking on “Health & Safety.” NFHS Hydration recommendations, administrators’ duties, and downloadable flyers on heat stress can be found by searching “heat illness” at: www.nfhs.org.
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The Rest of the Story
optimum performance
Success-driven athletes push themselves harder and harder in the weightroom, on the practice field, and in every other aspect of their lives. It’s up to you to teach them that rest and recovery are essential parts of the performance equation.
AP PHOTOS/Paul sakuma
By Dr. Terry Favero
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very athlete and every coach understands that hard work is a key to success. Athletes looking for an edge will train harder in an effort to outwork their opponents, teams going through a slump will try to “train their way out of it” by ramping up practices and workouts, and many athletes view working to exhaustion and beyond as a badge of courage and a sign of ultimate commitment. But there’s another component of athletic success that’s too often overlooked, and that’s recovery. When athletes do too much or coaches push too hard, the TR AINING-CONDITIONING.COM
regimen eventually becomes counterproductive—the body wasn’t designed to work without adequate rest. Evidence of this imbalance isn’t hard to find: In a recent survey of published literature, I found roughly 30 articles championing various training methods for every one article about the role of rest and recovery in the adaptation process. Planned recovery takes many forms, from improving sleep habits and eating patterns to scheduling days away from the gym that allow for regenerating tissue and rejuvenating the mind. Too many coaches spend their time scripting daily and weekly training programs, yet fail to
strategize for recovery and regeneration with the same depth and precision. Science has proven that proper recovery facilitates faster physiological adaptation and enhances performance. Ignoring recovery today leads to tomorrow’s poor practice session and, eventually, poor recovery habits that are tough to break. It Terry Favero, PhD, is Professor of Biology and Conditioning Coordinator for the women’s soccer team at the University of Portland. He has also worked with the U.S. Olympic Development Program, and can be reached at: favero@up.edu. T&C JULY/AUGUST 2009
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optimum performance also reinforces attitudes that can lead to overtraining injuries. But by taking advantage of planned recovery and making it an integral part of a comprehensive training program, you can help athletes
low an optimal recovery strategy. Today’s student-athletes must balance demanding training schedules with complex personal, social, and educational demands. The pressures of daily
Many athletes think recovery is about what they do immediately after a practice session. Others think it’s a state of being, and they’ll say they feel “recovered” after a practice or game and don’t need to do anything specific. But recovery isn’t about short-term activity or physical condition. experience the gains that elude them when they work hard, but not smart. STATE OF AFFAIRS Most high school and college athletes understand at least the basics of appropriate recovery. If they haven’t learned it from coaches, health classes, or other educational sources, they’ve at least felt the soreness after overworking their muscles, the fatigue from working out without proper fueling, or the overall misery of trying to function on too little sleep. And still, most athletes fail to fol-
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life are rarely factored into an athlete’s total training or overall workload, but they’re a major factor in the individual’s health and well being. What happens when an athlete has too many commitments and not enough time to meet them all? Recovery is usually among the first things to suffer. Rather than cut short a training session, they might skip a post-workout meal. Instead of missing practice to study for an exam or complete a class project, they’ll sacrifice a few hours of sleep that night. In the long run, these deci-
sions take a serious toll, both physically and mentally, and performance begins to decline. To better understand the current landscape surrounding this issue, I recently conducted an informal survey of high school and NCAA Division I athletes, examining nutrition, sleep, and recovery behaviors. While not scientifically rigorous (the sample size was only 40 people), the results provide an interesting snapshot that’s probably typical of many athletes in these age groups. Nutrition. I found no significant differences between high school and college athletes in eating habits—both were equally poor. Half the athletes skip breakfast at least once per week, while 20 percent said they miss it several times per week. Sixty percent reported missing other meals occasionally as well. Perhaps most troubling, only 46 percent of the athletes said they regularly eat within 60 minutes after completing exercise. Sleep. On average, most high school and college athletes get far less than the recommended eight hours of sleep per night. In fact, 38 percent of college freshman athletes in my survey get
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optimum performance less than seven hours in a typical night. Sleep is one of the most frequently mismanaged recovery habits among athletes of all ages, and the consequences are immense. Regular recovery activities. My survey showed that in general, high school athletes do more in terms of recovery activity than college athletes, but only when directed to do so by their coaches. Essential recovery activities include (but are not limited to) a daily cooldown, especially following demanding workouts, active re-stretching or lengthening of the most active muscle groups, and post-workout rehydration. In addition, foam rolling and deep static stretching should occur at least twice weekly apart from normal practice times. In the survey group, 52 percent of high school track athletes used a foam roller daily, compared with 18 percent of college track athletes. And 88 percent of the high schoolers stretched daily, compared with 53 percent of the college athletes. However, I found that in general, unless the coach leads a team through specific recovery activities, most athletes are consistently inconsistent in their recovery choices. The above data should sound an alarming note: Recovery behaviors for both high school and college athletes need serious attention. Athletes develop training habits at an early age, and most carry these habits—good and bad—into college sports. College often provides a wake-up call, since talented and healthy athletes might not have experienced any real consequences for poor habits in high school or club sports, where practices are far less demanding, competitive seasons are shorter, and athletes can get by on pure skill even if they’re not performing at 100 percent. SET OF SOLUTIONS Most of the athletes I surveyed said they rarely talk or think about recovery. Typically, no one tells them to monitor training and recovery activities, or to account for non-athletic stressors when planning their daily or weekly schedule. For that reason, it’s easy for them to ignore recovery habits until fatigue, underperformance, or injury set in—and by then, they’re forced to play catch-up. To improve this situation, all coaches and athletic trainers should be aware of recovery deficiencies and work constantly to teach athletes sound recovery strategies. This is especially important TR AINING-CONDITIONING.COM
for incoming freshmen at both the high school and college level, since they’re experiencing many lifestyle changes and have a great opportunity to incorporate new and better habits. In college, most athletic programs offer some form of academic guidance to ease the transition to college. This same concept can be applied to recovery education—eating habits at dining halls and on the road, sleeping patterns amid the newfound freedom of campus life, and recovery activities that fit into the college workout and practice schedule should be essential points of emphasis. Once an education program is in place, athletic trainers and coaches should devise a system to monitor recovery activities and reinforce good habits while modifying bad ones. (See “Recovery Scoring Guide” on page 34 for one example.) A sound monitoring system can also help athletes adjust their overall workload—athletic and otherwise—to a level that optimizes recovery. Education and monitoring are the two prongs of a successful recovery strategy, but implementing them can be a major challenge. I recommend basing your program’s recovery efforts around a specific continuum of habits to consistently remind athletes about the value of recovery on a daily, weekly, season-long, and yearly basis. Here are the essentials: Teach the concept. Recovery is a frequently misunderstood term. Many athletes think it’s about what they do immediately after a practice session. Others think recovery is a state of being, and they’ll say they feel “recovered” after a practice or game and don’t need to do anything specific. But recovery isn’t about short-term activity or physical condition—it’s a systematic and comprehensive program designed to maximize health and performance. Athletes must learn that true recovery encompasses several different responsibilities, including hydration, nutrition, sleep, and psychological or emotional well being. To experience all the benefits of the body’s complex recovery mechanisms, an athlete must establish and follow routines that provide consistent and adequate amounts of fuel, physical rest, and mental “time off.” Cool them down. The recovery process should begin as soon as the active phase of practice or a workout concludes. Coaches often call athletes together to summarize the day’s work, provide guidance for upcoming sessions,
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Recovery Scoring Guide Athletes can use this guide over the course of a week to assess their own recovery behaviors. Each day, they earn points for various recovery-related activities, including eating, sleeping, relaxing, and cooldown after a workout. Their total score for a day reveals whether they are paying adequate attention to physical and mental recovery needs. 17-20 daily points is optimal; 15-16 points is good but shows room for improvement; 14 or fewer points means the athlete needs a serious individual evaluation of recovery behaviors.
Possible Points Nutrition ......................................... 8 Breakfast........................................ 1 Lunch . ........................................... 2 Dinner............................................. 2 Pre-workout snack.......................... 1 Post-exercise carb ......................... 2 refueling within 60 minutes (recommended: 1.0 to 1.5 g per kg of body weight)
SCORING GUIDE ADJUSTMENTS Give 1⁄2 a point for a less than full breakfast Give one point for a less than full lunch Give one point for a less than full dinner Give one point for refueling below the recommended amount or for delaying more than 60 minutes.
Hydration......................................... 2 Pre-exercise urine:.......................... 1 clear or light color Post-exercise urine:........................ 1 clear or light color Sleep and Rest................................ 4 8 hours of restful sleep................... 3 Nap during the day.......................... 1
Give two points for 7 to <8 hours Give one point for 6 to <7 hours
Relaxation and Emotional Status.... 3 Fully relaxed 60 minutes .............. 1 post-workout or 30 minutes of feet-up relaxation post workout No daily psycho-social stress.......... 2 Stretching/Cooldown...................... 3 Adequate cooldown ....................... 2 after exercise
Give one point for mild stress Give one point for partial cooldown
Stretching for at least 10 minutes... 1 TOTAL............................................ 20 A printable full-page version of this guide can be downloaded at: www.training-conditioning.com/RecoveryGuide.doc.
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or prepare the team for competition. In most cases, athletes are then dismissed and they scatter—some get water, some do extra sport-specific work, and others head to the locker room or home to get on with their busy lives. What’s missing is an essential component of promoting team-wide recovery: cooldown. Structured cooldown activities address both physiological and psychological recovery. Most coaches recognize the physiological benefits, such as reducing blood lactate level, but few consider the psychological benefits, such as dampening nervous system activation. Slowly reducing the heightened state of the nervous system after athletic participation can lead to lower overall stress levels and more regular, restful sleeping patterns, particularly after evening workouts or practices. An easy and effective cooldown can involve simply modifying the dynamic warmup used to begin practice. For instance, the athletes I work with perform a warmup that generally consists of eight to 12 dynamic stretches of the major muscle groups, conducted while constantly jogging and progressing to running. For the cooldown, we perform almost the same set of stretches, but instead of transitioning from a jog to a run, we wind down from a jog to a walk. We hold the stretches for up to 20 seconds, and sometimes stretch the same body area more than once—for instance, if the day’s workout focused largely on the hamstrings, we’ll conduct two different hamstring stretches. I let the athletes select the cooldown stretches they want to perform, keying in on the body areas most in need of recovery. Kick-start restoration. Two of the most important restoration steps are post-activity treatment, such as hydrotherapy and massage, and immediate rehydration. To promote physical restoration, athletes can take simple steps such as contrast showers (alternating between hot and cold water) or warm showers coupled with self-massage. Contrast showers provide neural stimulation, while a 10-minute warm shower with self-massage promotes blood flow to muscles and overall relaxation. These strategies can help an athlete leave the sports environment alert but calm, and ready to transition to the next phase of the day. Hydration can best be addressed with sports drinks, which provide fluid along with electrolytes and carbohydrates. WaTR AINING-CONDITIONING.COM
optimum performance ter is an acceptable alternative, but is less advantageous because it can’t replace electrolytes such as sodium lost through sweat. The electrolytes in sports drinks also help to speed absorption of fluid from the gut after ingestion. A good rule of thumb on rehydration is that athletes should take in enough fluid to more than replenish what they lost from sweating. If it’s possible for athletes to weigh themselves before and after a workout, this provides an easy guide for how much fluid must be consumed. Refuel for recovery. Research has shown that carbohydrate replenishment should begin within 60 minutes of the end of training in order to promote maximum muscle glycogen restoration. During this 60-minute window, muscle membranes are primed for glucose entry and rebuilding, which essentially means faster muscle recovery. Delaying the post-workout meal will mean low glycogen stores the next day, which results in decreased muscle performance and lower overall energy. Following a heavy workout, research suggests that athletes should get between 1.0 and 1.5 grams of carbohy-
drate per kilogram of body weight per hour for at least two hours or until the next full meal. Some athletes don’t have a strong appetite right after workouts, so energy bars are a great way to bridge the gap until mealtime. A typical energy bar contains 40 to 50 grams of carbohydrate, and may also include protein that helps speed glycogen replacement in exhausted muscles. A 150-pound athlete is roughly 68 kilograms, so an energy bar and at least 24 ounces of a sports drink after workouts provides a great start to nutritional recovery. Sleep matters. A growing body of research is revealing the importance of sleep for recovery and mental and physical performance. Adolescents and young adults are notorious for haphazard sleep schedules, and they probably don’t realize the negative toll it takes on their health and athletic performance. The best advice for sleep is quite simple: Give yourself a bedtime and stick to it as often as possible. The body functions best when sleep habits are consistent. Once athletes establish a set routine that provides eight hours of sleep per night, they’ll find that they
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fall asleep faster once their head hits the pillow, and they probably won’t even need an alarm clock to get up at the same time each morning. Think short- and long-term. Daily, weekly, and mid-season rejuvenation planning can make a huge difference for individual athletes and entire teams. On a daily basis, athletes need structured downtime. They should be constantly reminded that daily activities like listening to music, reading for pleasure, and taking short naps can do wonders for the nervous system, promote relaxation, and give the musculoskeletal system a break. On a weekly basis, athletes should consider receiving a massage, performing some form of active recovery such as yoga, cycling, or swimming, and perhaps playing a sport other than their main sport to stay active but enjoy a break from structured training. In the middle of the competitive season, coaches might consider an occasional extra day off, a three-day weekend, or perhaps team activities such as barbecues or group walks during road trips. When rejuvenation-centered steps like
optimum performance these are neglected until stress and poor habits result in declining performance, it is often too late to change course and make any material difference. MONITORING PROGRESS The monitoring system on page 34 was initially developed as part of a program
and adapt more quickly, while those who average 14 or fewer recovery points are prone to maladaptive habits and overtraining. I have found that athletes like using a point system and may even engage in good-natured competition to see who can score higher, pushing each other toward better habits in the process.
With new athletes, the first step is to establish a baseline during the summer or non-competitive training season, typically with two weeks of data. Then, I’ll monitor recovery at critical times during the year. called the Total Quality Recovery System to help prevent overtraining in competitive athletes. The authors recommend that recovery behaviors be scored as a tangible indicator to help athletes avoid overstress. This particular version of the program has been modified to fit the needs I’ve discussed here. The system addresses all the critical areas of recovery, and research suggests that athletes who average 17 daily recovery points or more experience less fatigue
Implementing this system has allowed me to provide focused education about each of the components of proper recovery and its specific benefits. This makes the athletes more conscious of their recovery behaviors, and they’ve told me that when using the scoring guide, they are far more deliberate about their recovery than when not using it. The guide can be implemented in several ways depending on what best fits a team’s schedule and routines. I use
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it intermittently with athletes at key junctions when I sense recovery may be compromised. With new athletes, the first step is to establish a baseline during the summer or non-competitive training season, typically with two weeks of data. Then, I’ll monitor recovery at critical times during the year, such as during the transition to the competitive season, during planned increases in workout volume or intensity, or in the weeks leading up to major competitions. It can also help athletes keep on track during stressful non-athletic times, such as midterms. When athletes focus on their recovery as a team, with support and guidance from coaches and athletic trainers, they can experience tangible gains in the weightroom, during practice, on the scoreboard, and in virtually every aspect of their lives. By teaching them that what they do when they’re not running drills, lifting weights, or competing in their sport is just as important as the time they spend training and developing their skills, you can change the culture of an entire program and put athletes on the road to greater success. n
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A Private Matter S By Kenny Berkowitz
ix years after taking effect, the Health Insurance Portability and Accountability Ac t (H I PA A) Privac y Rule still confuses athletic trainers, coaches, administrators, and even lawyers. That’s not surprising— after all, the federal government’s “administrative simplification” exceeds 100 pages. But over time, as athletic trainers have scrambled to make sense of it, the outlines are becoming clearer. The Privacy Rule was created primarily to establish national standards for protecting the privacy and security of patients’ medical records. It was never intended to affect the care athletic trainers give their patients or complicate the work of healthcare providers. But even before the legislation was implemented, that’s exactly what happened. TR AINING-CONDITIONING.COM
If you understand HIPAA’s Privacy Rule and how it applies in your setting, there’s no reason it should be a barrier to athletic training communication, a source of administrative headaches, or a cause to fear legal action.
Across the country, high school and college athletic trainers worried about disclosing information to just about anybody. If a football player was injured during a game, what could they tell his coach? What could they tell the athletic director? What could they tell his parents? When a reporter called asking about an injury, what should they do? “In an effort to protect privacy, the
earliest drafts of HIPAA were very restrictive,” says Keith Webster, MA, ATC, Administrative Head Athletic Trainer at the University of Kentucky, who served as Chair of the NATA Governmental Affairs Committee when HIPAA was enacted. “The first version we saw would have required student-athletes to sign a release before a doctor could talk to their athletic trainer, and continue signing releases every step of the way. It was clearly going to be a roadblock to providing healthcare for our patients, and it was very scary.” The NATA voiced its concerns about the burdens HIPAA could place on athKenny Berkowitz is an Assistant Editor at Training & Conditioning. He can be reached at: kb@MomentumMedia.com. T&C july/august 2009
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LEADERSHIP letic trainers. Lawmakers listened, relaxing some of HIPAA’s restrictions and clarifying their intentions. They made it clear they wanted to encourage healthcare providers to communicate freely with athletic trainers about the patients they treat without compromising important protections. Their motive in drafting the legislation was ensuring that patient data wouldn’t be stolen or sold, and that outsiders wouldn’t have access to personal health information without a patient’s permission. In practice, the Privacy Rule has been much easier to navigate than athletic trainers initially feared. Still, the problems haven’t completely disappeared, and as Congress continues to refine HIPAA, athletic trainers are keeping a close watch. When Congress passed the American Recovery and Reinvestment Act of 2009, commonly called the economic stimulus bill, the rules for HIPAA changed again. New measures included a charge for violations due to “willful neglect,” a $100 fine for minor offenses, a broader application of criminal penalties, and a provision granting pa-
tients the right to sue for damages. “If your school is covered by HIPAA, now is the time to get much more serious about following the rules,” says attorney Maren L. Calvert, who specializes in medical malpractice and healthcare compliance. “With the stimulus bill, the regulations grew stricter and the penalties more onerous. And even though athletic trainers aren’t responsible for creating institutional policy, they’re the ones responsible for protecting their patients.” WHO’S COVERED After the dust settled, it became clear that HIPAA would not change the way most athletic trainers worked day-today. After all, many had long been working under another set of federal rules governing the release of student information—the Family Educational Rights and Privacy Act (FERPA), which was enacted in 1974. FERPA was designed to protect the privacy of “educational records,” which were broadly defined to encompass most student health and medical information kept by an institution. To help fulfill the school’s educational mission, athletic
trainers are employed by an athletic department, housed in an athletic department facility, and given responsibility for treating student-athletes. As long as they don’t bill students for services or provide treatment to non-students, they’re governed by FERPA. The HIPAA Privacy Rule only applies to “covered entities,” which the act defines as health plans, healthcare clearinghouses, and healthcare providers who transmit information electronically. And even for those entities, the Privacy Rule only governs “covered transactions” involved in the billing process, including requests for payment, certification of referrals, benefits coordination, claims for authorization, eligibility determination, and inquiries into health plan coverage. In practice, the term “covered entities” does include athletic trainers working in hospitals, health centers, sports medicine clinics, and physicians’ offices. And athletic trainers who work for university hospitals, which treat anyone who walks through the door, generally follow HIPAA as well. It can also apply to athletic trainers at campus medical centers,
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LEADERSHIP who treat faculty and staff alongside students and student-athletes. Athletic trainers employed by private schools that electronically bill for services are generally considered covered entities. Athletic trainers employed by covered entities can be contracted to provide healthcare at a public secondary school, where they would follow FERPA guidelines. If they split their work week, they’d follow HIPAA when they’re treating patients in the clinic and FERPA when they’re providing outreach at the school. Theoretically, two athletic trainers—one employed by the FERPA school and the other by a HIPAA hospital that bills per patient service—could work side by side at a high school football game, perform the same tasks, and fall under different privacy and security rules. Hybrids exist at the college level, too. At Kentucky, which considers athletic trainers part of a FERPA academic institution, there’s also an on-campus HIPAA-governed medical center where student-athletes are referred for treatment. At Princeton University, which primarily follows FERPA, athletic trainers are formally employed and
administered by the HIPAA-governed University Health Services, which houses all health records. Whether your practice is governed by HIPAA boils down to two questions: Do you bill patients or health plans for the care you provide to studentathletes? And do you process those bills electronically? If you answered yes to both, you’re most likely a covered entity. If you answered no to either, you’re probably not. How can you be confident about whether you’re supposed to follow HIPAA, FERPA, or both? “As an athletic trainer, if you feel concerned about HIPAA or FERPA, don’t take this question on yourself,” says Calvert, an associate attorney at the Honolulu law firm Alston Hunt Floyd & Ing and a consultant with the Hawai’i Athletic Trainers’ Association. “Because there are multiple levels of legal analysis, this is really an institutional question. The first thing to do is talk to your administration—it’s their job to figure out the athletic trainer’s responsibility. Get them involved in whether you fall under HIPAA or FERPA, find out which rules
your institution follows, and ask what you need to do to fully comply.” “First and foremost, athletic trainers need to know what rules they are supposed to follow,” agrees Jon Almquist, ATC, Fairfax County (Va.) Public Schools (FCPS) Athletic Training Program Administrator, who testified before Congress in 2007 about the problems facing athletic trainers due to HIPAA and FERPA. “It’s critical to understand the situation you’re in and confirm what you are and aren’t allowed to do.” At FCPS, help from legal counsel has made the rules clear, and communication flows smoothly between athletic trainers, coaches, and administrators. “If you’re employed by the school district, there’s no problem sharing a student-athlete’s medical information with another school employee, as long as you have a common responsibility for providing care,” says Almquist. “For instance, a teacher can’t go to another teacher and say, ‘So-and-so has suchand-such an injury.’ But athletic trainers, who are responsible for the care of athletes, can talk to coaches and athletic directors, who are responsible for
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LEADERSHIP providing a safe, healthy environment for their players.” For Almquist, who oversees 25 high schools and 50 athletic trainers, including many who work under contract through local medical practices, the difficulties with HIPAA come when athletic trainers reach outside the system. In providing care for student-athletes, athletic trainers often request records from medical practices that misinterpret the law and refuse to supply information. “If you look at the nuts and bolts of HIPAA, there’s nothing to restrict communication between healthcare providers who are treating a common patient,” Almquist says. “Both providers share an interest in caring for their studentathletes. But in practice, HIPAA can sometimes restrict communication, rather than truly protect it.” “Some people have attempted to use HIPAA as a shield, limiting the flow of information between healthcare providers, which is not the intent of the law,” agrees Calvert. “HIPAA isn’t supposed to make the practice of medicine more difficult.”
CLOSING THE COMMUNICATION GAP The sternest protections of HIPAA come when institutions are asked to disclose information beyond the immediate community of healthcare providers—especially to the media, which has no responsibility for patient care. How much should the public know about a student-athlete’s health? What can professional scouts be told without violating the Privacy Rule? Release forms are the backbone of both HIPAA and FERPA, and can legally be required by schools as a precondition for participation. Without release forms, there’s very little information a HIPAA institution can legally disclose beyond the immediate healthcare community. But with properly written, attorney-approved forms, there’s virtually no limit to the authority an athlete can give a school to release information. Some HIPAA release forms fit easily on a half page, while others fill five or six. Some forms are designed to be filled out once per disclosure, and others cover multiple disclosures over an extended period of time. Though the
longer forms provide more detail for patients, bigger isn’t necessarily better. Under HIPAA, says Calvert, any legitimate release form for disclosing information outside the circle of healthcare providers should include: • The name of the patient. • The names of the people releasing the information. • The names of the people receiving the information. • A meaningful description of the information being disclosed. • The reason for the request to disclose information. • A statement acknowledging the patient’s right to revoke the authorization. • A statement acknowledging the provider’s ability to require the authorization as a condition for participation. • A statement that once a patient has authorized the release of information, that information can be re-released by anyone for any reason. • An expiration date or expiration event. • The dated signature of the patient. If the HIPAA release you’re currently
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LEADERSHIP using doesn’t include all the required elements, Calvert advises consulting an attorney for a second opinion. “A blanket authorization that says, ‘You can disclose my healthcare information to anyone’ won’t satisfy the requirements of HIPAA,” she says. “A release form has to follow a certain format, and if it doesn’t, the authorization is not legally valid. “With the shorter release forms, I’d be concerned that all the requirements haven’t been met,” continues Calvert. “With the longer forms, where there’s more effort to educate patients, I’d be concerned about providing too much information. As an attorney, I advise institutions to keep the release forms as short as possible while including all the necessary details.” Kentucky takes extra precautions by using a two-tiered system for disclosing information to the public. At the beginning of each school year, student-athletes fill out an authorization form. Then, in response to any outside requests over the course of the year, they fill out a second form with more specific information on what can be disclosed. “The case-by-case forms are especially important when professional sports organizations ask for medical information,” says Webster. “To make sure we have all the documentation for both HIPAA and FERPA, we double up. Is that really necessary? Probably not. But we like the security of knowing there won’t be any surprises. “In a similar way, when athletes come into our program, we ask their healthcare providers back home to fax a blank authorization form,” he continues. “The student-athlete signs it and we fax it back to the physician’s office. That way, we’re in compliance and the records can be released. It may seem overdone, but we’re following HIPAA very carefully, which is easier and safer than arguing we shouldn’t have to.” At Princeton, where the athletic training department is formally administered by the FERPA- and HIPAA-governed University Health Services, there are two additional layers of protection. All media requests for student-athlete health information are funneled through university communications, which then forwards them to the sport coach. And after obtaining a signed release from student-athletes before the start of the season and an authorization after an incident, Princeton permits its coaches to disclose only the injured body part—not the diagnosis. “For example, even in my coaches’ reports, all I write about an injury is ‘left knee,’” says Head Athletic Trainer Charlie Thompson, MS, ATC, who currently serves as Chair of the NATA College/University Athletic Trainers’ Committee. “If a coach asks, I may discuss the injury in a private conversation. But I don’t write ‘MCL sprain’ and I don’t provide any description of the actual pathology. According to our lawyers, that falls safely within HIPAA guidelines for protecting patient privacy.” THE BEST DEFENSE FERPA and HIPAA have different kinds of penalties, but each can carry a high price. For FERPA schools, failure to follow the rules could lead to the institution losing its funding from the federal government. For HIPAA schools, lack of compliance could lead to lawsuits, monetary penalties, and strict requirements for notifying the people whose records have been compromised. For the past six years, before a school could be prosecuted for violating HIPAA, a complaint had to be filed with the U.S. Department of Health and Human Services and investigated TR AINING-CONDITIONING.COM
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LEADERSHIP by the Office for Civil Rights. (Under the 2009 revision of the law, state attorneys general can also file suit.) But in the years since the law was enacted, Calvert hasn’t heard of a single complaint filed against an athletic trainer. Out of 400 complaints filed in the first few years of the law, the only court cases have involved identity theft or selling patient information for personal gain. Calvert calls those examples “the most egregious violations.” That’s a long way from prosecuting an inadvertent mistake by an athletic
trainer. But in a new twist, lawyers have begun to argue that by failing to follow the standards of HIPAA, physicians can be sued for malpractice. Could athletic trainers be sued, too? According to Calvert, without any trial precedents, it’s too early to know. “In a couple of cases where doctors haven’t satisfied HIPAA standards, lawyers have filed suits claiming that’s a failure to meet the standard of care,” she says. “It’s a way they can sneak HIPAA through the back door, and there’s nothing that precludes attor-
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neys from doing that.” The best defense for satisfying HIPAA, says Webster, is to conduct an annual review of your compliance procedures, focusing on privacy and security and beginning with your athletic training room. Are student-athletes able to speak confidentially in your office? Or is it impossible to have a conversation without other people overhearing? “You need to take prudent measures to protect patient privacy,” says Webster. “If you’re at a clinic, that could mean adding a partition at the receptionist’s window, or moving the registration desk a little farther away from the waiting room seating. “The law doesn’t tell you to build a wall across your athletic training room, because that would be unreasonable,” he continues. “But you can still take steps to show your intention of protecting student-athletes’ privacy and security. Until a legal precedent has been set, we need to be very concerned about demonstrating our intent.” It’s also important to review the completeness of your records. Do you have up-to-date authorization forms on file for each student-athlete? Have they been properly filled out? If not, it’s important to secure that documentation to remain in compliance with the law. Schools are responsible for establishing safeguards for storing information in both electronic and paper form. “It’s not okay to have patient files and folders sitting out on a desk where anybody can see them,” says Calvert. “If you place paper records in a high-traffic area, you’re not adequately protecting that information, and you’re likely to end up with an inadvertent disclosure. To be safe, store student-athletes’ medical records in a locked file cabinet or a locked room that you control access to.” For added security of electronic records, there are a few easy steps. If you keep patient records on your computer, add a password to prevent unauthorized people from accessing the information. Or instead of saving the information on your hard drive, save it to a thumb drive, which can be worn around your neck and stored under lock and key. For maximum security, Calvert advises saving patient records on an encrypted thumb drive, which will protect the information even if the drive TR AINING-CONDITIONING.COM
LEADERSHIP is lost or stolen. She suggests other technology-based solutions for secure record keeping as well—for instance, rather than transmitting information electronically, a school could create a Web site where healthcare professionals log in, enter a password, and gain immediate access to protected records. “That way, the information is never actually transmitted,” says Calvert. “It simply resides on the server and can only be accessed through two or more levels of authentication.” For other concerns about keeping your electronic records secure, Calvert advises talking to your school’s information technology (IT) professionals. “The IT department is usually in charge of electronic security, because they have the greatest understanding of the technology that’s involved,” she says. “They’ve already looked at these issues from an institutional perspective, and rather than trying to reinvent the wheel, you should capitalize on the work they’ve already done. In most cases, they already have IT security policies in place, and you can simply make sure your department
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procedures are woven into those existing policies.” GETTING HELP As technology keeps evolving, regulations for safeguarding electronic communications will, too. This summer, the federal government plans to publish an updated set of guidelines for complying with HIPAA, and over the coming years, athletic trainers should expect more changes to the law. Changes could also come in state regulations, which may be even more demanding than HIPAA. “Whatever the strictest rule is, that’s the one athletic trainers should follow,” says Patty Ellis, NATA National Manager of Markets and Revenues, who serves as the association’s point person on HIPAA and FERPA. “That offers the greatest protection for both the patient and the athletic trainer.” When faced with questions about the safest course, Ellis refers athletic trainers to school attorneys and state athletic training associations. “Laws vary from state to state, so athletic trainers need to make themselves aware of
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which regulations apply to their own situation,” she says. “Through your state association, you can access upto-date, local information. Seek advice from others, and if there’s legal counsel at your school, talk to them about what you should be doing to comply with the applicable rules.” “If you have any questions about how HIPAA or FERPA affect you, always go to your school’s attorneys,” agrees Webster. “Their job is to protect the whole institution, including you, and to stay current on the laws that determine how you do your job. There’s a lot of uncertainty around HIPAA, because every attorney has his or her own opinion about what needs to be done. With that much inconsistency, the way your school attorney interprets the rules should determine how you act. “As athletic trainers, we need to work proactively with our attorneys to stay on top of any developments,” Webster continues. “HIPAA has brought privacy and security to the forefront, and if we’re really committed to providing the best possible care, that’s where they should remain.” n
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sport specific
AP PHOTOS/BRETT WILHELM (via NCAA PHOTOS)
Swing Theory Mental acuity, reflex awareness, balance, and functional muscle control are the key ingredients of a great golf swing. Are your golfers following the right recipe?
By Robert Mottram
O
ne thing that sets golf apart from other sports is the imbalance between the physical and mental demands of the game. Although a round takes several hours, the amount of time a player spends utilizing his or her physical skills—the skills that strength and conditioning can influence—typically adds up to just a few minutes. But so much happens in each splitsecond of the swing—both consciously and subconsciously—that golf is one of the most challenging sports for training both mind and body. Thousands of instructional programs, private coaches, training aids, books, and videos have searched for effective ways to teach the golf swing, with varying levels of success. The challenge is that with so many variables affecting each swing’s outcome, it’s difficult to know where to start the training process and which paths can optimize learning.
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Although golfers have a wide array of swing styles and teaching philosophies to choose from, execution always comes down to the same basic elements: club head speed, club face angle, club path, club angle of attack, and solidness of ball impact. All these factors are affected by a player’s physical ability, so the goal for a strength coach working with golfers should be to promote optimal mechanics and movement patterns within the realm of the athlete’s capabilities, and to get results without harming the body. To do this, you must first know what happens in both the mind and body during a golf swing. By understanding how information is collected and transmitted to the nervous system, how that information is processed and acted upon, and how an individual can take greater control of the entire process, you lay the foundation both to raise a golfer’s confidence and to improve their performance.
LEVELS OF AWARENESS The mental and physical challenges of golf are perceived mostly in the conscious mind, but there are certain subconscious control centers and safety mechanisms that oversee the motor patterns and fine movements that occur during the swing. Exploring these below-the-surface reflex systems can open new possibilities for performance enhancement and smoother, more efficient mechanics. The golf swing is a high speed, high range of motion activity requiring skill, precision, and control. Proper execution depends on two independent facRobert Mottram, PT, ATC, a Senior Titleist Performance Institute Advisor, works at Mission Hills Country Club in Rancho Mirage, Calif. He has served as a rehab and fitness specialist for the PGA Tour, Senior PGA Tour, and LPGA Tour, and can be reached at: golfpt@aol.com. TR AINING-CONDITIONING.COM
sport specific tors: First, the golfer must know how to apply effective form throughout the swing. Then, he or she must have the flexibility, strength, and coordination to perform the required moves. Many people think the golf swing is a completely unique sport-specific activity—a movement unlike any other performed in athletics. But a closer look at anatomy and kinesiology proves otherwise. Three-dimensional electromagnetic analysis performed at the Titleist Performance Institute in Carlsbad, Calif., and by Tom House, PhD, of BioKinetics West, has compared the golf swing to the baseball swing and throwing motions, and found numerous similarities. Kinematic sequencing— the sequence of body segment movement patterns—shows how the body uses ground reaction forces and muscle activation to generate power in a golf swing. These movements occur in essentially the same pattern in most striking and throwing activities. The body is equipped with a variety of sensory mechanisms that are vital to movement. These special protective and enhancing sensors operate by constantly communicating with the spinal column and brain in an attempt to avoid injury and facilitate movement. Of course, these critical structures are not especially concerned with the outcome of a golf swing—they exist to provide valuable information about body positions and motion. But by understanding how they work, a golfer can put them to sport-specific use. Body awareness, also known as proprioception, is the ability to perceive body positions and movements with help from sensors throughout the body, including mechanoreceptors in the joint capsules and muscle spindles in muscles. These sensors provide proprioceptive input any time they are deformed by a shear, tension, or compression force. In golf, they provide the athlete with instant feedback on static and dynamic conditions, movements, positions of joints, balance, equilibrium, speed and direction of movement, and stress and strain to joints and tissue. The body responds to these signals voluntarily and involuntarily by adjusting muscle activation, employing learned motor patterns, and engaging various joint and tissue reflexes. What does all this mean during a golf swing? The complex system of nerves and muscles that regulates movement TR AINING-CONDITIONING.COM
and force reacts mainly by switching the roles of certain muscles. A muscle group may behave as a stabilizer, a neutralizer, and/or a prime mover all within the same swing. Golfers who are not prepared to meet the physical demands of this high speed switching activity will experience frequent frustration. For this reason, a training program rooted in functional exercises that mimic the specific movement patterns of the golf swing will be more effective than work with fixed machines or isolated muscle training routines.
THREE SYSTEMS The pieces of information sent to the brain by the sensory systems during a golf swing are very brief and complex, and the conscious mind is too slow to interpret and learn from all of them effectively. Developing supportive subconscious proprioceptive systems, which can operate 10 to 15 times faster than the cognitive mind, is critical for improving both the success and safety of the swing. There are three proprioceptive systems relevant to the demands of the golf swing:
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sport specific Spinal cord. The most basic level of neuromuscular control comes from the spinal cord, which contains neuronal circuits that subconsciously mediate automatic, stereotyped reflexes. The knee jerk reflex is an example of this spinallevel control. Stretch sensors in muscles and tendons also use these reflexes to facilitate movement, such as in the stretch-shorten reflex. When a golfer’s body turns during a swing, the stabilizing and neutralizing muscles of the legs and core are placed in a stiffened position and can recognize unexpected joint loads, thanks to sensitive mechanical receptors. The spinal-level reflexes can help an athlete identify points in the swinging motion that produce the most stress and thereby increase the risk of injury. Having golfers practice their swing on unstable surfaces, such as instability discs, will enhance the reflex arc coming from mechanoreceptors at the spinal level. Drills in which the golfer must maintain control and avoid unwanted movement as unexpected external forces are applied will also work these reflexes. One effective example is a perturba-
tion drill in which the coach randomly pulls at elastic tubing attached to various joints or muscle areas while the golfer is in a swinging posture. If the athlete is using sound technique, the body will not move at all in response to these external forces, because it has developed the ability to instantly match and account for their timing, direction, and intensity. Brain stem. The brain stem and its partner, the cerebellum, play a key role in coordinating movements, posture, and balance. These components of the neurological system react more slowly than the spinal reflexes, but still faster than conscious, voluntary muscle contractions. Balance and equilibrium drills focus on this part of the reaction process. For example, while the athlete performs swing motion drills on instability discs and other unstable surfaces, you can add an extra challenge by cueing them to open and close their eyes at various points during the movement cycle. This sudden loss of visual input forces the brain to produce more efficient, responsive muscle reactions. As a result, the golfer will experience improved balance and muscle control during a normal swing.
Cerebral cortex. This is the third motor response system, which governs conscious awareness of position and movement. Voluntary muscle contractions are executed through the cerebral cortex, so not surprisingly, this is the area that most traditional golf instruction focuses on. Because this is the body’s slowest interpretation and reaction system, static and slower movements and drills are effective. Over time, optimal movement repetitions are converted from conscious to subconscious activation. For example, an athlete in front of a mirror can perform a basic golf “rehearsal” drill that involves address of the ball, top of the backswing, impact, and finish positions. Going through these motions statically and then slowly, while watching for inefficient or unwanted movements, provides real-time feedback and can train the conscious mind to see, feel, adjust, and then repeat correct mechanics. These movements can be broken down into small segments, and once mastered separately, they can be blended together to form the total pattern. Progressing from see-
PRIMAL MOVEMENTS Could early man have been a natural born golfer? Health and fitness specialist Paul Chek suggests that everyone is born “hard wired” with several basic movement patterns necessary for complex movement organization. Squatting, bending, lunging, pushing, pulling, and twisting, when linked together, allowed our primitive ancestors to hunt for food and defend themselves. Following this theory, there may be similar gross patterns that can help with a golfer’s swing. Golf, like most sports, involves short bursts of complex movement, and training for golf should focus on general and specific movement patterns, rather than on individual muscles. Muscles will develop naturally as different movements are repeated. So how can you take advantage of some basic instinctive movements to improve a golf swing? Most golfers are familiar with hitting a softball or baseball. Others may be familiar with chopping wood or cutting down trees.
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The basic movements in these activities combine several primal patterns—including body lunges, bends, rotations, and push patterns—that are similar to those required for swinging a golf club. Three-dimensional biomechanical analysis has shown that certain drills are ideal for replicating these instinctive mixtures of gross movements. For example, a golfer can strike a boxing or karate body bag with a baseball bat, working to optimize weight shift, balance, and muscle activation sequences to hit the bag as hard as possible. Next, they can begin to work their way down the bag, striking lower and lower, thus bringing the movement gradually closer and closer to that of the golf swing. They might then progress to using their clubs and hitting an impact bag designed for golfers. With some practice, the player learns how to recruit the same kinematic sequencing whether holding a bat or club.
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sport specific ing to feeling—visual to kinesthetic—is the primary goal for perfecting a skill. As a whole, the nervous system is highly adaptable. Thus, inefficient and injury-inducing motor programs can usually be corrected once they are identified. That process should be individualized based on a golfer’s specific mechanics, flaws, and risk factors. REMEDIAL WORK Golfers who are deconditioned, have been injured, or have chronically unsound movement patterns usually require a new and improved awareness of the sensory information their body provides. After injury, some degree of reduced awareness of joint and body position, speed of movement, and coordination is likely. Joint injuries in particular often lead to decreased ability to stabilize the joint due to delayed or weakened muscle response. To “rewire” an athlete’s system with heightened sensory awareness and better learned responses, it’s best to focus on developing functional movement without restriction or limitation. Too often, golfers (and their coaches) ignore
these fundamental issues and move directly into sport-specific movements before the athlete is truly ready. Mobility, stability, and efficient motor patterns make up the foundation on which a great golf swing is built. Often, a problem observed during the swing is just a symptom of a more fundamental biomechanical flaw that needs attention. For example, poor spine and waist flexibility may interfere with separation between pelvic rotation and upper abdominal rotation. This movement flaw limits internal and external oblique muscle stretching, thereby decreasing contractile and elastic force production. Rather than address the problem simply by attempting to fix the golf swing, the best approach is to recognize the underlying lack of flexibility, and prescribe exercises and stretches that can remedy it. Another common example is a golfer displaying upper cross syndrome. This condition, which involves a tightening of the anterior muscles of the upper torso and a corresponding weakening of the posterior musculature, typically manifests in golfers as forward-lean-
ing head and shoulders. It can hinder normal shoulder girdle and joint movements, leading to elevated shoulders, shoulder impingement, and various swing plane issues. Once again, addressing the problem and improving performance requires resolving the underlying issue. In the case of upper cross syndrome, an effective approach would be to have the athlete perform stretches to reduce the anterior tightness, and strengthening exercises for the muscles of the posterior upper torso. Following that type of intervention strategy, the unwanted forward leaning during the golf swing may soon correct itself. It is possible for some golfers to perform well even when poor form is used, but eventually, they will experience breakdown, inconsistency, fatigue, soreness, or injury. It should be the goal of every golf training program, on the course or in the training center, to create efficient movement. This will conserve energy, promote relaxation, and allow the golfer to practice more often and more effectively—all of which will help them to compete with greater success. n
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Maintaining Peak Performance for Athletes on the Road By Sue Falsone
Sue Falsone is the Director of Performance Physical Therapy for Athletes’ Performance and a physical therapist for the Los Angeles Dodgers. She is also a regular contributor to CorePerformance.com
Athletes who compete at the highest levels are always on the move, traveling, changing time zones, altering their sleep patterns, trying to fit in workouts when they can. They need efficient solutions to meet their needs as they often need to work on many things at a time to achieve and maintain peak performance. A holistic approach, focusing on mindset, nutrition, movement, and recovery has to provide athletes with solutions and systems that they can utilize both at their primary training center and on the road. One of the biggest challenges for our athletes has been maintaining the same high quality training sessions they are used to while traveling. We have recently added a new exercise modality to our methodology—Suspension Training®—that is helping us solve this problem. Using the portable TRX® Suspension TrainerTM provides us with a new, cutting-edge way to train our athletes in our facilities or on the road. Suspension Training allows the athletes to focus on total body kinematic control and force transfer to improve athletic power generation. It also provides the basic training philosophy of attaining core stability in order to achieve optimal range of motion. Another benefit we are seeing is that strength is improved with greater neuromuscular control, tying in the entire sensorimotor system into the athletes’ training, resulting in better mobility and stability. The net effect is that our athletes improve their performance while reducing their risk for injury. Here are a few key Suspension Training exercises we use with our athletes to improve their throwing velocity and upper body power:
TRX 45-Degree Row
START POSITION: Face anchor point with feet shoulder-width apart. TRX fully shortened. Hold both handles with arms extended. Lean back and walk feet forward to appropriate resistance angle. EXECUTION: Keep shoulders pulled down and back. Pull body towards anchor point using shoulders and arms. Elbows should maintain a 45-degree angle to body. Return to start position with slow, controlled movement.
TRX “W” Shoulder Fly
START POSITION: Face anchor point with feet shoulder-width apart and arms in “W” position overhead. TRX mid-length. Keep tension on the TRX. Step back slightly with one foot into offset stance.
Figure 1. 45-Degree Row Start Position
Figure 2. 45-Degree Row Execution
EXECUTION: Lean back, shifting weight to rear foot. Extend arms forward until fully extended. Do not let shoulder roll forward. Return to start position by pulling arms back into “W” position while shifting weight onto front foot.
TRX Prone Roll Out
START POSITION: Adjust TRX so that lowest point of foot cradles is 8’’ to 12’’ from ground. Kneel facing anchor point. Hold both handles at hip height. The closer the handles are to the ground the harder the resistance will be. EXECUTION: Press down on handles. Roll forward on knees, extending arms straight in front as far as comfortable while keeping shoulders and hips stable. Return to start position by pressing down on handles and engaging core muscles.
Figure 7. “W” Shoulder Fly Start Position
Figure 8. “W” Shoulder Fly Execution
TRX Chest Press Figure 3. Prone Roll Out Start Position
Figure 4. Prone Roll Out Execution
TRX Power Pull
START POSITION: Face anchor point and place both TRX handles in your right hand. Feet shoulder width apart facing the anchor point. EXECUTION: Lean back as if you are picking something off the ground with your left hand. Pull your left shoulder down and back, bend your right elbow and bring your left arm up using your core towards the anchor point. Perform on both sides.
Figure 5. Power Pull Execution Position
Figure 6. Power Pull Execution
START POSITION: Face away from anchor point with feet together. TRX fully lengthened. Hold handles in front of chest with arms extended. Keep hands high enough so TRX straps do not touch or rub arms. EXECUTION: Lower chest to handles in a push-up motion. Press arms back to full extension. Return to start position and repeat.
Figure 9. Chest Press Start Position
Figure 10. Chest Press Execution
2009 Supplier Web Site Directory
Hinged & Rigid Ankle Supports Site includes: • Product descriptions • Product pricing • Customer feedback • Injury care guide for ankle injuries Special features: • Online store • Related link to Active Ankle’s Chameleon® Web site
www.amerashield.com Antimicrobial Protectants for Surfaces & Textiles Site includes: • Product information • Video and print media highlights • Scientific explanation of how the product works • Frequently asked questions and answers Special features: • Explanation of “The Science of Clean” • Complete listing of microbes Amerashield protects against
www.aquajogger.com AquaJogger Aquatic Training Products Site includes: • Product specs • Product images • Online shopping • Information section Special features: • Online store • Video clips
See ad on page 11
See ad on page 26
See ad on page 32
www.pilates.com
www.biofreeze.com
www.antibodywear.com
Pilates Equipment & Education Site includes: • Product specs and features • Education and training information • Information on Pilates and sportsrelated activities • Online ROI calculator Special features: • Interactive space planner • Weekly podcast
Biofreeze Healthcare & Fitness Products
Custom Compression Sportswear & Injury Prevention
Site includes: • Product specifications • Educational resources • Customer testimonials • Company news
Site includes: • Product specs • Customer testimonials • Pricing • Research articles
Special features: • “Where to buy” locator
Special features: • Online store • Measurement tutorials
Supplier Web Site Directory
www.activeankle.com
See ad on page 44
www.cup.edu Online Degree Program (Cal U Global Online) Site includes: • University history • Information on degree programs • Admissions, financial aid, and application Special features: • Online registration and financial aid/ course information • Global Online test drive See ad on page 32 TR AINING-CONDITIONING.COM
www.cardinalpub.com Sports & Fitness Books Site includes: • Brown series • Ultimate Guide to Weight Training for Sports series • Hundreds of sports and fitness books • Brand name and self-published authors Special features: • Publisher link • Online store
www.chekinstitute.com Advanced Health & Wellness Education Site includes: • Advanced training programs • Continuing education credits • Free literature • Resources Special features: • Online store • Downloads
See ad on page 60 T&C JULY/AUGUST 2009
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Supplier Web Site Directory
www.cho-pat.com
www.cleveland.edu
Sports Medicine Products
Education
Sports Medicine Products
Site includes: • Product descriptions, sizing, and images • Company background • Customer/user testimonials • Catalog and contact information
Site includes: • College information • Admissions • Academic programs • Frequently asked questions
Site includes: • Product catalog • Bid builder • Athletic trainer forum • Corporate history
Special features: • Resources for prospective students and alumni • News and events
Special features: • Downloadable catalog • Virtual tours of products
Special features: • Downloadable catalog • New link to Facebook
See ad on page 2
See ad on page 16
See ad on page 7
www.cytosport.com
www.dynatronics.com
www.eggwhitesint.com
Top-Quality Nutritional Supplements
Rehabilitation Equipment & Supplies
100-Percent Pure Liquid Egg Whites
Site includes: • Product information • Company news • Interviews • Team Cyto athletes
Site includes: • Detailed dealer locator for the U.S. and Canada • Catalog with images, measurements, and descriptions • Online warranty registration • Investor relations and company information
Site includes: • Product info with health facts • Recipes • Customer testimonials • Frequently asked questions
Special features: • Video clips • Product recipes
See ad on back cover
www.customguards.com Gladiator Custom-Made Mouthguards Site includes: • Company information • Frequently asked questions • Testimonials • Newsletter Special features: • Team specials • Online ordering
Special features: • Look for Dynatronics’ new e-commerce site, launching September 1
See ad on page 12 T&C JULY/AUGUST 2009
Special features: • Online store • Link to Sport Formula multivitamin
See ad on inside back cover
See ad on page 37
www.lifefitness.com
www.hibigeebies.com/ sports
Hammer Strength Plate-Loaded Equipment Site includes: • Specifications for all products • Facility showcases and printable brochures • Retail information, including articles and press releases • Training and education information Special features: • Facility layouts • Athletic facility showcases
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www.cramersportsmed.com
Antimicrobial Antiseptic Site includes: • Product information • Clinical information • Product sample request • Reference articles Special features: • Downloadable educational materials • MRSA DVD
See ad on page 4 TR AINING-CONDITIONING.COM
Core Body Temperature Monitoring Systems Site includes: • Company/product background information • Complete descriptions of product applications • Customer testimonials • Product specs/catalog Special features: • Downloadable studies/scientific analysis • Video clips
www.hydrate1.com Sports Hydration Systems Site includes: • Pricing • Specs • Warranty info Special features: • Frequently asked questions
www.beatsuperbugs.com Bacrobial Natural Cleanser, Protectant, and Hydrator Site includes: • Sports-related product information • How to use Bacrobial • Where to buy • Testimonials Special features: • Online store
See ad on page 23
See ad on page 26
See ad on page 25
www.jumpstretch.com
www.legendfitness.com
www.magistercorp.com
FlexBand Exercise Equipment & Accessories Site includes: • Company background • Training philosophy • Articles on band training • CEU info for NSCA members Special features: • Online store • Video clips
Strength & Fitness Products
Non-Latex Resistive Exercise Products
Site includes: • Product specs and photos • Video library • CrossFit connection • Clientele showcase
Site includes: • Company information • Product information • Literature request • Image downloads
Special features: • “Build your own weightroom” • Legend University: training articles from industry experts
Special features: • Downloadable product descriptions
See ad on page 40
www.mcdavidusa.com Protective Performance Apparel & Sports Medicine Products Site includes: • Product/technology descriptions and pricing • McDavid in the news • Discussion forums • Company history
See ad on page 19
www.medspec.com
www.muellersportsmed.com
Sports Medicine Braces & Supplies
Sports Medicine Products
Site includes: • Product specs • Customer testimonials • Literature request • Pricing
Site includes: • Downloadable product catalog • Store locator • New product announcements • Product training modules
Special features: • Online ordering
Special features: • Detailed information on sports injuries and treatments • Product descriptions and specs
Special features: • Online store • 360-degree views of featured products See ad on page 41 TR AINING-CONDITIONING.COM
Supplier Web Site Directory
www.hqinc.net
See ad on page 8 T&C JULY/AUGUST 2009
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Supplier Web Site Directory
www.nasm.org Performance & Corrective Exercise Advanced Specializations Site includes:
• Course descriptions, customer testimonials, and store • Explanation of eligibility requirements • Online course lectures, videos, and exams • NASM Research Institute: scientifically tested research
Special features:
• NASMPro.com: online business and career tools for credentialed professionals • Access to articles, exercises, and anatomy library
Strength & Fitness Equipment Site includes: • Power racks and platforms • Leg press units • Free weight benches • Multi-stations Special features: • Photo gallery of Nebula-outfitted training facilities • Dealer locator
See ad on page 45
www.nucapmedical.com
www.newyorkbarbells.com Site includes: • Weight- and strength-training equipment • Customer testimonials • Shipping information • Order form Special features: • Showroom hours and services • Equipment closeout deals
See ad on page 38
www.nzmfg.com
www.optp.com
Kinesiology Tape Products
Resistance Training Products
Fitness & Rehabilitation Products
Site includes: • Product descriptions and photos • Application instructions • Company information • Outline of product benefits
Site includes: • Catalog request form • Product information • Company background • Testimonials
Site includes: • Customer reviews • Catalog and newsletter request • News and events page • Online ordering
Special features: • Library of application videos • Anatomical diagrams
Special features: • Training videos • Online store
Special features: • Book reviews and video clips • Links to industry-wide instructors and courses
See ad on inside front cover
www.performbetter.com Functional Training & Rehabilitation Equipment Site includes: • Interactive catalog with pricing • Monthly specials • Schedule of Perform Better seminars • 24/7 online ordering capability Special features: • Articles and video clips of training and conditioning • Facility design guidance and pricing See ads on pages 13 & 61 54
www.nebula-fitness.com
T&C JULY/AUGUST 2009
See ad on page 24
www.thepolarpool.com
See ad on page 49
www.powerlift.com
Aquatic Therapy Pools
Heavy-Duty Weightlifting Equipment
Site includes: • Company background information • Pool specs • Customer testimonials • Product photo gallery
Site includes: • Customer testimonials • Facility photos • Product images • Downloadable catalog
Special features: • Financing information • Details on sonic waves and cryotherapy
Special features: • Product videos • Links to partners and colleges
See ad on page 12 TR AINING-CONDITIONING.COM
www.power-systems.com
www.proorthopedic.com
www.injurybegone.com
Sports Medicine Supports & Bracing
Special features: • E-shop enabled for secure checkout • Site search and Web search available
Sports Medicine Braces, Supports, & More Site includes: • Detailed product descriptions and images • Information on specific injuries, treatments, and products • Company background information • Customer testimonials Special features: • Links to the best medical distributors • Rehab stretching and strengthening exercises
See ad on page 43
See ad on page 17
www.rogersathletic.com
www.whatsmyfoottype.com
www.samsonequipment.com
Football & Strength Training Site includes: • “Build Your Own” custom-colored Lev Sled option • New line of Pendulum strength equipment • Request forms for football and strength catalogs • Request forms for football and strength training DVDs Special features: • Football video demos • Downloadable PDF product spec sheets
www.save-a-tooth.com Save-A-Tooth Emergency Tooth Preservation System Site includes: • Ordering page • List of distributors • Product information • Customer testimonials Special features: • Online store • Frequently asked questions
See ad on page 24 TR AINING-CONDITIONING.COM
Site includes: • Easy catalog look-up by category • Pricing and color images for all available products • Company origin and background information • Convenient login for returning customers
Affordable Ready-To-Wear Orthoses Site includes: • Detailed orthotic descriptions and sizing • Educational programs: one- and 2.5-day courses • Testimonials on products and customer service • Schedule of upcoming trade shows and webinars Special features: • Detailed online biomechanical tutorial by foot type • Video gait clips by foot type See ad on page 6
www.spri.com
Strength, Conditioning, & Fitness Products Site includes: • Fitness products for athletes and general fitness • Access to special pricing for schools and coaches • FAQ section for product questions • Contact section for requesting more information Special features: • Video library of more than 350 exercises • Multiple ways to search for products
Supplier Web Site Directory
Fitness/Sports Performance Training Equipment Site includes: • Product descriptions, specs, and instructions, plus quantity discounts • Web-only products and specials • Weekly product features, including exercises and articles • Dynamic, interactive virtual catalogs Special features: • Video clips featuring product and exercise demonstrations • Search by category, goal, and keyword See ad on page 47
Weight Training Equipment Site includes: • Contact and company history information • Product information, including general specs and warranty info • Athletic training tables • Discount opportunities Special features: • The Samson Difference video • Featured facilities See ad on page 35
www.sprintaquatics.com Pool Products, Education, & Strength Training Site includes: • Product specs with customer testimonials • Online pricing, ordering, and catalog requests • Large variety of pool products • Company background Special features: • Online store with discounts • Video clips and educational materials See ad on page 60 T&C JULY/AUGUST 2009
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Supplier Web Site Directory
$WKOHWLFV
www.stayactiv.com www.con-cret.com
Natural Anti-Inflammatories, Creatine, & Endurance/Recovery Supplements Site includes: • Product photos and descriptions • Customer testimonials • Company background info • Articles about the products and the industry Special features: • Blog with articles of interest and athletes’ competition results with photos and video • Online store
www.swimex.com Aquatic Therapy Pools Site includes: • Detailed model comparison • Customer testimonials • Architectural design information • Therapy pool gallery Special features: • Video clips of work stations, conditioning, and swimming • Free DVD and information request
See ad on page 36
www.stromgren.com Athletic Supports, Apparel, & Equipment Site includes: • Product specs • Sizing info • Contact info • Catalog request Special features: • Links to moisture-management apparel • Product images
www.thera-band.com www.thera-bandacademy.com Thera-Band Healthcare & Fitness Products Site includes: • Product specs • Frequently asked questions • Company news • Upcoming events Special features: • Thera-Band Academy and scientific research database • Instruction guides, case studies, articles, and newsletters See ad on page 3
Ankle Braces & Supports Site includes: • Full product listing and specifications • Company background and history of developing innovative products • Complete sizing information on all products • Where to purchase Swede-O products Special features: • Injuries/ailments section to determine correct product needed • Instructions section details application of braces See ad on page 14
www.2toms.com Blister & Chafing Prevention Site includes: • National/international store locator • 2Toms history • Customer testimonials Special features: • 2Toms online store • “Ask the Doctor” question & answer
See ad on page 64
www.fitnessanywhere.com
www.wisstechenterprises.com
TRX Suspension Training Products & Programs Site includes: • TRX articles and video library • Product reviews and testimonials • Product comparison and photo gallery • Online store, including worldwide shipping Special features: • Free online community to share workouts • 100-percent product satisfaction guaranteed
Portable Drinking Fountains
Heart Monitors & ECG
Site includes: • Product descriptions • Pricing • Warranty information • Contact information
Site includes: • XRL 8001 portable ECG monitor • Ti Plus heat index monitor • Lightning detectors, PS and EWS • Cooling blankets
Special features: • Product photos • Printable price list
Special features: • Online store • Downloadable specs
See ad on page 22 56
www.swedeo.com
T&C JULY/AUGUST 2009
www.xgun.com
See ad on page 42 TR AINING-CONDITIONING.COM
New ProductS
The BodyGuard Custom Carpal Tunnel Wrist Brace Gladiator Custom Mouthguards Unique features: • Advancements in technology and design allow for superior protection and performance • Newest revolutionary design, the X-Treme, affords the ultimate in comfort while still providing the ultimate in protection
Unique features: • Designed to add compression and adjustable support with dual compression straps • Promotes muscle and tendon heat circulation, increased blood flow, strain distribution, and impact absorption to the wrist
Benefits for the user: • Maximum comfort means better compliance • Excellent protection means fewer injuries • Maximum air flow enhances performance • Improved speech capability promotes communication with teammates
Benefits for the user: • Effectively treats Carpal Tunnel Syndrome, a nerve disorder that causes pain, loss of feeling, and loss of strength in the hands • Ideal for athletes in sports that require strong hand or wrist action, such as tennis, racquetball, golf, skiing, weightlifting, baseball, football, bowling, archery, rowing, wrestling, boxing, gymnastics, hockey, and water skiing
“Gladiator” by Sport Guard Inc (SGI). www.customguards.com 877-848-2737 Circle No. 500
Antibody, Inc. www.antibodywear.com 877-546-2639 Circle No. 501
N e w
P r o d u c t s
Polar TEAM2 System Unique features: • Offers the ability to view player heart rate info live, in real time • Automatically downloads individual and team info directly to your PDA or PC during practice Benefits for the user: • Customized training sessions ensure individual and team success • Post-session analysis tells you whether to push harder or take time for recovery • Train athletes at the same intensity they experience in a game Polar Inc. www.polarusa.com/teamsports 800-290-6330 x3221 Circle No. 502 TR AINING-CONDITIONING.COM
i-Shape Unique features: • A revolutionary exercise technology that activates muscle spindles, increases blood flow, and raises body temperature • The next wave of vibration exercise technology • Stimulates both the physical and visual senses • Distinctive stretching cage and dual vibration platforms Benefits for the user: • Unique Tonic Vibration Reflex (TVR) technology stimulates muscles and tendons • Results in enhanced flexibility, strength, and explosive force efi Sports Medicine®/Total Gym® www.efisportsmedicine.com 800-541-4900 Circle No. 503 T&C july/august 2009
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Case study
Posture’s Newest Ally by Dr. Kevin D. Jardine
Kevin D. Jardine is a Chiropractor and the CEO of a Toronto-based multidisciplinary sports therapy clinic called The Urban Athlete. He is also co-inventor and designer of SpiderTech. Within the shoulder complex, the scapula has many important functions, allowing athletes to utilize the arm in a wide range of activities. Addressing the static and dynamic positioning of the scapula is a crucial component of shoulder girdle training and rehabilitation.
on nearby joints and muscles. If left unaltered, the poor positioning of the scapulae will continue to stress the adjacent structures in the kinetic chain, which will be forced to compensate, resulting in accelerated wear and tear and eventually structural breakdown.
The scapula is involved in the majority of shoulder girdle conditions. With the shoulder relying on soft tissue control and coordination to provide stability, any deficiency in the nearby musculature can alter the function of the shoulder. Proper coordinated co-activation of the shoulder muscles, along with proper scapular positioning, is necessary to minimize mechanical stresses imposed on the articular and myofascial structures around the shoulder.
To address scapular positioning, we will apply a Postural Spider to the athlete’s mid-back. The Postural Spider is a predesigned, ready-to-apply kinesiology taping application belonging to the comprehensive line of SpiderTech applications. It can be worn continuously for up to five days, during which the client can exercise and shower like normal. SpiderTech is an innovative functional medicine approach to modulate pain and myofascial dysfunction using specialized pre-cut elastic tape. There are three variations: microcirculatory applications, neurosensory applications, and structural applications.
Dysfunction in the normal scapulothoracic rhythm is associated with many common shoulder injuries. Common alterations in the positioning of the scapula include: • Excessive protraction of the scapula during arm movements, leading to anterior positioning of the head of the humerus. • Superior displacement of the humerus within the joint, leading to pinching of the space between the acromion and the humerus.
This athlete will be using the Postural Spider for structural applications, which is designed to dynamically support better static and dynamic postural positions, provide relative immobility to prevent harmful ranges of motion without a “hard end” feel, and reduce strain on affected muscles and joints.
• The shoulder blade sitting too high on the back, leading to the acromion being tilted anteriorly and therefore increasing the likelihood of impingement. Let’s examine a case study: An athlete’s primary complaint is pain over the tip of the shoulder, radiating over the upper lateral arm during movements involving horizontal arm abduction. It’s a classic case of impingement syndrome, and visual observation reveals anteriorly rounded shoulders and bilaterally protracted scapulae. To help this patient strengthen and rehabilitate the rotator cuff, we must address the scapular positioning in order to reduce the mechanical strain imposed
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and joint are provided with natural barriers to potentially harmful faulty postures and ranges of motion. SpiderTech can thus help athletes maintain proper positioning even when they are not consciously aware of their posture.
The improvement in posture and scapular stabilization allows for overhead arm elevations without the risk of impingement. Once the scapula is stabilized, the client can condition the appropriate musculature to develop the proper strength and length/tension relationships. Current evidence has shown that rehabilitation protocols emphasizing restoration of normal functional stability and movement, along with proper biomechanics, have excellent success rates. Taking an integrative and comprehensive approach to shoulder conditions will provide enhanced training and therapeutic outcomes, with the scapula playing a crucial role.
In the photo above, you see the structural application of the Postural Spider. Structural applications involve applying the tape while it is stretched to the desired level of tension as the body part is held in a neutral position. This way, the muscle
SpiderTech/NUCAP Medical 3370 Pharmacy Ave. Scarborough, ON M1W 3K4, Canada 416-494-1444 www.spidertech.com
TR AINING-CONDITIONING.COM
Keeping Athletes Safe
Heat Stress Prevention
Portable Drinking Systems
Hydration Solutions
Cramer Products offers three types of portable hydration units to help hydrate athletes: the Powerflo, Powerflo 50, and Coil Cool. Cramer’s newest unit, the Powerflo 50, offers an impressive 50 gallons of portable hydration. These hydration units are constructed of 100-percent water-portable and FDA-approved materials for drinking water. Cramer Products, Inc. • 800-3452231 • www.cramersportsmed.com Circle No. 504
Waterboy Sports has an extensive product line designed to fit various price ranges and meet the specific needs of the athletic training community. All Waterboy Sports products are designed to accommodate both the athlete and the athletic trainer. Each product is built to withstand the punishment of constant use. Visit the company online to learn more. Waterboy Sports, Inc. • 888-442-6269 www.waterboysports.com Circle No. 508
Monitor from the Inside The CorTemp™ monitoring system, featuring the CorTemp ingestible temperature pill, has been marketed throughout the world for more than 17 years. Once ingested, the pill wirelessly transmits an athlete’s core body temperature to a handheld monitor, where the data is picked up and recorded. It’s real-time, easy to use, and convenient for stationary or mobile environments. CorTemp is FDA-cleared and provides an internal, non-invasive, affordable approach for assessing elevated core temperature on the field, and measuring the effectiveness of cooling methods on the sidelines. HQ, Inc./CorTemp™ 941-723-4197 • www.hqinc.net Circle No. 505
Beat the Heat
No More Bottles
The SkyScan Ti-plus multi-function instrument features an easy-to-read arrow display showing all ranges of dangerous heat conditions. Audible warnings alert you to potentially dangerous heat index levels, and the large display shows temperature, relative humidity, and heat index. Critical information is stored in the unit’s memory for 24 hours and can be re-displayed as needed. The Ti-plus also functions as a countdown timer, stopwatch, and alarm, and it’s powered by a single wafer battery. Xtreme Research Corp. • 888-732-0665 • www.xgun.com Circle No. 510
The Hydrate Cart A-Frame can hydrate multiple athletes at the same time, without the need to fill bottles or cups. This product encourages athletes to hydrate themselves, while relieving athletic trainers from having to fill and transport coolers. Hydrate, LLC • 407-694-1034 www.hydrate1.com Circle No. 506
A Smart Water Carrier Every athlete needs water, and the Aqualift portable drinking system delivers—for children on the playing field and professionals in the NFL alike. Aqualift is one of the finest hydration systems on the market, and is made with only top-quality materials. It continues to be the hydration unit of choice for many pro, college, and high school athletic teams worldwide. Each 10-gallon Aqualift includes four drinking hoses, plus a battery with a charger. It’s protected by U.S. and foreign patents issued and pending. U.S. Patent No. 5,154,317. JDI Sports • 912-384-8165 www.hydrateorlose.com Circle No. 507 TR AINING-CONDITIONING.COM
Aquality’s products are designed to cool athletes on the sidelines, in locker rooms, at practice, and on the field to create a safer and more comfortable environment. Keeping athletes cool is more important than ever. Evaporative cooling and misting systems can create a space that’s typically 15 to 35 degrees cooler than the ambient air. They can protect your athletes from dangerous heat stress, protect your program from liability, and help keep athletes performing at their best in any climate. WissTech Enterprises • 800-809-8184 www.wisstechenterprises.com Circle No. 509
Essential Information
Innovative Cramp Relief iFan Health Products has introduced the much-anticipated Bounce-BAC™ sports towel to provide runners with relief from cramping. Tested during the 2008 college football season by a former Division II national championship team, Bounce-BAC performed perfectly on both running backs and defensive backs. It is now available through Medco and CFA Medical. iFan Health Products • 877-677-2999 www.beatsuperbugs.com Circle No. 511 T&C july/august 2009
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aquatic ther apy
Putting Water to Work
Anyone Can Float
Aquatic Flexibility
The AquaJogger Pro Plus belt is ideal for athletes with minimal body fat who need maximum flotation for vertical aquatic training and rehab. This belt option is 50 percent more buoyant than the Classic model. The maximum waist size is 44 inches, but longer elastic belts are available for wider waistlines if needed. This product was specifically designed for “sinker” body types. AquaJogger • 800-922-9544 www.aquajogger.com Circle No. 512
The 900T is SwimEx’s most flexible model, offering the best of both worlds. Its flat open floor in the rear half of the pool and the workstations in the front half allow you to treat athletes with various conditions simultaneously. For shallow work, add an optional floor insert. These features are combined with unique paddlewheel technology that delivers the deepest, widest water flow, for a therapy/ workout session unlike any other. SwimEx 800-877-7946 • www.swimex.com Circle No. 514
Water Workouts Water dumbbells provide users with both flotation and resistance. Power Systems has two options for water dumbbells: the traditional Water Dumbbell is available in one, two, or three float versions to enhance flotation and resistance, while the Premium Water Dumbbell is triangular in shape and offers a comfortable textured grip that provides variable resistance in the water. Both are made of EVA foam material that makes cleaning a breeze. Power Systems 800-321-6975 • www.power-systems.com Circle No. 513
An Aquatic Innovator Sprint Aquatics has been supplying the aquatics world 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 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. Sprint Aquatics 800-235-2156 • www.sprintaquatics.com Circle No. 515
317 pages 363 photos 6 x 9 inches $24.95, trade paper ISBN: 9789963916320 Available in bookstores nationwide, or direct from Cardinal Publishers Group
800-296-0481 www.cardinalpub.com
The all-new Third Edition of this classic title provides the most thorough, safetyminded, and illustrated book on exercise technique. Over 60 exercises covered. It’s the definitive source for everyone who lifts weights—men and women of all ages and levels of training experience, including athletes, fitness trainees, bodybuilders, and strength trainees. By Stuart McRobert, author of the BRAWN series.
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Putting Water to Work
aquatic ther apy
Portable Therapy
Smoother and Smoother
The PolarPool proudly announces the introduction of its latest product for enhancing athletic performance. The new Portable Salt Water Training Tank is 8’ x 14’ x 52” high and offers cold, hot, and salt water therapy. It is truly portable and can be up and running in a matter of minutes. Visit the company online to learn more about this unit and The PolarPool’s other product offerings. The PolarPool 617-480-7683 • www.thepolarpool.com Circle No. 516
This fall, the pool with the smoothest water flow will add the smoothest-running treadmill to create the ultimate aquatic therapy experience. SwimEx’s “wall of water” comes from the variable-speed paddlewheel circulating 30,000 gallons of water per minute, while Woodway combines a slat-belt running surface and smooth-rolling ball bearings for the most comfortable running environment. The quality, history, and engineering behind these two leaders combine to make one great product. SwimEx • 800-877-7946 www.swimex.com Circle No. 518
Stable Flotation The Bar Float, a 25-inch version of the traditional water dumbbell, features a triple float at each end. It gives you all the benefits of a regular water dumbbell, but also provides stable, secure buoyancy for added support and resistance for beginners and advanced users alike. The Bar Float is available as a single unit, unlike most water dumbbells, which come in pairs. Power Systems • 800-321-6975 www.power-systems.com Circle No. 517
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Ankle & Foot Care
Innovative Protection
No More Chafing 2Toms is the creator of BlisterShield and SportShield, which are anti-friction skin guards that eliminate the friction that causes blisters and chafing. BlisterShield is a powder for the feet and hands, while SportShield is a liquid for the rest of the body. BlisterShield and SportShield increase comfort and enhance performance and endurance. They’re odor-free, non-greasy, and last all day under the most extreme conditions. 2Toms, LLC 866-924-7847 • www.2toms.com Circle No. 520
Comfort In Color Ankle protection isn’t black and white anymore. With the All-Sport Chameleon from Active Ankle, athletes can choose from eight bright interchangeable strap covers that come with each brace. The solid U-shaped frame ensures maximum strength, and the molded, fabric-lined EVA padding provides lightweight comfort. Get great style and the same great protection that has made Active Ankle an industry leader. Active Ankle Systems, Inc. 800-800-2896 • www.getchameleon.com Circle No. 521
Sound-Assisted Mobilization Visit SASTM online to view a demonstration video, purchase SASTM instruments, and get certified without attending a seminar. The company offers three-, six-, and eight-instrument packages, which come in a case with cream, a manual, and treatment protocol forms. You will also have access to a provider-only page with treatment protocol videos for 18 diagnoses, charting forms, a brochure, an information video, and a certification test. Call for more information and for a free seminar. Carpal Therapy, Inc. • 317-919-1713 www.sastm.com Circle No. 522
Unprecedented Control Active Ankle has introduced the Power Lacer ankle brace, with unique Y-shaped vertical stabilization straps that provide unprecedented control over both the forefoot and the heel. This lace-up brace offers control and stabilization without the complication of multiple straps. The Power Lacer is made of 840-denier nylon and is lined with neoprene for maximum comfort and fit. The four spring steel stays (two on each side of the ankle) provide extra support and 62
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aid in preventing heel release. Cramer Products, Inc. • 800-345-2231 www.cramersportsmed.com Circle No. 523
Recognized for Excellence Health Enterprises has been awarded the prestigious American Podiatric Medical Association (APMA) Seal of Acceptance for its Therapeutic Foot Massager and Tru-Ice Reusable Ice Therapy. The APMA Seal of Acceptance program was created to inform podiatric physicians and consumers about products with the quality, safety, and effectiveness to promote good foot health. The Therapeutic Foot Massager helps relieve pain, reduce stress, and relax tired feet with three easy-to-use massage options (heat, cold, and basic). Tru-Ice provides cold therapy in one-third the time of an ice bag to help reduce swelling and relieve pain with an ergonomic, reusable design and a patented liner system. Health Enterprises, Inc. • 508695-0727 • www.healthenterprises.com Circle No. 524
Rethinking Sprains “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. Jump Stretch, Inc. 800-344-3539 • www.jumpstretch.com Circle No. 525
Band Leaders Virtually identical to latex bands, REP Bands® resistive exercise bands from Magister Corp. offer greater elastic response, higher resiliency, and faster recovery. Patented REP Bands are the only resistive exercise bands manufactured exclusively in the United States. Magister Corp. 800-396-3130 • www.magistercorp.com Circle No. 526
Improved Design The ASO ankle stabilizer features several improvements. There is no longer a felled seam under the foot. Instead, a hidden seam significantly enhances comfort and durability. The continuous stabilizing straps are now angled to better contour TR AINING-CONDITIONING.COM
Innovative Protection with the anatomy of the ankle, creating a more uniform tension across the stabilizing straps above the malleolii to provide greater support. In addition, padding over the Achilles tendon has been increased to offer superior comfort. Medical Specialties, Inc. • 800-582-4040 www.medspec.com Circle No. 527
Strapped for Support The new Hg80 ankle brace with straps is Mueller Sports Medicine’s latest addition to the Hg80 Mueller Mercury line. Neopreneand latex-free, the Hg80 is lightweight and extremely soft to the touch. The state-ofthe-art design conforms to either foot and is engineered to maximize comfort while protecting against ankle sprains and re-injury. Secure stirrup straps and longer elastic crossing straps provide support. Dynamic figure-8 straps add tension as the ankle moves for even more support and a secure fit. Mueller Sports Medicine • 608-6438530 • www.muellersportsmed.com Circle No. 528
Selection Made Easy The QuadraStep System provides six uniquely designed orthoses in five adult sizes, each tailored to meet the needs of a specific foot type. Each of the five drawers represents one of these five sizes, containing one pair of each orthotic style, for a total of 30 pairs. The practitioner quickly identifies an athlete’s foot type, and then selects the color-coded orthotic that best addresses his or her biomechanical needs. Nolaro24, LLC • 877-RX24-NOW www.whatsmyfoottype.com Circle No. 529
Don’t Fear This Spider The Calf and Arch Spider™ means less pain and more activity for more people. It’s part of a comprehensive line of 16 pre-designed and ready-to-apply kinesiology taping solutions known as SpiderTech™, which has taken the therapeutic world by storm. This elasticized application, which can be worn continuously for multiple days, supports the muscles of the foot and lower limb to reduce pain and restore function. Go online for more information. NUCAP Medical 416-494-1444 • www.spidertech.com Circle No. 530
Anchored for Easy Adjustment The PRO model 611 combines the Arizona ankle brace and a Calf Anchor TR AINING-CONDITIONING.COM
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Strap to provide significant resistance to inversion. On-the-fly adjusting capability makes this ankle bracing system second to none, allowing the wearer to tighten up the brace during activity with one quick adjustment of the anchor strap. The unit is ideal for injury prevention, and for treating chronic ankle instability or high ankle sprains. It’s lightweight and machine washable. PRO Orthopedic Devices, Inc. 800-523-5611 • www.proorthopedic.com Circle No. 531
Avoid Chafing and Blisters The advanced liquid technology in every LiquiCell Blister Band protects skin from rubbing and friction, guarding against blisters, hot spots, abrasions, and bunions. LiquiCell is an artificial blister that saves the body from having to go through the pain of making one. The liquid circulates and moves in all directions, so your skin doesn’t. With easy-to-use and completely safe peel-andstick application, LiquiCell Blister Bands provide the ultimate skin protection. Pro-Tec Athletics • 800-779-3372 www.injurybegone.com Circle No. 532
All-Day Protection 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. Swede-O, Inc. • 800-525-9339 • www.swedeo.com Circle No. 533
Smooth Moves The Volt ankle brace is engineered to include the latest carbon-fiber technology. The polypropylene shell is reinforced with carbon fiber—the same highperformance material used in racing cars and bicycles. It also features a molded bearing-design performance hinge for smoother range of motion, strengthening ribs for a thinner profile, and fabricbacked EVA foam pads for durability and comfort. Active Ankle Systems, Inc. 800-800-2896 • www.activeankle.com Circle No. 534 T&C july/august 2009
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Ankle & Foot Care
Innovative Protection
Support That’s Just Right (or Left!)
What’s My Foot Type?
Ideal Support
Sink Into Comfort
The ASO EVO ankle stabilizer is an evolutionary step forward in ankle protection with its unique stirrup strap, stabilizing straps, and dynamic cuff. This new design enables the ASO EVO to comfortably provide exceptional ankle support and stability in the treatment of ankle injuries, and to reduce the severity and frequency of future ankle injuries. The ASO EVO is bilateral and fits either the left or right foot. Medical Specialties, Inc. • 800582-4040 • www.medspec.com Circle No. 535 The PRO 610 Arizona ankle brace is designed to fit either the left or right foot and is constructed of heavy-duty nylon for a low-profile, durable, lightweight fit. Two figure-8 lift straps encircle the foot, providing lateral and medial support. Hook-andloop fasteners allow quick and easy adjustment, even with the shoe on. A neoprene tongue provides a comfortable pad under the laces, eliminating instep irritation. PRO Orthopedic Devices, Inc. • 800-5235611 • www.proorthopedic.com Circle No. 536
The RX24 QuadraStep System is a revolutionary new alternative to traditional custom orthotics. Based on a clinical algorithm identifying 24 unique foot types, the 24 foot types are subdivided into six groupings of four, known as “Quads”. Six unique biomechanically based orthoses are available for immediate dispensing. Clinicians can now classify a patient’s foot type and dispense prescription-based orthoses within minutes. Enjoy affordable, ready-to-wear orthoses with custom results. Nolaro24, LLC • 877-RX24NOW • www.whatsmyfoottype.com Circle No. 537 The Pro-Tec Roller Massager is a great tool to reduce muscle tightness, soreness, and pain to maximize muscle performance and flexibility. Raised sections “sink” into soft tissue to roll out tightness, and the rounded grip ends provide precision trigger-point release to loosen knots in the muscle. It’s great for rolling the arches to alleviate plantar fasciitis and heel and foot pain. An instruction manual containing a number of exercises is included. Pro-Tec Athletics • 800779-3372 • www.injurybegone.com Circle No. 538
web news Learn About Injuries and Treatment Options Online
Prevent Blisters & Chafing
SportShield & BlisterShield
2Toms www.2toms.com 866-924-7847 64
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Pro-Tec Athletics, a leading sports medicine company specializing in sports medicine braces, supports, hot/cold products, and massage therapy products, offers the most detailed up-todate injury and product information online. Visit the company’s site to view its complete line of braces, supports, hot/cold products, and massage therapy products available for ligament, tendon, and muscle injuries. Get comprehensive information on identifying specific injuries, the correct treatments, and how to choose the appropriate products. Find links to the best medical distributors and get the most current information on new products for 2009. www.injurybegone.com
For All Your Orthopedic Needs Texas Orthopaedic Products & Services designs and manufactures an extensive line of orthopedic soft goods, braces, immobilizers, sports injury products, and related items that stabilize, treat, and rehabilitate musculoskeletal conditions. Visit the company’s Web site to view its wide selection of products, ranging from back braces and ankle stabilizers to innovative cervical pillows, finger splints, and much more. The site even offers a slideshow, making it easy to familiarize yourself with the company’s product line. www.topsproducts.com TR AINING-CONDITIONING.COM
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Great Products, Great Value Keeps On Killing Amerashield surface and textile protectant offers 24/7 protection for killing and inhibiting the growth of bacteria. It’s a water-based solution that is very safe and easy to apply. This protectant is invisible and offers continuous protection between normal cleaning intervals. One application is 99.9-percent effective for 90 days to one year. It is effective against MRSA, staph, swine flu, mold, mildew, ringworm, and athlete’s foot. Amerashield • 800-572-2217 www.amerashield.com Circle No. 540
Crucial Protection The BodyGuard is a 100-percent custommade compression short that delivers compression, support, muscle heat circulation, strain distribution, and impact absorption. It reduces the effects of injuries and trauma to the groin, hamstring, quadriceps, thigh, pelvis, hip pointer, hip flexor, and lower back. The Bodyguard has a 360-degree groin protector sewn into the crotch that conducts all explosive movements in the groin area out and back evenly. The BodyGuard is a “pelvic shock absorber,” protecting the groin and an exoskeleton of thin muscle enveloping the lower body from the waist to the knees. Antibody, Inc. • 877-546-2639 www.antibodywear.com Circle No. 541
Add the Power of Protein BiPro is an all-natural unflavored whey protein isolate that has 0 grams of carbs and is fat free, sugar free, and lactose free. BiPro is the ultimate anabolic food for building and sculpting strong, lean muscles. There are 20 grams of protein per serving. BiPro can easily be added to your favorite beverage or recipe. Call today or go online to order your twopound jar. BiPro • 877-MY-BI-PRO www.biprousa.com Circle No. 542
The Title Says It All Build Muscle, Lose Fat, Look Great has more than 640 pages of great information to help any athlete transform his or her body, no matter their level of training experience. Stuart McRobert, the acclaimed author of Brawn and Beyond Brawn, has compiled a practical, safe, and highly effective instruction manual with more than 200 pages devoted to TR AINING-CONDITIONING.COM
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exercise technique. At $34.95, this book is a great value for any coach. Cardinal Publishers Group • 800-296-0481 www.cardinalpub.com Circle No. 543
Monitor Everything Since 1976, Creative Health Products has been a leading discount supplier of rehabilitation, fitness, exercise, and athletic equipment, as well as health, medical, and fitness testing and measuring products, all available at reduced prices. Creative Health Products offers heart rate monitors; blood pressure testers; pulse oximeters; body fat calipers; scales; strength testers; flexibility testers; stethoscopes; pedometers; exercise bikes; ergometers; stopwatches; fitness books and software; exercise bands; step benches; hand and finger exercisers; heating pads; and more. Creative Health Products, Inc. 800-742-4478 • www.chponline.com Circle No. 544
Works Three Ways Medical professionals helped design and evaluate Cho-Pat’s unique Shin Splint Compression Sleeve, which alleviates the symptoms of pain and discomfort associated with shin splints. The sleeve has a threefold approach: It uses compression to support the leg muscles and soft tissue, it stimulates circulation and maintains warmth to control fluid buildup, and straps at the top and bottom of the sleeve act as shock absorbers to reduce microtrauma to the tendons and other soft tissue, thus helping maintain the device in the proper position. Cho-Pat 800-221-1601 • www.cho-pat.com Circle No. 545
Expand Your Horizons Cleveland Chiropractic College (CCC), with campuses in Kansas City and Los Angeles, has been educating healthcare professionals for more than eight decades. More than one in every 10 doctors of chiropractic practicing in North America is a Cleveland graduate. CCC offers a Bachelor of Science in Human Biology and a Doctor of Chiropractic degree. In 2010, Cleveland begins the first in a series of university programs offering a Master of Science in Health Promotion. Cleveland Chiropractic College • 800-467-2252 www.cleveland.edu Circle No. 546
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Great Products, Great Value
Optimal Nutrition, No Guesswork
Enhance Your Credentials
Muscle Milk Ready-to-Drink is a lactosefree, protein-enhanced formula that promotes efficient fat burning, lean muscle growth, and fast recovery from exercise. Designed after one of nature’s most balanced foods—human mother’s milk—Muscle Milk takes the guesswork out of high-performance nutrition, delivering a precise blend of premium proteins, complex low-sugar carbohydrates, functional fats, vitamins, and minerals. For building lean body mass, toning your physique, or weight control, Muscle Milk Ready-to-Drink is the perfect complete protein supplement. CytoSport, Inc. 888-298-6629 • www.cytosport.com Circle No. 547
An elite training program for fitness and enhanced athletic performance, the NASM Performance Enhancement Specialist (NASM-PES) is designed for athletic trainers, chiropractors, physical therapists, coaches, and other sports professionals who want to work with players at all levels, from the secondary education and university tier to professional and Olympiclevel athletes. Con-Ed approved: NASM 1.9, ACE 1.8, NSCA 1.6, BOC 27 CEUs. National Academy of Sports Medicine 800-460-6276 • www.nasm.org Circle No. 551
Workplace Recognition Fitness Anywhere was named to Outside magazine’s second annual “Best Places to Work” list. Fitness Anywhere was ranked 22nd out of 30 selected companies. The full list and the related story are published in the May issue of Outside. The article explains that Fitness Anywhere offers free fitness classes to employees, provides financial assistance for employees, and has a very dog- and kid-friendly office. Fitness Anywhere, Inc. 888-878-5348 • www.fitnessanywhere.com Circle No. 548
Who Needs Friction? To eliminate friction on joints when exercising, Perform Better suggests Flowin: a neat way to perform safe stabilization training while maintaining the workload. The complete kit includes the Flowin Pro Board, two foot pads, two hand pads, and one knee pad. The hand and foot pads allow exercises to be performed with different points of support. Perform Better 800-556-7464 • www.performbetter.com Circle No. 549
Maintain Full Mobility The Mueller MAX knee strap is a lightweight, comfortable support for the relief of pain associated with soreness, stiffness, and arthritis. Compression tubes target above, below, and on both sides of the knee. This support provides targeted compression without reducing mobility. Upper and side compression tubes target misalignment and help improve patellar tracking. Breathable mesh fabric allows for an all-day comfortable fit. Mueller Sports Medicine • 608-643-8530 www.muellersportsmed.com Circle No. 550 66
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Functional and Versatile The Bio Horizontal Leg Press Machine features 2” x 3” steel tube construction with two angled foot pads to target specific muscle groups. The seat position adjusts on linear ball bearings, and the seat back has four different positions for maximum athlete comfort and workout versatility. Chrome weight storage posts and industrial-grade ball bearings provide sturdy functionality, while helper handles on the foot pad make it easy to initiate presses. Go online to learn more about this outstanding product. New York Barbells of Elmira, Inc. • 800-446-1833 www.newyorkbarbells.com Circle No. 552
Progressive Resistance MediCordz® safety bungie products provide rehab and strengthening programs with the added safety and security of strong and durable high-grade bungie. This patented line of products offers seven progressive resistance levels to choose from. Unlike latex exercise bands, MediCordz safety bungie provides resistance in rehab and exercise without the fear of latex allergies and possible breakage. The best-selling Bungie Rehab Kit (item #M394, shown) is used in upperbody, lower-body, and core stabilization exercises. NZ Manufacturing, LLC 800-886-6621 • www.nzmfg.com Circle No. 553
Science Meets Nature New Biofreeze pain-relieving spray is specially formulated with natural menthol, MSM, Ilex, and a new blend of botanical ingredients, such as arnica, calendula, chamomile, echinacea, juniper berry, and white tea. The new formula provides improved performance and longer-lasting relief from back, TR AINING-CONDITIONING.COM
Great Products, Great Value neck, hip, and leg pain, shoulder/arm discomfort, arthritis, painful joints, and sore or strained muscles. Biofreeze painrelieving spray complements Biofreeze gel and roll-on, delivering a blend of science and nature. Performance Health 800-321-2135 • www.biofreeze.com Circle No. 554
Because Time Matters Without proper care, a knocked-out tooth begins to die in 15 minutes. The Save-ATooth emergency tooth preserving system utilizes Hank’s Balanced Salt Solution (HBSS) to not only preserve, but also reconstitute many of the degenerated cells. The patented basket and net container are designed to protect tooth root cells. This is the only system that keeps tooth cells alive for up to 24 hours. Save-A-Tooth® 888-788-6684 • www.save-a-tooth.com Circle No. 555
Bigger Is Better Wilson Case’s new SplitTopXL is a larger version of the company’s popular Athletic Trainer’s SplitTop Case. The SplitTopXL has twice as much inside height as the standard version and comes with six-inch turf tires that can go anywhere with ease and will never go flat. Just like the standard SplitTop case, the SplitTopXL is sold as a base unit with interior options available. Wilson Case • 800-322-5493 www.wilsoncase.com Circle No. 556
Check Their Hearts The XRC-8001 is new to the Xtreme Research Corp. family of products. This high-tech instrument can save lives through preventive heart screening, and keeping track of your athletes’ data. It’s a multi-functional unit that allows ECG readings to be drawn from the leg, palm, and chest. It also includes a detachable three-lead system for measurement. It comes with software to print, read, and log the readings and data. Download the information to any PC using the USB cable (included). Xtreme Research Corp. 888-732-0665 • www.xgun.com Circle No. 557
For Shoulders In Need The Angle Shoulder Brace is a 100-percent custom-made compression shoulder brace that delivers compression, structural support, muscle heat circulation, strain distribution, and impact absorption. It’s TR AINING-CONDITIONING.COM
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designed to reduce the effects of shoulder separations/subluxations, dislocations, joint instability, impact trauma, and postoperative complications, while reducing genetic shoulder instability by compressing, compartmentalizing, and stabilizing the shoulder joint and the musculature of the entire shoulder region. Antibody, Inc. 877-546-2639 • www.antibodywear.com Circle No. 558
Organize Your Supplies Perform Better’s new Functional Training Racks provide effective, efficient, and organized storage for your functional training equipment. Both types of these racks can hold balls, bands, rollers, mats, and more without taking up a lot of space in your facility. They are only available through Perform Better. Request your free copy of the company’s new catalog by phone or online today. Perform Better 800-556-7464 • www.performbetter.com Circle No. 559
Keep Your Balance The Thera-Band Stability Disc joins a family of premier Thera-Band stability products utilized for sports performance enhancement, balance training, and rehabilitation. Packaged for practitioner resale and complete with a comprehensive exercise poster, the 13-inch Stability Disc is the most challenging balance product within the Thera-Band soft stability products category. Its versatile design supports a wide range of exercises, and it can be integrated with other resistance and balance products. Performance Health 800-321-2135 • www.thera-band.com Circle No. 560
Stand Up to Athlete’s Foot iFan Health Products introduced its allnatural athlete’s foot relief product, BACON TRAC™, at this year’s NATA show. BAC-ON TRAC has been successfully tested by a number of athletic trainers, coaches, and players this year. The first step in addressing any skin problem is cleanliness, and Bacrobial® is unequalled in its all-natural skin-cleansing abilities. This product is distributed by Medco and CFA Medical. iFan Health Products 877-677-2999 • www.beatsuperbugs.com Circle No. 561
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Director ies Circle Company No.
Advertisers Directory Page No.
Circle Company No.
Page No.
107. . . Active Ankle. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
106. . . Mueller Sports Medicine. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
120. . . Amerashield. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
137. . . NASM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
136. . . Antibody (The BodyGuard). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
131. . . New York Barbells of Elmira. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
126. . . AquaJogger . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
100. . . NUCAP Medical. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . IFC
119. . . Bacrobial (iFan Health Products) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
141. . . OPTP. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
124. . . BiPro. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
110. . . Perform Better . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
146. . . BlisterShield/2Toms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
145. . . Perform Better (seminars). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
125. . . California University of Pennsylvania . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
138. . . Power Systems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
144. . . Cardinal Publishers Group. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
135. . . PRO Orthopedic Devices. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
113. . . Carpal Therapy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
114. . . Pro-Tec Athletics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
101. . . Cho-Pat . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
104. . . RX24 QuadraStep System (Nolaro24). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
112. . . Cleveland Chiropractic College. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
128. . . Samson Equipment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
105. . . Cramer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
140. . . Save-A-Tooth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
148. . . CytoSport . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . BC
127. . . Shuttle Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
147. . . Dynatronics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . IBC
143. . . Sprint Aquatics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
130. . . Egg Whites. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
111. . . Swede-O . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
109. . . Gladiator Mouthguards. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
129. . . SwimEx . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
103. . . Hibiclens. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
108. . . The PolarPool. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
117. . . HQ, Inc. (CorTemp). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
102. . . Thera-Band速/Performance Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
121. . . Hydrate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
139. . . TurfCordz/NZ Mfg.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
122. . . JDI Sports (Aqualift) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
123. . . Waterboy Sports. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
132. . . Jump Stretch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
116. . . WissTech Enterprises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
115. . . Magister Corporation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
134. . . Xtreme Research Corp.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
133. . . Medical Specialties. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Circle Company No.
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Products Directory Page No.
Circle Company No.
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521. . . Active Ankle (All-Sport Chameleon). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
528. . . Mueller (Hg80 ankle brace) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
534. . . Active Ankle (Volt ankle brace). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
550. . . Mueller (MAX knee strap) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
540. . . Amerashield. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
551. . . NASM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
558. . . Antibody (Angle Shoulder Brace) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
552. . . New York Barbells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
501. . . Antibody (Carpal Tunnel Wrist Brace). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
530. . . NUCAP Medical (Calf and Arch Spider). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
541. . . Antibody (The Bodyguard). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
553. . . NZ Mfg. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
512. . . AquaJogger . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
549. . . Perform Better (Flowin). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
542. . . BiPro. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
559. . . Perform Better (Functional Training Racks) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
520. . . BlisterShield/2Toms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
554. . . Performance Health (Biofreeze 速). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
543. . . Cardinal Publishers Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
560. . . Performance Health (Thera-Band速) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
522. . . Carpal Therapy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
502. . . Polar, Inc.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
545. . . Cho-Pat . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
517. . . Power Systems (Bar Float) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
546. . . Cleveland Chiropractic College. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
513. . . Power Systems (Water Dumbbell). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
504. . . Cramer (portable hydration units) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
536. . . PRO Orthopedic (610 Arizona ankle brace) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
523. . . Cramer (Power Lacer ankle brace). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
531. . . PRO Orthopedic (model 611). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
544. . . Creative Health Products . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
532. . . Pro-Tec Athletics (LiquiCell Blister Band). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
547. . . CytoSport . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
538. . . Pro-Tec Athletics (Roller Massager). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
503. . . efi Sports Medicine/Total Gym . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
529. . . RX24 QuadraStep System (Nolaro24). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
548. . . Fitness Anywhere . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
537. . . RX24 QuadraStep System (Nolaro24). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
500. . . Gladiator Mouthguards. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
555. . . Save-A-Tooth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
524. . . Health Enterprises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
515. . . Sprint Aquatics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
505. . . HQ, Inc. (CorTemp). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
533. . . Swede-O. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
506. . . Hydrate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
514. . . SwimEx (900T). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
561. . . iFan Health Products (BAC-ON TRAC). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
518. . . SwimEx (treadmill). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
511. . . iFan Health Products (Bounce-BAC). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
516. . . The PolarPool . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
507. . . JDI Sports (Aqualift) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
508. . . Waterboy Sports. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
525. . . Jump Stretch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
556. . . Wilson Case . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
526. . . Magister Corporation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
509. . . WissTech Enterprises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
527. . . Medical Specialties (ASO ankle stabilizer). . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
510. . . Xtreme Research Corp. (SkyScan Ti-plus). . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
535. . . Medical Specialties (ASO EVO). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
557. . . Xtreme Research Corp. (XRC-8001) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
T&C july/august 2009
TR AINING-CONDITIONING.COM
CEU QUIZ
T&C July/August 2009 Volume XIX, No. 5
Training & Conditioning is pleased to provide NATA and NSCA members with the
Qu
icke You c a and g n now tak r & E a et yo e our ur C CEU q sier! uizze Click EU results s on www o a .train n “CEUs & C nd credit in line... s ourse ing-c s” at: tantly. ondi tio ning
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, readers can earn 2.0 BOC Athletic Training and 0.2 NSCA (two hours) continuing education units.
.com
Instructions: Go to www.training-conditioning.com and click on “CEUs & Courses” to take the quiz online. You may also mail your quiz to us: Fill in the circle on the answer form (on page 71) that represents the best answer for each of the questions below. Complete the form at the bottom of page 71, include a $25 payment to MAG, Inc., and mail it to the following address: MAG, Inc., ATTN: T&C 19.5 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 Boards (pages 5-6)
Objective: Learn about some of the latest news, research, and current issues relevant to sports medicine professionals.
1. The North Carolina Athletic Trainers’ Association estimates that enacting a new law to require athletic trainers at all public high schools in the state would cost: a) $5 million. b) $17 million. c) $21 million. d) $33 million. 2. A new study shows that the ______ receives the most stress during the “windmill” softball pitch. a) Biceps. b) Shoulder. c) Wrist. d) Elbow. 3. Which of the following is NOT a National Institutes of Health recommendation for working with athletes who have asthma? a) Having asthma management protocols in place. b) Having a pulmonologist present at all practices. c) Having a rescue inhaler at all practices. d) Having a rescue inhaler at all games. 4. To study the recovery effects of a sports drink compared with a bowl of cereal, researchers took athletes’ blood samples at ______ intervals after a workout. a) 10-minute. b) 15-minute. c) 20-minute. d) 60-minute.
Comeback Athlete (pages 9-13)
Objective: Follow the comeback story of Stanford University football player Jim Dray, who underwent extensive rehab after badly damaging his knee.
5. An MRI showed that Jim Dray had torn his: a) ACL and PCL. b) ACL, PCL, and LCL. c) ACL and sartorius. d) ACL, MCL, and LCL.
6. During Dray’s first surgery, Dr. Jason Dragoo repaired his: a) LCL and MCL. b) ACL only. c) LCL, biceps femoris, and popliteus. d) ACL, LCL, hamstring, and popliteus. 7. By week 18 of Dray’s rehab, one of his goals was to perform a ______ to 60 degrees. a) Single-leg squat. b) Double-leg squat. c) Forward lunge. d) Lateral lunge.
Healing Hands (pages 15-19)
Objective: Understand how sports chiropractic medicine has evolved and how it can provide orthopedic benefits to athletes in a wide variety of sports.
8. According to the author, chiropractors are typically concerned with which main facets of orthopedics? a) Vertebrae and nerves. b) Joints and soft tissue. c) Hands and feet. d) Joints and vertebrae. 9. Hypermobility occurs when a joint has excessive: a) Cartilage. b) Lateral flexibility. c) Motion or laxity. d) Tendinopathy. 10. Soccer players often experience degenerative changes in the foot and ankle by their early 30s due to: a) Excessive pronation. b) Excessive supination. c) A history of aberrant mobility. d) A history of ankle sprains. 11. A Diplomate of the American Chiropractic Board of Sports Physicians has completed at least ______ hours of postgraduate study. a) 100. b) 150. c) 280. d) 320.
Continued on page 70—with answer sheet on page 71...or take this quiz online and get instant results:
www.training-conditioning.com click on CEUs & Courses
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T&C July/August 2009
69
CEU QUIZ Taking the Lead (pages 20-28)
Objective: Learn about the risks of heat illness and the latest prevention and treatment methods used to protect athletes from heat-related injury.
12. Research from the University of Georgia shows that the risk of exertional heat illness increases when: a) The air temperature reaches 90 Fahrenheit. b) The heat index exceeds 90. c) The UV index exceeds 7. d) The wet bulb globe temperature reaches 82 Fahrenheit. 13. At the University of Oklahoma, if an athlete may be suffering from heat stroke, an athletic trainer will: a) Immerse them in a cold water tank. b) Have them drink at least 32 ounces of water. c) Cancel the rest of practice. d) Move the practice indoors. 14. Wet bulb globe temperature differs from heat index in that it accounts for: a) Radiation from the sun. b) Wind speed. c) Relative humidity. d) Barometric pressure. 15. Sandra Fowkes-Godek says that in a perfect scenario, all athletes would be protected from heat illness through the use of: a) Lighter equipment. b) Intestinal sensors. c) Ice water immersion. d) Intravenous fluids. 16. When the University of Oklahoma screened football players for ______, most athletes who tested positive didn’t know they had it. a) Anemia. b) Hyponatremia. c) Sickle cell trait. d) Chronic dehydration.
The Rest of the Story (pages 31-36)
Objective: Develop a more thorough understanding of the specific recovery habits athletes should use to maximize health and athletic performance.
17. In the author’s survey group, ______ of college freshman athletes got less than seven hours of sleep in a typical night. a) 16 percent. b) 22 percent. c) 29 percent. d) 38 percent. 18. According to the Recovery Scoring Guide system recommended in this article, an athlete’s recovery will be optimal if they score ______ daily points. a) 10-12. b) 13-15. c) 17-20. d) 14 or more.
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T&C July/August 2009
19. The author recommends that athletes weigh themselves before and after workouts to determine: a) Approximate calorie expenditure. b) Fat loss. c) The size of their recovery meal. d) Fluid loss from sweating. 20. The author’s advice for improving sleep habits is to: a) Stick to the same bedtime as often as possible. b) Avoid drinking fluids within two hours of bedtime. c) Avoid caffeine after 9 p.m. d) Set aside one night a week to catch up on lost sleep.
A Private Matter (pages 39-45)
Objective: Improve your understanding of the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule and how it affects healthcare professionals in an athletic training setting.
21. The HIPAA rules were changed most recently when Congress passed the: a) 2009 economic stimulus bill. b) 2009 federal budget. c) Digital Millennium Copyright Act. d) Family Educational Rights and Privacy Act. 22. The HIPAA Privacy Rule only applies to a specific type of person or group known as a: a) State actor. b) Covered entity. c) Health services provider. d) Healthcare clearinghouse. 23. The Family Educational Rights and Privacy Act (FERPA) was enacted in: a) 1938. b) 1962. c) 1970. d) 1974.
Swing Theory (pages 46-50)
Objective: Learn how various levels of an athlete’s sensorimotor system can be better controlled to improve performance in golf.
24. The term ______ describes the sequence of body segment movement patterns. a) Conscious coordination. b) Dynamic balance. c) Kinematic sequencing. d) Dynamic movement conditioning. 25. Subconscious proprioceptive systems can operate ______ times faster than the cognitive mind. a) 10 to 15. b) 20 to 25. c) 25 to 30. d) 40 to 50.
TR AINING-CONDITIONING.COM
CEU QUIZ Answer Form Instructions: Go to www.training-conditioning.com and click on “CEUs & Courses” to take the quiz online. You may also mail your quiz to us: Fill in the circle on the answer form below that represents your selection of the best answer for each question. 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 19.5 Quiz, 31 Dutch Mill Road, Ithaca, NY 14850. 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. Questions? Problems? E-mail: CEU@MomentumMedia.com.
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Comeback Athlete
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T&C July/August 2009
71
Next Stop: Web Site Our editorial continues on Here is a sampling of what’s posted right now:
This summer, NATA Hall of Famer Jim Booher retired after 42 years as Head Athletic Trainer at South Dakota State University. Read a Q&A with Booher on our Web site.
MONTHLY FEATURES A Conversation With Jim Booher Recently retired South Dakota State University Head Athletic Trainer Jim Booher, PhD, ATC, PT, is an NATA Hall of Famer who pioneered the Jackrabbit athletic training program in 1966. We caught up with Booher this summer, and in this interview he looks back at some of the memorable moments he experienced in his 42 years at SDSU.
Life Savers In June, an athlete at Wayzata High School in Plymouth, Minn., went into cardiac arrest during a workout. But thanks to quick action by members of the Wayzata staff, including Strength and Conditioning Coach Ryan Johnson, CSCS, and an automated external defibrillator, the athlete survived. Don’t miss Johnson’s first-hand account of this harrowing experience.
Q&A With Chris Hirth In just his first year as the University of North Carolina Men’s Basketball Athletic Trainer, Chris Hirth, ATC, saw the Tar Heels cut down the nets after winning the national championship. Be sure to catch our interview with Hirth as he talks about his climb up the career ladder and keeping UNC’s brightest stars at the top of their game.
www.training-conditioning.com/features.php
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