Training & Conditioning 19.7 by Momentummedia

October 2009 Vol. XIX, No. 7, $7.00

Rising Above Pain

Strategies to manage Complex Regional Pain Syndrome

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October 2009, Vol. XIX, No. 7

contents 21

27 Bulletin Boards 4 FDA issues warning on steroid-tainted supplements … High-risk high school football hits … Musculoskeletal ultrasound: Coming to a sideline near you? … The brain’s role in ACL injury.

Comeback Athlete Breanna Walukevich Sanborn Regional High School, Kingston, N.H.

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56 Advertisers Directory CEU Quiz 61 For NATA and NSCA Members

64 Next Stop: Web Site On the cover: University of Illinois volleyball player Kayani Turner returned to her team in 2008 after missing a full season due to Complex Regional Pain Syndrome. Story begins on page 12. Photo by University of Illinois Sports Information TR AINING-CONDITIONING.COM

Treating the Athlete

12 A mysterious and debilitating condition, Complex Regional Pain Rising Above Pain

Syndrome is showing up more frequently in young athletes. There is no cure, but researchers and practitioners are finding effective ways to manage the symptoms and reduce their impact on quality of life. By Maria Hutsick Optimum Performance

21 Technology that monitors the body’s response to training is opening new Measure for Measure

doors to performance enhancement for those who know how to use it. By Vern Gambetta Special Focus

of the Tape 27 Tale Elastic therapeutic tape is an emerging modality that offers great

potential to reduce the impact of soft tissue and joint injuries while enhancing the healing process. By Jayson Goo Nutrition

Armor 35 Antioxidant Research shows that free radicals can wreak havoc on muscle tissue health, slowing recovery and impairing performance. With the right diet, athletes can take advantage of antioxidant power to ward off these effects. By Lisa Dorfman Sport Specific

42 At the University of Alaska-Anchorage, track and field athletes are Learning Curve

taught to play an active role in setting their own individual strength and conditioning priorities. By Michael Friess T&C october 2009

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 Jim Berry, EdD, ATC, SCAT, NREMT 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

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

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

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

Christopher Ingersoll, PhD, ATC, FACSM Director, Graduate Programs in Sports Medicine/Athletic Training University of Virginia Allan Johnson, MS, MSCC, CSCS Sports Performance Director Velocity Sports Performance

Debra Brooks, CNMT, LMT, PhD CEO, Iowa NeuroMuscular Therapy Center

Publisher Mark Goldberg

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

Leslie Bonci, MPH, RD Director, Sports Medicine Nutrition Program, University of Pittsburgh Medical Ctr. Health System

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

October 2009 Vol. XIX, No. 7

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

Circulation Staff David Dubin, Director John Callaghan 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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Bulletin

Board FDA Warns of Hidden Steroids in Supplements After receiving several reports about unsafe substances in some popular supplements, the U.S. Food and Drug Administration (FDA) recently released a warning about eight products found to contain hidden steroids. All the supplements are manufactured by American Cellular Laboratories, Inc. The products in question are TREN-Xtreme, MASS Xtreme, ESTRO Xtreme, AH-89-Xtreme, HMG Xtreme, MMA-3 Xtreme, VNS-9 Xtreme, and TT-40-Xtreme. Since the FDA has little regulatory power over supplement producers, it typically issues such a warning only after a product has been on sale to the public and consumer groups or independent labs report that it poses health risks. In this particular warning, the FDA notes that supplements with steroids or steroid-like substances can lead to acute liver injury and kidney failure. Beyond the health risks, athletes who are subject to doping tests may jeopardize their eligibility by taking substances with impermissible ingredients, even if the product label is misleading or incomplete. As a general rule, the FDA recommends avoiding any supplements that make outlandish promises, and those that claim to alter the effects of hormones such as estrogen, testosterone, and progestin. Athletes should also be wary of products displaying words like “anabolic” and “tren,” and the phrases “blocks estrogen” and “minimizes gyno,” which suggest that a supplement attempts to mask steroid-related side effects such as breast swelling in men and female fat distribution.

High-Risk High School Football Hits As football players progress from high school to college, they tend to get bigger, stronger, and more powerful. That leads to more forceful and dangerous hits on the field, right? A new report published by the NATA found just the opposite. The goal of the report was to analyze risk for cervical spine injuries and concussions among high school players. Using a combination of new research and existing injury data, it found that tackles in high school games may pose a greater injury risk than those in college. Researchers from the University of Illinois fitted 35 varsity high school players with helmets containing sensors to measure force and impact to the head and neck during the 2007 season. The helmets measured linear and rotational acceleration—the speed at which the head moves after being struck, and the intensity and duration of the impact. Over 55 practices and 13 games, the researchers tracked 4

T&C october 2009

19,224 hits, and compared the data to similar studies conducted on college players. They found that the average linear acceleration from a tackle in a high school game was greater than in a college contest, and that impact to the front of the helmet was about 10 percent more common in high school than college and typically packed three more Gs of force. They also observed that high school defensive linemen took the most hits, blows to the top of the head were the most intense, and tackling in games was much more powerful than in practices. Several factors likely contribute to the disparity between high school and college hits. For one, high school athletes are less skilled in tackling. The researchers called on coaches to teach athletes to tackle with their head up to avoid impact to the crown of the helmet, which increases injury risk. The authors also noted that neck strength, endurance, and physical maturity could play a role. The average college athlete weighed 30 pounds more than his high school counterpart, but was only 1.2 inches taller. They said this means the college players have a “more developed musculature system that is better able to control head motion after impact.” High school football players suffer more sports-related concussions than any other group of athletes, but researchers could not determine if the increased linear acceleration resulting from tackling is the cause. Of the 1.2 million U.S. high schoolers who play football each year, between four and six percent suffer concussions. To view the report, go to: www.nata.org and search “Head Impacts During High School Football.”

Sideline Ultrasound on the Horizon Do you wish there was a cheaper, faster, easily portable way to diagnose orthopedic injuries? In the near future, musculoskeletal ultrasound may be the answer. “It’s very likely that this type of ultrasound will be on the sidelines in a couple of years,” says Joshua Hackel, MD, Primary Care Sports Medicine Physician for the Andrews Institute for Orthopedics & Sports Medicine and Team Physician at the University of West Florida. “It is already being used in some college settings. We are trying to start an ultrasound training program for high school athletic trainers and hope to implement a sideline ultrasound unit at the high schools our clinic takes care of here in Florida.” Musculoskeletal ultrasound works by emitting sound waves from a probe. The waves bounce off body tissue to determine depth and density, and use that information to create an image. Thanks to recent technological improvements—as well as its proven ability to identify injuries such as muscle and TR AINING-CONDITIONING.COM

Bulletin

Board ligament tears—ultrasound now boasts many advantages. “The technology has been used for decades, but the portability has improved a lot recently,” says Hackel. “Not only have the images gotten much better, but the unit itself is now the size of a laptop computer. It’s also much less expensive than a CT scan or x-ray.” Hackel feels the device is much easier on athletes, too. “You don’t have to worry about the patient being claustrophobic like with a CT scan or an MRI,” he says. “With those methods, the patient has to remain extremely still—if they move at all, it creates an artifact in the picture and gives you an unusable image. With ultrasound, claustrophobia is not an issue. “Another big advantage is that you can evaluate a patient dynamically,” continues Hackel. “You can look at tissues as they are moving and gliding.” Hackel says learning to analyze ultrasound images requires a medical education course, basic and advanced ultrasound courses, and at least six months of working with ultrasound on a regular basis. But with so much upside, he predicts many athletic training programs will eventually be convinced to make the investment. “It gives athletic trainers very useful information to make a decision on how a player is progressing,” Hackel says. “It’s an objective way to advance rehabilitation and make more informed decisions on return to play.”

The Brain’s Role in ACL Injuries It’s well established that fatigue increases ACL injury risk. But is that effect limited to fatigue in the knee itself? Researchers at the University of Michigan suggest the answer is no. In a study published in the August issue of Medicine & Science in Sports & Exercise, a group of female college athletes performed one-legged squats to fatigue on only one side, then underwent reaction time tests through a number of movements. During the tests, both legs displayed equally dangerous movement patterns that heightened the risk for ACL injury—not just the leg that completed the squats. This finding suggests that not only localized fatigue, but also the brain and reflexive response may play a key role in ACL injuries. The authors believe visualization, virtual reality technology, and quick-reaction drills could train the brain to make better split-second decisions in fast-paced situations, thereby decreasing fatigue-induced ACL injury risk. To view the abstract of the study, entitled “Fatigue-Induced ACL Injury Risk Stems from a Degradation in Central Control,” go to: www.pubmed.gov and search “fatigue-induced ACL injury.”

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ComebackAthlete

Breanna Walukevich Sanborn Regional High School, Kingston, N.H. By R.J. Anderson

Known for her toughness, Breanna Walukevich has a heart that doesn’t quit when she’s on the basketball court. However, when she was rushed to a hospital three years ago, it was her overactive ticker that had doctors concerned. For Walukevich, now a senior at Sanborn Regional High School in Kingston, N.H., playing hard can be a doubleedged sword. While she knows no other way than to give all-out effort, an elevated heart rate can become hazardous to her health. But thanks to an implantable cardioverter-defibrillator (ICD) and diligent care from her comeback team, including Matthew Szelog, LAT, ATC, CSCS, CES, Head Athletic Trainer at Sanborn and Director of Dynamic Performance Sports Training at Exeter Hospital in Exeter, N.H., Walukevich has learned to live with her condition and isn’t letting it hold her back. Walukevich’s comeback story begins in her freshman year following a preseason soccer practice. After completing the second session of two-a-days, she complained to her coach of dizziness and shortness of breath. Checking Walukevich’s pulse, the coach discovered that her heart rate was around 280 beats per minute (bpm). “You could actually see my heart pounding through my chest,” Walukevich recalls. An ambulance was called and the 14-year-old was rushed to a local hospital. Along the way, her heart rate returned to normal, but doctors felt the incident was serious enough to transfer her to Children’s Hospital Boston. She stayed for a week, undergoing an array of tests. Though doctors didn’t learn exactly what sparked the racing heart, Walukevich was diagnosed with a cardiac arrhythmia and the ICD was surgically implanted. The ICD monitors Walukevich’s heart rate and delivers a shock whenever it reaches an unsafely elevated level. The device uses an electrode wire, which passes through a vein to the right side of Walukevich’s heart. With the ICD set to deliver a shock whenever her heart rate exceeded 190 bpm, as well as a prescription for Toprol (a beta-blocker), Walukevich was released from the hospital. “They don’t really know what causes the arrhythmia,” says Walukevich. “I’m young, healthy, and athletic, so none of the traditional diagnoses really fit. They said it’s a case of me having an out-of-whack electrical system. “For example, whenever I get an EKG, the readings are abnormal for a young, athletic girl,” she continues. “My doctors TR AINING-CONDITIONING.COM

When a heart arrhythmia forced Breanna Walukevich to take an extended break from basketball and soccer, she turned to golf to remain active, and she now plans to play in college. told me I have the EKG readings of someone with anorexia— and I’m not anorexic.” Walukevich missed the first few weeks of classes as she recovered and got used to her new hardware and medication. Upon returning to school, she hadn’t been cleared to play soccer but rejoined her teammates as team manager and scorekeeper. When basketball season rolled around, Walukevich offered to serve as the manager for the freshman team. Then, midway through the season, she was given the green light to return to athletics. “My doctor told me that the arrhythmia was under control and that it was safe to play,” says Walukevich. “He said to ease into it and everything would be fine.” However, everything was not fine. An hour into her first practice, Walukevich was running through set plays when her heart rate hit 190 bpm. “I wasn’t even going that hard—I was taking it easy,” she recalls. “Suddenly, the ICD started beeping, and then it shocked me.” Over the next three minutes, it kept shocking her—eight times in all. “The ICD is only supposed to shock you a couple times, but it kept going because my heart rate wasn’t returnR.J. Anderson is an Assistant Editor at Training & Conditioning. He can be reached at: rja@MomentumMedia.com. T&C OCTOBER 2009

ComebackAthlete ing to normal,” says Walukevich. “The shocks hurt so bad that it felt like I blew out my chest. The doctors said the continued pain of the shock probably caused my heart rate to stay elevated.” Walukevich was taken back to Children’s Hospital Boston, where doctors spent three days examining her. They adjusted her ICD to go off at 210 bpm and sent her home with more

Traumatized by the incident, Walukevich retreated from athletics and spent the rest of her freshman year worrying when her next attack would come. “I was too afraid to do anything that might get my heart rate up,” she says. powerful beta-blockers and a prescription for Lisinopril, which is commonly used to treat high blood pressure—and a medication Walukevich’s grandmother also takes. Traumatized by the incident, Walukevich retreated from athletics and spent the rest of her freshman year worrying when her next attack would come. “I was too afraid to do anything that might get my heart rate up,” she says. “In fact, I would cringe whenever I heard any kind of beep, fearing it was my ICD about to go off again.”

T&C october 2009

In the fall of her sophomore year, at the urging of her parents and former basketball coach, Walukevich tried out for the golf team. Although she had never played the game before, she made the team as the only female on the roster. “Sports are my life, and when they were suddenly taken away, I needed to do something. Golf filled that void,” Walukevich says. “It’s a tough sport, but I picked it up pretty quickly.” When golf season ended, Walukevich still missed basketball—her favorite sport—so she joined the j.v. team as manager. Midway through the season, after watching Walukevich shoot around with the team, the coach asked if she’d consider playing again. She mulled it over and talked to her doctor. With her condition stabilized, he said it would be okay for her to give it a try. Szelog was adamant that a return-to-play protocol be firmly in place at the beginning. “The first time she came back, she somehow ended up on the court that first day without any of us meeting to talk about the situation,” he says. “The coach didn’t know any better and I wasn’t there that day to tell him any differently. I don’t know if it would have changed anything, but in hindsight, I wish we had all sat down beforehand and drawn up a definitive program before she was allowed on the court.” This time, Szelog would watch Walukevich like a hawk. “I told Bree we would follow a very strict program to con-

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ComebackAthlete dition her while also closely monitoring her heart rate,” he says. “We would take it day by day and slowly increase her workload to progressively get her back. Still, she was very hesitant.” To help assuage her fears, Szelog printed out articles he found online about athletes with ICDs returning to sport. He also outfitted Walukevich with a heart rate monitor watch and chest strap donated by a local health club affiliated with his clinic hospital. Designed to act as an early-warning system that would head off the ICD shocks, the watch was covered by a sweatband. Szelog also gave Walukevich a padded undershirt to protect the chest strap, as well as her ICD. “I set the monitor to sound an alarm when Bree’s heart rate got to 190 bpm, which was 20 below what her ICD was set at,” Szelog says. “I explained that if her heart rate ever got to 190, the watch would beep and she should immediately stop what she was doing and rest. Even if it were to go off during a game, we told her she should kneel down, calm her breathing, and not worry about the action around her. Thankfully, that never happened.” For six weeks, Szelog worked with Walukevich during team practices to slowly build her cardiovascular fitness. The first week was extremely simple and low-impact. Walukevich started workouts by jogging two laps around the gym at a very slow pace, then transitioned into a dynam-

ic flexibility routine, followed by a couple more laps, rest, then free throw shooting. Over the next few weeks, Szelog added more laps and some light agility work. After four weeks, he worked light sprinting into the routine. “No matter what we were doing, I’d continually check her heart rate, which was always right where we wanted it— around 130 or 140 bpm,” Szelog adds. “We charted every

“I explained that if her heart rate ever got to 190, the watch would beep and she should immediately stop what she was doing ... Even if it were to go off during a game, we told her she should kneel down, calm her breathing, and not worry about the action around her.” workout, and her coach even had her write down her heart rate after phys ed classes. We never had any problems with it getting too high.” Szelog says communication was the key in walking the fine line between getting Walukevich in shape and not letting her overdo it. “She was very honest and would regularly update me on how she was feeling,” he says. “She let me know right away when she needed to take a break and get a drink.”

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ComebackAthlete By mid-December, Walukevich was ready to be slowly introduced to team practice activities, although in a very limited capacity. “We started her with 15 to 30 minutes of shooting and defensive drills, and built her up to being able to jump into scrimmages during practice,” Szelog says. “Even then, we only let her go for three or four minutes before bringing her to the sideline to rest.” Walukevich got her first taste of game action in early January. It was only for a few minutes, but it meant the world to her. “It wasn’t long after I started playing that I wasn’t afraid anymore,” she says. “I realized that it was a lot more fun to play and not worry, than to not play and be worried all the time.” Throughout the ordeal, she also gained an appreciation for the joys of participation. “Before, I might have complained about going to practice or having to run two miles or do sprints,” she says. “But once all that was

“Before, I might have complained about going to practice or having to run two miles or do sprints. But once all that was taken away, I really wanted to get back into it. I realized I missed doing that hard stuff—I missed sprinting!” taken away, I really wanted to get back into it. I realized I missed doing that hard stuff—I missed sprinting!” After regaining her confidence as a sophomore, Walukevich enjoyed a fantastic junior year, especially on the golf course. After competing against boys during the regular season, she tied for third in the nine-hole division of the New Hampshire Interscholastic Athletic Association girls’ individual golf tournament. After high school, Walukevich plans play collegiate golf. In the winter, she made strides on the basketball court, earning more and longer playing shifts. “I’d go full out for like three minutes and then the coach would take me out,” says Walukevich, who chose to play on the j.v. team so she could continue to take things slowly. “I could give a lot of effort, just not for too long.” Szelog describes Walukevich as an incredible athlete whose trademark is grabbing a rebound and dribbling coast-to-coast for a layup. He says seeing her back in the game was rewarding, but not completely worry-free. “There was one game when the team decided to run and gun for three minutes straight without a break in the action,” he says. “Bree was full-out sprinting the whole time and our coach looked at me and asked, ‘Is this okay?’ I said, ‘Yeah. If her heart rate gets too elevated, the monitor will beep and she’ll back off.’ But it didn’t happen.” As a senior, Walukevich hopes to keep improving on the links and believes she may be ready to play varsity basketball. “With ICDs, they discourage you from playing varsity sports, but my doctor says I’ll be okay as long as I’m careful,” Walukevich says. “The coach underTR AINING-CONDITIONING.COM

Breanna Walukevich Sanborn Regional High School, Kingston, N.H. Sports: Basketball and golf Condition: Cardiac arrhythmia that required an implantable cardioverter-defibrillator Quote: “I probably wouldn’t be playing basketball if it weren’t for Matt [Szelog, Head Athletic Trainer at Sanborn Regional High School and Director of Dynamic Performance Sports Training at Exeter Hospital]. He understood that I was afraid and helped me slowly work my way back ... I owe a lot to him.”

stands my limitations, and I worked hard all summer playing pickup games to maintain my conditioning. I’m pretty comfortable with the idea.” Returning to athletics has been an incredible lift for Walukevich, who gives much of the credit to Szelog. “I probably wouldn’t be playing basketball if it weren’t for Matt,” she says. “He understood that I was afraid and helped me slowly work my way back. “He pushed me by watching me and asking questions,” Walukevich adds. “And when I didn’t feel up to par, he encouraged me to rest. I owe a lot to him.” Szelog says Walukevich taught him a lesson about true determination. “One thing I learned—and that I will share with other athletes—is you can’t let an injury stop you from doing what you want,” he says. “In Bree’s case, we saw that athletes can push themselves through something pretty serious if they put their mind to it.” n Want to read more Comeback Athlete stories? Log on to www.Training-Conditioning.com and type “Comeback Athlete” (in quotes) into the search window to access our archive of past articles. T&C OCTOBER 2009

University of Illinois volleyball player Kayani Turner missed a full season due to Complex Regional Pain Syndrome, but returned to the court in 2008 to help the Illini reach the NCAA Division I Sweet Sixteen.

University of Illinois Sports Information

TREATING THE ATHLETE

Rising Above

Pain A mysterious and debilitating condition, Complex Regional Pain Syndrome is showing up more frequently in young athletes. There is no cure, but researchers and practitioners are finding effective ways to manage the symptoms and reduce their impact on quality of life. By Maria Hutsick

“

y foot hurts whenever I touch it—even wearing a sock is unbearable,” the athlete tells you, pointing to her left ankle. You treated her for a simple sprain last month, but these new symptoms don’t make any sense. “Most of the time it feels like my skin is burning, or being zapped with electricity.” Your examination reveals moderate swelling and some redness. You also notice that the ankle is strangely cool to the touch, and has limited range of motion. In fact, even the slightest manipulation puts the athlete in obvious pain. She has suffered no other injuries since the sprain, so there’s no clear explanation for the current symptoms. Stumped, you refer the athlete to a physician and ask her to report back to you. A few days later, you learn the diagnosis: Complex Regional Pain Syndrome. If you’ve never heard of CRPS, you’re not alone. This under-recognized and often misdiagnosed condition can affect athletes of all ages, causing a major disruption in sport performance and everyday life. And while there’s no cure, clinical research and experience treating high school and college athTR AINING-CONDITIONING.COM

letes has shown me that CRPS can be managed successfully once it has been diagnosed. REAL PAIN Most of the time, pain can be attributed to a specific cause—a soft tissue injury, a strain or sprain, an abrasion, or some other damage or dysfunction within the body. But with CRPS, also known as Reflex Sympathetic Dystrophy (RSD), persistent pain in one or more limbs occurs without a clear physiological explanation. Several theories exist on where this pain comes from. Some researchers believe it stems from a malfunction of localized pain receptors, while others point to certain chemical messengers in the body that may disrupt functioning of the nervous system. In many cases, CRPS is triggered by an injury or surgical procedure, leading some to believe the condition is linked to problems with the body’s natural healing processes and immune system. While the cause remains mysterious, the symptoms are very real. The pain of CRPS is generally chronic, and often described as a burning, tingling, shooting, or “pins and needles” sensation. It can vary in intensity but is present most

of the time, and may fluctuate between throbbing, dull, aching sensations and acute, stabbing pains. The location of the pain is variable but it often concentrates in a leg, arm, knee, foot, or hand, and the pain distribution sometimes follows the shape of a glove or sock. Someone with CRPS typically presents with allodynia, or a painful response to normally innocuous stimuli, such as a light breeze, soft touch, or the normal rubbing of clothing over the skin. The individual also often experiences hyperpathia or hyperalgesia—heightened sensitivity to painful stimuli. A pin prick, slight bump, or other source of mild pain in most people will seem excruciating to this person. When examining someone with CRPS, it’s common to observe skin discoloration (usually redness, blueness, paleness, or blotchiness), some degree of swelling, and abnormal localized coldness to the touch. For example, if an athlete complains of pain in the left hand, that hand may feel cold while the Maria Hutsick, MS, LAT, ATC, CSCS, is Head Athletic Trainer at Medfield (Mass.) High School and former Head Athletic Trainer at Boston University. She can be reached at: mhutsick@medfield.mec.edu. T&C october 2009

TREATING THE ATHLETE right hand feels normal. Other times, the affected area will feel warmer to the touch than the same area on the unaffected side of the body. This symptom is most likely caused by abnormal blood flow and spasms in the blood vessels around the site, and it can also lead to general weakness and lack of coordination in the area. One of the hallmarks of CRPS is unpredictability. It may last for several months and then go away spontaneously, only to return later. Or it may last for months, then go away and never return. In addition, the symptoms can vary widely over the course of the disease, and some can be downright bizarre. In one of my athletes who suffered from CRPS in her arm, the hair on the affected skin developed a furlike texture. CRPS can strike at virtually any age, and medical survey research suggests it is becoming more prevalent in adolescents and young adults. Several studies have found that females are roughly two to three times more likely to develop the condition than males. AFTER THE DIAGNOSIS Since many clinicians are unfamiliar with CRPS/RSD, it often goes undiagnosed or is mistaken for another condition at first. In fact, according to the Reflexive Sympathetic Dystrophy Syndrome Association, people with CRPS see an average of five different physicians before the condition is correctly identified. Any time there is a disconnect between the amount of pain that’s expected in a given situation and the amount reported by the athlete, CRPS should be considered as a potential cause. Persistent, intense, unexplained pain after a minor injury or small medical proce-

oids, corticosteroids, anti-seizure drugs, or vasodilators. Sometimes, an athlete must experiment with several different medications before finding the one that best addresses their symptoms. In some cases, an anti-depressant

IRRITATION THERAPY One of the main strategies used to desensitize painful tissue in athletes with Complex Regional Pain Syndrome/Reflex Sympathetic Dystrophy (CRPS/RSD) is surface irritation of the affected area. In my athletic training room, we use several items to assist with this type of therapy. For example, we have separate five-gallon buckets filled with uncooked rice, dry macaroni, and sand. An athlete with CRPS in their hand or foot will stick the extremity into each bucket and move it around for 10 to 30 minutes (depending on how much they can tolerate) to irritate the skin. It is very painful at first, occasionally causing an athlete to cry or even vomit, but it eventually calms the nerves and dulls the pain receptors in the area, providing symptom relief. We also use rough sponges, vegetable brushes, and a variety of towels and cloths to rub the affected area as another form of irritation therapy. Massage tools, hot packs, and paraffin baths are helpful as well. Athletes with CRPS can come to the athletic training room when they feel they need treatment and use these implements on themselves—or, because they often cannot bear self-treatment of this type, I’ll do it for them. Usually, irritation treatment produces a vasoneural response. The athlete may break out into a cold sweat and become nauseated or dizzy. It’s sometimes difficult to continue with a session that puts them in obvious pain, but I frequently remind them that in the long run, it will bring relief and make it easier to function in sports and everyday life.

drug and/or psychotherapy also used to treat CRPS. While important to acknowledge that pain and other physical symptoms

are it’s the are

One of the hallmarks of CRPS is unpredictability. It may last for several months and then go away spontaneously, only to return later. Or it may last for months, then go away and never return. In addition, the symptoms can vary widely. dure is often the most pronounced sign that leads to a diagnosis. While there is no cure for CRPS, a number of options can help manage the pain and treat the symptoms, and a multi-disciplinary approach is often most successful. As a first step, a doctor may prescribe topical analgesics, opi14

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with an unknown cause. Physical therapy for someone with CRPS can take several forms, all of which focus on stimulation and movement. Many CRPS patients have been put in casts, on crutches, or even in

real and not simply psychosomatic, studies of CRPS patients have revealed a psychological component to the condition that often responds to treatment. The exact nature of this mental link is still poorly understood, but it may relate to the stress and anxiety produced by persistent pain

wheelchairs to reduce their pain, but this is the exact opposite of what should be done, since these steps do not address the physical problem and may exacerbate weakness and atrophy in the affected area. Movement must always be a top priority in treating someone with this condition. Since mobilizing joints and muscles can be very painful for the athlete, topical analgesics can make treatment more tolerable. Some therapists have also used desensitization therapy, in which the nerves and tissues affected by CRPS are actively stimulated with vibration, massage, heat, cold, or tactile irritation, with the goal of gradually diminishing the pain response. (See “Irritation Therapy” above for specific examples of how this therapy is performed.) TR AINING-CONDITIONING.COM

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TREATING THE ATHLETE Electrotherapy has also produced good results for some patients. Typically, electrodes are placed near the spinal cord and the electrical stimulation interferes with the pain-producing signals sent throughout the body. In severe cases, an electronic device can be surgically implanted

CASE STUDIES During my 32 years as a clinical athletic trainer, I have dealt with several high school and college athletes who were diagnosed with CRPS or RSD. In my current high school setting, I have three active cases:

A physician may recommend more aggressive measures. These can include pumps and implanted catheters that deliver pain medication directly into the spinal fluid, injections of pain-dulling substances called nerve blocks, or even surgical destruction of some of the nerves. near the spinal cord to provide consistent pain-relieving nerve stimulation. If CRPS symptoms do not respond to these treatments, a physician may recommend more aggressive measures. These can include pumps and implanted catheters that deliver pain medication directly into the spinal fluid, injections of pain-dulling substances called nerve blocks, or even surgical destruction of some of the nerves in an area affected by CRPS.

Athlete No. 1. As a 13-year-old in 2004, this female soccer player suffered a hard fall on the field and could not walk on her left leg when she got back up. The pain associated with her injury progressed rapidly, to the point where she was totally disabled with very limited use of all her limbs by January 2005 due to the extreme response of her neurological system. She even suffered from intermittent memory loss. An MRI, ultrasound, EMG, nerve

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conduction study, and spinal tap were all unable to pinpoint a specific cause of the pain and other symptoms. At times, the headaches and sensation of burning pain in her extremities were so severe that she could not tolerate anyone even touching her skin. After considerable frustration (including visits to a doctor who told her the pain was all in her head and that she was “making up” her symptoms), a physician and a neuropsychologist determined that her condition was caused by a combination of CRPS and a concussion. She underwent intensive therapy, including treatment at Children’s Hospital Boston’s Pediatric Pain Rehabilitation Center, a leader in providing care for young people with CRPS. The athlete learned that if she didn’t stay active daily, she would begin to lose function in the affected limbs. She recovered slowly and was eventually able to return to the soccer field, but soon developed severe leg spasms. She now takes a pain prescription called Gabapentin and undergoes intensive physical therapy, including irritation therapy, manual therapy, and proprio-

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TREATING THE ATHLETE ceptive neuromuscular facilitation. Today, the athlete is a senior in high school who plays varsity soccer and lacrosse. She still struggles with pain at times, has limited sensitivity in her fingers, suffers from a constant low-grade headache, and is abnormally sensitive to light, sound, and touch. But despite all this, she has developed a very positive attitude and a high pain tolerance to fight through the symptoms and lead a normal life. She exercises daily and undergoes deep tissue massage, acupuncture, and skin irritation sessions when the condition flares up. After all that she learned while battling CRPS, she is now planning on majoring in athletic training in college. Athlete No. 2. This 14-year-old female sustained an ankle injury that required surgery. During her rehab she showed signs of CRPS, but her physical therapy forced her to work through the pain and regain her range of motion and strength, and she responded well to the challenge. Then, two years later, as a competitive swimmer and active individual, she began to experience pain in her left big toe. Her family took her to

a physician, who placed her in a walking boot but did not closely review her x-rays. When she brought her x-rays to the athletic training room, we noticed that

ports to me when the symptoms reappear for assistance or to talk about self-treatment strategies. Her lower leg and foot sometimes become very inflamed, which causes difficulty walk-

The athlete learned that if she didnâ&#x20AC;&#x2122;t stay active daily, she would begin to lose function in the affected limbs. She recovered slowly and was eventually able to return to the soccer field, but soon developed severe leg spasms. She now undergoes intensive physical therapy. she in fact had a fractured sesamoid bone, which explained some but not all of her pain. The boot was discontinued in favor of a special foot pad that would allow for greater movement, and we began a therapy program that included range of motion exercises, irritation therapy, and strengthening. Her pain began to subside and she eventually returned to full weight bearing, participating in varsity field hockey and ice hockey. She undergoes irritation therapy at times when the CRPS returns, and re-

ing and extreme skin sensitivity, but the irritation therapy helps to reduce those symptoms. Athlete No. 3. This 15-year-old female had been a swimmer and soccer player, but when subluxation and eventually total dislocation became chronic problems in her shoulder, accompanied by persistent pain, she had to cease all athletic endeavors. A physician diagnosed her with both CRPS and a multidirectional instability. She lost most of her muscle control due to pain and atrophy, and her hu-

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BLOCKING PAIN When University of Illinois volleyball player Kayani Turner began spring practice in 2006, she was coming off rehab for a left leg stress fracture that had ended her 2005 season. After more than a month in a walking boot and another month rehabbing, the 6-foot-2 left outside hitter—one of the Big Ten Conference’s best—looked forward to playing her junior season pain-free. But after a few weeks of conditioning and slow reintroduction to volleyball activities, Turner’s pain returned—and it was more intense than ever. “I’d never experienced anything like it,” she says. “It felt like someone was taking a hammer and whacking my shinbone as hard as they could, causing sharp pains up and down my entire leg. Most of the pain was in my lower leg and around the knee, and I felt a lot of pressure as if my knee was swollen, but it wasn’t.” X-rays and an MRI ruled out another stress fracture and any other structural damage, so Turner played through the pain while the school’s medical team worked on diagnosing her condition. Suspecting that it might be Complex Regional Pain Syndrome, Illinois Team Physician Jerrad Zimmerman, MD, used a process of elimination before settling on the diagnosis. “Before we could come up with a diagnosis of Complex Regional Pain Syndrome, we had to rule out anything else,” he told ESPN.com. “It can take months to diagnose because of all the testing it takes to rule out other possible [sources] of her pain.” After diagnosis, Turner underwent a series of trial-anderror treatments and procedures, including lumbar shots, acupuncture, epidurals, and a course of arthritis medication, all to no avail. “At that point, my doctors told me the only other possible solution was rest,” Turner says. “So toward the end of the 2006 season, I completely shut things down.” Still in excruciating pain, Turner sat out the entire 2007 season. Spending the year as what she calls “a normal student,” she did no strength and conditioning work. Her only physical activity was walking to class and attending volleyball practices as a spectator. “We hoped the rest would allow me to be comfortable and lead a normal life,” she says. “During that year and a half off, I began feeling better. I was pain-free more

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often, so I eventually thought I should give volleyball another try.” In the spring of 2008, with Zimmerman and Illinois Assistant Athletic Trainer Randy Ballard, MEd, LAT, ATC, Turner began a series of low-impact workouts that gradually became more strenuous. “I’d start with 25 percent of what everyone else was doing, and if my pain was tolerable after a couple days, I’d move up to 50 percent and just keep going,” Turner says. “Eventually, I was able to do plyometrics and some jumping and landing, along with other volleyball-specific work.” Turner’s new goal was to rejoin her teammates in time for their trip to Europe in late May. She was successful, sitting out just one match, and the Illinois coaches used the trip to gauge her improvement and ability to contribute in the upcoming season as a fifth-year senior. They also moved her to a new position on the right side, which required less repetitive jumping and landing than left-side hitters do in the Illini system. In the 2008 season, Turner helped lead a young team to a Sweet Sixteen berth in the NCAA Division I Tournament and a final ranking of 11th in the Bison/American Volleyball Coaches Association final poll. Though she was not completely pain-free, she was able to successfully manage her symptoms with help from Zimmerman and Ballard. “We worked together and communicated well—I told them how I was feeling and they accommodated me with appropriate workouts,” Turner says. “Randy also looked out for me and made sure I was never doing more harm than good by pushing myself. There were days when I’d come to practice and my leg would be hurting badly, so I’d limit my jumping or do none at all. Everything was based on how I felt each day.” She also credits Ballard with helping her through some of her darkest times emotionally. “He was my rock,” says Turner, now an Assistant Volleyball Coach at Western Illinois University. “He saw me at my worst, when I’d be crying my eyes out after games, and he’d console me and reassure me that we’d figure things out. I doubt I would have gotten through this without his support.” — R.J. Anderson

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merus would dislocate in all directions even while she was at rest. She eventually underwent shoulder surgery and was placed in a sling and swathe for six weeks. That resolved the dislocation problems, but her CRPS remains. She has a long road of therapy ahead, and recently entered the pediatric pain program at Children’s Hospital Boston. All three of these young people faced a disruption in their academic, athletic, and social lives. Physically, they deal with all types of pain. Psychologically, they face the stress of the condition’s unpredictability, the fear of what it means for their short- and long-term health, and anxiety from people who doubt the validity of their complaints related to this mysterious and poorly understood condition.

Any time you suspect an athlete may have CRPS, it’s important to have them consult a doctor as soon as possible ... While it can be a frightening diagnosis, the right treatment and emotional support from athletic trainers can make a huge difference in reducing suffering.

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They have persevered through nerve blocks, various courses of medication, and many medical appointments. They have had to learn to tolerate extreme pain during simple tasks such as showering, and have received intensive physical and psychological therapy to learn how to cope with chronic pain and take care of themselves. Any time you suspect an athlete may have CRPS/RSD, it’s important to have them consult a doctor as soon as possible, and to make sure the doctor knows about your concerns. If they are diagnosed with a pain disorder, the physician will take the lead in planning a course of treatment, and you can play an active role in physical therapy to resolve and manage their symptoms. While CRPS can be a frightening diagnosis, the right treatment and emotional support from athletic trainers can make a huge difference in reducing suffering and improving quality of life. n TR AINING-CONDITIONING.COM

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GUESS WHAT ? You guess again.

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Optimum performance

Technology now exists to monitor the body’s response to training in ways never before thought possible. It’s opening new doors to performance enhancement for those who know how to separate valuable data from background noise.

Measure for Measure A By Vern Gambetta

fter 40 years of coaching and training, I’ve arrived at a conclusion that I’m fairly confident in: I do not see revolutionary changes on the horizon in the methods we use to train athletes. Don’t get me wrong—this isn’t like the legend of the U.S. Patent Office Commissioner purportedly saying in 1899 that the office should close because “everything that can be invented has been invented.” I have no doubt there will be refinements, and some very productive ones, to the ways we develop athletes. But I don’t believe there will be major changes to our basic concepts for training the body, because there are practical limits to how much we can do, and our scientific knowledge has progressed to a point where the major aspects of development are fairly well understood. However, that doesn’t mean progress in training is coming to an end. It just means we need to refine our search, and I believe some of the most fertile ground for future gains lies in the realm of athlete monitoring. Effectively gauging how athletes respond to their workouts and practice and competition workload, and making any needed adjustments to their regimen in response to the data we collect, lets us optimize training time and take performance to the next level.

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Vern Gambetta, MA, is the President of Gambetta Sports Training Systems in Sarasota, Fla., and a frequent contributor to Training & Conditioning. His daily thoughts on training athletes can be viewed on his blog at: www.functionalpathtraining.blogspot.com. T&C october 2009

Optimum performance EARLY EFFORTS I believe we need to fundamentally change the way we look at the connection between competition and training. In many settings, the training management process has not kept pace with the evolving demands of extended competitive seasons. One of the foremost

their training logs how difficult they felt each day’s session was. It had no scientific validation—it was just something I had read about other coaches doing, and it seemed logical. Though it was very rudimentary, this system provided some important feedback on who felt they were being pushed

Two soccer players on the same team might have entirely different profiles in terms of total distance traveled per game, average heart rate, number of full-intensity sprints, and countless other factors. The best programs are designed with individual needs in mind, even for athletes in team sports. challenges today is finding ways we can better translate work into competition results. The answer lies in better, more accurate monitoring of training and competition. Most coaches use some form of training monitoring, and it is usually intuitive, based on their own experience and knowledge. In my first years of coaching, I used a 10-point rating scale that relied on the athletes to self-report in

to their limit and who was coasting through workouts. But I soon realized it wasn’t ideal to have to wait until I read the athletes’ training logs to get feedback—I needed the information in real time. In essence, I had to coach more and observe more. I needed to be a more active participant in the workout process and develop a more analytical eye. I began predicting a rating for each workout, based on my own best guess

of how hard it would be for the athlete to complete. Then I would ask the athletes for their rating as soon as the workout ended, and it was always interesting to see how my ratings compared with theirs. I was pleased to learn that the longer I spent with a group of athletes, the better I was able to accurately predict their ratings. But even in this system, the numbers were still very subjective, with no way to truly pinpoint or define the difference between a “six” and a “seven.” This was before the Borg scale for rating of perceived exertion (RPE), but it served the same function, and had the same limitations. I knew there had to be a better way, but at the time, monitoring wasn’t first on my list of priorities. However, through the union of technology, sports science research, and coaching experience, today we are on the verge of a forward leap in our ability to monitor training, and the possibilities for how it can improve training program design are exciting. THE RIGHT KNOWLEDGE To train athletes effectively and meet

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Optimum performance specific goals, we must know the precise effects of their training and the exact physical demands of practices and competitions. We also need to measure stress levels from all performance parameters to avoid overuse and overtraining. Smart training sets targets and measures progress toward them, and we need to know why we either hit or miss each target. With the information available today, setting training load and intensity should never be a wild guess. The process begins with thorough analysis of the demands of the sport an athlete is preparing for. I am convinced that what we think occurs in competition and what actually occurs are often far apart. In addition, each athlete has their own way of performing in their sport. Two soccer players on the same team might have entirely different profiles in terms of total distance traveled per game, average heart rate, number of full-intensity sprints, and countless other factors. The best programs are designed with individual needs in mind, even for athletes competing in team sports.

Endurance sports. These are characterized by continual sub-maximal effort with the goal of finishing in the shortest time possible over a set distance. Sports that fall into this classification include marathons and triathlons. When you think of traditional athlete monitoring in any of these categories, the first thing that comes to mind may be heart rate. Conventional sports science wisdom has a heavy bias toward heart rate and a related number—VO2 max—since both are very measurable qualities. However, I believe they have little value as a true indicator or predictor of stress in intermittent, transition, and explosive activities. I think heart rate monitoring has actually led many training programs to a dead end, because the numbers aren’t typically viewed in adequate context. It reminds me of George Carlin’s sportscaster routine, in which he reads the days scores: two to one, five to four, six to three, and the whopper, 12 to six! Of course, the numbers mean nothing without context, which in the case of heart rate means a thorough understanding of the biomechanical

Because it can be a major challenge to personalize training programs in team sports, I have found it helpful to begin with broad general classifications of sports. The sport classification can help you determine the dominant physical characteristics that must be trained in an athlete, but they’re just a starting point. I prefer to break sports down into four categories: Sprint sports. These require one allout maximum effort. The goal is to achieve as fast a time as possible over a set distance. The ability to recover or quickly repeat the effort is not a factor. Sprint events in track and field are the best example of this category. Intermittent sprint sports. These require a series of maximum efforts with time for relatively full recovery in between. This category includes football, rugby, ice hockey, and volleyball. Transition game sports. These require a series of efforts of varied intensity that occur in random patterns. Recovery between efforts varies from almost non-existent to nearly complete. Soccer, field hockey, and lacrosse fit in this category.

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Optimum performance and neural demands that determine total load on the system and ultimately drive athletic success or failure. Just because it’s easy to monitor something and collect impressive amounts of data doesn’t mean the data collected carries great value. GLIMPSING THE FUTURE So where do we turn for a better way to enhance our program design? We have to find new paradigms for monitoring work output, exertion, biomechanical loading, and performance. The technology is available to do this accurately and in real time. When you know how far athletes move in a session, how fast they go, what their work-rest intervals are like, and how frequent and stress-inducing their movements are, you can construct more precise training, rehab, and practice sessions that take their progress to new heights. Here is an assessment of what I see as the most promising frontiers for cutting-edge athlete monitoring: Video analysis. Coaches who have been around long enough remember the cumbersome days of Super 8 video recording, and the somewhat less cumbersome days when VHS was in its prime. But today, digital video analysis is revolutionizing the way we monitor athletic activity, and we’ve yet to realize all the possible applications of this technology. By breaking down an athlete’s movements during a workout in slow motion, we can observe flaws and inefficiencies that go by too quickly to capture with the naked eye. Then, once these problems have been addressed through targeted training, video analysis can confirm that the new movement patterns have eliminated the flaws. Game video analysis can also provide valuable insights in areas where realtime observation has limited value. For instance, there is no weightroom exercise or practice drill that can truly capture the physical and mental demands placed on a football defensive lineman who needs to develop an explosive first step. But game film can reveal who excels in this area and who needs work, and progress can be tracked as athletes train to improve reaction time, firststep power, and force production from the ground. The possibilities are practically endless for analyzing specific aspects of on-field or on-court per24

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GETTING THE MOST While I believe there are many advances to be made by optimizing training monitoring systems, there are also some common pitfalls. To help you avoid some of them, I offer these pieces of advice: • Whenever possible, monitoring performance factors in real time is the best way to provide athletes with meaningful, actionable feedback. • When observing an athlete during a workout or practice, remember you are not always looking for distress, but for all types of stress and adaptation to imposed demands—that is what functional training is all about. • Tracking progress over time is essential. The longer the timeframe, the more meaningful the data and the more opportunities you have to evaluate whether your training strategy is producing optimum results. • One-time monitoring is rarely useful, because it produces numbers without a proper context. Ongoing monitoring in a systematic manner allows for development of key performance traits over time and promotes better overall control of the adaptive process. • Decide early on what constitutes “need to know” information, and separate that from “nice to know” information in your mind. The latter category is often just noise that will make your training program less focused on producing functional results. • Use monitoring as a motivational tool to help athletes push themselves to achieve goals, correct flaws and inefficiencies, and demonstrate that they are being responsive to your instruction. • Always seek ways to make your monitoring methods as non-intrusive as possible. If athletes are distracted by a monitoring device or testing method, they may adapt their performance to the task that’s being tested instead of developing functional performance that translates to their sport. • Make sure athletes fully understand the monitoring you’re doing, and involve them in the process of evaluating and analyzing the data you gather. Besides providing an excellent learning opportunity, this will help them understand the “why” behind your training program design. Always remember that coaching is something we do with athletes, not something we do to them. • Don’t base your entire training program solely on data collected through objective monitoring—common sense still must apply. For instance, in some sports, collisions with other athletes and with the playing surface produce a large amount of training stress, but since it’s difficult to quantify, the cumulative toll it takes on the body is easy to overlook. Don’t make the mistake of ignoring something just because you can’t objectively track its impact. • Overload comes not just from training volume, but also from a workload’s intensity and density. A smart monitoring strategy accounts for all parameters that may contribute to overload. • In rehab settings, objective measures of performance from athlete monitoring are an outstanding tool to determine when someone has returned to pre-injury levels. If baseline data is available, for instance, you can compare a rehabbing athlete’s performance in various drills with their “healthy” performance to help make informed return-to-play decisions and design targeted rehab protocols.

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Optimum performance formance, then monitoring team and individual progress to assess the effectiveness of a training program. Global positioning satellite (GPS) technology. When GPS became commercially available in the 1990s, the tracking systems that were adapted for sports use represented a quantum leap forward. Today’s systems can measure total distance traveled during a practice or game, speed in various zones of the field, and movement paths with a high degree of accuracy. This information can be invaluable to both sport coaches and conditioning coaches. Because GPS depends on satellite signals, this method cannot be used reliably indoors—in fact, some older systems may even have problems outdoors when the sky is overcast. But as the technology improves, it probably won’t be long before basketball and volleyball teams can wear GPS tracking devices and enjoy the same data collection benefits as athletes in football, soccer, lacrosse, and other outdoor sports. Accelerometer technology. Accelerometer use is another area that offers great promise. A triaxial (three-axis) accelerometer with a high sampling rate can provide very accurate information about distance traveled, speed, acceleration, and biomechanical load. In the weightroom, a device can be attached to equipment before lifts to measure power output, force, bar acceleration with various amounts of weight, and other performance factors. In sport-specific applications, a coach can monitor the timing and height of a hurdler’s leg kicks, measure how level a baseball player’s swing is as the bat passes through the strike zone, and assess whether a golfer’s head remains still during the swinging motion. Biochemical testing. Biochemical monitoring can include blood or urine analysis, muscle biopsies, hormone level testing, and other measures that can tell us a great deal about everything from hydration and lactic acid levels to cellular adaptations experienced during training. This highly specialized form of monitoring requires considerable training to collect and interpret the data, since a random snapshot of an athlete’s blood lactate concentration, testosterone level, or cortisol ratio means virtually nothing without the proper context. But this cutting-edge branch of athTR AINING-CONDITIONING.COM

lete monitoring may provide critical information on athlete health and safety, especially for endurance athletes. For instance, collecting information on an athlete’s urine osmolality and sodium level can diagnose hyponatremia, a potentially fatal condition in which blood sodium concentration falls to dangerously low levels. Of course, not all of these testing methods are ideal for all settings. Based on the sport, the athlete’s needs, and available resources, it’s up to athletic trainers and coaches to determine

whether these potential new frontiers in athlete monitoring can produce meaningful data that improves progress toward training goals. I like to think of training monitoring as a “gap analysis” tool. The ongoing task is to close the gap between what we are presently doing and what we must do to improve competition results. You can’t improve what you cannot measure. Accurately measuring what happens in a workout, practice, or competition helps close the gap, and helps us to translate work into wins. n

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SPECIAL FOCUS

Elastic therapeutic tape is an emerging modality that offers great potential to reduce the impact of soft tissue and joint injuries while enhancing the healing process.

Tale of the Tape University of Hawai’i Athletics

By Jayson Goo

he elastic therapeutic taping method first caught the attention of many athletes and sports medicine professionals worldwide during the 2008 Summer Olympics in Beijing. A number of prominent athletes were shown on TV wearing the sometimes strange-looking tape jobs before, after, and even during competition. Some of the world’s top tennis players, long jumpers, sprinters, hurdlers, and basketball players had the tape attached to their arms, legs, and shoulders, and people immediately wanted to know what it was and why so many athletes were wearing it. As I watched the Olympics, I had a different reaction—I was glad to see a modality I’d been using for a long time finally gaining broader acceptance. I have been involved with the Kinesio Taping Association as an instructor of elastic therapeutic taping for more than a decade, and I’ve seen firsthand the many benefits this type of treatment TR AINING-CONDITIONING.COM

can provide for athletes in practically any sport. Since it was first developed in the 1970s, elastic therapeutic tape has greatly enhanced sports medicine professionals’ ability to treat athletes’ injuries, relieve their pain, and improve their performance. And this modality is still growing in popularity and evolving in how it can be applied to meet specific therapeutic needs. Based on my own experience, I’m confident that many athletic trainers can enhance their treatment programs by adding this taping approach to their toolbox. WRAP SESSION At its core, elastic therapeutic taping is based on a simple principle: The body has built-in healing mechanisms, and we can speed up their work by removing barriers that impede them. More specifically, the tape provides extended soft tissue manipulation to prolong the benefits of manual therapy adminis-

tered in the athletic training room. The results are increased fluid flow through an injured area, better control over muscle contractions, reduced pain, and ultimately faster healing. The tape’s elasticity allows it to stretch lengthwise 40 to 60 percent beyond its resting length, and its thickness and weight are very similar to that of human skin. It is usually applied with help from a heat-activated acrylic adhesive, and when applied to the skin it creates a mechanical lifting effect, expanding the narrow space between the skin tissue and adjacent muscle tissue. This space is rich in blood vessels, lymphatic vessels, and neural receptors. When it is enlarged, intercellular fluids can flow more freely—for example, lymph moves more easily out of lymph Jayson Goo, MS, ATC, is an Athletic Trainer at the University of Hawai’i and a Certified Kinesio Taping Instructor. He can be reached at: jaygoo@hawaii.edu. T&C october 2009

SPECIAL FOCUS

Figure Two: I-shaped elastic therapeutic taping application.

Figure One: Y-shaped elastic therapeutic taping application.

Figure Three: Fan-shaped elastic therapeutic taping application.

WELCOME RECEPTION When elastic therapeutic tape is applied to an athlete’s skin, one effect is an amplification of messages sent to the brain by local neural receptors. For an example of this effect in action, I point to my experience using the tape with University of Hawai’i student-athletes returning from hamstring strains. As part of the normal rehab progression, we have these athletes start with jogging and eventually graduate to full-speed running. We always instruct them to stop if the injured leg begins to feel fatigued or just “not right.” But before we started using the tape, athletes would inevitably go too far with their running and often ended up re-straining the hamstring to some degree. The first time we applied the tape to an athlete with a hamstring strain, he returned to the athletic training room after a short period of jogging, reported that his hamstring felt “funny,” and asked us if he should stop. After an examination revealed no obvious problems, we told him to take the rest of the day off and continue his running program the next day. The athlete progressed through the rest of his rehab without any re-strains or feelings of tightness, and we’ve since repeated the success with several other athletes rehabbing from hamstring injuries. We think that in this instance, the stretching effect of the tape increases activation of the muscle’s stretch receptors. Rather than the athlete not feeling significant pain or tightness until the muscle is re-strained, this “early warning system” causes the brain to send instructions to the agonist and antagonist muscles in the hamstring to stop elongating and start contracting. The lifting effect of the tape also increases the space between the skin and muscle, boosting oxygen and nutrient availability in the area to promote healing.

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channels and into the larger lymph ducts. The increased flow of fluids allows more nutrients from the blood to be absorbed into tissue that’s healing, thereby helping the rebuilding process. For everyday athletic contusions that lead to swelling and edema, this increased flow has profound effects. Edema leads to localized areas of high capillary pressure, which can restrict lymph and blood availability to a region that greatly needs it. By holding the skin away from the muscle, the tape can relieve this pressure and produce dramatic improvements in healing time for soft tissue injuries. Opening up this space also relieves pressure on nerve endings that send pain messages to the brain. With the resulting decrease in pain, muscles and joints can begin moving in their normal, pre-injury movement patterns earlier in the rehab process. The pain reduction also increases athlete comfort during healing. In addition, this taping method affects the cobweb-like fascia structures surrounding damaged tissue. Muscle injuries typically lead to fascial tightness and scarring, and one goal of manual therapy in an injured area is to stretch the fascia to promote the return of normal function. The tape takes this manipulation a step further by allowing the fascia to be held in a stretched position for extended periods. In the process, it also helps control muscle spasms. These effects make elastic therapeutic taping different from traditional taping methods, which compress the skin and tissue beneath it. While compression can be helpful to control swelling immediately post-injury and limit range of motion of injured body parts, it also has drawbacks. Compression limits circulation to areas that most need blood flow during healing, and sometimes irritates local pain receptors. Elastic therapeutic tape provides support for an injured area without these negative effects. APPLYING IT Using the tape correctly requires specific education and training. The different applications for this modality include muscular; mechanical; fascial; space, ligament, and tendon correcting; functional; and lymphatic. It would be impossible to explain in one article how elastic therapeutic tape is applied to produce maximum benefit, but the folTR AINING-CONDITIONING.COM

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SPECIAL FOCUS lowing overview will provide an outline of how these treatments work and why they are effective. The essential first step is to identify an athlete’s symptoms and determine their cause. Like any other treatment approach, it’s important to not simply address an athlete’s pain and limitations, but to fix them at their source. Once a practitioner has determined what area of the body requires treatment and decided the mechanical lifting and pain relieving effects of elastic tape are warranted, the next step is choosing the shape and length of the tape application. The tape is commonly cut into the shape of an X, I, Y, a web, or a fan (see the figure photos on page 28 for examples). The shape that the tape is cut into depends on the size of the area being taped and the specific effects desired in the target zone. An “I” cut is commonly used when taping a tendon, and “Y” cuts are more suited for muscles. “X” cuts are often best when taping broad areas of the body, and the web and fan shapes are used in the lymphatic techniques and for scar reduction.

lease Techniques, author and researcher Leon Chaitow teaches that pressure directed away from the belly of a muscle toward golgi tendon organs produces relaxation of the muscle, while pressure toward the belly of a muscle strengthens the muscle. Elastic therapeutic tape’s stretching properties can produce this positive or negative pressure, essentially through a pulling effect.

As tape is applied to the skin, the practitioner adjusts the amount of stretching and lifting depending on specific correction and tissue manipulation goals. This process is a combination of art and science, and it’s a learned skill that’s refined through experience. cation and sticking with it, but rather using progressions and combinations of different modalities. Trial and error and listening to athletes’ feedback are sometimes the best ways to achieve the desired outcome. Muscle applications of elastic tape are among the most common in athletic settings. In his book Positional Re-

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The direction of the pull is determined by the method in which the tape is applied. Taping a muscle from its origin to its insertion site, or from a proximal point to a distal one, facilitates or improves muscle contraction. On the other hand, taping the muscle from insertion to origin after a massage or a muscle stretch will help the muscle

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SPECIAL FOCUS maintain relaxation and a lengthened, elongated state. Rehabilitating a muscle injury often requires building strength in a specific area while also decreasing contractility. For example, following a hamstring injury, the rehab protocol usually calls for hamstring strengthening work and

harmful movements while still allowing an active range of motion. In this way, the tape’s function is quite similar to that of a brace or strap, but with the added customization of tape. Fascial applications work to maintain fascial corrections after a practitioner performs stretches and manipulations

Placing the tape over a tendon or ligament can produce or amplify signals to the brain regarding the amount of tension over that particular area. In this way, it stimulates the golgi tendon receptors and helps the brain perceive and react to support of the ligament. reducing contractility of the quadriceps group. In this situation, tape would be applied to the quadriceps from insertion to origin (or distal to proximal), while the hamstring itself would be taped from origin to insertion (or proximal to distal). For mechanical corrections, the tape can be used much like a brace to change the forces acting on a muscle or joint. In a typical application, strips of tape are placed laterally across specific muscles and tendons to put them in a mechanically sound resting position and inhibit

to the fascia. The tape can be used first to oscillate the fascia, then applied in a manner that helps keep it in the desired position. It can also be used to create or direct movement of the fascia. Many sports medicine professionals are familiar with the concept of trigger points, or areas of tight muscle fiber that cause pain and limit movement. Applying tape over a trigger point can increase fluid flow through that area due to the elastic lifting properties. In addition, after a chiropractic adjustment, the tape can be applied over joints

TAPING PRECAUTIONS While application of elastic therapeutic tape may offer several benefits for soft tissue injuries, there are some conditions for which it is contraindicated. The increased flow of fluids through the body created by the tape is potentially dangerous for individuals suffering from certain diseases. It should not be used on over-active malignancy sites, active cellulites or skin infections, open wounds, or deep vein thromboses. It can also raise complications for patients who have diabetes, kidney disease, congestive heart failure, coronary artery disease, carotid artery bruits, or fragile or otherwise compromised skin. Taping for patients with these conditions should be performed only with physician approval. Some athletes may develop an allergic reaction to the tape. In these cases, a simple coating of milk of magnesia on the skin before application can provide a buffer that helps prevent the reaction. Some practitioners also use a spray adhesive to help the tape stay in place and increase athlete comfort. There are a few other minor complications that can easily be avoided. To prevent the tape from rolling up on the edges, athletes should pat it dry after showering, and trim the edges of the tape if it starts to curl or roll up off the skin. Our athletes have also told us they find it’s best to keep the tape application covered by clothes when sleeping, to prevent the bed sheets from pulling on the tape ends.

T&C october 2009

that have been “gapped” to prolong the effects of the adjustment. The tape offers proprioceptive benefits as well. Placing it over a tendon or ligament can produce or amplify signals to the brain regarding the amount of tension over that particular area. In this way, it stimulates the golgi tendon receptors and helps the brain perceive and react to support of the ligament. For functional corrections, the tape is typically applied to muscles and joints with the joint flexed and muscle in a shortened position, using the stretch in the tape to “preload” or assist the joint through its range of motion. When stretched tape is placed onto a shortened muscle, two things happen: more information is passed through the neural network, and muscle contractions are supported and assisted. These effects help prevent muscles from overstretching while also encouraging proper muscle firing. For example, in athletes suffering from carpal tunnel issues, the tape can be used to hold the wrist in an extended position to facilitate contraction of certain wrist muscles that would otherwise be inhibited. IN MY EXPERIENCE For me, the hardest part of becoming proficient in this modality was “unlearning” how to apply traditional athletic tape, particularly with regard to how much tension and pressure to use. I also had to realize that elastic taping is much more versatile than traditional taping protocols—with various techniques and applications, it can be used in all phases of the healing process, from right after an injury to the time an athlete returns to play. In our athletic training room, we’ll typically begin elastic tape treatment immediately after an athlete injures a muscle, joint, or tendon. A lymphedema-controlling tape application is used to reduce swelling by promoting the free flow of lymphatic fluid. When possible, I like to have an athlete move the affected area as soon as possible to assist in this process, so the less-restrictive nature of this tape provides a definite advantage over traditional strapping methods. We also often use muscle taping applications immediately post-injury to get the affected muscles to relax and elongate while eliminating dysfunctions TR AINING-CONDITIONING.COM

SPECIAL FOCUS to correct many postural faults. in movement patterns created by the inSince elastic therapeutic taping is fairjury and resulting pain. Then, throughly new to the mainstream athletic trainout the healing process, we use the tape ing community, some may wonder if in conjunction with massage and other this is an evidence-based form of treatmanual therapy to remove any fascial ment. While much of the support for restrictions that may occur. these applications is anecdotal and only We employ specialized mechanical a few randomized, double-blind studies and tendon-based taping techniques to have been completed to date, the body mitigate secondary issues that arise in of relevant research is growing. the rehab process. For instance, after For instance, a study published in spraining an ankle, many athletes expethe Journal of Orthopaedic & Sports rience Achilles tendon tightness, which Physical Therapy in 2008 examined the causes the pelvic muscles to change effectiveness of this taping to relieve their reflexive movement patterns. Tapshoulder pain in college patients diaging the Achilles tendon to promote renosed with rotator cuff tendonitis or laxation while taping the piriformis and impingement. One group wore an elasgluteal muscles for facilitation helps tic therapeutic tape job for two consecuprevent hip and lower-back pain and tive three-day intervals, while a placebo gait changes in these situations. group wore a “sham” tape job with no Beyond those uses, we regularly apphysiological effect. ply elastic therapeutic tape to both The researchers monitored self-rehealthy and injured athletes to proported pain, disability, and pain-free mote optimal static and dynamic active range of motion. They found posture. Aside from facilitating and that patients wearing the elastic tape supporting the muscles that determine showed clinically significant immediposture to eliminate movement dysate improvement in pain-free shoulder functions, bilateral muscle taping of 160330 ppc_TandCmag_steve_lehman_v1.qxp 3/25/09 2:17 PM Page 1 abduction. the distal third of the front of the neck In the study, the authors did note has just enough effect on muscle tone

that overall this method “has gained significant popularity in recent years, but there is a paucity of evidence on its use.” While that fact remains, the existing evidence and my experience lead me to believe the future is bright for elastic therapeutic taping applications. Best uses for this therapy are still being theorized, and I’m confident that the clinical research will eventually catch up to the anecdotal evidence. As the tape continues growing in popularity, you’ll likely see it applied to the joints and muscles of more athletes and active individuals in all settings. And as with any new innovation or modality, trying it with an open mind is the most important step toward drawing your own conclusion. If you do, and your experience is anything like mine, you may find yourself using it more and more to help injured athletes achieve the best possible outcomes. n Full references for this article can be viewed at: www.trainingconditioning.com/references.

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nutrition

Research shows that free radicals can wreak havoc on muscle tissue health, slowing recovery and impairing performance. With the right diet, athletes can take advantage of antioxidant power to ward off these effects.

Antioxidant Armor O By Lisa Dorfman

photos: istock/illustration: suzanne lynch

xygen is the body’s ATM for funding nearly every metabolic transaction. It helps the heart to beat, muscles to contract, and the digestive system to absorb nutrients from food. Oxygen is found in every molecule of water, which makes up nearly 60 percent of the body. During exercise, oxygen helps muscles utilize carbohydrates, protein, and fat to help athletes run faster, lift more, and keep going longer. The body must metabolize a great deal of oxygen when an athlete works out, and while this essential process has numerous benefits, there are also side effects. One of them is the production of free radicals, a specific type of molecule that can damage tissue. But luckily, the body can be equipped to limit free radical damage with help from compounds called antioxidants. You’ve no doubt heard of these substances, and probably seen advertisements for everything from fruit juices to dietary supplements touting antioxidant benefits. But do you know what antioxidants do, how they work, and how to make sure your athletes are taking advantage of their benefits? With sometimes confusing and conflicting research, that’s not easy. But when helping athletes plan a diet that promotes optimal health and performance, antioxidants should definitely be part of the discussion. CHEMISTRY LESSON During a workout, the body’s overall oxygen level increases 10 to 20 fold, and as much as 100

Lisa Dorfman, MS, RD, CSSD, LMHC, is Director of Sports Nutrition and Performance and an adjunct professor at the University of Miami. A former pro triathlete, she has completed more than 30 marathons, and can be reached through her Web site at: www.foodfitness.com. TR AINING-CONDITIONING.COM

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nutrition

ORAC VALUES In 2007, the U.S. Department of Agriculture used Oxygen Radical Absorbance Capacity (ORAC) to create a list showing the antioxidant levels in 277 common food items. The higher a food’s ORAC score, the more potent its antioxidant properties. Here are some examples: Food

Serving Size

ORAC Score

Wild Blueberries.................................... 1 cup.................................. 9019 Cranberries............................................ 1 cup..................................8983 Artichoke hearts.............................. 1 cup cooked...........................7904 Cinnamon.............................................. 1/3 tsp................................6000 Strawberries.......................................... 1 cup..................................5938 Red delicious apple...................................1.....................................5900 Pecans.....................................................1 oz...................................5095 Sweet cherries ..................................... 1 cup..................................4873 Russet potato......................................1 cooked...............................4649 Black beans...................................... ½ cup dried............................. 4181 Plum..........................................................1..................................... 4118 For the complete list, go to: www.training-conditioning.com/ORAC.pdf.

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to 200 fold in some individual muscle groups. As oxygen molecules are metabolized, they either partner up with other molecules in the body or remain unpaired. The unpaired loners are free radicals—free because they’re not bonded to other molecules, radicals because their chemical structure makes them unstable and prone to react with other substances. Free radicals can damage muscle protein, fats, and DNA within cells, producing both immediate and longterm effects. In the short term, free radical oxygen molecules can reduce muscle power and endurance during activity, contribute to fatigue, and initiate muscle soreness and even injury. In the long term, free radicals can weaken the immune system and play a role in the development of everything from heart disease and cancer to cataracts, arthritis, and several other chronic conditions. In addition to the free radicals created as a byproduct of exercise, the body can also be bombarded by unhealthy oxidizing compounds from outside sources. Radiation, pollution, sunlight, food

nutrition additives, alcohol, and caffeine can all contribute to free radical proliferation in the body. Taken together, these factors lead to oxidative stress—which for our purposes can be defined as physical damage and decreased performance caused by free radicals. While exercise inevitably leads to some degree of free radical production, the extent of it is determined by numerous factors. Short exercise sessions produce fewer free radicals than long ones, and intense work performed in hot weather or at high altitude leads to greater free radical production. Studies suggest that training experience matters as well— over time, a well-conditioned body builds up its own defenses against free radical damage, particularly by “learning” how to protect muscle tissue. LINE OF DEFENSE Antioxidants are the primary chemical line of defense against the negative impact of free radicals. These compounds also help to repair cells already impacted by free radical damage. The body produces some antioxidants on its own in the form of certain en-

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zymes, such as superoxide dismutase, glutathione peroxidase, and catalase, which change the structure of free radicals and break them down. These enzymes essentially scavenge for and destroy free radicals throughout the body. To support the endogenous antioxidants, we also consume them through

level, and exposure to environmental toxins. Trained athletes generally have more finely tuned endogenous antioxidant systems working for them, while untrained or out-of-shape individuals, athletes early in their training season, those who are suddenly increasing training intensity or duration, and

Athletes early in their training season, those who are suddenly increasing training intensity or duration, and those training at high altitude or in extreme heat are most in need of antioxidant support through food or supplementation. diet. Exogenous antioxidants include vitamins A (carotenoids), C, and E, selenium, and various flavonoids. All these substances can help prevent free radical damage, and together with the body’s natural antioxidants, they are the main source of protection for muscles and other tissue. The strength of athletes’ defenses against free radicals varies greatly, depending on age, genetic disposition, diet, lifestyle habits (such as smoking and alcohol use), physical activity

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those training at high altitude or in extreme heat are most in need of antioxidant support through food or supplementation. How does an athlete choose a diet rich in antioxidants? A relatively new method of measuring antioxidant potential in foods is called Oxygen Radical Absorbance Capacity (ORAC). This method, developed by scientists at The National Institute on Aging (a division of the National Institutes of Health) involves test tube analysis that deter-

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nutrition

ON THE MENU Here are two examples of antioxidant-rich daily meal plans: Breakfast

Breakfast

• Whole-grain toast with vegetable oil spread

• Egg white omelet with spinach, tomatoes, and peppers

• Yogurt with berries

• Blueberry whole-grain waffle with berry fruit syrup

• Glass of orange juice or lowfat chocolate milk

• Grape juice or lowfat chocolate milk

Morning Snack • Apple slices with dried fruit trail mix • Iced green tea

Morning Snack • Strawberry yogurt parfait topped with almond slivers • Soy-based snack bar

Lunch • Green vegetable salad with carrots, tomatoes, celery, and onion • Vegetable oil dressing

• Spinach salad with shredded carrots, yellow peppers, and mushrooms

• Grilled chicken breast seasoned with curcumin and parsley

• Cinnamon-seasoned tuna wrap made with whole-grain tomato tortilla

• Steamed broccoli

• Orange juice

• Baked potato fries

Afternoon Snack

• Berry juice blend

• Whole-grain pita chips

Afternoon Snack

• Soy nut butter spread

• Whole-grain crackers

Dinner

• Baby carrots with dip

• Mixed green salad

Dinner

• Chicken stir fry with broccoli, carrots, and mushrooms

• Green salad • Lean roast beef

• Brown rice

• Steamed broccoli with parmesan cheese

Late Snack

• Whole-grain roll

• Sparkling water with lemon

Late Snack • Citrus fruit salad topped with granola/trail mix

Lunch

T&C october 2009

• Honey almond soy crisps

mines the antioxidant levels of foods and other chemical substances. In 2007, the U.S. Department of Agriculture published a list of ORAC values for 277 foods. (See “ORAC Values” on page 36 for a link to the complete list, along with scores for select food items.) It revealed that some of the best natural sources of antioxidants are fruits, vegetables, legumes, and spices. There’s one important caveat: Knowing a food’s ORAC score can be helpful in menu planning, but the exact relationship between ORAC values and antioxidant health benefits has not yet been established. Also, while foods with high ORAC scores are typically nutrient-dense and healthy overall, there are no magical properties associated with the ORAC score—just because food X scores 20 percent higher than food Y, that doesn’t mean it is 20 percent better at protecting the body. In short, the jury is still out on exactly how much ORAC scores truly mean for physical health, but it’s probably the best available starting point when seeking an antioxidant-rich diet. ANTIOXIDANTS & PERFORMANCE When researchers in the early 1980s first looked at the relationship between exercise and free radical production, they found a two to three fold increase in free radicals in the muscles and livers of rats during physical activity. Today, this relationship continues to be studied, using human subjects under specific training conditions, with a focus on trying to identify specific ways that free radical production hurts performance. In general, research into free radicals and antioxidants has been plagued by inconsistency in the measurements used to gauge the role of dietary and supplemental antioxidants on oxidative stress. As a result, while we know that antioxidants offer some health benefits for athletes related to combating free radicals, it’s difficult to be much more specific than that. Studies have used widely varying exercise conditions, modalities, training intensities, genders, ages, and measures of oxidative stress through blood and urine. One newer test, called Raman spectroscopy, involves a laser light pointed at the fat pad of the palm to measure the amount of carotenoids in the body. So while progress continues, there are still many questions left to answer. TR AINING-CONDITIONING.COM

nutrition We do know that the importance of antioxidants for performance varies greatly from one sport to the next. For example, a 2006 study of endurance-training athletes working out at altitude for six weeks found that antioxidant levels in these athletes were below normal after the training sessions. This suggests that the antioxidants were doing their job neutralizing free radicals, and being used up in the process, helping to limit oxidative stress and likely boosting performance. But a 2009 study by the same researchers found that elite swimmers training for 13 days at altitude did not experience decreased antioxidant levels, suggesting that the antioxidants in their bodies (both endogenous and exogenous) didn’t have to fight off free radicals and thus didn’t play a significant role in performance. Other studies have looked at specific antioxidant vitamins, such as vitamin C, and produced conflicting results on whether high doses can reduce postworkout muscle soreness and damage. Vitamin E, meanwhile, has been shown to enhance oxygen utilization at

altitude, but does not seem to be as effective for that purpose at sea level. What does all this mean? Essentially, it’s not yet clear just how much oxidative stress affects athletic performance, but it likely contributes to muscle damage, decreased power, fatigue, and slow recovery. And while antioxidants’ precise effects are still being debated and likely vary greatly from person to person and sport to sport, they can help limit oxidative stress and thus help protect the body. In summary, antioxidants can help many athletes, though the precise benefits are variable and not always well defined. HOW MUCH IS ENOUGH? Despite the many unknowns, Americans spend $2.3 billion a year on antioxidant supplements. Most of these products are marketed for their ability to protect muscle tissue, boost recovery, and improve athletic performance. If an athlete wants to maximize whatever benefits antioxidants may provide, there’s an obvious question: What should they consume, and how much? One thing research has told us quite clearly is that individuals’ level of antiox-

idants varies greatly, based on diet, genetics, and other factors. It’s likely that those who are chronically deficient in antioxidants (consistently consuming an amount below the recommended daily allowance) stand to experience the biggest gains, and might be able to improve performance and overall health by resolving the deficiency. For example, one study found that vitamin C in supplement form improved performance among people who were shown in prior tests to be vitamin C deficient. However, well-nourished individuals (who were getting the recommended daily allowance of vitamin C through diet) did not experience an improvement due to supplementation. Other studies have shown that high antioxidant consumption makes a difference only if it’s consistent over a long period of time—using a supplement for just a week during a particularly intense training phase will probably not have a significant effect. So just how much is enough? The National Academy of Sciences recommends that women should consume 75 milligrams of vitamin C daily, and men

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T&C october 2009

nutrition should consume 90 milligrams. For vitamin E, the standard recommendation is 15 milligrams per day for both genders, and for selenium, both men and women are advised to take 55 micrograms per day. Vitamin A’s standard recommended allowance is 5,000 international units (IU) daily for men and 4,000 IU for women. It shouldn’t be difficult for most athletes to achieve these levels through food alone, and thus take full advantage of antioxidant benefits. Foods and beverages rich in vitamins A, C, and E, selenium, and polyphenol antioxidants can easily become a greater part of an athlete’s daily diet. In “On the Menu” on page 38, I’ve provided two sample days’ meal plans containing ample amounts of antioxidant-rich foods. But athletes don’t have to follow a daily script to ensure they’re getting enough antioxidants—a few simple guidelines can make all the difference. For someone with a generally healthy diet, adding an ounce of trail mix with seeds and almonds and a peanut butter sandwich every day can provide the boost they need. For others, adding a leafy salad with a mix of vegetables and some green tea as a between-meal snack will do the trick. Fruits are another convenient choice—apples, oranges, cherries, berries, and cantaloupe are all packed with antioxidants. If an athlete wants to boost antioxidant consumption but won’t change their eating habits, beverages can be a great alternative. Coffee, green tea, and cocoa, along with fruit juices such as orange, apple, prune, grape, cherry, and berry are all rich in antioxidants. Spices like curcumin and parsley can also give the diet an extra antioxidant kick without really affecting food choices. For athletes who want to use supplements, it’s important to note that more is not always better when it comes to antioxidants, and in some cases it can actually be harmful. Doses far above the recommended daily allowance can shift intracellular antioxidant balance and pose serious health risks. For example, a few studies have shown that prolonged overconsumption of certain forms of vitamin A can increase some people’s risk for lung cancer, and may also increase the rate of birth defects in pregnant women. Athletes who do use antioxidant supplements should be advised of a value called the tolerable upper intake level (UL) for the substance(s) they’re taking. This is the highest level of daily intake that’s unlikely to pose a risk of adverse health effects. The tolerable upper limits for some key antioxidants are: • Vitamin A: 10,000 international units per day • Vitamin C: 2,000 milligrams per day for adults; 1,800 milligrams per day for teens • Vitamin E: 1,000 milligrams per day for adults; 800 milligrams for teens • Selenium: 400 micrograms per day. As with most aspects of sports nutrition, the lesson with antioxidants should be food first, and supplementation only if deemed necessary to resolve a deficiency. By eating a consistent diet containing a broad array of antioxidant-rich foods, athletes can rest assured they are equipping their bodies with compounds that can help protect their muscles, promote fast recovery, and optimize performance. n

Full references for this article can be viewed at: www.training-conditioning.com/references. TR AINING-CONDITIONING.COM

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sport specific

The University of Alaska-Anchorage’s Cory Pena (far left) competes in the 800 meters at the 2009 NCAA Division II Championships.

Learning Curve

university of alaska-anchorage sports information

At the University of Alaska-Anchorage, track and field athletes are taught to play an active role in setting their own individual strength and conditioning priorities. By Michael Friess

he 2009 track and field season was one to remember for our University of AlaskaAnchorage Seawolves. We set new school records with five All-Americans and 10 athletes qualifying for the NCAA Division II Championships. We also had three performances that broke Great Northwest Athletic Conference individual records. Some may wonder—how can we produce so many successful competitors out here on the Last Frontier? Of course the athletes themselves deserve most of the credit, as I’m continually impressed by their dedication, enthusiasm, and willingness to make whatever sacrifices are needed to take their

T&C OCTOber 2009

skills to the next level. But part of their success is due to our sport-specific strength and conditioning program. We emphasize frequent performance assessment and encourage athletes to feel a sense of ownership of their customized workout regimens, with a few universal training principles mixed in to address teamwide priorities. In this article, I’ll outline what we do and explain how it helps keep our athletes strong, injury free, and performing at their best. TEST & RETEST Like most programs at the Division II level, our incoming athletes arrive with widely varying strengths, training histories, and weightroom experi-

ence. Some were regular lifters in high school, especially if they played multiple sports, while others have barely set foot in a weightroom before. To help ensure that everyone makes steady progress in conditioning, whatever their starting point, we rely on testing and performance assessment throughout the year. One of our top priorities for our new athletes is finding muscle and joint weaknesses, which cause mechanical flaws that can lead to injury, wasted energy, and decreased performance. Michael Friess is the Head Men’s and Women’s Track and Field Coach at the University of Alaska-Anchorage. He can be reached at: track@uaa.alaska.edu. TR AINING-CONDITIONING.COM

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sport specific Two areas we find most frequently need attention in our runners are the hips and core. Hip weakness, often seen in our incoming distance runners, is fairly easy to spot during initial evaluation of an athlete’s running mechanics. While observing running gait on a track or a

Beyond fixing individual deficiencies, we test all our athletes roughly every three weeks when we’re not in-season to gauge their progress in conditioning. One of the main skills we want runners to develop is the ability to push into the ground to generate greater and greater force, and a great way to test that is

Rather than have all the athletes follow a cookie-cutter approach, I encourage them to take ownership of their strength and conditioning strategy ... and choose exercises to target the areas where they most need to improve. treadmill, I’ll notice that one hip dips down too low during the stride, there is excessive swinging from side to side, or the athlete has trouble maintaining the natural, level equilibrium of the pelvic girdle. These are all signs of hip weakness, which hampers running and jumping ability and can lead to iliotibial band injury. For runners who display weak hips, we will prescribe exercises that develop hip abduction with resistance bands or machines. Closed-chain work, such as single-leg pressing, lunging, and Bulgarian split squats, will also help build hip strength. We have athletes with weak hips avoid leg curls in favor of stifflegged deadlifts, because we want to train the hamstrings more for decelerating the leg than for acceleration—working the hamstrings from an elongated position in deadlifts provides this effect while also helping increase active range of motion. If an athlete has a weak core, one of the first signs is usually lower back pain during running, particularly hill running. We will also frequently observe “sitting” or collapsing movements upon landing during jumping and plyometric work, and problems with overall posture. For these athletes (who are often the same ones who display weak hips), we focus on strengthening the core through stabilization and extension movements. We believe too many people overemphasize flexion alone when training the core at the expense of extension work, so we use ground-based stabilization exercises such as bridging, as well as training on a gluteham machine to develop the extensor groups. Olympic lifting also helps to train core stabilizer muscles and build core strength. 4 4

T&C OCTOber 2009

through 30-meter weighted sled pulls. As athletes’ times decrease throughout the training year, we know they are building speed by generating more force from the ground, while also increasing their ability to run with proper mechanics as they accommodate a resistance load. In the weightroom, we test the athletes on cleans, push presses, and squats to gauge overall strength development. These lifts are explosive and train multi-joint movement, which translates well to the demands of sprinting. The athletes also feel stronger and become more confident in their overall conditioning when they become proficient in squats, cleans, and presses. THEIR OWN COACH We believe strongly that athletes must take responsibility for their conditioning and strength programs to build con-

hamstrings than her landing leg. This is fairly common, especially among athletes who have never consistently strength trained and thus developed most of their functional muscle simply from practicing and competing in their event. Once she learns of this strength disparity, she might realize it explains the soreness she sometimes feels on one side after training runs, and the uneven gait she experiences when fatigue starts setting in. If everyone in our program followed the same strength training regimen, this imbalance might go uncorrected. But under our philosophy of athletes setting some of their own priorities and taking responsibility for their fitness, she can emphasize single-leg strength work to fix the imbalance. We will of course guide her on which exercises to choose, make sure she learns proper technique, and help her to understand progression variables. But the main idea is for her to feel like she’s in control of her conditioning program and helping to shape her own training. Our focus on responsibility in training also allows athletes to continue using methods and strategies that have worked for them in the past. For instance, one of our top sprinters two years ago came into our program as a sixth-degree black belt in karate. He had a battery of exercises that he felt optimized his functional strength, explosiveness, balance, and coordination, and once he explained the pro-

One of the main skills we want runners to develop is the ability to push into the ground to generate greater and greater force, and a great way to test that is through 30-meter weighted sled pulls. As athletes’ times decrease throughout the training year, we know they are building speed. fidence and motivation. Rather than have all the athletes follow a cookiecutter approach, I encourage them to take ownership of their strength and conditioning strategy, set a few specific priorities or areas of focus, and then choose some of their exercise and lifting progressions to target the areas where they most need to improve. For example, during strength tests in early fall, let’s say an incoming hurdler learns that her push-off leg is significantly stronger in the quads and

gram to us, we allowed him to stick with it. We monitored his progress in the same categories as our other sprinters and were satisfied that his program was helping him achieve his performance goals. While some of those exercises were unlike anything I would prescribe to the rest of the team, they worked for him and he was comfortable doing them, so we let him take complete ownership of those portions of his training. TR AINING-CONDITIONING.COM

sport specific Even though we give our athletes a great deal of freedom, that does not mean our strength workouts are a free-for-all. Each individual is encouraged to keep a basic training journal that catalogs the lifts and exercises they did for each workout, including sets, reps, and weight used. They also include any notes on progress, difficulties they are experiencing with a particular exercise, and other observations. The journals are a great way to open lines of communication between athlete and coach. I look through them at least once a week and provide individualized feedback on how they can make adjustments to enhance their training. For example, if someone appears to have reached a plateau with a certain lift, I will recommend switching to different exercises that develop the same muscle groups. If someone reports problems completing an exercise, I will observe them one-on-one to look for flaws. If I find they’re lifting their heels during squats, for instance, I’ll give them some range of motion exercises

to increase flexibility, then talk them through proper squatting technique. Other times, I’ll simply help them find another exercise that offers the same benefits. BEST PRACTICES While our athletes have come to take pride in the individualized nature of their workouts and conditioning progressions, there are a few training principles that we like everyone to follow. I have learned through experience that these can pay off for virtually all track and field athletes. For one thing, everyone incorporates the Bulgarian split squat into their training. If our athletes could do only one movement to build strength, I’d choose this one, because it trains each leg independently for the balance, stability, and power that runners need most. In the Bulgarian split squat, the athlete begins by standing on one leg, with the other behind them with the knee bent and the foot resting on a plyo box, bench, or bar. The standing leg is positioned slightly forward, so

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that the heel is roughly even with the front abdominal wall (this typically requires a small forward hop once the back leg is in place). The athlete then performs lunge-like movements, bending the knee of the standing leg and lowering the body until the back knee touches the ground, then returning to the starting position. Since the standing leg does practically all the work, athletes can use different weight loads for each side to address strength disparities. They can perform the squat with no external resistance, with a dumbbell in each hand, or in a power rack with the bar resting on their shoulders. In addition to building quad and hamstring strength, this movement also engages the stabilizer muscles in the foot, ankle, and calf to maintain balance and keep the shin from moving laterally. Athletes who become proficient at this squat show improvements in sprinting, horizontal jumping, and ability to accelerate. Another staple of our strength program for all athletes is Olympic lifting. Much like sled pulls, lifts such as

sport specific the hang clean and clean and jerk train athletes to push with maximum force against the ground, which helps develop speed and acceleration. For sprinters in particular, we want to train pushing against the ground in as many ways as possible, and Olympic lifting accomplishes this while also requiring coordinated movement of the hip, knee, and ankle joints. There’s also a psychological component to these lifts. They activate the entire body and leave the athletes feeling stronger and more powerful, particularly when they complete their first set with a higher weight load. It’s hard to quantify that benefit, but we believe it provides an extra motivational edge during tough workouts. Outside the weightroom, there is one key aspect of our track and field conditioning that differs from most other programs: We pay more attention to cardiovascular work. We want everyone, even our sprinters—who sometimes have never run for distance before—to be able to jog steadily for 30 minutes. I might be slightly biased because of my own background (I was a distance runner in college), but I believe longer bouts of steady-state running can benefit any athlete. Distance running is the most basic form of plyometric work,

Everyone incorporates the Bulgarian split squat into their training. If our athletes could do only one movement to build strength, I’d choose this one, because it trains each leg independently for the balance, stability, and power that runners need most. and it promotes soft tissue and ligament integrity, which can improve performance and decrease injury risk in virtually any activity. Our program’s emphasis on distance running began out of necessity. Until recently, we didn’t have an indoor track, and during the long Alaskan winters, all our runners used treadmills for speed training. Our fastest treadmill topped out at just 16 mph, so to make the sessions challenging, we had to increase running volume. We liked the cardiovascular benefits and noticed that our injury rates were consistently very low, so we’ve maintained that focus even now that we have access to a beautiful new indoor facility. To reduce impact stress during longer runs, the athletes will often do their work on our artificial turf surface instead of on the track. And of course, those who struggle with compartment syndrome, alignment issues, or other special considerations won’t run for volume as much as their teammates. But overall, even those with no distance running experience have reported feeling that it helps them become better athletes. For all of our program’s training philosophies and techniques, the true measure of value is meet performance. When we see our runners’ times steadily dropping, our long jumpers earning top spots in national competition, and our field athletes breaking school records, we’re confident that our strength and conditioning priorities are setting up our athletes to maximize success. n 46

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“Challenging, Functional and Fun” Product Review: The TRX Suspension Trainer by Todd Durkin, MA, CSCS Todd Durkin is a strength, speed, & conditioning coach, personal trainer, bodyworker, and motivational speaker. He is the owner of Fitness Quest 10 in San Diego CA. Todd earned his B.S. degree in Kinesiology and his M.A. degree in Biomechanics/Sports Medicine. Todd is also the head of the Under Armour Performance Council.

As a personal trainer and owner of a successful health and human performance center that trains dozens of professional athletes and hundreds of clients a week, I have used practically every kind of equipment and training tool to challenge my clients to their limits. In the world of human performance and personal training, there are thousands of tools a trainer can use to derive results with a client. Although I believe there are several ways to skin a cat, one of my favorite tools is the TRX® Suspension Trainer® from Fitness Anywhere, Inc. and it has changed the way I train my clients. The TRX was invented by a Navy SEAL who needed to maintain peak physical condition while deployed for weeks or months in remote locales. Out of necessity, they made the first prototypes from parachute webbing. As the system’s design was refined, its library of exercises continued to grow. Fitness Anywhere has now programmed over 300 highly functional strength, flexibility and core stability progressions; I’ve even invented a few myself. The TRX uses variable bodyweight as resistance, and is as challenging as you want it to be. You can also control the amount of instability to develop the stabilizing muscles, which makes it even more effective. I love training with bodyweight resistance and the system allows me to vary the intensity and complexion of these exercises to meet each client’s unique goals. Whether training a 240lb NFL linebacker, a 50-year-old executive, or a physical therapy client, the TRX will challenge your clients appropriately regardless of age, shape, size, or strength. Our staff trainers use the TRX all day with countless clients and the equipment stands up to the challenge. We place several units next to each other in order to train multiple people at once, performing the same exercises, but at varying levels. With the system I can switch quickly from drop sets to supersets, compound sets, multi-joint movements, or isolation type exercises. 20-30 minutes of exercise on the TRX provides an awesome overall workout for the entire body. My clients really enjoy the TRX. It is fun and challenging. The ability for a client to “self-adjust” the level of difficulty by simply changing body position while exercising is a big advantage. Many of my clients now own the system for in-home use and I prescribe their in-home training programs. It takes up little room and attaches easily to a door, tree, fence, or any stable apparatus in the gym like squat racks and cable towers. Fitness Anywhere has done a phenomenal job in preparing educational material to support the TRX for both the trainer and the client. A comprehensive demonstration DVD and basic guidebook are included with the TRX. Other good material, including a Military Fitness Guide (developed for the Navy SEALs selection program), club exercise posters, and a range of sport specific training guides (Core Strength, Flexibility, Team Sports, Train Like the Pros) is also available. I now recommend that all trainers add Suspension Training into their clients’ programs. The TRX is good for everyone, and is clearly one of the most effective, affordable, and versatile pieces of equipment on the market today. It will soon be a familiar fixture in every segment of the sports and fitness industry. If you are serious about getting results, the TRX is a must have for your fitness arsenal. I rate the TRX as Outstanding. Sometimes the best things in life are simple. This simple idea will shape the fitness industry for years to come. Results speak volumes. The TRX delivers.

Can’t get enough

Training & Conditioning ? Start your week off right with Training-Conditioning.com’s Weekly Blog series. Every Monday, our award-winning authors and industry leaders post a new article profiling what’s hot in the fields of athletic training and strength and conditioning. T&C Weekly Blogs provide a valuable resource for tracking trends and sharing industry ideas. It’s information you won’t find anywhere else.

www.training-conditioning.com Give us five minutes and we’ll get you ahead of the game. Circle No. 134

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T&C october 2009

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Non-Operative Knee Treatment The Elite Seat by Kneebourne Therapeutic is a portable knee-extension device designed for the non-operative treatment of degenerative knee conditions. By evenly distributing force across the leg, the Elite Seat provides effective full-knee hyperextension and reduces pain in bent knees caused by any of these conditions: acute ACL injury; inadequate post-operative rehabilitation after ACL reconstruction; total-knee arthroplasty; arthrofibrosis; deconditioned knee with a flexion contracture; and arthritis. Kneebourne Therapeutic • 866-756-3706 www.eliteseat.com Circle No. 510

Get Specialized The NASM Corrective Exercise Specialist (NASM-CES) advanced specialization was developed in response to the growing need for professionals who can assist clients TR AINING-CONDITIONING.COM

Relief and Beyond experiencing musculoskeletal impairments, muscle imbalances, or rehabilitation concerns. The NASM-CES integrates the science and the solutions for optimal injury prevention and recovery success. Develop injury prevention and recovery expertise to generate more revenue working with today’s deconditioned population. Earn the preferred injury prevention and recovery credential of professional athletes and teams. Con-Ed approved: NASM 1.9, ACE 1.5, NSCA 1.6, BOC 37 CEUs. National Academy of Sports Medicine 800-460-6276 • www.nasm.org Circle No. 511

Stretching Toward Comfort While aiding in physical mobility and flexibility, the Stretch EZ’s cradle design encompasses the foot to allow for a comfortable stretch to the foot, heel, Achilles tendon, hamstring, quadriceps, inner/ outer thigh, and calf. This unique stretching aide assists in the treatment of plantar fasciitis, heel spurs, and calf, thigh, hip, and low back strains and injuries. For more information or to request a free catalog, call OPTP or go online. OPTP 800-367-7393 • www.optp.com Circle No. 512

PA IN MANAGEMENT

Relief for the Groin The PRO 315 Rodeo Wrap was originally designed for use by professional bull riders in the treatment of groin pulls. A full 14 feet in length, the unique elastic in this product contours to the thigh and waist to provide a low-profile wrap. Compression and support provides relief for groin strains and pulls. PRO Orthopedic Devices, Inc. • 800-523-5611 www.proorthopedic.com Circle No. 515

A Simple Self-Care Solution The Original Backnobber® II is constructed of fiberglass-reinforced nylon. Use it to apply deep pressure to trigger points to reduce muscle tension and pain and increase range of motion and overall function. A built-in locking device allows it to be taken apart for convenient storage and travel. This simple and effective self-care tool is lightweight, durable, compact, attractive, and versatile. A 35-page illustrated user guide is included with purchase. The Pressure Positive Co. • 800-603-5107 www.pressurepositive.com Circle No. 516

Beauty and Function

Biofreeze pain-relieving spray, the most clinically used and recommended topical analgesic, can be used as an effective adjunct to the Kinesio Taping Method. After applying the tape, the practitioner simply sprays the taped area. Because the tape is porous, the athlete receives all the pain-relieving benefits of Biofreeze. In addition, Biofreeze allows for more freedom of movement to increase joint range of motion. Performance Health 800-321-2135 • www.biofreeze.com Circle No. 513

The Clinton Classic Wood Taping Station features the beauty of real wood in four popular finishes, famous Clinton durable construction, and desirable standard features—like leg extensions that save valuable space and comfortable adjustable back rests. With more than 14 available options, this product is sure to be on every athletic trainer’s wish list. Plus, Clinton’s modular design, available in four depths, allows the units to be configured to fit large or small sports training facilities. Clinton Industries, Inc. 800-441-9131 • www.clinton-ind.com Circle No. 517

For Deeper Massage

Replace What’s Lost

Spraying Does More

Massage muscle tissue by rolling the four bumpy balls of the Massage Bar along large muscle areas or along the arms and legs to stimulate tissue and promote blood flow through tired, sore, or cold muscles. The nodules deepen the massage and enhance the function. The handles feature a firm ergonomic grip for comfort. The bar measures 18 inches with four 2.5-inch (diameter) balls. Power Systems, Inc. 800-321-6975 • www.power-systems.com Circle No. 514

TR AINING-CONDITIONING.COM

With all the benefits of the Hyland’s Muscle Therapy formulas, Hyland’s Arnisport has the added benefit of containing all 12 cellular tissue salts. Helpful in recovery from training and injury, this all-natural, FDA-approved product assists with healing after injuries and replacement of minerals depleted by exercise. Hyland’s Arnisport is available in quick-dissolving soft tablets. TXOptions & Hyland’s Homeopathic 800-456-7818 • www.txoptions.com Circle No. 518

T&C october 2009

PA IN MANAGEMENT

Relief and Beyond

Get It Fast

Target Your Trigger Points

Hausmann offers the quick-ship PROTEAM Two-Seat Taping Station (model A9520-346-24). It’s 6’ long x 3’ high x 3’ deep, and oak laminate is the stock finish. This unit is equipped with a hamper in the middle storage module, and you can choose from nine Pro-Form vinyl colors. It’s available for shipment five working days after receipt of your order. Call the company or go online to learn more. PROTEAM by Hausmann 888-428-7626 • www.proteamtables.com Circle No. 519

The Original Index Knobber II is a simple device designed to let you apply deep pressure to yourself or others. It’s the ideal instrument for clinic or home use, allowing for firm, sustained pressure on painful trigger points. Its unique patented design allows it to be used in several hand positions and by the right or left hands comfortably and interchangeably. It’s virtually indestructible and easily cleaned between uses. The Pressure Positive Co. • 800-603-5107 www.pressurepositive.com Circle No. 523

Take It With You

Help for Healing

The Dynatron Solaris Series offers ultrasound, seven stim waveforms including direct current, and the option of adding light therapy. The state-of-the-art Solaris Series also provides a choice of four infrared light probes, including the D405 infrared/blue light probe and the powerful Dynatron Xp light pad. Along with the latest technology and ease of use, its durable construction and portable size mean Solaris can travel anywhere. Call for a free demonstration. Dynatronics • 800-874-6251 www.dynatronics.com Circle No. 520

Hyland’s Muscle Therapy offers all-natural relief from the symptoms of pain, swelling, and bruising due to trauma or exercise. This FDA-approved formula contains Arnica montana and other natural remedies that are effective in healing and recovering from injuries. Hyland’s Muscle Therapy is safe and effective with no contraindications, drug interactions, or reported side effects. Hyland’s Muscle Therapy is available in topical gel or oral strips. TXOptions & Hyland’s Homeopathic 800-456-7818 • www.txoptions.com Circle No. 524

Follow the Maps

Innovative Cramp Relief

The Body Has a Mind of its Own by Sandra and Matthew Blakeslee is a summary of current research on how the brain and body interact via body maps. Body maps in the brain determine how you perceive reality (filter information) and how you respond to that perception. The book is illustrated, features a hardcover, and consists of 240 pages. Contact OPTP for more information. OPTP • 800-3677393 • www.optp.com Circle No. 521

iFan Health Products has introduced the much-anticipated Bounce-BAC™ Runners Relief 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 Runners Relief performed perfectly on both running backs and defensive backs. It is now available through Medco. iFan Health Products • 877-677-2999 www.beatsuperbugs.com Circle No. 525

Unique Shape The rigid spike design of the Massage Peanut provides firm but stimulating tissue massage to promote blood flow through tired, sore, or cold muscles. The peanut shape allows a larger surface area to be affected and rolls very well on the body’s surface and contours. An excellent tool for self-massage and relaxation, the Massage Peanut is six inches long and 3.5 inches in diameter at its widest point. Power Systems, Inc. • 800-321-6975 www.power-systems.com Circle No. 522

T&C october 2009

Convertible Convenience The Two-Seat Taping Station (model 4061) is the perfect taping station for any high school or college athletic training room. It converts to a treatment table by simply adding a middle pad so the athlete can lie down on a 74” x 34” padded surface for treatment. This unit has an oak laminate finish, is available in nine Pro-Form vinyl colors, and has one drawer and six doors for storing tape and supplies. PROTEAM by Hausmann • 888-428-7626 www.proteamtables.com Circle No. 526 TR AINING-CONDITIONING.COM

Case study

Novel Exercise Delivers Relief From Tennis Elbow Study reveals a cost-effective, at-home treatment Research has shown that isokinetic eccentric training of the wrist extensors is effective for treating chronic lateral epicondylitis (also known as tennis elbow). However, isokinetic dynamometry is not widely available or practical for daily exercise. Recognizing these limitations, a team at the Nicholas Institute of Sports Medicine and Athletic Trauma in New York City, led by Timothy F. Tyler, PT, ATC, Clinical Research Associate, decided to search for a treatment that was as effective but more readily available. Ideally, this treatment could be utilized at home.

FlexBar is held in the involved wrist in maximal extension.

The other end of the rubber bar is grasped by uninvolved hand.

FlexBar is twisted by flexing the uninvolved wrist while holding the involved wrist in flexion.

“Up until now, the only way to do isolated eccentrics for tennis elbow was on a big $50,000 isokinetic machine that would be in someone’s office,” says Tyler. “With up to three percent of the population suffering annually from tennis elbow—a condition that can arise from simple everyday activities—we felt this population deserved some additional treatment options.” The team, wanting a way to make therapy work at home, began to assess the efficiency of a novel eccentric wrist extensor exercise when added to the standard physical therapy treatments for chronic lateral epicondylitis. The exercise involves the Thera-Band® FlexBar®, a ridged-surface flexible bar initially designed for wrist, forearm, and hand rehabilitation. The study involved 21 patients who had reported chronic symptoms of tennis elbow for at least six weeks but had no prior surgical treatment for it. The patients were separated into two groups. All the patients received standard physical therapy, which included wrist extensor stretching, ultrasound, cross-friction massage, and heat and ice for seven weeks. Additionally, the standard treatment group performed isotonic wrist extensor strengthening, while the eccentric group performed isolated eccentric wrist extensor strengthening using the FlexBar. Eccentric exercise involves putting tension on a muscle as it opposes a stronger force, which causes the muscle to lengthen as it contracts. The eccentric exercise involved twisting the Thera-Band FlexBar with concentric wrist flexion of the uninjured arm and slowly releasing the twist with eccentric wrist extension of the injured arm. Three sets of 15 repetitions were performed daily as part of a home program with intensity increased progressively through the three levels of FlexBar resistance during the treatment period. A variety of pain and movement scales were utilized to determine progress. Patients using the FlexBar had vastly better results on all scales, especially related to strength. “All outcome measures for chronic lateral epicondylitis were markedly improved with the addition of the FlexBar exercise to the standard physical therapy routine,” explains Tyler. “In fact, we stopped the study because we saw such a vast improvement in the FlexBar group—we didn’t feel it was ethical to keep people who weren’t getting better on the standard treatment protocol.

While maintaining twist, both arms are brought in front of body.

FlexBar is slowly untwisted.

“We recognize that this study was limited by its small sample size, but it supports using an exercise that is practical, inexpensive, does not require direct medical supervision, and has no significant side effects,” Tyler continues. “The maximal efficacy of this new treatment would thus likely compare favorably against anything else available, and could lower healthcare costs.” Timothy Tyler is a physical therapist in private practice in New York. He is also a Research Associate at the Nicholas Institute of Sports Medicine and Athletic Trauma at Lenox Hill Hospital. His research interests include developing new objective measurements and evidence based rehabilitation guidelines. He has been published in several journals and texts. Tyler also serves on the Thera-Band Research Advisory Committee (TRAC). The Thera-Band FlexBar is available from Performance Health/Hygenic Corp. The findings of this study were presented at the American Orthopaedic Society for Sports Medicine’s Annual Meeting in Keystone, Colo., earlier this year. The complete study and abstract can be viewed at: info.thera-bandacademy.com/flexbarelbow.

Performance Health/Hygenic Corp. 1245 Home Ave. Akron, OH 44310 800-321-2135 Fax: 724-733-4266 information@thera-band.com www.thera-band.com

Hot & Cold

Targeted Therapy New and Improved

Cold Works

The Pro-Tec Athletics Hot/Cold Therapy Wrap has gotten even better. The new XL form-fitting shoulder wrap offers the same great dual strapping system that allows for even, effective compression of the entire target area, but with wider 4.5-inch straps. The advanced gel technology packs remain flexible during application and retain cold or heat longer, and now there are two of them. The addition of a second pack allows for greater coverage and treatment to both sides of the shoulder. Call or go online for a free brochure. Pro-Tec Athletics 800-779-3372 • www.injurybegone.com Circle No. 530

The Ice-Up portable ice massager is a breakthrough product in the world of ice treatment for soft tissue injuries. There are many benefits of direct, active ice massage, including effectiveness in five to seven minutes (versus 15 to 20 minutes for passive ice packs); quick, deep tissue relief for ligament, tendon, and muscular injuries; and faster recovery. The Ice-Up comes inside a portable, insulated carrying cooler that keeps the stick frozen for up to 12 hours. The leak-proof design keeps you dry during travel so you can take it anywhere for an immediate post-activity ice massage. Pro-Tec Athletics • 800-779-3372 www.injurybegone.com Circle No. 533

For the Big Guys The Slantback (SB-100) whirlpool is constructed of 304 stainless steel and designed for the average 300-pound lineman. The SB-100 is available as a mobile or stationary whirlpool and has a 1/2-horsepower turbine with inside dimensions of 32” x 72”. It is an ideal whirlpool for serious athletic departments. Whitehall Mfg., Inc. • 800-782-7706 www.whitehallmfg.com Circle No. 531

Wrap It Up PRO ice wraps are the ideal method for applying cold therapy to most minor injuries. Made with quality neoprene for durability, these wraps are perfect for treatment of pulls and strains. The wraps are quick and easy to use, allowing for adjustable compression to keep ice packs in place. They’re available for the shoulder (#439), knee (#103), and back (#208) in black only. PRO Orthopedic Devices, Inc. 800-523-5611 • www.proorthopedic.com Circle No. 532

Bring the Heat The Thermalator is a moist heating unit designed for easy and convenient use. It is available in five convenient sizes, from the popular four- and six-pack units to the practical eight- and 12-pack units. All units are constructed of 304 stainless steel with coved bottoms and have a rubberized, coated stainless-steel rack. Mobile Thermalators have locking casters for added safety in your training facility. Whitehall Mfg., Inc. 800-782-7706 • www.whitehallmfg.com Circle No. 534

Portable Aquatic Therapy 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. The PolarPool • 617-480-7683 www.thepolarpool.com Circle No. 535

Web News

Everything You’d Expect, and Much More

Choose Your Product, See It In Action

The Samson Equipment Web site features product images, equipped facility images, paint and upholstery color choice options, the “Samson Difference” video, and the “Samson Goes to the White House” video, among other highlights. Log on today and see how Samson is leading the way in customdesigned, heavy-duty weight training equipment, athletic training equipment, and even custom football lockers. www.samsonequipment.com

Strength Systems’ Web site is easy to navigate and designed to offer information about the company’s great line of products in a straightforward manner. The home page shows a video of a young athlete demonstrating all of the company’s products. This is a great overview of what Strength is all about. Its individual products are listed on the page, so if you’re interested in the Original Strength Shoe, you can click on that link and go directly to the Strength Shoe page. The site also lists company contact information, making it easy to get in touch with customer service representatives. www.strength-systems.com

T&C october 2009

TR AINING-CONDITIONING.COM

Stretching Your Boundaries

Kinesio introduced the world to elastic therapeutic tape under the guidance of inventor and company founder Dr. Kenzo Kase. Today, Kinesio continues to drive the industry by offering Kinesio Tex Gold, a product utilizing premium materials and backed by over 35 years of research and development. Primary Advantages: • Pain relief and support without limiting range of motion • Over 35 years of research and development • Company provides educational training manuals, videos, and seminars

Kinesio USA 888-320-TAPE www.kinesiotaping.com Circle No. 540

EL ASTIC THER APEUTIC TAPE

Developed by Dr. Kevin Jardine, SpiderTech elastic therapeutic tape uses high-grade cotton material with 100-percent acrylic, hypoallergenic adhesive. The tape is water-resistant, breathable, and can be worn for up to five days. It’s an outstanding modality to help athletes regain pain-free mobility and resume training after soft tissue and ligament injuries. Primary Advantages: • Pre-cut taping products are ready to apply • Customized for specific body areas • The original Nitto Denko kinesiology tape from Japan

NuCap Medical 416-494-1444 www.nucapmedical.com Circle No. 541

Ever wonder where the pro teams get those GIANT rubber bands they use for stretching?

Look no further! Jump Stretch has been supplying the large continuous-loop FlexBands® to high school, college, and pro teams since 1980. We have a total of seven sizes, but most teams use either the Light or Average bands for stretching. For more information, visit our website at www.jumpstretch.com or call 1-800-344-3539.

Jump Stretch, Inc.

1230 N. Meridian Rd. Youngstown, OH 44509 www.jumpstretch.com 1-800-344-3539 Fax: 1-330-793-8719 TR AINING-CONDITIONING.COM jumpstretch62v0v3.indd 1

Circle No. 135

T&C october 2009 1/3/07 1:39:01 PM

Director ies Circle Company No.

Advertisers Directory Page No.

Circle Company No.

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115. . . Amrex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

139. . . Muscle Milk (CytoSport) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . BC

134. . . AthleticBid.com . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

105. . . NASM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

136. . . BlisterShield/2Toms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60

125. . . New York Barbells of Elmira. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

110. . . Bushwalker Bags . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

121. . . NUCAP Medical (SpiderTech) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

114. . . C.H.E.K Institute . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

123. . . NUCAP Medical (SpiderTech) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

107. . . California University of Pennsylvania . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

127. . . OPTP. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

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

103. . . Perform Better . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

116. . . Cleveland Chiropractic College. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

104. . . Polar . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

108. . . Clinton Industries. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

106. . . PolarPool. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

131. . . Dr. Jill’s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

119. . . Power Systems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

138. . . Dynatronics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . IBC

124. . . Pressure Positive Company. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

130. . . Egg Whites. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

129. . . PRO Orthopedic Devices. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

111. . . Flexall . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

133. . . Pro-Tec Athletics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46

118. . . Hibiclens/Hibistat. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

109. . . PROTEAM by Hausmann . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

122. . . Hyland’s/TXOptions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

132. . . Samson Equipment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

117. . . iFan Health Products . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

137. . . Save-A-Tooth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60

135. . . Jump Stretch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

102. . . Thera-Band®/Performance Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

120. . . Kinesio . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

134. . . Training-Conditioning.com. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

100. . . Kneebourne Therapeutic. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . IFC

113. . . TurfCordz/NZ Mfg.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

126. . . Lebert Fitness. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

112. . . Whitehall Manufacturing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

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545. . . Ari-Med (Bushwalker Bags) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58

554. . . New York Barbells (kettlebells) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

505. . . Ari-Med (Flexall). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

541. . . NUCAP Medical. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56

504. . . BlisterShield/2Toms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

512. . . OPTP (Stretch EZ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51

501. . . BlisterShield/2Toms (new product). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

521. . . OPTP (The Body Has a Mind of its Own). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

500. . . Boiron . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

559. . . Perform Better (Kettlebell Buddy) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

546. . . C.H.E.K Institute . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58

553. . . Perform Better (SoloStrength) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

547. . . California University of Pennsylvania . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58

513. . . Performance Health (Biofreeze®) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51

506. . . Cho-Pat . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

551. . . Performance Health (Thera-Band®) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58

548. . . Cleveland Chiropractic College. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58

550. . . Polar (RS300X) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58

507. . . Clinton Industries (Laminate Taping Station) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

563. . . Polar (Team2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60

517. . . Clinton Industries (Wood Taping Station) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51

535. . . PolarPool . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

549. . . Creative Health Products . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58

514. . . Power Systems (Massage Bar) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51

555. . . Dr. Jill’s (Foot pads). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

522. . . Power Systems (Massage Peanut). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

564. . . Dr. Jill’s (ECOGEL). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60

558. . . PowerCranks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

520. . . Dynatronics (Solaris Series). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

516. . . Pressure Positive (Original Backnobber II) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51

508. . . Dynatronics (Vforce) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

523. . . Pressure Positive (Original Index Knobber II). . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

518. . . Hyland’s/TXOptions (Arnisport) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51

515. . . PRO Orthopedic (315 Rodeo Wrap). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51

524. . . Hyland’s/TXOptions (Muscle Therapy). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

532. . . PRO Orthopedic (ice wraps). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

525. . . iFan Health Products . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

519. . . PROTEAM by Hausmann (model A9520-346-24). . . . . . . . . . . . . . . . . . . . . . . . 52

509. . . Jump Stretch (Don’t Ice That Ankle Sprain!) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

526. . . PROTEAM by Hausmann (model 4061) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

562. . . Jump Stretch (Door Harness) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60

530. . . Pro-Tec Athletics (Hot/Cold Therapy Wrap) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

540. . . Kinesio. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

533. . . Pro-Tec (Ice Up) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

510. . . Kneebourne Therapeutic. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

556. . . Save-A-Tooth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

502. . . Lebert Fitness (Buddy System) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

557. . . Strength Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

552. . . Lebert Fitness (Equalizer). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

560. . . TurfCordz/NZ Mfg. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60

503. . . Legend Fitness. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

531. . . Whitehall Manufacturing (Slantback). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

511. . . NASM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

534. . . Whitehall Manufacturing (Thermolator) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

561. . . New York Barbells (2000 Family Center set) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60

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Company Q& A

Pure Protein Powder Expands Athletes’ Options For Building And Maintaining Muscle

Anna Bredl is Marketing Manager at BiProUSA.

What does BiProUSA offer, and how does your product differ from others in the marketplace? We offer whey protein powder that’s 100-percent pure, all-natural, and flavorless. It is produced through an ion exchange process, resulting in a product with no fat, carbs, sugars, or lactose.

Many other protein powders, like those athletes may find on the shelves at a nutritional supplement store, contain fillers that add carbs, sugar, and fats. Ours is the purest powder on the market, without any of those unwanted extras. Who can benefit from this product, and how? BiPro can benefit anyone who needs to increase their dietary protein intake. Many athletes use it after an injury when they need to boost muscle repair, or when they’re strength training and need the extra protein for glycogen replacement and to support muscle growth. Another advantage for athletes is that it prevents a decline in immune system function that can sometimes result from overtraining. Athletes who are vegetarians sometimes struggle to get enough protein in their diet. BiPro is perfect for these individuals— because it’s a flavorless powder, it can be added to muffins, pancakes, mashed potatoes, yogurt, and practically any other food that needs a quick and easy protein boost. Can you provide a specific example of how someone might use it? I use it myself to enhance muscle recovery after workouts by stirring it into my chocolate milk. It’s not gritty or clumpy—it just dissolves into the liquid and you can’t tell a difference in taste or texture. If I wanted to get that much protein through whole food, I’d probably have to eat a steak after my workout, and then I’d be getting a lot of extra fat and calories. TR AINING-CONDITIONING.COM

What kind of feedback have you received from users of the product? We’ve had athletes tell us that BiPro has helped them build significant muscle mass. In fact, a bodybuilder recently told us he was able to add 30 pounds of muscle in just a couple months, and he attributed it largely to his use of our product. Athletes have also told us they appreciate the fact that our product is gluten-free. Some people have trouble digesting foods with gluten, and that can limit their dietary options for getting enough protein. With BiPro, they have a much easier time planning an optimal diet. Where can consumers buy this product, and can they try it for free first? It’s only available online at www.biprousa.com, and yes, people can contact us online or by phone to request a free sample. If they decide they want to buy the product, it’s available in two-pound jars that contain 41 servings. We also have an affiliate program that offers savings of 30 percent for customers who purchase in bulk (12 or more jars at a time). I encourage readers to request the free sample, and I’m confident they’ll be impressed with the product and the results it can provide. To learn about BiProUSA’s other whey protein, BioZzz, an all natural sleep supplement, go to BiProUSA.com.

BiProUSA 11000 West 78th St., Ste. 210 Eden Prairie, MN 55344 877-692-4776 Fax: 952-914-0887 www.biprousa.com T&C october 2009

MORE PRODUCTS

Great Ideas, Great Value

Setting the Standard Since 1980, Bushwalker bags have been handcrafted in America to exacting standards for quality and durability. Discover Ari-Med’s complete line of Bushwalker medical bags, belt packs, crutch bags, field kits, equipment bags, luggage, and specialty bags that are some of the best in the industry. They come with a lifetime warranty on workmanship. The bags are available in six standard colors, and custom embroidery is also available. Bushwalker bags set the standard. Ari-Med Pharmaceuticals 800-527-4923 • www.ari-med.com Circle No. 545

A Name You Trust The C.H.E.K Institute provides cutting-edge, scientifically based educational programs, products, and services for fitness and healthcare professionals, and individuals in pursuit of better living through optimal health. C.H.E.K Institute-trained professionals are recognized as experts in their field, performing detailed assessments and client evaluations as a prerequisite to designing corrective or performance-enhancing exercise programs, recommending lifestyle changes, or implementing stress-reduction techniques. C.H.E.K Institute • 800-552-8789 www.chekinstitute.com Circle No. 546

Never Stop Learning California University of Pennsylvania has helped build the character and careers of its students for more than 150 years. Cal U’s dedication to providing high-quality, in-demand programs to its students continues through the University’s Global Online 100-percent online programs of study. Through an asynchronous format, Global Online allows students the opportunity to complete coursework anytime, anywhere. All that’s required is a computer with Internet access. Go online for more information. California University of Pennsylvania 866-595-6348 • www.cup.edu/go Circle No. 547

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 58

T&C october 2009

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. 548

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. 549

Smarter Running Experience running in 3D with the new Polar RS300X. The RS300X training computer is designed to measure speed and distance, but more crucially your heart rate. It helps you train at the right intensity, recover at the right times, and constantly build on your performance. With the optional FlowLink accessory, you can upload your running data to polarpersonaltrainer.com, a free online training diary. Go online to learn more. Polar, Inc. • 800-290-6330 www.polarusa.com Circle No. 550

Steady Progress Thera-Band stability products offer industry-leading solutions for sports performance enhancement, balance training, and rehabilitation. The product family is based on the Thera-Band Trusted Progression: a broad, complete spectrum of challenge levels that provides athletic trainers and therapists with the tools they need to progress their athletes. The products offered include the Rocker and Wobble Boards, three densities of ovalshaped stability trainers, and the Stability Disc. The Stability Disc can also be used for active sitting and core development. Performance Health • 800-321-2135 www.thera-band.com Circle No. 551

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Great Ideas, Great Value

MORE PRODUCTS

Pull Your Own Weight

Because Time Matters

The Lebert Equalizer total-body strengthener is a simple, cost-effective, portable, multi-purpose, and versatile piece of strength training equipment that works the arms, chest, back, and core muscles like no other item can, using your own body weight as resistance. It comes complete with a free beginner/ intermediate DVD and workout poster. It’s available online or through Power Systems, Gopher Sports and Perform Better. You can see it in action on YouTube by searching for Lebert Equalizer. Lebert Fitness, Inc. 905-785-0626 • www.lebertequalizer.com Circle No. 552

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. 556

Power of One SoloStrength is the ultimate all-in-one body weight training system. By making simple adjustments to the bar, you can change the activity and resistance levels instantly. This product is great for pull-ups, rows, abdominal work, stretching, and more. For more information on SoloStrength, visit Perform Better’s Web site or call for your free copy of the company’s 2009 catalog. Perform Better 800-556-7464 • www.performbetter.com Circle No. 553

Guard Your Hands New York Barbells of Elmira offers PVCcoated cast iron kettlebells in weights ranging from eight to 25 pounds. They’re specially designed with large openings to prevent bruising of the back of the hand or wrist. The PVC coating and wide handles make these kettlebells a great choice for any strength training facility. New York Barbells of Elmira, Inc. • 800-446-1833 www.newyorkbarbells.com Circle No. 554

Everything for Feet Dr. Jill’s Foot Pads is your complete onestop source for foot pads and padding supplies at the guaranteed lowest prices. The company offers over 100 pre-cut pad shapes and rolls of felts, foams, and moleskin. There are also tapes, gels, pads, and shoe accessories. If you are buying these items elsewhere, you are paying too much. Dr. Jill’s is the manufacturer, and no matter what discounts you may get from another vendor, you can’t beat the company’s prices. Dr. Jill’s Foot Pads, Inc. • 866-FOOTPAD www.drjillsfootpads.com Circle No. 555

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To the Next Level Run faster. Jump higher. Strength has helped determined athletes train better, train smarter, and significantly improve performance since 1985. Strength created the Original Strength Shoe, and it continues to set the standard for dramatically increasing the effectiveness of sustained plyometric training. Strength also offers a range of products designed to increase an athlete’s speed and quickness through resistance training. Strength Systems, Inc. • 800-451-5867 www.strength-systems.com Circle No. 557

Something Really Different It looks like an ordinary exercise bike, but PowerCranks takes both training and rehabilitation to a whole new level. The product features independent bicycle cranks, so one leg cannot help the other. This innovative tool allows the coach to train all the lower-extremity muscles at once to improve performance and technique, reduce injury risk, enhance rehab after injury or surgery, and more. It has been successfully used by Olympians, world champions, and players in the NFL, MLB, and at colleges in many different sports. PowerCranks, Inc. 888-733-2572 • www.powercranks.com Circle No. 558

A Little Extra Meet Perform Better’s new Kettlebell Buddy. This kettlebell attachment screws into the bottom of all First Place kettlebells to increase their weight in smaller increments, making them slightly heavier without going up a full size. The Kettlebell Buddy weighs two kilograms, is made of chrome, and is only available through Perform Better. Call or go online to request your free copy of the company’s 2009 catalog. Perform Better • 800-556-7464 www.performbetter.com Circle No. 559 T&C october 2009

MORE PRODUCTS

Great Ideas, Great Value

Resisting to Win Professional sports teams and international Olympians train and condition with TurfCordz to increase speed, endurance, and flexibility through explosive start drills, footwork exercises, and simulated play action. Developed by NZ Mfg., a leader in resistance training and physical rehabilitation products, TurfCordz provide maximum function and comfort while withstanding the rigorous demands of team, clinic, and personal use. NZ Mfg. also engineers StrechCordz and MediCordz resistance products. NZ Manufacturing, LLC • 800-886-6621 • www.nzmfg.com Circle No. 560

Buy More, Save More The 2000 Family Center set includes a power rack, dipping attachment, flat/ incline/decline bench, arm curl attachment, leg curl attachment, 300-pound Olympic weight set, Olympic dumbbell bars, and an Olympic EZ Curl bar. This starter set can be expanded with a lat/row attachment and a cable crossover attachment. It’s a cost-effective way to purchase

New packagiNg

high-quality equipment for performing squats, bench presses, incline presses, military presses, deadlifts, pull-ups, chin-ups, dips, leg and arm curls, extensions, good mornings, and much more. New York Barbells of Elmira, Inc. • 800-446-1833 www.newyorkbarbells.com Circle No. 561

Flex on the Go The Jump Stretch Door Harness makes it easier than ever to train with FlexBands® when you travel. This sturdy harness conveniently attaches over any door that can be closed to hold it in place. Position it on the top or side of the door and attach your bands (sold separately) to perform back extensions, standing benches, leg curls, and a host of other exercises. It’s also great for home use. The Door Harness adjusts easily, and an instructional video is available. Jump Stretch, Inc. 800-344-3539 • www.jumpstretch.com Circle No. 562

Follow the Beat The new Team2 system is Polar’s latest innovation in team sports. Designed specifically for coaches, the Team2 allows you to view player heart rate and training information in real time from the sidelines on a PDA or a PC. Now you can customize training sessions and optimize training intensities for each player, determining whether to train them harder or take time for recovery. Train for your best season yet with Polar. Polar Electro, Inc. 800-290-6330 • www.polarusa.com Circle No. 563

800,000 Teeth are Knocked Out Each Year During Sports! Protect Your Athletes!

Top-Quality Gel

Prevent Blisters & Chafing www.2toms.com 866-924-7847 60

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T&C october 2009

Save-A-Tooth gives you time to treat more serious injuries and get athletes to the dentist or emergency room. Call (888) 788-6684 or visit www.Save-A-Tooth.com for more information Circle No. 137

ECOGEL is the leading choice for over 3,500 pro and college teams and athletic trainers. If you are using any other gel padding, you are spending too much. Dr. Jill’s manufactures its gels with the highest-quality materials and can get you what you need while saving you money. From toe caps to corn pads, the company has it all—and don’t forget about Dr. Jill’s complete line of felt, foam, and moleskin. Dr. Jill’s Foot Pads, Inc. • 866-FOOTPAD www.drjillsfootpads.com Circle No. 564

TR AINING-CONDITIONING.COM

CEU QUIZ

T&C October 2009 Volume XIX, No. 7

Training & Conditioning is pleased to provide NATA and NSCA members with the

opportunity to earn continuing education units through reading issues of the magazine. The following quiz is based on articles that appear in this issue of Training & Conditioning. By satisfactorily completing the quiz, readers can earn 2.0 BOC Athletic Training and 0.2 NSCA (two hours) continuing education units.

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

.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 63) that represents the best answer for each of the questions below. Complete the form at the bottom of page 63, include a $25 payment to MAG, Inc., and mail it to the following address: MAG, Inc., ATTN: T&C 19.7 Quiz, 31 Dutch Mill Road, Ithaca, NY 14850. Readers who correctly answer 70 percent of the questions will be notified of their earned credit by mail within 30 days. Bulletin Board (pages 4-5)

Objective: Learn about recent research, current issues, and news items of interest to athletic trainers and other sports medicine professionals.

1. A recent FDA statement on steroid-containing supplements warns that these products may cause acute failure of the: a) Lungs and heart b) Liver and kidneys c) Nervous system d) Respiratory system 2. A University of Illinois study found that impact to the front of the helmet was about ______ percent more common in high school football than college football. a) 10 b) 20 c) 30 d) 40 3. In U.S. high school football every year, between ______ percent of the athletes suffer concussions. a) One and three b) Four and six c) Eight and 10 d) 12 and 14 4. Joshua Hackel, MD, says one benefit of musculoskeletal ultrasound is that it allows users to look at tissues as they are: a) Deteriorating b) Growing new cells c) Contracting eccentrically d) Moving and gliding 5. A University of Michigan study has found that ______ may play a key role in ACL injuries. a) The brain and reflexive response b) Respiratory health c) Cardiovascular health d) Endocrine response

Comeback Athlete (pages 7-11)

Objective: Follow the rehab story of Breanna Walukevich, a high school athlete who participates in athletics despite having a serious heart condition.

6. ICD stands for: a) Internal cardiovascular delineator b) Instantaneous cardiac divergence c) Implantable cardioverter-defibrillator d) Internal collagen deformity

TR AINING-CONDITIONING.COM

7. Walukevich’s ICD is set to go off when she reaches a pre-determined: a) Body temperature b) Blood pressure c) Heart rate d) Blood glucose level 8. After high school, Walukevich plans to play collegiate: a) Basketball b) Golf c) Soccer d) Field hockey

Rising Above Pain (pages 12-19)

Objective: Learn about Complex Regional Pain Syndrome (CRPS) and how athletes who suffer from this condition can successfully manage their symptoms.

9. A painful response to normally innocuous stimuli is known as: a) Allodynia b) Hypoalgesia c) Rhabdomyolysis d) Chondromalacia 10. Heightened sensitivity to painful stimuli is known as: a) Rhabdomyolysis b) Blepharitis c) Dystrophy d) Hyperalgesia 11. Stimulating skin tissue with rough sponges, vegetable brushes, and other abrasive objects is a form of treatment called: a) Hyperpathia b) Irritation therapy c) Surface therapy d) Contrast therapy 12. Studies have found that females are roughly ______ times more likely to develop CRPS than males. a) One to two b) Two to three c) Four to five d) Six to eight

Continued on page 62—with answer sheet on page 63...

Or take this quiz online and get instant results:

www.training-conditioning.com click on CEUs & Courses

T&C october 2009

CEU QUIZ 13. One treatment for CRPS involves injecting pain-dulling substances called: a) Signal disrupters b) Axion interrupters c) Spinal ORCs d) Nerve blocks

Measure for Measure (pages 21-25)

Objective: Understand how various methods of monitoring an athlete’s performance during workouts and in competitive settings can enhance program design.

14. The Borg scale for RPE measures: a) Protein expenditure b) Carbohydrate use c) Power output d) Perceived exertion 15. Which of the following is NOT one of the categories the author uses to classify different sports? a) Sprint sports b) Overhead sports c) Transition game sports d) Endurance sports 16. The author discusses using ______ technology to measure total distance traveled during a practice or game. a) Accelerometer b) Global positioning satellite c) Biochemical testing d) Computer-aided drawing

Tale of the Tape (pages 27-33)

Objective: Understand treatment modalities based on elastic therapeutic taping and the specific benefits they can provide for athletes and active individuals.

Antioxidant Armor (pages 35-40)

Objective: Learn about the dangers of free radical damage, the physical benefits of antioxidants, and how athletes can improve their dietary antioxidant intake.

20. During a workout, the body’s overall oxygen level increases: a) 10 to 20 fold b) 30 to 40 fold c) 70 to 80 fold d) 80 to 90 fold 21. According to the article, radiation, pollution, and sunlight can all contribute to ______ in the body. a) Antioxidant mutation b) pH imbalance c) Free radical proliferation d) Enzyme destruction 22. A relatively new method of measuring antioxidant potential in foods is called: a) Rating of Antioxidant Production Capacity b) Free Radical Protection Quotient c) Antioxidant Absorbance Rating d) Oxygen Radical Absorbance Capacity 23. The author states that Americans spend ______ a year on antioxidant supplements. a) $2.3 billion b) $4.6 billion c) $5.9 billion d) more than $8 billion

Learning Curve (pages 42-46)

Objective: Follow the development of the strength and conditioning program for track and field athletes at the University of Alaska-Anchorage.

17. The principle behind elastic therapeutic taping centers on removing barriers that impede the body’s: a) Respiratory function b) Built-in healing mechanisms c) Hormonal balance d) Tissue equilibrium

24. The author’s incoming distance runners often display: a) Nutritional deficiencies b) Hip weakness c) Chondromalacia patella d) Patellofemoral syndrome

18. Elastic therapeutic tape can typically stretch lengthwise ______ percent beyond its resting length. a) 40 to 60 b) 60 to 80 c) 80 to 90 d) 100 to 120

25. The author says that one of the first signs of a weak core is usually: a) Chronic knee instability b) A knock-kneed gait c) Iliotibial band injury d) Lower back pain during running

19. Which of the following is NOT one of the shapes that elastic therapeutic tape is commonly cut into? a) I b) X c) P d) Y

T&C october 2009

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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 19.7 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.

Bulletin Board

1. 2. 3. 4. 5. 6. 7. 8.

m m m m m

m m m

m m m m m

Rising Above Pain

9. 10. 11. 12. 13.

m m m

m m m m

m m

Measure for Measure

Comeback Athlete

m m m m m

14. 15. 16.

m m m

Tale of the Tape

17. 18. 19.

m m m

Antioxidant Armor

20. 21. 22. 23.

Learning Curve

24. 25.

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

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T&C october 2009

overtime

Next Stop: Web Site

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

WeeKlY blOG Soccer Preseason to In-Season By Rich Jacobs, MS, SCCC, CSCS With only three weeks of organized preseason strength training, time is of the essence for the Xavier University men’s soccer team. That’s why Assistant Strength and Conditioning Coach Rich Jacobs’s training plan includes orderly progressions that build to the first competition while accounting for the inevitable soreness that accompanies preseason workouts.

Xavier University’s Ricky Sutherland dribbles against Fordham University. Sutherland and his teammates are strong in the fall thanks to a conditioning program designed by Assistant Strength and Conditioning Coach Rich Jacobs.

www.training-conditioning.com/blogs.php

Web exclusives H.S. Heat Illness by the Numbers

Fighting Irish Stepping It Up

Researchers from the Center for Injury Research and Policy at the Research Institute at Nationwide Children’s Hospital in Columbus, Ohio, share their analysis of heat illness and hydration for high school athletes. Their findings, a sport-by-sport statistical breakdown, reveal that it’s not just football players who have problems getting enough water and staying cool.

Every athletic department wants improved sports performance. The University of Notre Dame has taken it a step further by establishing a new division dedicated to providing individual athletes with every possible advantage. Be sure to check out this inside peek at the Fighting Irish’s new cutting-edge program that addresses strength and conditioning, nutrition, and sports psychology.

www.training-conditioning.com/blogs.php

www.training-conditioning.com/features.php

By Dawn Comstock, PhD

By Kyle Garratt

WWW.TRAINING-CONDITIONING.COM

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