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July/August 2010, Vol. XX, No. 5

contents

Bulletin Board 4 Soccer injury risk linked to game frequency … Weightlifting injuries on the rise ... Ginger root: a natural pain reliever? … Athletic training students find fame on YouTube. Comeback Athlete 8 Barry Bock Milan (Mich.) High School

Nutrition

The D Factor

Chances are some (if not most) of your athletes don’t get enough vitamin D to support optimal health and performance. But that’s easy to fix, and doing so can pay major dividends. By Randy Bird Optimum Performance

23 Dumbbells and kettlebells provide unique advantages that can add Bell Power

Sponsored Page 29 Fitness Anywhere

value to any strength regimen, but only if you know how to fit them into a functional training approach. By Vern Gambetta

Special Feature 56 Supplier Web Site Directory

Treating the Athlete

Product News 66 Heat Stress Prevention 68 Aquatic Therapy 70 Ankle & Foot Care 75 More Products

54 Books & DVDs 72 Advertisers Directory CEU Quiz 77 For NATA and NSCA Members 80 Next Stop: Web Site On the cover: University of Texas Longhorn Cody Johnson scored 12 touchdowns in 2009, including this one against the University of Central Florida. Texas’s J. Allen Hardin provides a comprehensive look at treating and preventing heat illness, beginning on page 30. Photo by © Getty Images TR AINING-CONDITIONING.COM

They’re Hot… 30 When Being prepared to treat heat illness is essential, but it’s even better to follow smart prevention steps that keep athletes from needing treatment at all. By J. Allen Hardin

Leadership

Hospital Rounds

Whether they’re helping patients overcome paralysis, conducting rehab, or assisting in the operating room, these athletic trainers have found the hospital setting to be a rewarding and dynamic workplace. Is this “new frontier” of the profession right for you? By Kenny Berkowitz Sport Specific

49 The University of Maryland men’s soccer strength and conditioning Pursuing Greatness

program uses a 12-month cycle to help players excel on the pitch in college and beyond. By Barry Kagan T&C JULY/AUGUST 2010

Editorial Board Marjorie Albohm, MS, ATC/L President, National Athletic Trainers’ Association Jon Almquist, ATC Specialist, Fairfax County (Va.) Pub. Schools Athletic Training Program Brian Awbrey, MD Dept. of Orthopaedic Surgery, Massachusetts General Hospital, and Instructor in Orthopaedics, Harvard Medical School Jim Berry, EdD, ATC, SCAT, NREMT Head Athletic Trainer, Myrtle Beach (S.C.) High School Leslie Bonci, MPH, RD Director, Sports Medicine Nutrition Program, University of Pittsburgh Medical Ctr. Health System Christine Bonci, MS, ATC Co-Director of Athletic Training/Sports Medicine, Intercollegiate Athletics, University of Texas Cynthia “Sam” Booth, ATC, PhD Manager, Outpatient Therapy and Sportsmedicine, MeritCare Health System Debra Brooks, CNMT, LMT, PhD CEO, Iowa NeuroMuscular Therapy Center Cindy Chang, MD Team Physician, University of California-Berkeley Dan Cipriani, PhD, PT Assistant Professor Dept. of Exercise and Nutritional Sciences, San Diego State University Gray Cook, MSPT, OCS, CSCS Clinic Director, Orthopedic & Sports Phys. Ther. Dunn, Cook, and Assoc. Keith D’Amelio, ATC, PES, CSCS Strength & Conditioning Coach for Men’s Basketball, Stanford University Bernie DePalma, MEd, PT, ATC Head Athletic Trainer/Phys. Therapist, Cornell University Lori Dewald, EdD, ATC, CHES, F-AAHE Department of Health Science, Kaplan 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 Athletic 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, Liberty High School, Colo.

Joe Gieck, EdD, ATR, PT Director of Sports Medicine and Prof., Clinical Orthopaedic Surgery, University of Virginia (retired) Brian Goodstein, MS, ATC, CSCS, Head Athletic Trainer, DC United Gary Gray, PT, President, CEO, Functional Design Systems Maria Hutsick, MS, ATC/L, CSCS Head Athletic Trainer, Medfield (Mass.) High School 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 Tim McClellan, MS, CSCS Director of Perf. Enhancement, Makeplays.com Center for Human Performance Michael Merk, MEd, CSCS Director of Health & Fitness, YMCA of Greater Cleveland Jenny Moshak, MS, ATC, CSCS Assistant A.D. for Sports Medicine, University of Tennessee Steve Myrland, CSCS Owner, Manager, Perf. Coach, Myrland Sports Training, LLC, Instructor and Consultant, University of Wisconsin Sports Medicine Mike Nitka, MS, CSCS Director of Human Performance, Muskego (Wis.) High School Bruno Pauletto, MS, CSCS President, Power Systems, Inc. Stephen M. Perle, DC, MS Professor of Clinical Sciences, University of Bridgeport College of Chiropractic 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

July/August 2010 Vol. XX, No. 5 Publisher Mark Goldberg Editorial Staff Eleanor Frankel, Director Greg Scholand, Managing Editor R.J. Anderson, Kenny Berkowitz, Patrick Bohn, Abigail Funk, Mike Phelps, Dennis Read Circulation Staff David Dubin, Director Sandra Earle Art Direction Message Brand Advertising Production Staff Maria Bise, Director Neal Betts, Natalie Couch, Trish Landsparger Business Manager Pennie Small Special Projects Dave Wohlhueter Administrative Assistant Sharon Barbell Advertising Materials Coordinator Mike Townsend Marketing Director Sheryl Shaffer 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© 2010 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 Soccer Injury Rate Linked to Game Frequency Do soccer players need more rest between matches to stay healthy? Yes, says a study published in the American Journal of Sports Medicine April online edition, which found that competitions in close succession led to an increased injury rate. At the Laboratory of Human Movement Studies at the University of Lille in France, researchers followed professional soccer players in the UEFA Champions League for 52 games over two seasons. They reviewed match results, compiling data on each player’s total distance run, high-intensity distance completed, sprint distance, and number of sprints per game while also documenting injuries and player participation statistics. Gregory Dupont, PhD, lead author of the study, told the Kansas City Star that injury risk was doubled when athletes played two games per week compared to one game per week. “Playing multiple matches in a week without sufficient time for adequate recovery can lead to fatigue, and … physiological function may not be returned to normal when the recovery time is too short,” he noted. “[Players] experienced a variety of different injuries, however the most common injuries included ligament sprains and strains/tears of muscles and tendons. The sites most injured were the ankle, the knee joints, and the thigh, groin, and calf. In addition, most major injuries occurred when players played two games per week.” According to Dupont, the study highlights a need for improved recovery strategies when athletes compete frequently. He said this includes immersion in an ice bath after games and using compression garments after competition. “We also recommended that recovery following a game can be further optimized by consuming high glycemic index carbohydrate foods and proteins, such as sports drinks, milkshakes, yogurts, soup, and sandwiches,” Dupont said. For more information on the study, “Effect of 2 Soccer Matches in a Week on Physical Performance and Injury Rate,” go to ajs.sagepub.com and enter “2 Soccer Matches” into the search window.

Weightlifting Injuries on the Rise According to researchers from the Center for Injury Research and Policy (CIRP) at Nationwide Children’s Hospital in Columbus, Ohio, emergency rooms in the U.S. saw more than 970,000 weight training-related injuries from 1990 to 2007. That represents a 50-percent jump from the previous 18-year period. Their study, published in the April issue of the American Journal of Sports Medicine, analyzed injuries directly related to weight training. Among the findings, which were based on data drawn from the National Electronic Injury Surveil 4

T&C JULY/AUGUST 2010

lance System, was that males ages 13 to 24 remain the most frequently injured population, but the percentage of females injured while lifting weights is on the rise. The researchers also found that injuries to the upper trunk were most common, prompting 25 percent of ER visits, while injuries to the lower trunk made up 20 percent. Sprains and strains were the most frequently diagnosed injury type, followed by soft tissue injuries. Free weights were the most common cause of weightroom injuries, with 90 percent of all injuries attributed to their use (or misuse). Among those, 65 percent resulted from a weight being dropped. Children 12 and under had the highest free weight-related injury rate of any age group, with a higher proportion of lacerations and fractures than older lifters. The take-home message? Athletes need instruction before exertion. “Before beginning a weight training program, it is important that people of all ages consult with a health professional ... to create a safe training program based on their age and capabilities,” study author Dawn Comstock, PhD, Principal Investigator at CIRP, said in a press release. “Getting proper instruction on how to use weightlifting equipment and the proper technique for lifts, as well as providing trained supervision for youths engaging in weight training, will also reduce the risk of injury.” To view the abstract of the study, “Epidemiology of Weight Training-Related Injuries Presenting to United States Emergency Departments, 1990 to 2007,” go to ajs.sagepub.com and search for “weight training injuries.”

Sore Muscles? Treat them Ginger-ly Long known as a remedy for upset stomachs, ginger root may also be an answer for muscle soreness brought on by exercise, according to researchers at the University of Georgia. Two studies published late last year in The Journal of Pain chronicled the effects of ginger supplementation on muscle pain and reported that ginger root was an effective natural pain reliever. Patrick O’Connor, PhD, a professor in the UGA College of Education’s Department of Kinesiology, directed the studies, which examined the effects of ingesting raw and heat-treated ginger (some believe that cooking ginger enhances the root’s pain-relieving effects). For each day of the two 11-day studies, about 35 participants consumed two-gram capsules containing raw ginger, heat-treated ginger, or a placebo. On the eighth day of the study, each person performed 18 elbow flexor extensions with a heavy weight to induce moderate stress on the arm muscles. Arm function, inflammation, and pain were assessed prior to and for three days after the TR AINING-CONDITIONING.COM

Circle No. 103

Bulletin

Board exercise. Results showed a 25-percent reduction in pain among those who consumed raw or heat-treated ginger, with no additional effects from the heating. To view an abstract of the study, “Ginger Reduces Muscle Pain Caused by Eccentric Exercise,” go to: www.jpain.org and search for “ginger reduces muscle pain.”

Athletic Training YouTube Video Goes Viral By now, you’ve probably seen or at least heard about “Smooth Professional,” the brainchild of James Madison University student athletic trainers Pratik Banjade and Jared Miller. The online video features original lyrics about athletic training set to Michael Jackson’s 1980s hit song “Smooth Criminal.” With over 60,000 YouTube views to date, “Smooth Professional” became an Internet sensation this spring, and Banjade and Miller were invited to show it at the NATA convention in June. After the NATA Hall of Fame induction ceremony, over 3,000 people looked on while the video played on four large screens at the Pennsylvania Convention Center. When it ended, Banjade and Miller took the stage to raucous applause. “It was a bit surreal—my rock star moment,” says Miller, who will pursue a master’s in athletic training at Michigan State University in the fall and work with the Spartan wrestling team. “We were approached with congratulations, questions, and even gratitude throughout the four days we were at the convention.” The video first went online in late April, and Miller says the reception was eye-popping. “We received a ton of e-mails in the first few weeks following its release,” he recalls. “Support came from everywhere—from new students just starting out and from athletic trainers who have been in the profession for over 20 years. It was refreshing to see how athletic trainers will support the work of their peers.” The pair made the video while preparing for finals and the ATC certification exam. They spent three weeks shooting footage around JMU’s campus and 25 hours editing the film, which won the NATA’s 2010 Most Creative Project award. Intended as a fun way to educate the public about athletic training, “Smooth Professional” has achieved popularity beyond its creators’ wildest dreams. “It has been so exciting getting e-mails from other students or professors who loved the video and want to use it to promote the profession in their region,” Miller says. “We also had numerous media outlets covering us, including newspapers and blogs, and we even came in as the top viral video on G4, a national cable TV channel. It was very rewarding to see the interest it received from the general public, since that’s who it was intended for.” Still haven’t seen the video for yourself? Search for “Smooth Professional” at: www.youtube.com. Circle No. 104 6

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ComebackAthlete

Barry Bock Milan (Mich.) High School By R.J. Anderson

Have you ever hoped that one of your athletes wouldn’t return to the field after a devastating injury? Amanda Kaiser, ATC, Athletic Trainer at Milan (Mich.) High School, has. She lobbied for star football and baseball player Barry Bock to sit out his senior year of football after spending nine months helping him rehab from a major knee injury suffered the season before. Kaiser did not get her wish. Despite a ruptured patellar tendon, ACL, PCL, LCL, and MCL, and a torn meniscus—not to mention Kaiser’s reservations—Bock returned to the gridiron, earning all-conference honors at linebacker and never missing a snap because of injury. Along the way, he impressed his athletic trainer, who was with Bock during every step of his laborious and sometimes painful rehab. His comeback story began during the team’s fifth game of the 2008 season. The muscular 5-foot-9, 200-pound Bock, who starts at fullback, linebacker, and on special teams, fielded the second half kickoff and prepared to cut to his right. As he planted his left cleat, an opponent dove at his feet, colliding with the outside of his left knee. The knee buckled and Bock collapsed to the ground, screaming in pain. He was helped off the field and Kaiser evaluated him on the sideline. “It didn’t take me long to figure out that he wasn’t okay,” Kaiser recalls. “There was immediate swelling and I thought he might have a dislocated patella—but I couldn’t have imagined that it was ruptured. That just doesn’t happen very often, especially to a kid his age. “Realizing that the injury was pretty severe, I shortened my examination and checked his pulse to make sure he didn’t have any arterial ruptures,” Kaiser continues. “His pulse was strong and stable, so I packed his leg in ice and sent him to the hospital with his father.” During the 45-minute ride to Saint Joseph Mercy Hospital in Ypsilanti, Mich., Bock felt every agonizing bump. Doctors x-rayed his leg and told him to come back on Monday for further evaluation. But the next afternoon, Brian Borden, MD, an orthopedic surgeon with Orthopedic Surgery Associates at the Michigan Orthopedic Center, called Bock’s mother and told her to bring her son to the hospital immediately. After evaluating Bock’s x-rays that morning, Borden had determined the injury was much worse than originally thought. “He told me I may never be able to play sports again,” re8

T&C JULY/AUGUST 2010

Barry Bock (far right, in three-point stance) played fullback as a senior after returning from a devastating knee injury that included a torn ACL, PCL, LCL, and MCL. calls Bock. “I’ve played sports my whole life and everything I do revolves around athletics, so it was very hard hearing that.” Never having dealt with this combination of injuries before, Borden faced a difficult decision. “A patellar rupture repair and ACL repair are so much in opposition as far as how you perform them and how you conduct rehab afterward, the surgeon [Borden] had to do some research and decide how to proceed,” Kaiser says. “He could have done the surgeries separately—which would have made the rehab last a year and a half—or done them at the same time and allowed us to perform the rehabs simultaneously, which would mean a faster recovery process.” Borden chose the latter. The surgeries proved successful, and a week later Bock began rehabbing with Kaiser, a self-employed athletic trainer who works part-time at Milan, a small-town school outside Ann Arbor. Choosing Kaiser over visiting a clinic for rehab was an easy decision for Bock and his family. “I’ve always trusted her,” says Bock, who has known Kaiser since he was in eighth grade. At first, the two met every day. “I don’t work in a clinic and my only job is providing coverage at the high school,” says Kaiser. “He could make an appointment to work with me whenever his schedule would allow, whether it was after R.J. Anderson is an Assistant Editor at Training & Conditioning. He can be reached at: rja@MomentumMedia.com. TR AINING-CONDITIONING.COM

ComebackAthlete school or when he had a break between classes. I was always available.” Like Borden, this would be Kaiser’s first time working with a simultaneously injured ACL and patellar tendon. As such, she was in constant contact with the surgeon—even attending Bock’s monthly doctor’s appointments. “They were in the afternoon and we would just close down the training room and go,” says Kaiser. “It was a big help for me to see all the x-rays and ask questions as they came up.” Besides seeing Borden at the appointments, Kaiser phoned him about every two weeks with additional questions. “The conversation would go something like, ‘Barry thinks he’s ready to walk … what do you think? Barry wants to do this … tell me what we can do,’” Kaiser recalls. “And I would usually play Barry’s advocate. I would tell the doctor how he was feeling and what range of motion he had, and ask what was holding us back.” Per Borden’s orders, Kaiser used a patellar tendon repair protocol to guide the rehab timeline. “When I rehab a torn ACL, I don’t really follow a protocol—I progress the athlete based on what they are ready for and how their knee reacts,” she says. “In this case, Dr. Borden wanted me to adhere to relatively strict deadlines that drastically slowed down flexion progressions [versus an ACL tear rehab] so that the tendon could heal and completely reattach.” Bock was also rehabbing his torn meniscus, which meant no bearing weight for three weeks and wearing a full-length brace

locked at zero degrees of flexion. He used a wheelchair to get around, and its limitations frustrated him. “It was difficult at school, but the other kids were great about helping him,” Kaiser says. “We were counting down the days until he would be out of the wheelchair. There was a paper chain in the athletic training room with 21 links—one for each day he had left before he could walk. He got to remove a loop every day when he came in.” Though those weeks were physically and emotionally difficult, Bock’s spirits were buoyed by the presence of a teammate who was rehabbing a ruptured ACL suffered during the same game. “Having someone to work with side by side was very helpful,” says Kaiser. “Even though the other player progressed more quickly, I think it really motivated Barry.” At this point, Bock’s sessions with Kaiser consisted of 30 to 45 minutes of table-based exercises. He would lie on his back while sliding his heel back and forth to activate his quad and hamstring (with a rope attached to his foot so he could assist himself in moving his leg). He also performed isometric muscle contractions in all four directions of the hip, and used resistance bands for calf strengthening. During this period and throughout the rehab, Bock worked very hard on improving his abdominal and core strength. “We did a lot of ab work because he could really go after it and feel like he was actually doing something,” Kaiser says. “An active kid like Barry needs to feel that he’s tiring himself out and making strength training progress. By the end of his rehab, we had worked up to about 1,000 ab and back reps per day.”

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ComebackAthlete

Barry Bock Milan (Mich.) High School Sports: Football and baseball Injuries: Ruptured patellar tendon, ACL, PCL, LCL, and MCL, and torn meniscus Result: Returned to play baseball as a junior and both football and baseball as a senior. Bock will study physical therapy at Wayne State University in the fall.

As with any knee rehab, addressing the inevitable quad atrophy—something that usually requires about two or three weeks—was among Kaiser’s earliest goals. And how Bock’s body reacted was one of her biggest surprises. “I did a happy dance when he fired that quad muscle for the first time after only three or four days of rehab,” she says. “That’s when I knew his rehab was going to be a success. “I remember asking myself, ‘Is that rapid improvement a byproduct of his internal motivation, or is it because of his physical build?’” Kaiser continues. “He certainly had enough muscle already built up, and his motivation was off the charts, so it was probably a combination of the two.” On Oct. 27, three weeks post-surgery, Bock tore the last link off his wheelchair countdown chain. A week later, his brace was released to allow 50 degrees of flexion and he began working with Kaiser for up to two hours per day. By Nov. 10, he had progressed to 50 percent weight bearing, and his flexion was increased to 60 degrees. A week later the brace went to 70 degrees, and on Nov. 21, Bock was cleared to resume full weight bearing with a locked brace. Throughout this time, Kaiser was looking for ways to incorporate cardiovascular conditioning into Bock’s workouts, so she introduced 20-minute hydrotherapy sessions once or twice a week. “Barry’s flexion wasn’t enough to water jog, so I had him swim,” she says. “I was concerned for his MCL and didn’t want the pressure from the water to push his leg into an awkward position and stress that repair. So I tied a foam

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ComebackAthlete buoy between his thighs for support, and we had him swim using just his upper body while clutching the buoy between his legs to increase adduction strength and protect his knee from side-to-side movement.” A major rehab milestone arrived Dec. 1 when Bock was at 90 degrees of flexion and allowed to unlock the brace to 30 degrees for ambulation. The patellar tendon rehab protocol restrictions were complete, and Kaiser could base Bock’s range of motion and strength work more on his physical response than a rigid timeline. This helped clear the way for faster progress. “As soon as Barry could unlock his brace for walking and start moving again, he just flew through his rehab,” says Kaiser. She began incorporating sprint mechanics drills borrowed from her husband, an assistant track and field coach at the University of Michigan. It was her first experience using them in a rehab. “I would take something traditional in the rehab setting, like straight-leg raises, and adapt it into straight-leg marches or straight-leg acceleration kicks—supine and standing—to mimic and enhance the movement,” Kaiser says. “Barry started by walking through each of the sprint drills,” she continues. “For example, he would walk around cones and through an agility ladder. He would walk over mini hurdles in all different directions and thigh-high foam hurdles both forward and backward. We did cariocas at a walking pace, then a running pace. We did giant steps and mini lunges—during which

we had to be very careful to not overstress his patellar tendon. Those drills took the rehab in a more functional direction and gave him something to look forward to.” In January and February, Kaiser began ratcheting up the loads, and Bock did a lot of body weight activities such as stair climbs, squats, and lunges. She also utilized med balls for stability, core, and functional movement exercises and prescribed flexibility work for his glutes, calves, hip flexors, quads, hamstrings, piriformis, and lower back. For each exercise, Kaiser offered a thorough explanation of how it would affect his progress. “I would tell him the reasons behind the stuff he was doing,” she says. “When I told him he needed to dorsiflex his foot during a drill, I would explain that he can’t run fast without dorsiflexing his foot. And when we worked on hip flexibility, I told him he couldn’t squat deeply without increasing his ROM. If you can’t squat deeply, you can’t lift heavier weights and get stronger. He bought into all of it.” By late February, Bock’s cardio workouts involved 25 minutes on the bike and 15 on the elliptical machine. He slowly progressed to doing more on the elliptical and less on the bike. From there, he moved on to light jogging. “We started him slow, then sped him up very gradually,” says Kaiser. “There wasn’t a day when we said, ‘Okay, today you can run.’ It was 217-431_ExScience_3.4x4.8_4C:Layout 1 1/8/10 11:10 just kind of phased in. And it worked out nicely.”

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ComebackAthlete As winter turned to spring, Bockâ&#x20AC;&#x2122;s return goals began to take shape. And first on his list was re-joining his teammates on the baseball diamond. Kaiser was hesitant and held him out of baseball preseason, but allowed him to participate in certain workouts. â&#x20AC;&#x153;Our baseball team does a lot of unique things like yoga and other core training, and I would pull him out of rehab and send him to do those types of activities with his teammates,â&#x20AC;? she says. â&#x20AC;&#x153;By the time they were ready to start the regular season, he was doing full sprints and chomping at the bit to get back on the field.â&#x20AC;? Bock re-joined the team in time for its first game, ending his rehab sessions. â&#x20AC;&#x153;Fortunately, baseball isnâ&#x20AC;&#x2122;t that stressful on the body,â&#x20AC;? Kaiser says. â&#x20AC;&#x153;He could stop and start and run the bases, so the doctor felt he was okay to play. Also, Barry played first base so he didnâ&#x20AC;&#x2122;t have to run very fast or far.â&#x20AC;? Though he didnâ&#x20AC;&#x2122;t start, Bock was a super sub on a seniorladen team that reached the semifinal round of the state tournament. And through it all, Kaiser was a very nervous spectator. â&#x20AC;&#x153;Iâ&#x20AC;&#x2122;d spend part of the game sitting with his parents, then go down to the dugout,â&#x20AC;? she says. â&#x20AC;&#x153;I bit my fingernails every time he took the field.â&#x20AC;? Three months passed and Bock prepared for an even bigger challenge: returning to the sport that had injured him. After strength and conditioning work with his football teammates all summer, he played sparingly in the preseason due to soreness in his surgically repaired knee. Kaiser was concerned. â&#x20AC;&#x153;I talked to him about it being a big gamble,â&#x20AC;? she says. â&#x20AC;&#x153;I said that if he re-injured his knee, it might never be the same again. â&#x20AC;&#x153;Dr. Borden and I werenâ&#x20AC;&#x2122;t in favor of him playing, but neither of us felt it was our risk to takeâ&#x20AC;&#x201D;it was his and his familyâ&#x20AC;&#x2122;s,â&#x20AC;? Kaiser continues. â&#x20AC;&#x153;The doctor said, â&#x20AC;&#x2DC;Heâ&#x20AC;&#x2122;s strong and capable of withstanding the punishment, but if he were my child, I wouldnâ&#x20AC;&#x2122;t let him play football.â&#x20AC;&#x2122;â&#x20AC;? Despite Kaiserâ&#x20AC;&#x2122;s and Bordenâ&#x20AC;&#x2122;s objections, Bock suited up for the teamâ&#x20AC;&#x2122;s first game. â&#x20AC;&#x153;I was sitting on the sidelines before the game shaking from nervousness,â&#x20AC;? Bock says. â&#x20AC;&#x153;But after that first hit, when it didnâ&#x20AC;&#x2122;t hurt, I knew I had made it all the way back.â&#x20AC;? Bock scored a touchdown in that first game and helped lead his team to a 6-3 record and a berth in the playoffs. Though his speed and lateral movement didnâ&#x20AC;&#x2122;t return to preinjury levels, he improved his mental game to compensate. â&#x20AC;&#x153;When I knew my speed wasnâ&#x20AC;&#x2122;t going to be the same, it forced me to improve my angles on tackles and blocks,â&#x20AC;? says Bock, who led the Milan Big Reds in tackles. â&#x20AC;&#x153;Barry didnâ&#x20AC;&#x2122;t complain about his knee the entire season,â&#x20AC;? says Kaiser. â&#x20AC;&#x153;He was a true leader on the team. The doctor and I hate that he played, but weâ&#x20AC;&#x2122;re so proud that he did.â&#x20AC;? Bockâ&#x20AC;&#x2122;s successful senior year carried over to baseball, as he started at first base and helped his team to a top-10 state ranking. He also took on a senior internship, working under Kaiser to study athletic training. Inspired by what he learned during his own rehab, Bock will attend Wayne State University this fall and major in physical therapy. â&#x20AC;&#x153;After making it back like I did, I really want to help other athletes get through their injuries and return to the field as soon as possible,â&#x20AC;? he says. â&#x20AC;&#x153;Much like Amanda did for me.â&#x20AC;? n

.LI 2?= 0IFF?L +;MM;A?L with Trigger Point Release Grips

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NUTRITION

The By Randy Bird

Factor Chances are some (if not most) of your athletes don’t get enough vitamin D to support optimal health and performance. But that’s easy to fix, and doing so can pay huge dividends.

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WHY IT MATTERS What we call vitamin D is actually a class of fat-soluble vitamins called secosteroids, and its primary function in humans is to promote calcium absorption. It also helps regulate inflammation and neuromuscular control. There are two major forms of vitamin D: vitamin D2 (ergocalciferol) and vitamin D3 (cholecalciferol). The only good naturally occurring source of vitamin D2 is mushrooms that have been exposed to UV light. Whenever vegetarian or vegan products are fortified with vitamin D, the manufacturer uses D2 . Vitamin D3 is found in small amounts in a few animal based foods, and it can also be extracted from the lanolin of sheep’s wool and used to fortify foods or sold in supplement form. In addition, the human body produces its own D3 when skin is exposed to sunlight (specifically the sun’s UVB rays). Research has shown that D3 is better than D 2 at staying in the bloodstream in adequate levels, allowing the body to take advantage of its many benefits. Because vegetarians and vegans are less likely to consume D3 through food, they may benefit even more than other athletes from taking a vitamin D supplement. Some people are at greater risk of vitamin D deficiency than others. Because the body’s own vitamin D factory depends on sunlight, the most vulnerable are those with limited exposure to the sun. Athletes who practice and play indoors, live in Randy Bird, MS, RD, CSSD, CSCS, is Sports Nutritionist for the University of Kansas Athletic Department. He can be reached at: rbird@ku.edu. TR AINING-CONDITIONING.COM

images: istock.com/DIGITAL COMPOSITION: SUZANNE LYNCH

f you follow nutrition and public health news, you may have noticed that vitamin D is getting more attention of late, and with good reason. Vitamin D deficiency, once thought to be conquered in the industrialized world, has made a comeback and is reaching epidemic proportions. Today, an estimated 75 percent of Americans are vitamin D deficient. Although there is little concrete data on the deficiency rate among athletes, it’s safe to assume they’re not far away from the general population. The hazards of a chronic vitamin D shortage—including heightened stress fracture risk, decreased immune function, and elevated blood pressure—are especially troublesome for those who play sports, yet vitamin D remains largely ignored in sports nutrition planning. The good news is that vitamin D deficiency is quite easy to address. Once athletes understand why this readily accessible substance is crucial for their health and performance, they can make a few simple changes to their daily habits to ensure an adequate supply.

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NUTRITION northern climates, and keep their skin covered when outside are unlikely to obtain much vitamin D from sunlight. Sunscreen can also block the production of vitamin D. In fact, one study found that an SPF as low as eight decreased vitamin D production by 95 percent. (For more on sunscreen and vitamin D production, see “Under the Sun” on page 20).

some have been documented in the literature. One recent study published in the Journal of Internal Medicine found that people with vitamin D deficiency showed more depressive traits than those with normal levels. When some of the test subjects were treated with regular vitamin D supplementation for a year, their mental health improved significantly.

The list of health problems linked to vitamin D deficiency is staggering. It includes weakened bones, a compromised immune system, muscle weakness and pain, weight gain, depression, certain types of cancer, heart disease, and hypertension. Skin tone affects vitamin D synthesis as well. People with darker skin (higher levels of melanin) have a reduced ability to produce vitamin D from exposure to sunlight. Dark-skinned people may need two to three times the exposure to sunlight to produce the same amount of vitamin D as fairskinned people. Lastly, individuals with difficulty absorbing dietary fat are at increased risk for deficiency, since vitamin D in food requires some dietary fat in the gut for absorption. Fat malabsorption can be caused by several medical conditions, including pancreatic enzyme deficiency, Crohn’s disease, cystic fibrosis, celiac disease, some forms of liver disease, and surgical removal of part of the stomach or intestines. The list of health problems linked to vitamin D deficiency is staggering. It includes weakened bones, a compromised immune system, muscle weakness and pain, weight gain, depression, certain types of cancer, heart disease, and hypertension. One of the most serious effects— bone weakening—occurs because vitamin D regulates calcium and phosphate concentration in the blood, which helps govern bone mineralization, growth, and modeling. For the general population, an inadequate supply can lead to diseases such as rickets, osteomalacia, and osteoporosis. For competitive athletes, additional concerns are chronic musculoskeletal pain, stress fractures, and heightened risk for trauma-related fractures. The mental health effects of vitamin D are not as well understood, but 16

GETTING ENOUGH An individual’s vitamin D level can best be determined by a simple blood test that measures 25-hydroxyvitamin D (25-(OH)D). The optimal level of serum 25-(OH)D is thought to be around 50 nanograms per milliliter (ng/mL), and research has demonstrated that a level below 32 ng/mL is inadequate for good health. In the U.S., a federal panel is evaluating vitamin D research to update the daily recommendation, which now stands at 400 international units (IU) per day. Many scientists believe 400 IU is far too low, arguing that a daily intake of approximately 1,700 IU is needed to raise 25-(OH)D concentration in the blood to a healthy level. It should be every athlete’s goal to have a vitamin D level greater than 32 ng/mL. Time in the sun is part of the equation, but dietary intake should be emphasized as well. The challenge is that only a few foods naturally contain vitamin D. Fish and fish liver oils are among the best sources—wild salmon, for instance, contains roughly 1,000 IUs per 3.5-ounce serving, and farm-raised salmon typically has around 250 IUs. Small amounts of vitamin D3 are also found in beef liver, cheese, and egg yolks. The aforementioned UV-exposed mushrooms are also a dietary source, providing a moderate amount of D2 . Because of its scarcity in natural food, most vitamin D in the American diet comes from fortified foods. Almost all of the U.S. milk supply is fortified with 100 IU of vitamin D per cup, a practice that began in the 1930s to combat rickets. Other fortified foods include cereal,

flour, some dairy products, and fruit juices (particularly those that are also calcium-fortified). Unless someone frequently eats oily fish and consumes a lot of milk and other fortified foods and beverages, obtaining sufficient dietary vitamin D can be can difficult. Supplements are an easy and convenient solution in these cases: Both D2 and D3 are available in supplement form, and while either can be effective at raising serum 25-(OH)D levels, D3 appears to be more than three times as effective as D2 . Any time an athlete purchases a supplement, it’s important to check the label for banned or unsafe substances, and to choose a product that is certified for purity by an agency such as USP, NSF, or InformedChoice. Dosing should be determined by an athlete’s serum 25-(OH)D test results. Research suggests that an intake of 1,700 to 2,000 IU per day is necessary to maintain a serum level over 32 ng/mL, though the figure varies based on body chemistry and other factors, such as time of year and climate (which determine exposure to sunlight). Follow-up blood testing after several months on a supplement can reveal whether an appropriate level has been achieved. What can athletes expect once they resolve a vitamin D deficiency? One of the first observed benefits is often a stronger immune system, noticeable in the form of less frequent illness. This has two causes: First, the vitamin D receptor complex appears to control production of lymphocytes (a type of white blood cell). Second, researchers have found a link between vitamin D status and the release of antimicrobial peptides that attack the cell membranes of pathogens. Some studies suggest that these antimicrobial peptides also help fight off the flu virus, and that seasonal fluctuations in vitamin D levels could explain the higher incidence of colds and flu in winter. One group of researchers found that 2,000 IU per day reduced occurrence of the flu by 70 percent. This finding needs to be repeated in future research, but for athletes who compete in winter when the flu is a constant threat, it suggests vitamin D supplementation may be as important as getting a flu shot. Recovery after workouts is another area where athletes often see TR AINING-CONDITIONING.COM

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NUTRITION improvement after augmenting their vitamin D supply. Intense exercise creates elevated levels of pro-inflammatory cytokines, which are linked to damage caused by overtraining.

en with the deficiency had increased fat infiltration into muscle tissue, but much more research is needed in this area. Still, the best available evidence suggests that athletes’ muscles may

Athletes who take vitamins and other supplements often follow the mistaken notion that if a little is good, more must be better. With this mindset, they could potentially achieve a toxic level of vitamin D. Check the labels and dosing of any supplements they may be using. Vitamin D has been shown to reduce the production of these cytokines while increasing the production of anti-inflammatory cytokines. Thus, it’s possible that an adequate supply of vitamin D may speed recovery from intense training sessions. There is limited research looking directly at vitamin D and athletic performance. Recent studies have found a link between vitamin D deficiency and loss of muscle strength in the elderly and in post-menarchal adolescent females, and one found that young wom-

function better with a sufficient vitamin D supply in the body. WHEN TO SAY WHEN It is possible to get too much vitamin D. Most cases of vitamin D poisoning (also known as hypervitaminosis D) stem not from sunlight or food, but from overdoses of supplements. Toxicity can cause non-specific symptoms such as nausea, vomiting, poor appetite, constipation, weakness, and weight loss. More seriously, it can also raise blood calcium levels, causing

heart rhythm abnormalities and mental status changes such as confusion. Over time, it may lead to deposits of calcium and phosphate in the kidneys, heart, and lungs, reducing their ability to function. In some cases, the kidney damage is irreversible. A serum 25-(OH)D concentration consistently above 200 ng/mL is considered to be potentially toxic. Vitamin D toxicity is treated by discontinuing any supplementation and restricting calcium intake. The maximum long-term safe dose of vitamin D is not known. Since 1997, the U.S. Dietary Reference Intake Tolerable Upper Intake Level (UL) of vitamin D for children and adults has been 2,000 IU per day, but many scientists believe that figure is outdated. A 2007 risk assessment suggested that 10,000 IU per day did not produce toxicity in healthy adults and therefore should be adopted as the tolerable upper limit. Meanwhile, research has shown that sustained intake of 100,000 IU per day is enough to produce toxicity in adults within a few months.

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NUTRITION

UNDER THE SUN The human body produces some vitamin D on its own when skin is exposed to sunlight (specifically UVB rays), thus helping to prevent deficiency. But with the recent public health push for wearing sunscreen to reduce skin cancer risk, athletes may wonder which concern outweighs the other. Does sunscreen stunt the bodyâ&#x20AC;&#x2122;s ability to produce valuable vitamin D? The short answer is â&#x20AC;&#x153;yes and no.â&#x20AC;? Some studies have found that sunscreen use significantly hampers endogenous vitamin D production, while others have followed subjects for extended periods and found that the effect of sunscreen is negligible. The New York Times recently asked Henry Lim, MD, Chairman of Dermatology at the Henry Ford Hospital in Detroit and a spokesman for the American Academy of Dermatology, what to make of the conflicting information. He said the most reasonable interpretation is that sunscreen users typically donâ&#x20AC;&#x2122;t apply enough of the product to block all UV rays, so they still receive the vitamin D-producing benefits of sunlight. That isnâ&#x20AC;&#x2122;t surprising, since the National Institutes of Health reports that as little as five to 30 minutes of direct sun exposure twice a week may be enough to produce an adequate amount of endogenous vitamin D. Lim concluded that the benefits of wearing sunscreen outweigh any potential harm from a vitamin D reduction. Thatâ&#x20AC;&#x2122;s especially true because vitamin D is easy to obtain otherwise through multivitamins, supplements, and diet.

Because of vitamin Dâ&#x20AC;&#x2122;s limited availability through food and the bodyâ&#x20AC;&#x2122;s natural limits on how much it produces through UV exposure, there is virtually no risk of reaching a toxic level by sitting in the sun all day eating salmon and drinking milk. But athletes who take vitamins and other supplements often follow the mistaken notion that if a little is good, more must be better. With this mindset, they could potentially achieve a toxic level of vitamin D. Check the labels and dosing of any supplements they may be using, and if youâ&#x20AC;&#x2122;re concerned about someoneâ&#x20AC;&#x2122;s vitamin D level, recommend that they undergo a blood test. Given all that we know about vitamin Dâ&#x20AC;&#x2122;s positive impact on health, there is no excuse for the high rate of deficiency in todayâ&#x20AC;&#x2122;s population. And since athletes demand more of their bodies than other people, itâ&#x20AC;&#x2122;s essential for them to achieve adequate vitamin D levels. Sound dietary choices and possibly a trusted multivitamin or vitamin D supplement are all thatâ&#x20AC;&#x2122;s needed to ensure they are maximizing their health and athletic potential. n

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Optimum performance

Dumbbells and kettlebells provide unique advantages that can add value to any strength regimen, but only if you know how to fit them into a functional training approach.

By Vern Gambetta

Bell Power

Vern Gambetta, MA, is 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: www.functionalpathtraining.blogspot.com. TR AINING-CONDITIONING.COM

istock.com

thletic trainers and strength coaches are constantly inundated with marketing claims about the next “latest and greatest” training aid or exercise method. Many of these pitches are laden with buzzwords, puffery, and half-truths about the training approaches being plugged and the science that supposedly backs them up. Of course there have been some significant achievements in the training aid marketplace in recent decades, so I don’t want to paint all new products and systems with a broad brush. But despite the never-ending barrage of new ideas, the most basic and time-tested equipment is sometimes still the most practical. Such is the case with two of the oldest types of training implements: dumbbells and kettlebells. Dumbbells have been around for so long that some early versions were literally “dumb (soundless) bells,” from which the

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Optimum performance

KETTLEBELL SAFETY Every strength training method carries some degree of injury risk, especially if a proper progression is not followed and technique is not emphasized. The unique design of the kettlebell presents some challenges that must be overcome to minimize risk. Here are some points of advice on making kettlebell training as safe as possible: • Even though kettlebell work is thought of primarily as a form of upperbody exercise, instruct athletes on proper leg stance to reduce the risk of poor body alignment during various movements. • Teach the most basic swings and let the athlete get comfortable with those before moving on to more complex movements. • Start with light kettlebells, and don’t progress to heavier ones until the athlete displays mastery of technique—and then, increase the load only in small increments. • Don’t focus on the quantity of reps at the expense of quality of movement. A large number of reps with less-than-optimal technique provides fewer advantages and poses a much greater injury risk than a smaller number with excellent technique.

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clapper had been removed so someone could lift the heavy metal objects repeatedly without making a racket. And kettlebells were a staple of Eastern European training long before achieving their current revival of popularity in the West. This article will give you some practical advice on getting the most out of dumbbell and kettlebell work. Using my experience with both modes of training for various sports and in the rehabilitation environment, I’ll discuss what these implements can and can’t do for athletes who use them, and cover ways to make dumbbell and kettlebell training as functional as possible. MOVEMENTS, NOT MUSCLES Regardless of the type of strength training, the goal of any sound program is to develop strength that an athlete can use in his or her sport. To accomplish this, I think of training as the process of moving through a spectrum of different movements and muscle actions with varied modes and loads to elicit maximum adaptation. Moving across

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Optimum performance the spectrum is a means to an end, and the end is a stronger, more functional athlete. In my opinion, traditional approaches to strength training have been too heavily influenced by convenience. Many lifts and exercises focus on movement in a single plane with one joint because these movements are easy to describe to athletes, easy to relate to what we see in anatomy textbooks, and easy to evaluate through visual observation. But performance in any sport is a multi-dimensional activity that takes place in a dynamic environment. Thus, truly functional performance involves moving the whole body in all three planes—sagittal, frontal, and transverse—using as many joints and muscles as needed to produce and reduce force. This is a key reason why the freedom of movement achieved with dumbbell and kettlebell training is so valuable. Athletic movement involves synergists, stabilizers, neutralizers, and antagonists all working together. The central nervous system constantly mod-

ifies movement patterns in response to gravity, ground reaction forces, and momentum. Each activity is further refined and adjusted by feedback from the body’s proprioceptors. Strength training, at its core, is actually coordination training with appro-

• Pushing • Squatting (and derivatives like lunges and step-ups) • Rotation • Bracing In a well-designed program, all these movements should be incorporated

I am currently working with volleyball players, who rely heavily on swinging movements in their sport. For that reason, the swing-based mechanics of kettlebells are an excellent fit. priate resistance, with the main goal of enhancing linkage and connectivity to produce more powerful and efficient movements required in an athlete’s sport. Dumbbells and kettlebells are excellent tools to train multi-dimensional movements and enhance power and coordination. Because of their versatility, dumbbells and kettlebells can be used for resistance in all the essential movements needed for comprehensive athlete development: • Pulling

through multi-plane, multi-joint movements that involve the full range of motion and high proprioceptive demand. FITTING THEM IN To design a functional training program and decide when and how best to incorporate dumbbells and kettlebells, it’s important to ask the following questions: • What are the strength requirements of the sport? • What muscle groups are used in the sport, and how can dumbbells and ket-

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Optimum performance tlebells be used to engage those muscle groups? • What are the primary movement requirements and force reduction requirements? • In what direction(s) are the greatest forces applied? • What is the range of movement, and are dumbbells and kettlebells the best way to introduce resistance within that range? • What are the most common injuries in the sport? Dumbbells and kettlebells can both

be viable modes of resistance in virtually any athlete’s training program, but they’re not a stand-alone training method. They must be part of a comprehensive program to achieve optimal results. Kettlebells in particular have become something of a training fad lately, and despite their clear value, some claims regarding their benefits are a bit over the top. There are no “Russian secret” kettlebell training methods that singlehandedly produced the huge, intimidating Soviet athletes of past generations, as some of the more ambitious market-

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ing hype would lead you to believe. In fact, kettlebells were a staple of U.S. and European gyms and physical education programs in the late 19th and early 20th centuries. Just like climbing ropes, Indian clubs, and various other training implements, they fell out of favor as physical education moved away from movement gymnastics and toward team sports. There has been revived interest in kettlebells over the last 10 years, and today they can frequently be seen in commercial fitness centers and high school, college, and pro team weightrooms. So how do you fit them into a comprehensive strength program? I think kettlebell training is best added as a later step in most progressions, after an athlete has built a solid foundation of strength and is starting to look for variability and different adaptive responses. Safety is a major reason behind this approach, since improper technique with a kettlebell can quickly put unwanted stress on the wrist and elbow. Mastering correct mechanics for the various movements performed with a kettlebell is essential to gaining optimum return and minimizing injury risk. I am currently working with volleyball players, who rely heavily on swinging movements in their sport. For that reason, the swing-based mechanics of kettlebells are an excellent fit. On our total-body training days, I use the basic two-arm kettlebell swing for two sets of six, followed by one set of six onearm swings with each arm and one set of six “swing and catch” movements with each arm. We then do jump shrugs with the kettlebell, and that leads into either high pulls with the kettlebell or kettlebell cleans (for the more advanced athletes). This is just one example of how kettlebells can be incorporated into a sport-specific program for highly trained athletes. Dumbbells, meanwhile, are appropriate for practically all levels of athletes, even those just being introduced to strength training. The most common alternative to dumbbells is a bar, which can be limiting because its minimum weight is often more than a beginner can lift with proper technique. In addition, the athlete has to adapt and “fit” to the bar, fixing the hands in one position relative to the torso. Because the user is unable to turn his or her hands when using a bar, greater stress is placed on the elbow and shoulder, espeTR AINING-CONDITIONING.COM

Optimum performance cially with inexperienced lifters. A dumbbell, meanwhile, places virtually no restrictions on movement and positioning. For total-body movements like high pulls, cleans, and snatches, the maneuverability of dumbbells provides a major advantage. I have found that dumbbells are the best way to teach total-body pulling movements, such as the high pull, clean, and snatch, and once the athlete is proficient, we progress to bar work for added resistance and greater variety. One of the most frequent questions athletes ask when working with dumbbells or kettlebells is how much weight they should lift. I use percent of body weight as a guideline to start, with the amount obviously depending on the movement and complexity of the exercise. Whole-body movements demand a higher percentage of body weight than pressing movements, and the load should never be so great that the athlete cannot perform the prescribed sets and reps with the desired tempo and range of motion. Remember that rep speed—not just load—is critical for power development. Also, it is important to have dumbbells available in 2.5-pound increments, or to use magnetic add-ons called PlateMates to fine-tune the load. The standard five-pound increments commonly found on dumbbell racks are generally not sufficient to customize a progressive workout. BENEFIT PACKAGE If you want to make muscle power as functional as possible, nothing is more important than coordination and synergy between muscle groups and body parts. Dumbbells and kettlebells force this synergy while also requiring each limb to work independently, eliminating the potential for one side to compensate for the other at any point throughout the range of motion. For deconditioned athletes and beginners, one of the most common factors limiting performance is a weak link somewhere in the kinetic chain. Once you’ve identified a weakness, dumbbells are versatile enough that you can customize a lift or movement to address the deficiency, and transition from lighter to heavier weight as the athlete makes progress. Another advantage is that many beginners, especially female athletes TR AINING-CONDITIONING.COM

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Optimum performance strength training for the first time, find dumbbells much less intimidating than bars. I find that they quickly “dive in” with dumbbells, while with the bar they are hesitant to increase load or even to begin lifting. When working with more advanced athletes engaged in high-level performance training, one of the best selling points for dumbbells and kettlebells is simple availability— they provide a weightroom without walls. With these implements’ easy portability, they can be used on a field, court, track, pool deck, or practically anywhere else athletes find themselves. For all these reasons, dumbbells and kettlebells are valuable tools for athletes looking to build functional strength. And like with all pieces of equipment, the key is determining how best to use them based on an individual’s ability, experience, and performance goals. There’s good reason why some training tools have stood the test of time. n

WHICH TO USE? This article discusses dumbbells and kettlebells more or less interchangeably at times, because from a training perspective, they provide many of the same benefits relative to other types of strength work. But each is a unique resistance tool, and while the dumbbell can be used for practically any single-arm lift, the kettlebell has more specialized applications. The shape of the kettlebell and the placement of its handle provide a weight distribution that significantly increases the difficulty of lifting it. That’s one reason why I recommend kettlebell work only for intermediate and advanced lifters. Mastery of swing mechanics and variations of the swing are essential for safe and effective kettlebell training. I use the swing and its permutations as a lead-in to pulling movements, and I find that swinging with a kettlebell is very helpful for developing the muscle memory and timing of multi-joint movements necessary for proficient pulling. I don’t typically make the kettlebell my only resistance training tool for an athlete. Instead, I blend it with other methods in the same workout. This is partly for practical reasons and partly strategic. Practically, I just do have not a wide enough range of kettlebell weights to accommodate the diverse needs of the athletes I’m working with. Strategically, I think kettlebells are perfect for certain movement patterns (like the aforementioned swinging) and great for adding variety to a workout, but by themselves they do not offer the range of possibilities necessary for comprehensive strength training.

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The TRX® Big Five By Mike Boyle, MS, ATC

Mike Boyle is a leading expert in the area of sports performance training. His company Mike Boyle Strength and Conditioning trains athletes and clients of all ages and abilities. Mike Boyle Strength and Conditioning was recently named one of the top ten gyms in the US by Men’s Health magazine.

Every decade or so, a tool comes along that allows certain exercise or exercise progressions to be improved. To be honest, at first glance, I didn’t see the TRX as one of these tools. However, the key to understanding the TRX was seeing the possibilities to improve exercises you already do. For my athletes at Boston University and for the athletes at Mike Boyle Strength and Conditioning, we have started to use what I refer to as our TRX “Big Five.” I know there are potentially hundreds of exercises you can perform on the TRX, but what I like about our Big Five is the ability to easily progress and regress the movements.

Exercise #1- TRX Row The TRX Row is hands’ down my favorite TRX exercise. It’s the reason I originally bought the TRX. An adjustable row machine for under $200? It’s unheard of. The TRX is better than any expensive single station piece out there. The TRX Row allows the shoulder to work comfortably from internal rotation to external rotation. This means athletes with shoulder issues can perform the movement pain free. You can stick with the basic movement, or you can use boxes to elevate the feet and weight vests for increased resistance.

Exercise #2 - TRX Push-up The TRX Push-up is an instant core exercise. Just get in position and dorsiflex. You have to try it to appreciate it. Just dorsiflex, and you’ll turn on the entire anterior chain.

Exercise #3 - TRX Lunge The TRX Lunge is a great exercise you can progress for both strength and injury prevention. Think slide board lunge but with an element of instability to really draw in the hip stabilizers.

Exercise #4 - TRX Hamstring Curl The pendulum effect of the TRX Leg Curl allows an almost infinite scale of progression. Perform the movement with your body under the anchor point, and you have a challenging exercise. Perform the movement with your feet under the anchor point, and you’ll challenge the posterior chain of even the strongest athletes.

Exercise #5 - TRX Standing Roll Out Looking to make roll outs more difficult? Here is your progression from the ab wheel. The TRX Standing Roll Out attacks the anterior chain from the feet to the hands. This truly is one total body core exercise. There you have it. Five reasons the TRX is a must-have piece to challenge athletes.

When They’re Hot…

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TREATING THE ATHLETE

Being prepared to treat heat illness is essential, but it’s even better to follow smart prevention steps that keep athletes from needing treatment at all.

By J. Allen Hardin

ere’s a staggering fact that shouldn’t be true, but is: Heat illness is the third leading cause of death among high school athletes in the U.S. It shouldn’t be true because in the vast majority of cases, heat illness is preventable with little more than common-sense precautions. And when it does occur, early detection and proper management can minimize if not eliminate the mortality risk. In short, there’s no good reason for most of the heat-related deaths that occur on athletic practice fields every year. Many factors contribute to the body’s ability to regulate internal temperature during exercise. Air temperature, humidity, sun exposure, workout intensity, hydration status, supplement use, and the athlete’s fitness level and acclimatization all play a role. Armed with the latest information and strategies for evaluating and dealing with heat risk in any situation, you can keep your athletes cool, safe, and performing at their best. DEGREES OF DIFFICULTY “Heat illness” is an umbrella term that encompasses several different conditions of various severity. The four most commonly recognized categories are: Heat cramps. Exercise-associated muscle cramps are a common result of working out in hot weather, particularly when accompanied by profuse and prolonged sweating. The exact etiology is unknown, but cramping is most likely associated with low serum electrolyte concentration secondary to sodium depletion. It is characterized by acute, TR AINING-CONDITIONING.COM

painful involuntary skeletal muscle twitching and spasms, usually affecting the arms, legs, and abdomen. Some athletes are naturally more susceptible to heat cramps than others, and this may be explained by individual differences in sodium balance. When compared to athletes with no history of cramping, research has found that crampers are generally “salty sweaters,” losing as much as twice the sodium through their sweat as noncrampers. In addition, they usually have a higher sweat rate, increasing both salt loss and dehydration. Heat cramps can obviously be debilitating on their own. But they may also serve as an early indicator of impending heat exhaustion, as well as a warning sign that an athlete is dehydrated. Heat syncope. This condition presents as an orthostatic syncopal episode (fainting) or lightheadedness during exposure to hot temperatures. It’s most often seen after a bout of extreme effort, when the blood vessels are maximally dilated. Predisposing factors include exercising without a cool-down period and being in a dehydrated state during physical activity. Like with cramps, some athletes are naturally more prone to heat syncope than others. If an athlete has experienced a syncopal episode before, they are often more likely to experience another in the future due to innate cardiovascular characteristics, so they may warrant additional monitoring during workouts. Heat exhaustion. By definition, this is a physical inability to continue exercise in the heat, and it is associated

with heavy sweating, dehydration, sodium loss, and energy depletion. Also known as exertional hyperthermia, it occurs when an athlete performs strenuous exercise in the heat and loses large amounts of fluid and electrolytes through sweat. Symptoms include profuse sweating, fatigue, general malaise, nausea, vomiting, the urge to defecate, headache, hyperventilation, an elevated heart rate (tachycardia), hypotension, vertigo, anxiety, and confusion. Dangerous clinical manifestations include circulatory collapse and increased core temperature, ranging from slightly above normal up to 104.9 degrees Fahrenheit (this is generally considered the cut-off for heat stroke). There are two classifications of heat exhaustion: water-depletion and sodium-depletion. Water-depletion heat exhaustion usually occurs during one particularly grueling exercise session, while sodium-depletion exhaustion usually shows up after several days of exercising in a hot environment. The water variety has a more rapid onset and is more likely to progress to heat stroke if untreated, but the sodium variety is equally serious because it may lead to a “hyperhydrated” status called hyponatremia, in which the body’s sodium level becomes low enough to possibly cause heart attack, seizure, or even death. J. Allen Hardin, ATC, LAT, PT, MS, SCS, CSCS, is Co-Director of Athletic Training/Sports Medicine at the University of Texas. He can be reached at: allen.hardin@athletics.utexas.edu. T&C JULY/AUGUST 2010

TREATING THE ATHLETE Exertional heat stroke. This most extreme form of heat illness is characterized by a core temperature of greater than 104.9 degrees Fahrenheit accompanied by signs of organ system failure. It is life-threatening and should be considered an immediate medical emergency. The degree of physical damage depends on how high the individual’s core temperature reaches and how

be dry at the time of collapse), hyperventilation, altered mental status, irritability, lack of muscle control (ataxia), vomiting, diarrhea, seizures, coma, and decorticate (abnormal) posturing. PREVENTION MEASURES Even light or moderate exercise that’s easy to perform in cool conditions can become extremely difficult during an

Most acclimatization occurs during the first week of heat exposure, and in the majority of cases, a reasonable degree of acclimatization has set in by day 14. However, in the most extreme cases, athletes may not be fully acclimatized for two to three months. long it remains elevated. A heat stroke diagnosis is typically made when a severely elevated rectal temperature and changes in mental status follow physical activity with heat exposure. The signs of exertional heat stroke include tachycardia, hypotension, sweating (although the skin may also

athlete’s first exposure to hot weather in a long while. However, repeated exposure to a hot environment produces physiological changes that improve work capacity and thermoregulation. This acclimatization process is one of the most critical concepts to understand in order to keep athletes safe in the heat.

Acclimatization occurs through a series of adaptations in the body, including decreased heart rate, decreased internal temperature, and increased plasma volume and sweat rate. Essentially, the body “learns” that its response to exercise shouldn’t be the same on an 85-degree day as on a 65-degree day. Over time, the same amount of work in hot weather becomes less physically stressful, and an athlete can work harder and longer without an increased health risk. How exactly to structure an acclimatization period varies based on an athlete’s initial conditioning level, body composition, and natural physiology, along with the intensity of work, weather conditions, and other factors. Most acclimatization occurs during the first week of heat exposure, and in the majority of cases, a reasonable degree of acclimatization has set in by day 14. However, in the most extreme cases (such as with very hot, humid weather or a highly deconditioned state), athletes may not be fully acclimatized for two to three months.

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TREATING THE ATHLETE While acclimatization may be the most important longer-term guard against heat illness, hydration is a critical short-term consideration. Acclimatized or not, athletes who aren’t properly hydrating before, during, and after workouts—especially in the heat—are at much greater risk for serious health

ulation is severely hampered. In addition, dehydration can cause cramping, decreased cardiovascular performance, mental status changes (such as confusion), and in extreme cases, organ failure and death. How do you know if an athlete is properly hydrating? One of the best

The effects of dehydration on overall health and safety can’t be overstated ... Core body temperature has been shown to rise by roughly .25 to .35 degrees Fahrenheit for every one percent of body weight lost to dehydration during exercise. problems than athletes who are. Dehydration occurs any time an athlete loses more fluid (mainly through sweat and urine) than they replenish through drinking. It can occur acutely within a workout, or cumulatively over the course of multiple days, and the effects can be devastating. Sweat is the body’s primary means of cooling during exercise, and without an adequate volume of fluid to perspire, thermoreg-

methods is monitoring daily prepractice and post-practice body weight. Athletes should be drinking enough during activity to replace 16 to 20 fluid ounces per pound lost due to sweat, meaning their pre- and postpractice weight should be roughly the same. A good starting point is to aim for at least eight ounces of fluid intake every 20 minutes during activity, and if the athlete is still found

to be losing weight during workouts, this number should be adjusted accordingly. From a clinical standpoint, a combination of total-body water and plasma osmolality testing provides the “gold standard” for hydration assessment, but because these methods require considerable expense, resources, and analytical expertise, they aren’t practical for day-to-day hydration status monitoring. An easy and reliable alternative is self-monitoring urine color—athletes should be advised to notice how dark their urine appears all day long. A general rule is the clearer the better, and urine with a dark yellow shade (similar to apple juice or darker) indicates that the body is not adequately hydrated. Frequently feeling thirsty is another potential sign of dehydration, but thirst sensation naturally varies from one person to the next, so its absence shouldn’t be interpreted as a sign that an athlete is properly hydrated. Two important buzzwords in heat illness prevention are prehydration and

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TREATING THE ATHLETE rehydration. The best available evidence suggests athletes should ingest at least 16 to 20 fluid ounces of water or a sports drink two hours prior to physical activity to promote good hydration status and “kick start” the body’s absorption mechanisms. In particularly hot conditions, they should drink another 10 to 20 fluid ounces 30 to 60 minutes before exercise. After exercise, post-workout weight should determine how much the athlete must drink to rehydrate. Any time they’ve lost weight due to a workout, they should drink enough fluid to return to pre-activity weight. Sports drinks are a better option than water, as they replenish sodium and other electrolytes lost through sweat, along with carbohydrates and other ingredients that help replace glycogen stores. The effects of dehydration on overall health and safety can’t be overstated. During exercise in hot weather, research shows that fluid loss of just two percent of body weight may predispose an athlete to exertional heat illness. Furthermore, core body temperature has been shown to rise by roughly .25 to .35 degrees Fahrenheit for every one percent of body weight lost to dehydration during exercise. Not surprisingly, one more key physical factor in heat stress risk is conditioning level. Those who are out of shape—with a higher body fat percentage, or who have been sedentary in

Every program should have an emergency action plan in place. It’s important to cover all the details, such as arrangements for summoning an ambulance and providing it with easy access to the field, immediate availability of cold submersion, and having a method to monitor vital signs. their off-season, for instance—are less able to internally regulate body temperature. They also typically lose more sodium through sweat than athletes who are better conditioned. These athletes, commonly football offensive and defensive linemen, require closer observation during workouts in hot weather, especially during the acclimatization period. As part of standard pre-participation physicals, every athlete should be asked about any history of heat illness symptoms—even ones they may consider minor, such as occasional lightheadedness or cramping during workouts in the heat. Athletes who have a history of heat illness also warrant special attention and close monitoring during workouts. EARLY INTERVENTION Even if you make sure athletes follow an acclimatization schedule, are well hydrated before, during, and after workouts, and don’t push themselves beyond safe activities for their conditioning level, it’s still possible they’ll be struck by some degree of heat illness. While prevention steps are essential, it’s equally important to have a plan in place for fast and effective detection and treatment of all forms of heat illness. Cramps are the easiest to treat, typically through temporary removal from activity for oral rehydration and sodium replacement through sports drinks and/or salt tablets. In casTR AINING-CONDITIONING.COM

TREATING THE ATHLETE es of severe cramping, intravenous fluid replacement may be necessary. Because of the clear link between cramping and heavy sweating (that is, dehydration and salt loss), athletes who struggle with cramps should be encouraged to

removal from activity for cooling and rehydration as soon as symptoms occur. In mild cases, in which the athlete has normal vital signs and is not vomiting, this alone is usually adequate. In athletes with altered mental status,

Thirsty?

Because of the clear link between cramping and heavy sweating (that is, dehydration and salt loss), athletes who struggle with cramps should be encouraged to consume fluid and sodium more frequently during exercise. consume fluid and sodium more frequently during exercise. Heat syncope can also be treated simply in most cases. The athlete should be placed in a supine position, preferably in a cool indoor facility or at least out of the sun, and given fluids orally or intravenously. Core temperature should be monitored after syncope or lightheadedness to ensure that a more serious form of heat illness is not present. In cases of heat exhaustion, intervention should consist of immediate

cardiac arrhythmia, or vomiting, or when the more conservative measures fail to improve their condition, treatment with intravenous rehydration, more intensive cooling (such as an ice bath), and careful monitoring may be required, as untreated heat exhaustion can lead to heat stroke. If you follow the prevention and early intervention strategies outlined so far, heat stroke will hopefully never affect one of your athletes. If it does, however, treatment begins with monitoring respiratory and cardiac status and managing

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RESOURCES NATA The NATA’s position statement and tips for recognizing, preventing, and treating heat illness can be found by searching “heat illness” at: www.nata.org. ACSM The American College of Sports Medicine’s consensus statements and other documents on heat illness and hydration can be found by searching “heat illness” at: www.acsm.org. CDC The Centers for Disease Control and Prevention has an entire Web site devoted to extreme heat and its effects. A prevention guide, the signs and symptoms of heat illness, extreme weather tips, and other resources can be found at: www.bt.cdc.gov/disasters/extreme-heat. NCAA To view the NCAA’s Out-of-Season Football Conditioning Educational Initiatives, search for “Football Conditioning” at: www.ncaa.org.

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NFHS Heat illness prevention information aimed at the high school sports community can be found by searching “heat illness” at the Web site of the National Federation of State High School Associations: www.nfhs.org.

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TREATING THE ATHLETE any findings according to first-aid protocols. Rapid external cooling to bring down the core temperature is critical for minimizing harm, and the generally accepted best method is cold water or ice water immersion. In addition, every program should have an emergency action plan in place. It’s important to cover all the details, such as arrangements for summoning an ambulance and providing it with easy access to the field, immediate availability of cold submersion, and having a method to monitor vital signs and core

temperature until the athlete can be transported to the hospital. SIMPLE STEPS Hopefully, most of what you’ve read so far has reinforced what you already knew. Heat illness has received much attention in the sports medicine community in recent years, so today’s athletic trainers are more educated on the topic than ever before. But there are a few points of advice on minimizing risk that I believe every program can benefit from.

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Watch the weather. Environmental factors that affect exertional heat illness risk include ambient air temperature, relative humidity, air motion, and the amount of radiant heat from the sun. The best way to judge the risk on any given day is wet bulb globe temperature (WBGT), which accounts for all these factors. Every athletic department with athletes who work out in warm weather should have a way of gauging the WBGT, the easiest being a wet bulb globe thermometer. Recommendations for the threshold above which athletes shouldn’t exercise outdoors vary from one researcher to the next. In general, if the WBGT is above 82 degrees Fahrenheit, an athletic event should be delayed, rescheduled, or moved into a controlled climate. In the mid to high 70s and around 80, out-

Because of the cumulative nature of dehydration and heat’s impact on the body, the day after a high-WBGT day carries additional risk as well. The previous day’s WBGT may be one of the best predictors for incidence of exertional heat illness.

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door activity should at least be modified to reduce physical stress. Interestingly, because of the cumulative nature of dehydration and heat’s impact on the body, the day after a high-WBGT day carries additional risk as well. In fact, some experts have found that the previous day’s WBGT may be one of the best predictors for incidence of exertional heat illness. Talk about supplements. For better or worse, athletes often seek to boost their performance, energy level, or muscle growth with over-the-counter dietary and nutritional supplements. Many of these products are harmless if used properly, but some carry significant health risks, particularly for athletes exercising in the heat. Stimulants, for example, speed the rate of increase in core temperature and augment the body’s heat production. These products, which range from amphetamines to herbal ephedra and cafTR AINING-CONDITIONING.COM

TREATING THE ATHLETE Change clothes. Clothing creates a feine, put athletes at greater risk for barrier to evaporation, impairing the exertional heat illness, and some can body’s ability to dissipate heat. The contribute to dehydration as well. They material properties and how much skin may also trigger serious side effects, is covered determine the impact on including dizziness, headache, gastrothermoregulation and heat tolerance. intestinal distress, heart palpitations, Athletes who wear apparel and equipheart attack, stroke, and seizure. ment that doesn’t allow for heat dissipaEven supplements generally considtion are obviously at increased risk for ered benign, such as vitamins, minerexertional heat illness. Before a workals, creatine, and protein powders, can out, think about how much clothing and be harmful if taken beyond the recompadding will be required, and advise athmended doses. And because supplement letes to remove any unnecessary barriers makers remain largely unregulated, to heat release. On hot days, you might some products are contaminated during consult with a team’s coaching staff to the manufacturing process. According modify a workout so that less padding to a few estimates, up to 25 percent of is necessary. And it’s always smart for dietary supplements may contain subathletes to wear light colored clothing stances not listed on the label. that reflects light and minimizes heat The best defense against supplement absorption. problems is education. Talk to your Encourage vigilance. Even the most dilteams and individual athletes about any igent athletic trainer can’t be watching all products they may be taking, and disathletes at all times. Athletes themselves cuss how they can usually achieve their can help you by serving as extra eyes and goals by improving nutritional habits ears to detect any signs of exertional heat without the need for supplementation. illness among their teammates. For those who want to continue using Every athlete should know the sympa product, at least ensure that they are toms of heat illness and be instructed to following dosage instructions to minireport to an athletic trainer when they quarter_page_ad_Layout 7/8/10 5:21 PM Page 1 mize the risk of negative1 side effects.

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see someone who may be struggling. Some of the more subtle signs, such as confusion or altered mental state, will most likely be noticed by teammates before anyone else. In addition, all parents and coaches should be educated on heat illness symptoms, so that problems can be identified as soon as possible in any workout setting. As long as athletes and hot weather coexist, the dangers of heat illness cannot be ignored. The body’s ability to regulate cardiovascular homeostasis, internal temperature, and muscle function can be compromised due to the potentially deadly combination of heat, dehydration, and physical stress. But with a proactive approach rooted in prevention, education, and preparedness, you can rest assured that your athletes are as safe as possible. n

REFERENCES To view full references for this article, go to: www.Training-Conditioning.com/ References.

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LEADERSHIP

Hospital Rounds Whether they’re helping patients overcome paralysis, conducting rehab, or assisting in the operating room, these athletic trainers have found the hospital setting to be a rewarding and dynamic workplace. Is this “new frontier” of the profession right for you? By Kenny Berkowitz

At the Brain and Spine Recovery Center in Austin, Texas, Marlene Rios uses her athletic training knowledge to help patients regain normal function after nervous system injuries.

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s an athletic training student at the University of Texas, Marlene Rios, LAT, ATC, assumed she’d start her career in a traditional setting—a full-time role in a high school or college athletic department. Instead, three months after receiving her certification, she applied for an opening at University Medical Center Brackenridge in Austin, and walked out of the interview with her first professional athletic training job. “I’d just graduated from our curriculum program, and I wasn’t sure what to expect working in a hospital,” says Rios, who works in the Brain and Spine Recovery Center. “They were starting this program from the ground up. It turned out there was a lot more to this setting than I’d realized, and I decided it was an avenue worth pursuing.” Four years later, she’s glad she did. She faced a steep learning curve in the transition from treating NCAA Division I student-athletes to paraplegics and quadriplegics recovering from spinal cord injuries. But she found ample resources at every turn, from state-ofthe-art equipment to close working relationships with the rest of her team, which includes managers, surgeons,

jim lincoln

Kenny Berkowitz is an Assistant Editor at Training & Conditioning. He can be reached at: kb@MomentumMedia.com. T&C july/august 2010

LEADERSHIP physicians, nurses, and physical and occupational therapists. Rios isn’t alone in seeing the advantages. Many athletic trainers have found good reason to work in the hospital setting, and they encourage other athletic trainers and athletic training students to consider the possibilities.

soon set his sights on becoming a college athletic trainer. A bachelor’s degree from Messiah College led to a job as Assistant Athletic Trainer at Wheaton College (Ill.) and a master’s degree from DePaul University, where he provided coverage for men’s soccer, softball, and track and field as a graduate assistant.

“By the time I finished grad school, I was burned out from all the travel. Every other week, I was flying to one place after another, then spending hours working the sidelines in the cold, wind, and rain. I needed to recharge my batteries.” “We’re not trying to win championships here—we’re helping people live their lives,” says Rios. “There’s a different kind of reward that comes from working in this setting, and when you help patients feel good about themselves, it’s enormously gratifying.” IN FROM THE COLD A wrestling injury during his sophomore year of high school brought Mike Huxford, MEd, ATC, CSCS, to the athletic training room for the first time, and he

Although he loved working with Division I student-athletes, those two years at DePaul made him rethink his career path. “By the time I finished grad school, I was burned out from all the travel,” says Huxford. “Every other week, I was flying to one place after another, then spending hours working the sidelines in the cold, wind, and rain. I needed to recharge my batteries.” He shifted gears for the next two years, providing part-time coverage as an independent contractor at Wheaton

Academy and for the Chicago Eagles amateur soccer club. Then Children’s Memorial Hospital opened its Institute for Sports Medicine, and Medical Director Cynthia LaBella, MD, who had worked with Huxford as a team physician at DePaul, hired him as the hospital’s first athletic trainer. He began work as a physician extender in August 2004, and as the institute has grown—it’s added a second physician and a second athletic trainer— so have his responsibilities. Huxford spends most of his time seeing patients in the clinic, but he’s increasingly focused on other projects, including marketing the institute, developing a knee injury prevention program for teenage girls, creating an athletic training educational internship program, teaching CPR to hospital staff members, giving presentations at schools and conferences, and conducting research on injuries in the Chicago Public Schools. Even though starting any new venture can be enormously labor intensive, there hasn’t been any travel, and he’s no longer concerned about burnout. “Helping build this institute has been

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LEADERSHIP a great experience,” says Huxford, who works as Sports Medicine Coordinator. “I don’t have as much time to work directly with athletes, but by developing injury prevention programs, I keep people healthier longer, and that’s exciting. I love the consistency of working closely with a physician, bouncing ideas off each other, and continually learning. “It’s hard work, but at the end of the day, I can go home and spend time with my wife,” continues Huxford. “That has dramatically improved my quality of life.” After Huxford’s second year at the hospital, administrators encouraged him to pursue an MBA, which he expects to complete in February 2011. When he does, his responsibilities may change again, and he’s looking forward to using his business training to enlarge the hospital’s injury prevention programs, increase its involvement in the community, and expand its research in the public schools. “I’m not sure yet where my job will go next, but this has been a great path to be on,” he says. “It may not be right for everyone, but for athletic trainers

who don’t want to stand outside in the cold, it’s a warm, dry place to work. If you’re looking for a stable environment that’s challenging and rewarding, the hospital setting is it.” HEALTHY BALANCE Even before receiving her bachelor’s degree in athletic training from Eastern Washington University, Jennifer Hamsher, PT, OCS, ATC, knew she

for a career that would allow me to balance work and home, which didn’t seem likely in the traditional athletic training setting,” says Hamsher, who works 30 hours a week as a physical therapist at Wenatchee Valley (Wash.) Medical Center. “But getting my ATC was an important step in the process, and I’m constantly drawing on what I learned in the athletic training room.” In her current position in the outpa-

“I don’t have as much time to work directly with athletes, but by developing injury prevention programs, I keep people healthier longer, and that’s exciting. I love the consistency of working closely with a physician, bouncing ideas off each other, and continually learning.” wanted to stay for a second degree. Two years later, she completed a bachelor’s in physical therapy, and in 15 years of working in hospitals, nursing homes, and sports rehabilitation clinics, she’s combined the best of both worlds—with enough time to start a family, too. “From the beginning, I was looking

tient physical therapy department, she often finds herself assessing patients’ readiness to return to sport, analyzing gait, fitting orthotics, creating sport-specific rehab programs, teaching taping techniques, and helping senior athletes reach their competitive goals. She also rotates to the 20-bed

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LEADERSHIP Wenatchee Valley Hospital, where she treats post-operative inpatients with rehab modalities, fits assistive devices, retrains stroke victims, mobilizes joints, and helps athletes and non-athletes return to independent living. “Athletic training has given me extra tools in my kit for treating acute injuries,” says Hamsher. “It’s given me a broader perspective on sports medicine and taught me a lot about the mindset

ting lends itself to family time—in fact, seven of the eight physical therapists in her department are raising children. As she grows older, Hamsher has found that treating a varied population is much more satisfying than she’d expected. “Athletes are great, but I’m glad they’re not the only people I see,” she says. “When I started school, I imagined myself working with young, healthy, motivated athletes. But some of my most

“It’s given me exposure to the most current surgical procedures, techniques, and equipment, which is a great advantage in helping patients both before and after surgery. When people come into the clinic after an operation, I have a broader perspective on their recovery.” of athletes. Keeping up with continuing education credits in athletic training helps me every day in my role as a physical therapist.” Without the flexibility of her current work schedule, Hamsher, who adopted a son last year, can’t imagine trying to balance work and home. She says the set-

rewarding experiences have come from helping elderly patients regain bladder control or learn how to get out of a chair by themselves. Watching athletes achieve a personal best is a great feeling, but it doesn’t compare to the reward of helping someone walk across a room.” For Hamsher, the key to choosing the

right workplace was thinking long-term, and she encourages athletic trainers to consider going back to school for a PT degree. “Ask yourself where you’d like to be in five or 10 years,” she says. “Do you envision spending a lot of quality time with your family? Adding a physical therapy degree gives you more opportunities for different work settings. Whether you’re in a large or small community, if you have two credentials, you’ll have an easier time finding a job. And with two degrees, you’re likely to make more money—even in a recession.” IN THE OPERATING ROOM By the time she started as a physician extender, Jeanna Polonchek, EdD, ATC, CSCS, OT-SC, CPED, had spent 15 years working in the traditional setting. Her first job, as an Assistant Athletic Trainer at Colgate University, was followed by positions with Attleboro (Mass.) High School, Johnson State College, Bridgewater State College, and the American Basketball League’s New England Blizzard, with one detour to work as a sales rep for an orthotics manufacturer and another to complete her doctorate.

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LEADERSHIP Working for the past 10 years as an people come into the clinic after an Orthopedic Clinic and Surgical Assistant operation, I have a better understandat Wareham (Mass.) Orthopedic Associing of what they’ve been through and a ates, she’s combined all that experience broader perspective on their recovery.” into one job. “One day a week, I assist Over the years, she has most frequentour surgeons in the operating room at ly assisted surgeons in joint replacements Tobey Hospital, and the other four days (total hip, total knee, unicompartmenI work in the clinic,” says Polonchek. tal knee, and shoulder), fracture care “It’s a great combination of responsibili(pinning, rodding, and plating), and reties and a culmination of all the work I’d constructions (ACL, rotator cuff, CMC been doing in athletic training.” joint, carpal tunnel, and Achilles tenPolonchek’s work week begins at 7:15 don). But no matter how many times on Monday morning, when she arrives she assists in an operation, she’s always at the hospital, reports to the operatlearning, and as surgical techniques ing room, and changes into scrubs. Aschange, so does her role. sisting the clinic’s three surgeons, she’s “I love working in the operating responsible for draping and prepping room,” says Polonchek. “Being part of surgical sites, dressing wounds, monia surgical team has taken me far betoring equipment, applying braces, and yond what I’ve read about in textbooks, instructing patients in post-operative and in the 10 years I’ve been here, the wound care. She typically sees patients equipment and procedures have been again three or four days after surgery, continually evolving. That puts us at the when they return to the clinic for their leading edge of patient care, and every first follow-up visit. day feels different.” “It’s given me exposure to the most From Tuesday through Friday, she dicurrent surgical procedures, techniques, vides her time between outreach coverand equipment, which is a great advanage for area high school teams, clinical tage in helping patients both before and appointments, cast applications, equipSpencoSandals_JulAug2010.pdf SpencoSandals_JulAug2010.pdf 6/29/10 6/29/10 9:13:26 9:13:26AMAM after surgery,” she continues. “When ment purchases, inventory control,

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marketing work, educational programs, and patient surveys. In the evenings, she builds custom foot orthotics at home for her business, Sole Remedy, and before going to the clinic each morning, she takes time to exercise at the gym. “As a physician extender, I’m able to use a lot more of my athletic training skills than I could in the traditional setting,” she continues. “Overall, I see a wider variety of patients and injuries than I did at my other jobs, and I’m always building relationships with physicians, nurses, hospital staff members, and sales reps. There’s an enormous amount of resources available to me, and being part of this team of allied healthcare professionals is an incredible experience.” MOVING TO MANAGEMENT As a grad assistant at Morehead State University, Shad Bernard, MA, LAT, ATC, dreamed of someday working in professional sports. But after graduation, he took the first job offer that came his way—and loved it. For the next eight years, he provided outreach coverage for high school games through the Dayton Sports Med-

LEADERSHIP icine Institute, in Dayton, Ohio, making use of both his bachelor’s in athletic training and master’s in sports administration. Bernard developed marketing strategies, started community wellness programs, consulted for high school strength and conditioning programs, and negotiated service contracts. Then in 2006, a phone call from out of the blue changed his life. Good Samaritan Hospital in Dayton was creating a position for an athletic trainer to run its sports medicine program, and he had been highly recommended. Would he consider coming for an interview? “I was working for a good organization and felt very comfortable about what I was doing,” says Bernard, now the Manager of Sports Medicine at Good Samaritan. “I was being asked to step off a ledge and become a fulltime administrator. So I talked to my wife, who’s also an athletic trainer, and we decided it was worth the risk. Four years later, Good Samaritan has grown into one of the largest health service providers in the area, and I wouldn’t trade this job for the world.” Bernard’s primary responsibility is

supervising the sports medicine department’s 16 outreach athletic trainers, who provide coverage for 15 area high schools, a professional indoor football team, and the University of Dayton. Other responsibilities include working with the hospital’s communications department to market the program and meeting regularly with administrators to expand its offerings. In one of the most significant developments since coming on board, Bernard helped set up partnerships with 10 area high schools, which have signed contracts for 10 years of athletic training coverage in return for naming rights to their stadiums. That multi-million dollar investment into the athletic training program’s growth has guaranteed his staff members long-term employment and given Bernard his biggest on-thejob challenge: providing balanced, consistent coverage to schools—large and small, urban and rural—over a wide geographic area. “Communication is key in everything we do here,” he says. “That means staying connected with athletic directors, coaches, and students, which is why we

implemented a patient survey this year to provide feedback on our outreach athletic training. It means talking with athletic trainers about their role as ambassadors for this program, strategizing with marketers about how we can keep growing, and helping make policy at committee meetings with hospital administration. There’s a lot of politics in working at an institution this size, but that’s turned out to be one of my favorite parts of the job.” Since making the transition, Bernard misses the hours spent in hands-on athletic training, but still provides occasional coverage for high school games and the hospital’s “Flyin’ to the Hoop” high school basketball tournament. His schedule is much more predictable than when he worked in the traditional setting, his work-life balance feels healthier than ever, and he’s grateful for the time he can spend with his two daughters, now four and six years old. Moving to administration was a leap he questioned for much of his first year on the job. But he’s glad he took it, and he advises other athletic trainers to consider all their options. “Don’t limit

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LEADERSHIP yourself to the traditional setting,” says Bernard. “If you’re going to keep growing as a professional, you need to take advantage of everything around you. “I would never have thought in a million years that this was the direction I would go in,” he continues. “But when an opportunity comes along, you need to seize it. Don’t be afraid to put your toe in the water—you might like it.” NEW CHALLENGES After four years as an athletic trainer at the Brain and Spine Recovery Center, Marlene Rios still sees some of her original patients. Some come in at 9 a.m., when she assists in treatments with the physical and occupational therapists. Others arrive at the fitness center at 2 p.m., when she oversees workouts, answers questions, and offers encouragement. “With a population of people who’ve had spinal cord injuries, it takes a lot longer to achieve results than with strong, healthy student-athletes,” Rios says. “But ultimately, it’s more rewarding. This rehab is their life. It’s something they wake up with every day and

go to sleep with every night. Knowing that someone believes in them gives them a sense of hope, which is what they need to keep making progress.” Her responsibilities have continued to grow over the years, and along with setting up exercises programs, Rios often assists in educational outreach, counsels patients on nutrition, assists with research, and networks with other healthcare professionals and community service workers. Since she began, she’s tried to put herself in her patients’ shoes, and after being diagnosed with multiple sclerosis early last year, she’s found a new sense of empathy. “I’ve learned a lot about myself through the diagnosis, and it’s given me more patience and compassion for other people, too,” says Rios. “Even though we’re not going through the same thing, I can understand their adversity, and we’ve had a lot of positive conversations that go both ways.” Although the MS makes it hard to predict where her career path will lead next, Rios is healthy enough to supplement her full-time job with outside work as an independent contractor,

providing coverage for Concordia University (Texas) and the Austin Independent School District. Next year, she hopes to begin a doctorate in physical therapy, which could take three years of full-time study. After that, she might pursue a master’s in nutrition, and she ultimately hopes to open a clinic of her own. “Working in a hospital has taught me to think outside the box,” says Rios. “By focusing on the whole patient, including all their physical attributes and medical history, I’m better able to help them work toward their goals. It’s a very creative place to be, with a lot of thinking on your feet. I’ve been able to make this job my own, and every day I make the most of my athletic training certification.” The key, says Rios, is to keep a positive attitude. “Don’t be scared,” she advises. “Keep an open mind about hospitals. This isn’t a setting where you can shy away from adversity. You have to meet it head-on and not get discouraged. The work can be difficult, but it teaches you a lot about yourself and the people around you.” n

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Chris Blunck, InsideMDSports.com

Pursuing T Greatness

By Barry Kagan

The University of Maryland men’s soccer strength and conditioning program uses a 12-month cycle to help players excel on the pitch in college and beyond.

he men’s soccer team here at the University of Maryland has been highly successful during the tenure of Head Coach Sasho Cirovski. His teams have earned seven trips to the College Cup (the NCAA’s “Final Four” for soccer) since 1998 and claimed two national championships in the process. The culture Coach Cirovski creates with his players embodies a pursuit of excellence. As part of that culture, we’ve created a player development program that brings together all facets of the college soccer experience to promote success at our level and beyond. This wouldn’t be possible without coordination between Barry Kagan, CSCS, MSCC, LMT, is Assistant Strength and Conditioning Coach at the University of Maryland, where he has primary responsibility for training the men’s soccer, women’s soccer, and field hockey teams. He can be reached at: barryk@umd.edu.

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sport specific the soccer coaching staff, academic support, athletic training, and the strength and conditioning unit. Our players are already elite athletes—they come here wanting to hone their skills, and many hope to earn professional contracts when they leave. But they also want to earn degrees, so they often take accelerated course loads to allow for early departure if they’re presented with the chance to go pro. A pleasant side effect of this is that they’re almost always around campus taking classes, which means our conditioning program can be based on a full 12-month cycle. That’s great for strength and conditioning, because while the workouts are optional in the off-season, they’re well attended and provide a sense of accomplishment and cumulative yearround progress, capitalizing on the players’ ongoing desire to improve. CONSISTENT GOALS Before breaking down our training approach, I must outline the goals we focus on all year long. They’re probably similar to the goals of most serious strength and conditioning programs, but it’s impossible to talk about our system without first briefly explaining them. Injury prevention. This is our top priority. We want to keep players on the field, and if they are injured, we want to return them to action as quickly as possible. We work with our athletic training staff to address what caused the injury in the first place, and design a training approach that will help prevent a recurrence. Efficiency. We don’t have many drills or exercises that emulate soccer-specific

movements—that would create redundancies with what happens at team practices on the field. However, we want all our exercises to develop traits and skills that will enhance soccer ability. Performance enhancement. Our predominant areas of focus are strength, balance, linear speed, and lateral speed and agility. We want players to meet individualized long-term development goals in each of those areas. Coordination with team activities. Our workouts are structured to minimize interference with the coaches’ sport-specific skill development so the players are in optimal condition to perform at team practices. This means different things depending on the time of year and the team’s progress toward the coaching staff’s broader goals. Smooth transitions. The players must be physically ready to move from one training phase to the next—from the summer to the preseason to the traditional season to the early off-season to spring semester training. This helps prevent injuries and ensures that everyone is prepared to perform at their best when it matters most. Recovery. We understand that the choices a player makes after lifting or working out play a major role in his physical recovery. With that in mind, we educate players on optimal recovery methods and follow up to make sure they’re heeding our advice. STARTING IN WINTER Our soccer postseason typically ends around the time our fall semester is wrapping up, so we think of winter break as the start of a new training year. Many of our players stay on cam-

FOR GOALIES While our goalies train with the rest of the team most of the time (sometimes with modified versions of agility drills), we also have a set of strength drills for them to perform twice a week to develop a few positionspecific attributes. The sequence includes: • Rotator cuff movements: in/outs, up/backs, empty cans, D1/D2 (12 each) • Vertical jump + plate punch-up, 22 pounds (2 x 12) • “Ready position” plate holds (33 pounds) with teammate tapping the plate after two weeks (45 seconds) • Cross-body one-arm med ball throws (12 each side)

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pus for most of the break to take one academic course, so it’s a great time to begin working out again after taking a few weeks off following the season and around the holidays. Because they may be somewhat deconditioned from the weeks off, this is the one time of year when I assign a longdistance steady-state run each week. Other assigned runs at this time are limited to fartlek-style aerobic running, accompanied by one weekly anaerobic session. The end of December marks the start of winter break strength training. We think of this as a preparatory phase for spring—the lifting is not particularly structured, as players are assigned lifting cards and told to come into the weightroom when their schedule permits. Winter in the weightroom is an opportunity for our athletes to reacquaint themselves with key lower-body lifts. Working through some degree of glute, hamstring, and quad soreness is unavoidable with the reintroduction of our staple strength work, such as squats, Romanian deadlifts, and lunge movements. Volume is moderate and the loads are fairly light, with intensity increasing only toward the end of January as spring classes begin. Since the winter is a less structured time of year and the players have spent several weeks away from the sport after their season, they are usually anxious to start playing soccer together again. Accordingly, they reserve time in our indoor facility three or four nights per week during the winter. The coaches and I are never there, but we encourage this activity and take it as a great sign of our players’ commitment to and love of the game and the team. From what I am told, the games are quite intense—the players only have one speed, and that’s game speed. Besides the recreational and team cohesion benefits of these pick-up sessions, they also help return the athletes to the conditioned state they’ll need for the upcoming spring. Playing increases their substrate storage capabilities and sportspecific endurance, and because soccer requires both prolonged low-intensity movement and intermittent intense bursts, it provides an ideal blend of aerobic and anaerobic conditioning. Plus, with all the starting, stopping, accelerating, and other required movements, the players’ adductors, knees, ankles, and core remain engaged and “practice ready” throughout the winter period. TR AINING-CONDITIONING.COM

sport specific SPRING FORWARD The NCAA limits teams to five competition dates during the spring semester. With so little focus on competitive soccer, it’s an ideal time for some of our most intense, multi-faceted training of the year based on progressive overload principles. Our spring program leads off with a hypertrophy phase, which typically lasts until roughly one week before the start of full spring practices. At that point, when overall physical demand increases for the players, we shift to a strength and power phase. The transition normally occurs a week before the start of full spring practices, but it varies depending on our meetings with the coaching staff and evaluation of the team’s strength needs. One of our top priorities in the spring semester is lower-body development, which is obviously paramount in soccer. To balance that with our broader objective of never interfering with the players’ readiness for team practices, we follow a carefully planned schedule to avoid overtaxing their legs. In a typical week, we have three lift-

ing sessions: Tuesday is full-body lifting with high intensity but limited volume; Thursday involves upper-body lifts combined with lower-body explosive movements; and Friday evenings feature heavy lower-body training. Each Tuesday and Thursday session begins with a plyometric warmup consisting of: • Skate jumps (4 x 16) • Skips for height (4 x 20 yards)

and a prehab exercise. This is followed by a squat movement supersetted with a major upper-body movement (usually the incline press) and two to four sets of prehab or core exercises to allow for recovery between squat sets. Loads vary in relation to exercise difficulty—for example, pause squats may be conducted at 55 percent of one-rep max for eight reps, while regular squats may be at 72 per-

Our spring program leads off with a hypertrophy phase, which typically lasts until roughly one week before the start of full spring practices. At that point, when overall physical demand increases for the players, we shift to a strength and power phase. • Lateral single-leg hurdle hops (2 x 12 each leg) • Front/back single-leg hurdle hops (2 x 12 each leg) • Push-ups, sit-ups, and other calisthenics between the plyo sets. After warmup, Tuesday workouts begin with an Olympic-style lift supersetted with an upper-back movement

Circle No. 145

cent. After the primary upper-body and lower-body exercises, we perform three sets of a barbell lunge (forward, reverse, lateral, or a combination) supersetted with a dumbbell pressing movement and more prehab. Tuesday’s workouts are the most taxing due to the quick pace we maintain in the weightroom, but the actual vol-

sport specific ume of upper- and lower-body work is not overly fatiguing. There is no time to sit and rest, but the interspersed prehab supersets allow for adequate recovery. For Thursday’s workouts, we typically incorporate an Olympic movement such as the hang snatch, five sets on the bench press, and a dumbbell pressing movement, again with intermittent prehab and stretching work such as partner hip stretches, side lunges, and ladder work using ankle bands. Like on Tuesdays, the complete workout takes less than 50 minutes. Friday’s workouts are the longest of the week in spring, often lasting around an hour and 10 minutes. They usually include five sets of squats, a single-leg strength movement, and three to four sets of RDLs combined with hamstring prehab and flexibility exercises. We expect the players to be sore after Friday’s sessions, but they don’t practice or lift again until Monday morning, so there is no interference with soccer development. Tuesday’s and Thursday’s workouts are always conducted prior to practice, a schedule we prefer for two main reasons. First, it allows the players to perform weightroom work while completely fresh, so I know that any technique flaws or weaknesses I observe are not simply the result of an especially fatiguing team practice. That helps me to quickly identify and address any problems on an individual basis. Second, because the players practice right after lifting, active recovery is built into their routine, which is one of the best ways to limit next-day soreness. For Coach Cirovski and his staff, our schedule means they get players with fresh legs on Monday, only slight fatigue on Tuesday, possible minor residual soreness on Wednesday, and fresh legs on Thursday and Friday mornings. It’s a schedule that has served us well over the years, so we maintain it until the end of the semester when the players go through a spring testing battery that includes shuttle running, sprints, vertical jumps, bench pressing, and squats. SUMMER SCHEDULE Most players stay in town over the summer while taking classes or completing an internship. They come in for strength training when possible, and we try our best to schedule times when the entire group can work out together. We spend very little time on sport-specific fitness through the first half of the summer. The exception is on Fridays, when we often integrate a high-tempo soccer-like agility training session that lasts 20 to 25 minutes, typically incorporating fartlek and standard agility work. Some strength coaches may question the generalized fitness regimen we follow in summer, but we have seen consistent success with this approach, especially when combined with competitive timed runs on the track and anaerobic shuttle drills. Fitness level determines a player’s capacity for concentration and crisp play in the late stages of a game, so besides all the physical benefits, being in great overall shapes gives our athletes an important confidence boost and mental edge. My goals during this phase are continued athletic development, substrate storage, and team building. Near the conclusion of the summer training cycle, workouts become more game-specific and lifting gets more intense. We usually build in an offload week in mid-July to coincide with final exams for the summer academic session. PRESEASON & SEASON In early August, as we transition to the preseason period, we perform extensive testing. We use a version of the Yo-Yo Intermittent

Circle No. 146

TR AINING-CONDITIONING.COM

sport specific Recovery Test, which involves a series of 40-meter runs (20 meter out-and-back shuttles) performed with 10 seconds of recovery between reps. We also time each player individually in 3 x 300-yard shuttles with 50-yard increments and two minutes’ rest between runs. In addition, we measure vertical jump to assess lowerbody power and one-rep max in the bench press for upper-body strength. Coach Cirovski makes clear to everyone that playing time isn’t determined by the test results. But having conducted the same tests with only a few alterations for the past 15 years, the data is valuable for tracking player development and comparing progress from one season to the next. We use it to show players tangible evidence of their hard work paying off, to identify individual training needs, and to compare our current roster with past players who excelled at the college level and moved on to national or professional teams. One other note on testing: We do not test squat max in the preseason. I assign in-season squat maxes based on summer lifting performance instead, because the injury risk and muscle soreness associated with a squat max test at this time is too great. Preseason serves as our transition period from off-season lifting (aimed primarily at strength gains) to in-season lifting (focused on strength maintenance). The loads are very light—for instance, players may squat 2 x 8 with 135 pounds and perform RDLs with 88 pounds—and lifting is completed right before practice along with prehab exercises, including flexibility work and foam rolling. Once the season begins, lifting sessions are shortened to a maximum of roughly 20 minutes, still performed immediately before team practices. We cover the bare minimums—workouts normally start with weighted jumps, various squats and lunges, and an Olympic lift. As the season progresses, we phase out the squats and lunges for players who log 60 or more minutes per game and replace them with prehab assignments to reduce physical stress during the long soccer season. All players perform RDLs twice a week throughout the season—one day with moderate weight (110 to 132 pounds) and the other day with light weight (88 pounds) and with both feet on Dyna Disks to add a proprioceptive component. The RDLs are supersetted with hamstring stretches and rolls, and we alTR AINING-CONDITIONING.COM

ways perform iliotibial (IT) band rolls at some point in the lifting sessions—this was recommended by our team physical therapist, who noticed tight hamstrings and IT bands on many players visiting her for rehab after injury. Prehab circuits during the season are customized for players as needed, and typically include two or three exercises for each body part that is most at risk for injury. This usually means flexibility, strength, or foam rolling work targeting the adductors, hamstrings, core, ankles, and knees. Many of the exer-

cises integrate a proprioceptive component, and almost all are performed on one leg at a time to eliminate the risk for bilateral compensation. Our year-round strength and conditioning program builds in enough variety and customization to keep the players engaged and motivated all year long. We hope that a continued commitment from the players will result in continued team success, and that those with the talent to reach the pro level will leave here with the tools necessary to make it happen. n

Our award-winning product line features more than 2,000 products. Go to power-systems.com today or call 1.800.321.6975 to request a FREE 2010 Catalog from our friendly team of customer service representatives. Circle No. 147 T&C JULY/AUGUST 2010

Introducing Published by Training & Conditioning!

Performance Nutrition For Football

The Nutrition Edge

By Lisa Dorfman, M.S., R.D., C.S.S.D.

A compilation of the best sports nutrition articles from Training & Conditioning magazine.

The book provides athletic trainers, strength & conditioning professionals, coaches and football players with cutting-edge information on how to gain a competitive edge in this demanding sport. It follows the annual football calendar and offers nutrition strategies for each of these stages. There are tips on such topics as food timing, gaining weight, and how to assess supplements. Author Lisa Dorfman is Sports Nutritionist for the University of Miami Athletic Department and Director of Sports Nutrition & Performance in the Department of Sports Medicine at the University of Miami. She combines her two decades of work in the field (and experience writing two other books) into a comprehensive, easy-tofollow strategy for football players at all levels. 268 pages Price: $18.95

Item Number: 111001

Edited by Susan Kundrat, M.S., R.D., C.S.S.D., L.D.N.

Susan Kundrat, Sports Dietitian for University of Illinois Athletics and President of Nutrition on the Move, Inc., has selected and improved the content from T&C articles to produce a book that is full of valuable information on sports nutrition. Chapters include tips and advice on recovery nutrition, nutrient timing, pregame meals, losing weight, caffeine, and hydration. The Nutrition Edge also includes case studies and a look at specific situations, such as celiac disease and vegetarian athletes. Whether you are a loyal reader of Training & Conditioning, an athlete, a parent, or a sport coach, this book will give you the edge you need on the topic of sports nutrition. 180 pages

Price: $16.95

Item Number: 111002

To view more books/DVDs, go to the new training-conditioning.com

To buy these new releases—and more than a hundred other related books and DVDs—go to: www.training-conditioning.com and click on the “Books & DVDs” section in the menu bar. Buy online for easy ordering & fast delivery or complete the form below. ORDER FORM

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Performance Nutrition For Football T&C’s The Nutrition Edge

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PRICE

Website Directory

www.activeankle.com Rigid & Lace-Up Ankle Supports

www.allproscience.com Supplements for the Health-Conscious

www.aaesports.com Outdoor Athletic Equipment

• Injury treatment videos • Injury prevention tips • Fitting instructions

Learn about the company’s complete line of health-conscious protein and recovery drinks, including information on flavors and nutrition facts. • Products • Testimonials • Advice from professional athletes

There’s a “Quote Tote” feature for wish list submissions, along with downloadable product drawings, CSI specs, and assembly instructions. • Product descriptions, drawings, video clips, and pricing • Special Values section highlighting monthly discounts • Customer testimonials

See ad on page 7

See ad on page 19

At the new “Community of Sport” section of the site, athletes, coaches, and athletic trainers can share information and ask questions.

www.athleticrecordboards.com Athletic Record Boards Download the company’s printer program and you can print your own records. • Samples and images of boards for various sports • Pricing information • Technical information

www.pilates.com Pilates Equipment & Education Download a variety of podcasts that cover everything from specific exercises to equipment “how-to” instructions. • Product and service info/pricing • Podcasts and DVD video clips • Customer and client success stories

See ad on page 20

www.calu.edu/go Online Graduate/Undergraduate Degree Programs See descriptions of online programs, the online application process, a virtual tour of Global Online, and information about California University of PA. • “Test drive” virtual tour • Online application process • Tuition calculator See ad on page 12

www.ceraproductsinc.com CeraSport Rice-Based Hydration Drinks CeraSport prevents and corrects dehydration, providing energy, electrolytes, and hydration. It is glutenfree and has no added sugar, so it prevents cramping and nausea. • Product specifications • Pricing and company background • Customer testimonials See ad on page 39 56

T&C july/August 2010

www.cho-pat.com Sports Medicine Products Learn about each Cho-Pat product, including a detailed description, sizing information, an image, and possible medical issues each product addresses. • Company background • Customer/user testimonials • Catalog and contact information

www.athletixproducts.com Facility Cleaning & Maintenance Products Get information on all the company’s products for cleaning, disinfecting, and maintaining your facility. • Product information • News and articles • Sample requests

See ad on page 2 TR AINING-CONDITIONING.COM

Website Directory

www.cramersportsmed.com Sports Medicine Products

www.cytosport.com Sports Nutrition Products

Check out the downloadable catalog and virtual tours of products. • Product catalog • Bid builder • Athletic trainer forum

Receive updates on CytoSport’s latest product offerings and learn about the full line of Muscle Milk and Cytomax items. • Product information • Company news • Subscription for updates

See ad on page 33

See ad on back cover

www.eggwhitesint.com 100-Percent Pure Liquid Egg Whites

www.hybresis.com The Hybresis™ Iontophoresis System

Get health facts and even recipes involving liquid egg whites. • Customer testimonials • Frequently asked questions • Online store

Get extensive information about this innovative system. • Customer testimonials • Product specs • Product demo

See ad on page 21

See ad on inside front cover

www.trxtraining.com A Body Weight Training Solution Experience how the TRX can improve athletes’ performance and durability with minimal investment. • Testimonials from professional coaches and athletes • Training DVDs, programs, and guides • Videos of the latest TRX training tips

TR AINING-CONDITIONING.COM

www.dynatronics.com Medical Devices, Equipment, & Supplies Dynatronics’ new e-commerce site provides quick, accurate online ordering of the company’s full line of medical devices, equipment, and supplies. • Online catalog • Online ordering • Access to your account information See ad on inside back cover

www.fernoperformancepools.com Pools, Underwater Treadmills, & Whirlpools Check out downloadable spec sheets and the whirlpool tank selector tool. • Product descriptions and specs • Customer testimonials • Reimbursement codes

See ad on page 25

www.fyrstusa.com Sport Medical Kits & Supplies

www.gatorade.com Sports Performance Innovation

Learn about skin wipes to kill MRSA and the flu virus, blood removal for uniforms, and a cold pack holder. • Sports medical kits • Cold packs • Sports medical kit refill packs

The site features Gatorade’s line of sports innovation products as well as its athletes and programs. • Sports performance innovation • Gatorade’s world-class athletes • Gatorade Sports Science Institute (GSSI)

See ad on page 38

See ad on page 5 T&C july/august 2010

Website Directory

www.everwhiteboards.com Custom-Printed Dry Erase Boards Request a catalog and printed whiteboard examples to jump-start your own printed whiteboard idea. • Product descriptions • Catalog request • Order information

www.healthy-shot.com Fruit-Flavored High-Protein Beverage The site provides a wealth of information on Healthy Shot high-protein drinks, including a portal for ordering Healthy Shot online. Enjoy great prices and free shipping. • Nutrition information and facts • Product information • Shopping cart and online ordering

www.hqinc.net Core Body Temperature Monitoring Systems See a product demo of the CorTemp® ingestible temperature pill, along with validation of its use versus other methods of external temperature monitoring. • Customer testimonials • Product catalog • Product specs/applications

See ad on page 18

www.humankinetics.com. Information Leader in Physical Activity

www.hydroworx.com Aquatic Therapy Pools

The company provides accurate and useful books, online courses, and DVDs to help customers practice their profession better and live healthier lives. • Online certification courses: print and e-books • Author interviews, excerpts, and DVD clips • Newsletter sign-ups

Learn about how to keep your athletes safe and hydrated. • Pricing • FAQs • Product specs

The instructional video library is an online compendium of case studies that allows clinicians to view relevant rehabilitation and exercise protocols. • X80 underwater treadmill product information • Therapy and fitness pool product information • Over 900 free video case studies

See ad on page 46

See ad on page 34

See ad on page 48

www.infinityflooring.com Rubber Flooring for Weightrooms Check out the Flash slideshow of weightroom installations. • Photo gallery • Product specifications with custom color and logo options • Catalog and pricing requests

www.hydrate1.com Team Hydration Systems

T&C july/August 2010

www.kinesiotaping.com Kinesio® Taping Method & Tape Gain access to the Kinesio Taping Association membership database as well as a full KTA seminar schedule. • Products and product information • Access to Kinesio Taping database • Kinesio Taping seminar schedule

www.eliteseat.com Portable Knee Extension Device Download prescription and certification of medical needs forms and view practitioner pages. • Product information • Instructions • FAQs

TR AINING-CONDITIONING.COM

Website Directory

www.legendfitness.com World-Class Strength Equipment

www.medspec.com ASO® and EVO® Ankle Stabilizers

www.medicalbags.com Professional Medical Bags

The first-ever fully featured cage configurator allows you to customize the cage of your dreams. • Design your own weightroom • Legend University articles and training advice • Clientele showcase

View product information on the ASO and EVO ankle stabilizers. • Online purchasing • Information request • Trade show schedule

MedPac Bags is continuously evolving to meet your needs and stay on the cutting edge of design and quality. • Product specs • Catalog • Pricing

See ad on page 26

See ad on page 43

See ad on page 20

www.performbetter.com Functional Training & Rehabilitation Equipment

www.port-a-cool.com Portable Evaporative Cooling Units

Look through the online interactive catalog with pricing. • Monthly specials • Schedule of Perform Better seminars • 24/7 online ordering capability

The site includes literature downloads in PDF format containing product information, owner’s manuals, warranties, and more. • Product specs, descriptions, and comparisons • Company information • Information on heat stress and evaporative cooling See ad on page 32

See ad on pages 27 and 67

www.hibiclens.com Antimicrobial, Antiseptic Skin Cleanser

www.muellersportsmed.com Braces, Supports, Tape, & Taping Supplies

View product information, a Q&A about MRSA and staph infections, upto-date information on prevention, and free educational resources. • Customer testimonials • Product line-up • Free educational support materials

See taping technique video demonstrations, full-color photographs, and descriptions of Mueller products. • Product descriptions and information • Downloadable product catalog • Taping techniques and training video

www.milkdelivers.org Refueling with Chocolate Milk Get free educational resources about the science of chocolate milk and recovery, plus the new “Spotlight On” program for coaches and athletic directors. • Tips and tools for refueling with chocolate milk • Research on chocolate milk and recovery • Spotlight On: share your success story See ad on page 17

www.NASM.org/tc Enhancement & Corrective Exercise Specialization Get an in-depth look into sports performance and injury prevention training. • Product specs • Company background • Information request form

See ad on page 3 TR AINING-CONDITIONING.COM

T&C july/august 2010

Website Directory

www.newyorkbarbells.com Strength Training & Weight Equipment Learn about showroom hours and services, and take advantage of equipment closeout deals. • Product information • Customer testimonials • Order form

See ad on page 22

www.nzmfg.com Resistive Exercise Equipment Search the company’s products by the sport you play. • Catalog request • Search products by sport • Testimonials

www.zamst.com Injury Prevention Products & Education Zamst provides consumers with detailed information about injury prevention, along with features and benefits of key products to meet their needs. • Detailed product specifications and sizing • Video footage and tutorials • Sales representative locator and dealer information See ad on page 40

www.optp.com Rehab & Fitness Products & Books Access extensive product information, including demo videos and book reviews. • Customer reviews • Monthly newsletters • Catalog request page

See ad on page 24

www.thera-band.com Thera-Band Progressive Resistance Products Access the Thera-Band Academy’s scientific research database. • Product specifications • “Where-to-buy” product locator • Company news and upcoming events

See ad on page 6 60

T&C july/August 2010

www.whatsmyfoottype.com Orthotic System Customized to Foot Type See a detailed online biomechanical tutorial by foot type and view typespecific video gait clips. • Product specs and ordering information • Educational information • Customer testimonials See ad on 39

www.biofreeze.com Biofreeze Pain-Relieving Products Take advantage of a “where-to-buy” product locator. • Product specifications • Educational resources • Customer testimonials and FAQs

See ad on page 6

www.power-lift.com Heavy-Duty Strength-Training Equipment One of the biggest features on Power Lift’s site is the client list, which includes facility photos. • Customer testimonials • Downloadable brochures • Facility photos

www.power-systems.com Exercise, Fitness, & Sports Training Equipment Learn about over 2,000 products in health, exercise, fitness, and sports training categories with excellent customer service and support. • Quantity discounts • Catalog requests • Customer testimonials See ad on page 53 TR AINING-CONDITIONING.COM

Website Directory

www.proorthopedic.com Sports Medicine Supports & Bracing

www.injurybegone.com Sports Medicine Braces, Supports, & More

PRO’s e-shop is very clear and easy to use, without the clutter that makes many other sites difficult to navigate. • Pricing and color images for all available products • Company origin and background information • Convenient login for return customers

View the company’s complete line of braces, hot/cold products, and massage therapy products. • Detailed product descriptions & images • Comprehensive injury & treatment info • Best medical distributors links

See ad on page 52

See ad on page 13

www.proteamtables.com Taping Stations & Athletic Taping Equipment The online map of installations shows facilities owning PROTEAM by Hausmann products. • Product specs • Photo gallery • Map of installations

$WKOHWLFV

www.samsonequipment.com Weight Training & Athletic Training Equipment

www.save-a-tooth.com Save-A-Tooth Emergency Tooth Preservation

There is an impressive gallery of product pictures and weightroom completion examples. • Company background and history • Pictures of completed weightrooms • Product images

Learn all about protecting and preserving knocked-out teeth. • Ordering page • List of distributors • Product information and customer testimonials

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See ad on page 24

www.swedeo.com Ankle Braces & Supports The injuries/ailments section helps you determine exactly which product is needed. • Full product listings and specifications • Company background and history of developing innovative products • Complete sizing information on all products

www.stromgren.com Athletic Supports, Apparel, & Equipment Get detailed product information, links to moisture-management apparel, and much more. • Product specs • Sizing info • Catalog request

www.swimex.com Resistance Pools for Exercise, Conditioning, & Rehabilitation

www.pressurepositive.com Practical Deep Muscle Massage Tools

View the SwimEx workstation pool videos and challenge your clients with workstations for stretching, therapy, seated exercise, and closed-chair activities. • Customer testimonials • Blog for news and SwimEx updates • Request a PT brochure

The testimonials tell you more about the company’s massage tools than any product description in a shopping cart. • Customer testimonials • Free catalog request • Buy direct from the manufacturer

See ad on page 11 TR AINING-CONDITIONING.COM

T&C july/august 2010

Website Directory

www.therightstuff-USA.com Hydration for Serious Athletes Not just another sports drink, this NASA-patented formula is for before, during, and after activity. It has been scientifically proven to fight dehydration better than any other formula tested. • Product information • Customer/athlete testimonials • Online store

www.fatbars.com Weight Equipment & Accessories The company’s complete product line is available on its Web site. • Catalog requests • Product features • “How to” videos

See ad on page 35

www.aqualitywater.com Misting Fans & Personal Cooling Devices Enjoy fast and easy online ordering for misting fans, ventilation fans, evaporative coolers, personal cooling devices, and infrared heaters. • Product pictures and specifications • Product pricing See ad on page 34

www.everythingtrackandfield.com Everything Track & Field Check out the online interactive catalog with pricing. • Sales and closeout specials • Track and field camps and clinics • 24/7 online ordering capability

T&C july/August 2010

www.whitehallmfg.com Medical Equipment You have the ability to choose between therapy and hospital products at the home page. • Product specs • Catalog requests • Downloadable literature

See ad on page 42

Coldtub www.coldtub.com Aquatic Therapy Pools Get financing information and details on sonic waves and cryotherapy. • Pool specs • Customer testimonials • Product photo gallery

See ad on page 12

www.mcdavidusa.com Protective Performance Apparel & Sports Medicine Products Site includes: • Product/technology descriptions and pricing • McDavid in the news • Discussion forums • Company history Special features: • Online store • 360-degree views of featured products

www.versaclimber.com Strength Training & Rehabilitation Equipment The company is dedicated to creating, developing, and providing products and services that benefit and improve health, fitness, conditioning, and rehabilitation. • Company news and blog • VersaClimber Hall of Fame • Product specs and images See ad on page 28

www.lifefitness.com Hammer Strength Plate-Loaded Equipment Site includes: • Specifications for all products • Facility showcases & printable brochures • Retail information, including articles and press releases • Training & education information Special features: • Facility layouts • Athletic facility showcases TR AINING-CONDITIONING.COM

Product Launch

Excel

Impact Athletic Equipment

Active Ankle Systems, Inc. www.activeankle.com 800-800-2896 Circle No. 500

Unique features:

• Circumferential strap helps stabilize the brace • Lacing system tightens all the way around for a better conforming and more comfortable fit • Neoprene lined for maximum comfort and fit • Nylon eyelets reduce pressure points

Impact Athletic www.impact-athletic.com 877-277-0896 Circle No. 501

Benefits for the user:

Unique features:

• For athletes who want the best of both worlds: the comfort and mobility of a lace-up with the support and security of a “tape job”

• Industry-leading load capacities • Standard, premium, and custom colors • Customized with your logo or mascot

Woodway Aquatic Treadmill

• Slat-belt surface is

smoother and more comfortable to run on • Fits into most SwimEx pool models • No belt tracking issues • Lasts 10 times longer than conventional belt treadmills

Benefits for the user:

• Proven to be better on joints and connective tissue • Provides unlimited protocol possibilities for conditioning/rehab needs

TR AINING-CONDITIONING.COM

• Unmatched performance and durability • Designed specifically for athletic trainers and team physicians • A full line of gamechanging products

Healthy Shot® Hormel Health Labs www.healthy-shot.com 800-866-7757 Circle No. 502

SwimEx, Inc. www.swimex.com 800-877-7946 Circle No. 560

Unique features:

Benefits for the user:

Unique features:

• Ready-to-drink so there’s no mess • Concentrated formula: just 2.5 fluid ounces • Your choice of 12 grams or 24 grams of protein • 100 percent of all essential amino acids, no fat, and just 100 calories

Benefits for the user:

• Clear, clean, refreshing fruit flavors: tropical and peach • Shelf-stable • Lactose and gluten free

T&C july/august 2010

PRODUCT DEBUT Didn’t make it to all the booths at the NATA show? Couldn’t attend the show this year? We’re pleased to provide information on products that made their debut at the convention. Aqualtic Therapy HydroWorx www.hydroworx.com 800-753-9633

The X80 portable underwater treadmill includes a powerful resistance jet with massage capabilities, adjustable water depths, and an underwater camera.

Athletic Equip & Apparel XPROTEX www.xprotex.com 661-705-8000

A full line of protective batting gloves that can reduce the impact of a 100 mph pitched ball by 60 percent, effectively lowering the impact to 40 mph.

Braces & Supports Active Ankle Systems Inc. www.activeankle.com 800-800-2896

Everyone was excited to see the Excel lace-up brace at NATA because of its conforming and more comfortable fit.

ZAMST www.zamst.com 877-926-7887

ZAMST’s IW-2 Icing Set provides complete coverage of the shoulder, waist/back, and joints. It’s machine washable and includes two large ice bags.

Educational Materials Human Kinetics www.humankinetics.com 800-747-4457

“Effective Functional Progressions in Sport Rehabilitation” helps clinicians understand the important concepts of functional progressions and equips them to develop programs specifically for their clients.

T&C july/August 2010

Nutrition All-Pro Science www.allproscience.com 949-222-1009

APS Recovery with grass-fed whey was favored by athletic trainers, who agreed it was a great-tasting protein shake.

Muscle Milk www.musclemilk.com 888-298-6629

Muscle Milk Light Ready-to-Drink is now available in an all-new Café Latte flavor. It’s sugar-free, gluten-free, lactose-free, and infused with caffeine.

The UCAN Co. www.ucanco.com 230-397-8226

Generation UCAN products sustain energy balance, do not spike glucose or insulin, and force the mobilization of fat for fuel.

Top Form, Inc. www.topform.us 518-477-2700

Medifast Nutritional Plan — a doctor prescribed nutritional program. Body Shaper Vibration Plate — vibration therapy platform with the best price in the industry. ATC’s felt both would be great additions to their facility/school.

Rehab Equipment Mettler Electronics Corp. www.mettlerelectronics.com 800-854-9305

Athletic trainers demonstrated the new G5® Plus™ machine in the Mettler booth and drew crowds of enthusiastic spectators.

Strength Training/Rehab Fitness Anywhere-TRX www.fitnessanywhere.com 888-878-5348

Leading practitioners are finding success with the TRX Suspension Trainer. It delivers a safe and effective functional training solution that’s portable and affordable.

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

Pro-Tec Athletics’ high-density foam rollers in various sizes are great for stretching, promoting flexibility, and myofascial release. Each includes an exercise program.

Standing Firm www.standingfirm.com 724-946-2051

Standing Firm is a total sports medicine solution. This product improves the functional potential of the hips through closed-chain rotation.

Training Rooms Bailey Manufacturing Co. www.baileymfg.com 800-321-8372

The Bailey Custom Dual Whirlpool Table is built to facility’s needs, as are all of the company’s custom products.

Benchmade www.benchmade.com 800-800-7427

“I can’t believe I’ve been able to do my job without this tool.” And, “this will change my life.” Just two of the many quotes heard at the show about Benchmade Safety Cutters.

BioTech Medical, LLC www.spectrasan.com 800-284-9857

Keeping athletes healthy and in the game, SpectraSan 24 disinfectant is EPA-registered, kills germs 20 times faster, and lasts for 24 hours.

CeloxSales.com www.celoxsales.com 716-834-1096

Celox stops bleeding in 30 seconds. Athletic Trainers can get their athletes back in the game with Celox.

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

The Cramer Emergency Kit was praised for its modular design that allows for the separation and organization of supplies.

TR AINING-CONDITIONING.COM

Helio Medical Supplies, Inc. www.heliomed.com 800-672-2726

Helio offers medical supplies, including quality kinesiology tapes and accessories.

Health Enterprises, Inc. www.healthenterprises.com 508-695-0727

Instant Reusable Cold Pack is the only reusable cold pack that offers instant cold therapy and effective pain relief. The gel remains flexible and comfortable after being frozen.

PediFix www.pedifix.com 800-424-5561

PediFix Foot Treatment Kits offer GelSmart, ankle sleeves with ViscoGEL protection, GelStep heel cups, and Sore Spot skin and blister bandages.

MedPac, Inc. www.medicalbags.com 800-414-9031

MedPac’s SlingPac 1 and SlingPac 2 are styled to wear comfortably as a sling. They have a spacious main compartment, grab-and-go pocket, and detachable rain cover.

Treatment Options/Hyland’s www.txoptions.com 800-234-8879

Hyland’s Muscle Therapy Gel with Arnica provides quick relief of muscle pain and bruising without side effects, drug interactions, or contraindications.

Wonder Warmers www.wonderwarmers.com 646-602-9289

ing muscles, and soothing aches and pains on and off the field.

Whitehall Manufacturing, Inc. www.whitehallmfg.com (800) 782-7706

The Little Freeze is just the tip of the iceberg. This unit comes standard with specially designed shelves that facilitate the easy removal of the four included glacier packs. It performs the same big chill as the Glacier Freeze in one small, economical unit.

Z Blok, LLC www.zbloksun.com 401-241-5648

Z Blok sun block solves the problem of burning eyes so athletes can stay focused on performing at their best.

Wonder Warmers instantly-activated reusable (100+ times) heating pads are perfect for keeping warm, relax-

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. 148 TR AINING-CONDITIONING.COM

T&C july/august 2010

Heat Stress Prevention Stay Cool

Aquality’s misting fans, ventilation fans, and personal and evaporative cooling units are designed to cool athletes on the sidelines, in locker rooms, at practice, and on the field to create a safer and more comfortable environment. With median temperatures rising every year, keeping athletes cool is more important than ever. Evaporative cooling and misting systems can create a space that’s typically 15 to 35 degrees cooler than the ambient air. It can protect your athletes from dangerous heat stress, protect your program from liability, and help keep athletes performing at their best in any climate.

Aquality Water Systems, Inc. • 210-493-4545 www.aqualitywater.com

In the beginning, there was just hydrogen and oxygen. Later, electrolytes and sugar joined the mix, then even a dash of vitamins. Now comes Muscle Milk Protein H 2O. Naturally colored, delicious, and completely sugar-, lactose-, and gluten-free, it does what water was always intended to do: rehydrate, replenish, and refresh. Muscle Milk Protein H 2O is fortified with 10 grams of ultra-pure whey protein isolate and a full spectrum of electrolytes, making it ideal for post-workout recovery or any time during the day as a refreshing, hydrating protein source. Muscle Milk • 888-298-6629 www.musclemilk.com

The Name Says It All

CeraSport ® and CeraSport EX1 ricebased hydration and performance drinks, developed along with doctors from Johns Hopkins, feature a patented blend of brown-rice and essential electrolytes, including citrate to counteract acidosis. CeraSport is fat-free and certified gluten-free. It provides energy for performance and quick yet sustained hydration. Available in powder, concentrate, and ready-todrink in several flavors, CeraSport can be delivered to your home or office. CeraSport • 1-866-237-2770 www.cerasport.com

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Potable and Portable

Cramer Products offers three types of portable hydration units to help hydrate athletes. Cramer’s newest unit, the Powerflo 50, offers an impressive 50 gallons of portable hydration. Cramer’s hydration units are constructed of 100-percent water-portable and FDA-approved materials for drinking water.

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

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Sports Performance Hydration

The Right Stuff is not just another sports drink—it is serious hydration for serious athletes. This NASA-patented electrolyte liquid drink additive is for performance athletes before, during, and after exertion. It’s scientifically proven to increase athletic endurance and fight dehydration symptoms, such as muscle fatigue, headaches, and cramps, better than any other formula tested. Go online to read what athletes, coaches, and athletic trainers are saying about how it helps with training. The Right Stuff • 720-684-6584 www.therightstuff-usa.com

Waterboy Sports is not just a single hydration product, but an extensive product line designed to fit various price ranges and meet the specific needs of the athletic training community. Visit the company online to see its complete product line. All Waterboy Sports products are designed to accommodate both the athlete and the athletic trainer. Each product is built to withstand the punishment of constant use and any abuse an angry athlete can dish out. Waterboy Sports, Inc. • 888-442-6269 www.waterboysports.com

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Specialized Hydration

G Series Pro Endurance Formula delivers almost twice the sodium and more than three times the potassium of Gatorade Thirst Quencher ® to replace critical electrolytes lost in sweat and help maintain proper fluid balance. G Series Pro Gatorlytes is an electrolyte mix specially formulated for cramp-prone athletes and designed for use with G Series products.

Gatorade • 800-884-2867 www.gatorade.com

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Hydration Solutions

Trusted, scientifically proven Gatorade Perform 02™ Gatorade Thirst Quencher ®, from the G Series, helps athletes replace fluids, replenish electrolytes, and refuel working muscles during activity. Gatorade Perform 02™ G2® is a low-calorie thirst quencher that delivers functional hydration for active people during exercise, but with less than half the calories (and carbohydrates to fuel working muscles) of Gatorade Thirst Quencher ®.

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Sustained Hydration

Real Progress

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Heat Stress Prevention Water Wherever Needed

environments, and the 42-gallon water capacity and easyaccess filling allow the three-speed unit to provide cool air for up to eight hours without refilling.

The Hydrate cart is well known for performance and reliability. Its warranty is unmatched in the industry, and the machines are very easily transported. If you want a machine that will last and equipment that you can count on, trust Hydrate for your hydration system needs. Go online for more information. Hydrate, LLC • 407-694-1034 www.hydrate1.com

Port-A-Cool • 936-598-5651 www.port-a-cool.com

A Better Water Carrier

Every athlete needs water, and the Aqualift portable drinking system delivers—for children on the playing field and professionals in the NFL alike. Aqualift is one of the finest hydration systems on the market, and is made with only top-quality materials. It continues to be the hydration unit of choice for many pro, college, and high school athletic teams worldwide. Each 10-gallon Aqualift includes four drinking hoses (with stacking capabilities), plus a battery with a charger.

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Cool Anywhere

The Port-A-Cool Vertical Tank portable evaporative cooling unit has easy-roll casters for quick spot cooling anywhere traditional air conditioning is ineffective or cost prohibitive. The unit lowers temperature as much as 15 to 25 degrees Fahrenheit using just tap water and 115 volts of electricity. The Vertical Tank model is rust- and leak-proof, making it ideal for harsh

Contact JDI Sports at 1-912-384-8165. Sports Innovations • 912-384-8165 www.sportsltd.com

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with Gray Cook

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performbetter.com/seminars

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5/27/10 2:17 PM

T&C july/august 2010

Aquatic Therapy Swim in Place

Ferno Performance Pools offers an extensive line of therapy, rehabilitation, fitness, and conditioning pools. Choose an in-ground, partially in-ground, or above-ground pool to maximize your athletes’ aquatic experience. Ferno’s leading line of performance pools offers a system to fit in any space, large or small. The optional swim-in-place swim current and underwater treadmill allow athletes to maximize their workouts without the devastating effects of land-based conditioning. Ferno Performance Pools • 888-206-7802 www.fernoperformancepools.com Circle No. 513

No Plumbing Required

The Coldtub cryotherapy spa offers cold water therapy, hot water therapy, and saltwater therapy—all in one. It’s completely portable, so you can provide athletes with state-ofthe-art treatment and pain relief without installing new plumbing or redesigning your entire facility. Users can sit or kneel in the pool, and the purification and sanitization systems keep the water clean while the solid-state cooling system maintains the temperature you want. New deeper seating accommodates taller athletes. Coldtub • 617-480-7683 www.coldtub.com Circle No. 514

Treat More Athletes

The 3500 Series is a 12’ x 16’ therapy pool that comes standard with HydroWorx’s patented underwater treadmill technology and resistance jets. An additional underwater treadmill can be added to the pool footprint. The large interior space allows greater function68

T&C july/August 2010

Testimonial ality for multiple therapy stations or group training and conditioning. With an optional seven-foot deep-water area and up to five powerful jet and massage stations, the 3500 Series is a game-changing piece of equipment.

The Pool Choice of So Many Colleges and Universities

HydroWorx International, Inc. • 800-753-9633 www.hydroworx.com Circle No. 515

Just Your Speed

The Ferno Hydro Track underwater treadmill system is ideal for smaller clinics or training rooms with limited space. The Hydro Track offers a low-impact, high-resistance workout for athletes limited by pain or weightbearing restrictions and those who wish to maximize their cardiovascular workout. It features a variable-speed treadmill ranging from 0.5 to 7.0 mph, dual-speed resistance jets, and a digital display unit that includes speed, distance, and time to monitor performance. Ferno Performance Pools • 888-206-7802 www.fernoperformancepools.com Circle No. 516

The X Factor

Release the potential of your existing aquatic space with the X80 portable underwater treadmill. The X80 series can be lowered into any size pool and can easily be folded, transported, and stored. It comes ready to perform and requires no construction. Features of the X80 include a premium underwater treadmill, powerful resistance jets, massage with adjustable speeds, adjustable water depths (3’6” to 5’6”), and an underwater camera with gait and balance views. HydroWorx International, Inc. • 800-753-9633 www.hydroworx.com Circle No. 517

Get your athletes back in action with one of the best resistance pools on the market. Only SwimEx offers built-in exercise stations, integrated treadmills, pool-wide adjustable current, all-fiberglass construction, varying water depths, and powerful water flow (up to 30,000 gallons of water per minute) all in one pool. Choose from 11 different pool models to meet your needs and the needs of your athletes. Customize your SwimEx with accessories and options, such as an integrated Woodway treadmill, to challenge your athletes’ progression. Here is a list of just some of the programs that have purchased a SwimEx pool:

Arizona State University Arkansas State University Boston University Colorado State University New Mexico State University Oakland University Oregon State University Providence College San Diego State University Southern Methodist University University of Alabama UCLA U.S. Air Force Academy U.S. Naval Academy Western Kentucky University Western Michigan University Wichita State University For the safest and most dynamic workouts, you want the smoothest, deepest, and widest water flow there is. You want SwimEx. SwimEx, Inc. 846 Airport Rd. Fall River, MA 02720 800-877-7946 sales@swimex.com www.swimex.com

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Case Study

How Does Alpha-L-Polylactate™ in Cytomax® Work Faster than Glucose? By Dr. George Brooks

ost cellular energy is generated in an area of the cell called the mitochondria, also referred to as the “powerhouse of the cell.” The mitochondria within cells are where oxygen is utilized (Lehninger). Mitochondria form a vast energy production and distribution network, in which the products of food digestion and enzymatic breakdown are burned (Brooks, Fahey, and Baldwin). The first reason Alpha-L-Polylactate works faster than glucose is that lactate is a more direct fuel source (Azevedo). In order to provide cellular energy, glucose from the blood must move past the cell membrane barrier. This process is not fast, because glucose transport proteins on the muscle cell surface act relatively slowly. Once inside, glucose must be broken down into pyruvate (P) and lactate (L). At rest, the muscles contain 10 times more lactate than pyruvate. During sustained exercise, when oxygen uptake is high, the L/P ratio rises to 100 or greater, indicating that lactate, not pyruvate, is the major fuel for oxidative metabolism. ™

The second reason why lactate is used faster than glucose is that cell membranes contain transport proteins designed by nature to move lactate into and out of cells (Brooks). These fast-working transporters are abundant on the cell membrane surface and efficiently allow energy fuels into the mitochondria. In sum, the lactate in Alpha-L-Polylactate™ in Cytomax ® is a faster fuel in mitochondria than glucose for two reasons: Cellular lactate transport proteins are faster and more abundant, and the processes of converting glucose to pyruvate and lactate are skipped. Cytomax ® Performance Drink is the only sports drink formula that contains patented Alpha-L-Polylactate™. Cytomax ® helps keep strength at peak levels longer so you can train harder. If you are trying to improve

stamina and speed, Cytomax ® will help you exercise longer and train harder. Cytomax ® works for three reasons: 1) It takes advantage of more transport mechanisms to get nutrients to muscles and other tissues that need energy faster. 2) Cytomax ® supplies the essential fluid and electrolytes that the heart and circulatory system require during physical activity. 3) Perhaps most importantly, Cytomax ® contains quality ingredients that are blended to taste great. No matter the scientific basis of any sports drink, it can’t work if people don’t drink it. Ultimately, Cytomax ® works because it tastes great and athletes use it.

Muscle Milk • (888) 298-6629 www.cytosport.com 4795 Industrial Way • Benicia, CA 94510

Dr. George Brooks, a former track and field athlete, was trained in classic human exercise physiology and mitochondrial energetics at the University of Michigan. Dr. Brooks has been on the University of California-Berkeley faculty for 39 years. Originator of the Lactate Shuttle and Crossover Concept and inventor of Alpha-LPolylactate, Brooks is the author or co-author of over 200 peer-reviewed publications and invited scientific reviews and perspectives.

References: Azevedo JL, Tietz E, Two-Feathers T, Paull J, Chapman K. http://www.ncbi.nlm.nih.gov/pubmed/17895968?itool=EntrezSystem2. PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=1”Lactate, fructose and glucose oxidation profiles in sports drinks and the effect on exercise performance. PLoS One. 2(9):e927, 2007. Brooks, G.A. http://www.ncbi.nlm.nih.gov/pubmed/19805739?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_ RVDocSum&ordinalpos=1”Cell-cell and intracellular lactate shuttles. J Physiol. 587:5591-5600, 2009. Brooks, G.A., T.D. Fahey, and K. M. Baldwin. Exercise Physiology: Human Bioenergetics and Its Applications, Fourth Edition, McGrawHill, New York, 2004, Chapters 4-7. Lehninger, A.L. Bioenergetics: The Molecular Basis of Biological Energy Transformations (2nd Edition)” Addison-Wesley (1971).

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Ankle & Foot Care Relief and Protection

The Active Ankle T2 rigid ankle brace provides exceptional ankle protection during exercise or athletic activity. The solid U-shaped design relieves pressure on the ankle and provides superior inversion/ eversion protection. The bilateral anatomical hinge allows freedom of motion in plantar flexion and dorsiflexion. The T2 features a single quick-fit strap that adjusts for high- or low-top shoes and custom-molded EVA padding for a comfortable fit and firm support. Active Ankle Systems, Inc. • 800-800-2896 www.activeankle.com

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Uniform Compression

Cho-Pat’s new Dynamic Ankle Compression Sleeve helps alleviate ankle pain and discomfort. It uses a knitted four-way stretch material to conform to the configuration and apply uniform compression to the ankle. The sleeve also includes two padded inserts that add compression and help stabilize and give more support to the ankle tendons and ligaments. Finally, it promotes circulation and generates warmth to enhance healing. It’s latex- and neoprene-free, available in multiple sizes, and made in the USA. Circle No. 520

The Next Degree of Support

The Aircast A60 ankle brace is a streamlined, lightweight prophylactic support that fits into any athletic shoe. The 60-degree stabilizers and anatomical strapping hold the ankle in appropriate alignment during athletic activities to help prevent inversion and ankle injury, and the product is made with breathable materials for cool comfort. This is just one of the many effective solutions from DJO—delivering clinically proven outcomes through innovation.

DJO • 800-526-8785 www.aircast.com

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Medical Specialties, Inc. • 800-582-4040 www.medspec.com

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The One You Need

Cramer Cohesive Stretch Tape is an innovative choice that beats traditional stretching and self-adhering tape. It has excellent tensile strength, tears clean, and features a non-slip grip, making it superior to many traditional tapes. It’s excellent for use as an anchor for tape applications or compression bandages. It contours easily to the body, allowing you to effortlessly wrap any appendage.

Cho-Pat • 800-221-1601 www.cho-pat.com

The ASO EVO ankle stabilizer is an evolutionary step forward in ankle protection with its unique stirrup strap, stabilizing straps, and dynamic cuff. This new design enables the ASO EVO to comfortably provide exceptional ankle support and stability in the treatment of ankle injuries and to reduce the severity and frequency of future ankle injuries. The ASO EVO is bilateral and fits either the left or right foot.

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Wrap It Right

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

Moving Forward

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Designed to be extremely light and low-profile, The One ankle brace is comfortable to wear in shoes or cleats during competition. Offering all the traditional benefits of taping but with all the adjustable flexibility of a soft strap brace, The One protects against inversion and eversion ankle sprains. Anti-slip criss-crossing side straps can be adjusted while the shoe is on the foot to help prevent slippage and ensure a tight, comfortable fit. Sidepulling stirrup straps imitate the effects of taping while a cushioned, breathable tongue keeps the brace comfortable. Neoprene- and latex-free, The One fits the right or left foot and comes in black and white in sizes XS to XXXL. Mueller Sports Medicine • 800-356-9522 www.muellersportsmed.com

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Wipe-On Relief

The new Biofreeze maximum strength pain-relieving wipe is the latest addition to the company’s product line and the strongest Biofreeze formula available. The wipe’s integrated cooling technology provides maximum strength, yet it’s small enough to fit in a pocket. These single-use disposable wipes are paraben-free, contain more natural extracts, and are available in 24-count packs. Performance Health • 800-321-2135 www.biofreeze.com

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What’s Your Foot Type?

The Rx24 QuadraStep system is based on a clinical algorithm identifying 24 unique foot types. These 24 types are subdivided into six groupings of four, known as Quads. Each Quad has its own specific foot and gait characteristics, contributing to various conditions and pathologies that can afflict a patient throughout their life. Unlike other prefabricated orthoses that have a “one shape fits all” limitation, the RX24 QuadraStep system offers a more tailored solution for each foot type. Nolaro24, LLC • 877-RX24-NOW (792-4669) www.whatsmyfoottype.com

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Ankle & Foot Care Strength and Stability

The Leg Developer isolates the muscles in the front of the lower leg simply by varying resistance with weight plates. Move the plates to the end of the post to increase resistance and toward the feet to decrease it. The comfortable rubber/neoprene handles fit securely over the feet. This product includes two collars for securing weights and uses standard plates only.

Power Systems, Inc. • 800-321-6975 www.power-systems.com

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Surrounded with Support

Designed to fit either the right or left foot, the Arizona PRO 610 ankle support is constructed of heavy-duty nylon to create a lowprofile, durable, and lightweight brace. Two figure-8 lift straps encircle the foot to provide lateral and medial support. Hook-and-loop fasteners allow quick and easy adjustment, even with the shoe on, and a neoprene tongue provides a comfortable pad under the laces, eliminating instep irritation. This product is machine washable for extended life. PRO Orthopedic Devices, Inc. • 800-523-5611 www.proorthopedic.com Circle No. 527

The advanced liquid technology in Pro-Tec Athletics’ LiquiCell Blister Bands protects skin from rubbing and friction to prevent blisters, hot spots, abrasions, and bunions. LiquiCell is a blister that’s created so you don’t have to go through the pain of your body making one. The liquid in a LiquiCell bandage circulates and moves in all directions so your skin doesn’t. With easy and completely safe peel-and-stick application, LiquiCell Blister Bands provide the ultimate skin protection.

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Power Up

The Active Ankle Power Lacer is for athletes who desire added support in a lace-up. The Power Lacer features unique Y-shaped vertical stabilization straps for control of the forefoot and heel, dual spring stays for ankle support, and a neoprene nylon shell for comfort. The unique “pull and play” design allows for easy use by athletes of all ability levels. Call today for more information. Circle No. 531

Step In, Strap Up, and Go

The Aircast AirSport ankle brace incorporates a clinically proven semi-rigid shell and aircells to provide comfort and support. Compression and stabilization are provided by the anterior talofibular cross-strap and integral forefoot and shin wraps. The unique “step in” design and automatic heel adjustment make the AirSport extremely fast and easy to put on. DJO • 800-526-8785 www.aircast.com

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New and Improved

Spenco PolySorb is a line of replacement insoles that feature lightweight contoured polyurethane bonded to a layer of SpenCore material to provide shock absorption and energy return for overall foot comfort. This line includes the Spenco PolySorb Cross Trainer, Walker/Runner, Total Support, and Spenco Earthbound replacement insoles. Spenco is also introducing PolySorb Total Support Sandals, which offer the firm support and comfort of a performance insole in a flip-flop style.

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

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Absorb the Shock

Spenco Medical Corp. • 800-877-3626 www.spenco.com

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

Active Ankle Systems, Inc. • 800-800-2896 www.activeankle.com

Good Bye, Blisters

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

Relief When Needed

The ASO ankle stabilizer features several improvements. Padding over the Achilles tendon has been increased to offer superior comfort. There is no longer a feld seam under the foot, and the invisible seam significantly enhances comfort and durability. The continuous stabilizing straps are now angled to better contour with the anatomy of the ankle. This creates a more uniform tension across the stabilizing straps above the malleolii to provide greater support. Medical Specialties, Inc. • 800-582-4040 www.medspec.com

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