Training & Conditioning 20.6 by Momentummedia

September 2010 Vol. XX, No. 6, $7.00

Strong as Bulldogs A look at Butler's conditioning program

Post-Concussion Management Healthy Weight Gain

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September 2010, Vol. XX, No. 6

contents 12 23

30 Bulletin Board 4 Examining why ACL repairs fail ... Less knee pain with stronger hips? … Drinking milk for weight loss and muscle gain … Accuracy of BMI questioned. Q&A 8 Brian Brewster Portage Health Sports Medicine Institute Sponsored Pages 29 Balanced Body 45 Fitness Anywhere Product News 55 Nutrition Products 57 Lower Body Strengthening 61 Pilates Equipment 61 More Products

46 Books & DVDs 58 Advertisers Directory CEU Quiz 65 For NATA and NSCA Members 68 Next Stop: Web Site On the cover: Butler University’s Shelvin Mack takes a shot during the 2010 NCAA Division I Men’s Basketball Tournament championship game. The Bulldogs’ strength coach offers a glimpse inside the team’s conditioning program in our story beginning on page 49. Photo by Bob Donnan-US PRESSWIRE. TR AINING-CONDITIONING.COM

Nutrition

Weighty Issue 12 AWhen athletes want to gain weight to meet performance goals, they

require careful guidance to avoid packing on pounds of unhealthy fat. By Ingrid Skoog Leadership

For Help 23 Cry An athlete’s mental well-being is just as important as their physical

health. Athletic trainers are in a great position to recognize the signs of anxiety and depression, and to step in if need be. By Dr. Nicki Moore Special Focus

30 In most contact sports, concussion risk comes with the territory. What Happens Next?

After the injury, safe and complete recovery depends on ample rest time—both physical and mental—followed by a gradual return-to-play protocol. By Dr. Steven Broglio Treating the Athlete

37 In more and more athletic training rooms, video game systems are Game Theory

being used for active rehab and injury prevention. This author has found creative ways to make gaming both fun and functional. By Dr. Kirk Brumels Sport Specific

as Bulldogs 49 Strong Make no mistake—Butler didn’t get lucky as the Cinderella team

of the 2010 NCAA Division I Men’s Basketball Tournament. The Bulldogs’ conditioning program was a key element of their run to the championship. By Jim Peal T&C SEPTEMBER 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.

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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

September 2010 Vol. XX, No. 6 Publisher Mark Goldberg Editorial Staff Eleanor Frankel, Director Abigail Funk, Managing Editor R.J. Anderson, Kenny Berkowitz, Patrick Bohn, 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 What Causes Failed ACL Repairs? It is estimated that 400,000 people have ACL reconstruction surgery each year. Of those, 18,000 to 35,000 repairs will eventually fail and require surgical revision—a procedure that tends to be more complicated, less successful, and more challenging to rehab than the initial surgery. While the reasons behind failed repairs vary, Jon Sekiya, MD, Associate Professor of Orthopaedics at the University of Michigan, says improper surgical techniques are usually to blame. “The most common reason for an ACL [repair] to fail is technical error, where the actual graft is placed in a nonanatomic position and the most common wrong position is too vertical—too up and down—which doesn’t allow the graft to restore rotation,” Sekiya told MedicalNewsToday.com. Backing Sekiya’s claim is an American Board of Orthopedic Surgery survey that found 85 percent of surgeons who perform ACL reconstruction surgeries do 10 or fewer per year. “I definitely don’t think that the exact number of surgeries you do is indicative of necessarily the skill level,” Sekiya said. “However, I do think there are subtleties to this surgery that if encountered during an operation, may not be recognized in a less experienced ACL surgeon and can lead to failure.” Because experience is typically the best teacher, Sekiya advises those with torn ACLs to seek out surgeons with a strong body of work. “When trying to choose a place to take care of their ACL and their injury, [patients] should make sure the surgical staff and therapists are well versed to take care of all the problems they may encounter,” he said. “Patients can simply ask their surgeon if they are comfortable doing the procedure—they will likely get an honest answer.” Ed Wojtys, MD, Director of the MedSport sports medicine clinic at Michigan, agrees with Sekiya’s assessment and advice. He also believes history is a fair indicator of risk for a second ACL tear. “Why those ligaments fail is subject to a lot of debate,” Wojtys told MedicalNewsToday.com. “But [it] probably has something to do with the techniques used the first time, and then the fact that so many [patients] go back to the sports that originally caused the problem.”

Strengthening Hips May Alleviate Knee Pain Research out of Indiana University-Purdue University Indianapolis (IUPUI) has shown that a twice-weekly hip-strengthening regimen performed for six weeks can reduce and even eliminate patellofemoral pain (PFP) in female runners. Lead investigator Tracy Dierks, PhD, Assistant Professor in the Department of Physical Therapy at IUPUI, hypothesized that strengthening a runner’s hips would remedy the mechanical flaws that lead to PFP and says his six-week pilot study is the first of its kind to test a possible treatment for PFP in female runners. 4

T&C SEPTEMBER 2010

PFP results when a runner’s thigh bone rubs against the back of their kneecap. The pain typically begins with activity, grows worse over the course of a run, and then subsides when the activity is completed. The study examined five runners performing a hip strengthening routine and a four-person control group that did not. Twice a week for 30 to 45 minutes, the five runners performing exercises did single-leg squats and other work using a resistance band. Hip strength measurements were taken before and after a six-week period. Running on a treadmill, the subjects performing the exercises began the six-week trial reporting an average pain level of seven on a scale of zero to 10. After the six-week strengthening program, all the runners reported pain levels of two or lower on the same scale. “I wasn’t expecting such huge reductions,” Dierks said in a statement. The findings were presented at the American College of Sports Medicine Annual Meeting in June. Dierks said he plans to seek funding to test the effect of the same exercises on a larger group of runners.

Milking It For Muscles Women looking to tone up and shed a few pounds may find a helping hand in their refrigerator. A new study from researchers at McMaster University, which appeared in the June issue of Medicine & Science in Sport & Exercise, found that women who consumed two glasses of milk within two hours after weight-training lost fat and improved muscle tone. The results caught the researchers a little off guard. “We expected the gains in muscle mass to be greater, but the size of the fat loss surprised us,” Stu Phillips, a professor in the Department of Kinesiology at McMaster, wrote in the study. “We’re still not sure what causes this but we’re investigating that now … The combination of calcium, high-quality protein, and vitamin D may be the key, and, conveniently, all of these nutrients are in milk.” Conducted over a 12-week period, the study monitored young women who had not previously participated in a resistance training program. Their routine—which consisted of bench presses, chest flys, seated lateral pull-down abdominal exercises without weights, leg presses, and seated two-leg hamstring curls—was overseen by personal trainers who provided technique instruction. Two hours before each session, the women were prohibited from eating or drinking anything except water. Then immediately after exercising, one group consumed 500 milliliters of non-fat milk while another consumed the same amount of a similar-looking energy drink that was sugarbased. An hour later, the participants consumed another 500 milliliters of what they drank earlier. TR AINING-CONDITIONING.COM

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Bulletin

Board “The women who drank milk gained barely any weight because what they gained in lean muscle they balanced out with a loss in fat,” wrote Phillips, whose lab is conducting a large clinical trial studying weight loss in women. “Our data show that simple things like regular weightlifting exercise and milk consumption work to substantially improve women’s body composition and health.” The study also reported that the milk drinkers displayed better muscle tone than those who consumed the sugar-based energy drink. To view the abstract of the study, “Body Composition and Strength Changes in Women with Milk and Resistance Exercise,” go to: bit.ly/MilkStudy.

Study Says Body Mass Index is Misleading Though convenient and easy to calculate, Body Mass Index (BMI) is not an accurate indicator of obesity in high school football players, because it doesn’t differentiate between muscular bodies and fatter ones. So says a study presented at the 2010 American College of Sports Medicine Annual Meeting. Following an overnight fast, 71 males from seven different

high schools were examined by researchers who evaluated each subject’s body weight, height, body fat percentage, fat mass, and lean mass. According to the results, 45 of the players had a weight in the “normal” range, 18 were considered overweight, and six were obese. However, based on BMI, only 26 players would be classified as being a normal weight, 21 would be overweight, and 24 would be obese.

“The use of age-adjusted BMI percentile rank in high school football players is not effective for determining obesity levels as it can lead to misclassification. This is especially true for bigger athletes.” In other words, around 40 athletes were misclassified as overweight or obese according to BMI. “The use of age-adjusted BMI percentile rank in high school football players is not effective for determining overweight/obesity levels as it can lead to misclassification of overweight and obese status,” said study presenter Gary D. Steffes, who completed his research as an exercise science major at Miami University. “This is especially true for bigger athletes such as linemen.” n

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Q&A Brian Brewster

Coordinator of Sports Medicine Portage Health Sports Medicine Institute

In addition to his supervisory role, Brewster provides hands-on care for the Michigan Tech football team and is an instructor in the school’s Exercise Science, Health and Physical Education Department. And those are just the jobs he gets paid for. In fact, most of the miles on Brewster’s odometer have come while volunteering with the U.S. Paralympic Sled Hockey Team. As Head Athletic Trainer and Strength Coach, he’s traveled with the team to places such as the Czech Republic, Japan, and most recently the 2010 Vancouver Paralympics. In this interview, Brewster shares thoughts from his journey, including his philosophy on working with athletes and his unique employment arrangement. He also talks about his experience working with disabled athletes and the thrill of watching the team capture gold in Vancouver. T&C: How are Portage Health and Michigan Tech connected? Brewster: Our services are contracted out by Portage, but my office is really in the Michigan Tech athletic training room. Our team physician has an office in Portage’s physical therapy clinic, which is 300 yards away from Michigan Tech’s campus. It works really well because we can get kids in to see him very quickly—it’s just a short walk to his office. How do Portage’s physical therapy services fit in? It’s a different dynamic from most college settings in that we send a lot of our rehabs to a commercial clinic. We have three athletic trainers at Tech working with about 300 athletes—I cover football by myself and am responsible for about 105 kids—so having the PT clinic so close is vital. Plus, I’ve learned a lot from them, and hopefully they have from me. How did you get started with Portage Health? After getting my bachelor’s degree at the University of Nebraska-Omaha, I went to Hastings College, an NAIA 8

T&C SEPTEMBER 2010

AP PHOTOS

Brian Brewster, ATC, Coordinator of Sports Medicine at Portage Health Sports Medicine Institute in Houghton, Mich., is a man of many hats and many miles. At Portage, his duties include planning athletic training coverage for Michigan Tech University, Finlandia University, and 750 athletes at five area high schools.

Brewster serves as Head Athletic Trainer and Strength Coach for the U.S. Paralympic Sled Hockey Team. Above, the team scrimmages in preparation for the 2010 Games. school in Nebraska, where I got my master’s and served as an assistant athletic trainer for five years. There, we had just two athletic trainers providing coverage for 500 athletes—it was good training for what I’m doing today. In 2005, I started at Portage as an athletic trainer and was promoted to Coordinator in 2007. What are your main responsibilities at Michigan Tech? During the fall, about 95 percent of my job is working with the football team. During the winter and spring, 75 percent is spent working with all Tech athletes. I divide up the rest of my time providing home game coverage for a local high school hockey team and filling in wherever I’m needed. What is your philosophy on working with athletes? Athletic trainers need to do more than treat injuries. We need to be there to help with athletes’ personal lives, school, or anything else that’s bothering them. Athletic trainers should impact athletes not only during practice and competition, but also outside of athletics. I like being in the athletic training room and having guys come in before and after practice. I like talking to them, connecting on a personal level, and joking around and having fun—that’s why I love my job. Getting to know each other that TR AINING-CONDITIONING.COM

Q&A way also helps me to earn their trust. You need to work hard and have fun while you do it. If you’re not having fun, you’re probably not doing it the right way. How did you hone your administrative chops? My current boss was promoted from the position I have now, so he’s given me a lot of guidance. Also, the head athletic trainer I worked under at Hastings taught me vital time management skills. He showed my how to do a task as well as I could, get it off my desk, and move on to the next thing as soon as possible. With today’s technology, the organizational requirements aren’t that big of a challenge. Being able to text and e-mail from my phone makes me accessible all the time and allows me to communicate with our other athletic trainers pretty efficiently.

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How did you get involved with the paralympic sled hockey team? Basically, I was in the right place at the right time. I did a two-week volunteership at the United States Olympic Training Center in Colorado three years ago, when the team was holding tryouts and I was assigned to work with them. I was talking to Dan Brennan, the team’s general manager, about what they did for coverage during the rest of the year and he told me to send him my resume. A couple weeks later, they had some turnover in their staff and he asked me to come work a camp. I’ve been with the team ever since. What is the time commitment like? I don’t work with the sled hockey team during football season, but after the fall, I start traveling with them about one week a month. This past winter was busy. In November, for example, we were on the road for 10 days for a tournament in Prince Edward Island. In December, we had a five-day camp, and then in January, we traveled to Japan for a weeklong tournament. We had another 10-day camp in February, took five days off, and then went to Colorado Springs for a couple of days. Then it was on to Denver, and finally Vancouver for a little over two weeks for the Paralympics. TR AINING-CONDITIONING.COM

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Q&A How did Michigan Tech and Portage feel about you spending so much time away? Everybody I work with realized it was important to me and were very supportive and happy that I had the chance to be involved with the team. Jen Nesseth and Chris Ipson, two other athletic trainers here at Portage, picked up a lot of the coverage slack for me while I was gone.

“I see a lot of rotator cuff tendonitis. I tell the guys who use wheelchairs that because they push so much in their daily lives, we need to work on keeping their shoulders from rounding anteriorally.” What was the first thing you learned working with disabled athletes? That they’re very self-sufficient. They have the same drive and motivation and they’re very competitive. What they do every day to participate in a sport they love is absolutely amazing. There are a lot of things able-bodied athletes take for granted, like getting on and off a bus before and after games. That’s a chore for some of the guys on our team. But they just do it and take everything in stride. They don’t complain about

anything and like to joke around a lot and have fun. The team is a blast to work with. How did you familiarize yourself with each player’s physical limitations? I had each of them fill out a health history form—the same one our athletes here at Tech fill out. Probably five or six of our athletes have spina bifida, which is a birth defect that affects the spinal cord. There were also six amputees. I couldn’t even pronounce the names of some of the other disabilities or conditions, and I had to do a lot of research to educate myself. Then I learned about their limitations by talking to them and charting their injury histories. What is the scariest scenario you’ve dealt with while working with the team? The worst actually happened away from the ice during a tournament in the Czech Republic. We were out touring on an off day and one of our athletes started having a seizure on the bus. He didn’t have a history of them, so it was completely out of the blue. An ambulance took him to the hospital and he had an MRI and CT scan. The results showed that he was fine and he has been ever since. While that was great news to hear, the hospital refused to take his insurance, so we had to pay cash—it was like trying to bail him out of jail. Our general manager and I

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Q&A How did you manage the team’s strength training program? Once I started working with the team, I sent out programs once a week—mostly ideas for off-ice workouts. Each athlete would update me weekly on how he was feeling, how much time he spent on the ice, and what he was doing in the weightroom. I just got them started in the right direction because they didn’t have any formal guidance for what they should do in terms of off-ice training and I wanted to be sure they were doing something.

Brian Brewster Coordinator of Sports Medicine Portage Health Sports Medicine Institute

Duties: Plans athletic training coverage for Michigan Tech University, Finlandia University, and five high schools. Head Athletic Trainer and Strength Coach for the U.S. Paralympic Sled Hockey Team. Instructor in Michigan Tech University’s Exercise Science, Health and Physical Education Department.

each went to the ATM and took out the maximum allowable amount so we could pay the bill. Surprisingly, it was actually pretty cheap compared to what we would have had to pay in the United States for the same services— less than $1,000 for everything when all was said and done. What are some common injuries you encounter with sled hockey athletes? Lateral epicondylitis, or tennis elbow, might be the most prevalent injury I see on the team. I’ve worked on every player’s elbow at least once. They use their hands and arms to get around all day and then also grip their hockey stick for an hour and a half to two hours during practices and games, so that area of their body receives a lot of stress. I also see a lot of rotator cuff tendonitis. I tell the guys who use wheelchairs that because they push so much in their daily lives even outside of playing sled hockey, we need to work on keeping their shoulders from rounding anteriorally. So we work on their back muscles a little more to keep them symmetrical. TR AINING-CONDITIONING.COM

What are your most memorable moments from the past year? The top professional moment in my life would have to be the Paralympics in Vancouver, specifically the opening ceremonies. We walked out in front of 65,000 people screaming for us. Winning the gold medal was the cherry on top. But really, the best part was hanging with the guys. They’ve been so good to me, and so has the coaching staff. It was a great all-around experience.

“When you're traveling overseas you only have what you can fit in your kit ... Now, I don't use modalities as much as I used to. I realized the power of laying my hands on a person and really got back to basics.” How has working with the sled hockey team improved your skills as an athletic trainer? When you’re traveling overseas you only have what you can fit in your kit, so you need to use your imagination on a lot of rehabs. For example, I learned a lot of manual therapy techniques to promote muscle energy, active release, and soft tissue mobilization. I carried a lot of what I learned back to our athletic training room at Tech. Now, I don’t use modalities as much as I used to. I realized the power of laying my hands on a person and really got back to basics. What’s the hardest part of your job? Like any athletic trainer would say, it’s the hours. I love coming to work and I don’t mind working, but being away from my wife and family is the hardest. During the fall, I work close to 80 hours a week, but every Thursday, no matter what’s going on, my wife and I have a standing lunch date. It’s usually at the same place and we never skip it. What else would you like to try in your career? I enjoy hockey and would like to work with a college team at some point. Being around the sled guys has exposed me to the sport’s culture, which I really enjoy. There are a lot of good people working in hockey. Currently, Chris Ipson works with our team at Tech and he’s been here for 23 years. If I hold out long enough, I may get the same chance. n T&C SEPTEMBER 2010

NUTRITION

A Weighty Issue

CHRIS MURPHY

When athletes want to gain weight to meet performance goals, they require careful guidance to avoid packing on pounds of unhealthy fat.

By Ingrid Skoog

aining weight isn’t difficult. Our country’s obesity rate, currently over 30 percent, provides ample evidence of that. But when athletes want to gain weight, obesity isn’t what they have in mind. Adding muscle mass, sometimes called “positive weight gain,” without accumulating fat in the process is much more challenging. Popular fitness magazines and Web sites often tell athletes the secret is in special supplements, protein powders, and high-energy shakes. Yet while some of these products may

T&C SEPTEMBER 2010

be helpful, they’re only a small part of the picture. If an athlete wants to add mass to improve their sport performance, do you know how to advise them? An optimal strategy involves paying careful attention to meal planning, body composition, and training demands. Healthy weight gain is a long-term goal that requires serious commitment over an extended time period, with plenty of opportunity for pitfalls along the way. But with the proper guidance, any athlete can increase their size and strength.

CONTROLLING FACTORS Besides the most obvious things— nutrition and training habits—several other factors determine how easy or difficult it is for an individual to gain weight. Here’s a brief summary of three key players. Body type. You can’t change your Ingrid Skoog, MS, RD, CSSD, is a sports dietitian in Eugene, Ore., specializing in performance nutrition for collegiate and elite athletes. She can be reached at: ingrid.skoog@oregonstate.edu. TR AINING-CONDITIONING.COM

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NUTRITION

SAMPLE MENU The menus below provide one day of optimal food intake for an athlete with low body fat (less than eight percent for males and 16 percent for females) and one day of intake for an athlete with body fat in the healthy â&#x20AC;&#x153;middle rangeâ&#x20AC;? (eight to 16 percent for males and 16 to 24 percent for females). LOW BODY FAT

MIDDLE-RANGE BODY FAT

BREAKFAST: 1,200 calories

BREAKFAST: 1,000 calories

2-3 egg omelet with lean ham and grated cheese 2 large pieces of toast with margarine and jam, honey, or peanut butter 2 cups of 2% milk Banana

2 cups of fruit and nut granola mixed with 2 cups of 1% milk Banana MID-MORNING SNACK: 700 calories Peanut butter and jelly sandwich

MID-MORNING SNACK: 700 calories

2 cups of 100% fruit juice

Peanut butter and jelly sandwich

LUNCH: 700 calories

Large fruit juice LUNCH: 900 calories Large bean, chicken, and rice burrito with cheese and salsa

Whole wheat pasta with meat sauce Side salad with croutons and light dressing

Tortilla chips with guacamole

AFTERNOON SNACK: 300 calories

Vegetable or fruit juice

Fruit and yogurt smoothie

AFTERNOON SNACK: 400 calories

DINNER: 800 calories

1/2 cup of mixed nuts

Baked chicken pieces

DINNER: 800 calories

Baked potato with fixings

Lean roast beef

2 cups of 1% milk

Rice with seasoning and margarine

1 cup of steamed carrots

LATE-NIGHT SNACK: 300 calories

2 cups of 2% milk

Low-fat cottage cheese and fruit

LATE-NIGHT SNACK: 400 calories

3#/2% !./4(%2 7). 7)4( -),+ The workoutâ&#x20AC;&#x2122;s finished, the body isnâ&#x20AC;&#x2122;t. The two hours after exercise are when rebuilding begins. And lowfat chocolate milk has the right mix of carbs and protein, plus fluids that can help student athletes refuel and rehydrate. Tell us how youâ&#x20AC;&#x2122;ve helped your athletes refuel with chocolate milk. You could win a got milk?ÂŽ cooler, or other great monthly prizes, and maybe even be our Spotlight On Winner for 2010, with a Milk Mustache ad of your own.

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Total: 3,800 calories

Bowl of granola with milk and fruit Total: 4,400 calories

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Jason Tindal, Head Coach

Eugene Ashley High School Wilmington, NC

After drills, his team chills. The workout’s finished, the body isn’t. That’s why the Screaming Eagles of Eugene Ashley High School drink chocolate milk after games, practices and workouts. They know that the two hours after exercise are crucial for taking in the right balance of carbohydrates and protein, plus fluids and electrolytes to help replenish what’s lost in sweat. And that research suggests that lowfat chocolate milk may be just as effective as certain commercial sports drinks in helping athletes refuel muscles after a workout. Coach Jason Tindal checked out the data, and he’s a chocolate milk believer. See the science for yourself, or even tell us your success story, at milkdelivers.org. You could be our next winner, with a Milk Mustache ad of your own.

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NUTRITION DNA. I have talked with many people whose body type and genetic makeup undermine their goal of getting six-pack abs or gaining 20 pounds of muscle mass. There are three main body types, each with its own unique characteristics that affect weight gain: Endomorphs have stocky builds, and usually see rapid improvements in strength when training. They tend to gain both muscle mass and body fat more easily than other body types, but due to their higher body fat levels they may have a harder time achieving visible muscle definition.

Ectomorphs have tall, naturally thin and lean bodies. These are the people who seem able to eat anything and everything without gaining weight. Due to their long bones, they have longer muscles and often struggle to achieve large changes in muscle size and girth. They can and do still gain strength, but they don’t add muscle mass as easily as other body types. Mesomorphs typically have wide shoulders, large chests, narrow waists, more muscle definition, and the sort of body shape and proportions traditionally seen as most desirable. These individuals have the best of both worlds—they

COMMON MISTAKES When athletes struggle to achieve weight gain goals, it’s often because they made one of these mistakes: • Too little fiber. Some athletes stay away from whole fruits, vegetables, and grains when trying to gain weight, assuming that these foods are relatively low in calories and/or fat. As a result, they end up without enough fiber, which can lead to constipation. • Too much protein. Protein-rich foods promote satiety, which basically means they more quickly signal the brain that the stomach is full. They also take longer to break down during digestion, which delays the onset of subsequent hunger. Taken together, the result is decreased overall calorie intake. Encourage moderation in protein consumption, and remind athletes that feeling full doesn’t necessarily mean they have consumed enough energy to fuel muscle mass gains. • Too few carbs. During periods of weight gain, around 50 to 65 percent of overall energy should come from carbohydrates, but some athletes still remember the anti-carb craze of a few years ago and mistakenly think “carbs = fat.” • Taste fatigue. Athletes who rely on “weight gainer” products such as high-protein shakes tend to get tired of them quickly. Such shakes can be a great choice for a between-meal calorie boost with a good mix of carbs, protein, and a little fat, but encourage athletes to switch up their choices—a shake as a snack one day, a sandwich or bowl of granola the next. • Sleeping in. Believe it or not, this is sometimes an athlete’s biggest barrier to successful weight gain. Getting up late simply pushes breakfast back to lunch, lunch to dinner, and dinner to a late-night snack. It’s much more difficult to spread energy intake evenly throughout the day and to support the critical periods before and after strength training when an eating schedule is “running late.” • Overdoing fast food. Athletes may hear the advice to increase their calorie intake as an invitation to hit the drive-thru early and often. Remind them that not all calories are created equal, and the highly processed, nutrient-poor options available at many fast food windows won’t provide the quality carbs and protein they need to support muscle growth.

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tend to gain muscle easily while being less prone to packing on body fat. Knowing and understanding an athlete’s body type will help you talk with them about setting realistic goals. It will also help them to view progress toward weight goals realistically— two athletes with different body types shouldn’t expect the same gains just because they perform the same workouts and share similar eating habits. But they can both improve fitness level and overall strength with a comprehensive strategy for diet and training. Hormones. The most important members of this category are testosterone, growth hormone, estrogen, progesterone, insulin, glucagon, cortisol, leptin, and ghrelin. They all influence the body’s ability and predisposition to gain muscle mass and body fat. Their exact mechanisms are diverse and very complex, but for our purposes, it’s sufficient to say that anabolic and catabolic hormone levels increase and decrease according to stage of physical development, age, nutritional status, and stress level. Males have the most success gaining muscle mass in their late teens and early 20s, when anabolic hormones like testosterone and growth hormone are elevated. Females in that age range have an advantage in adding muscle mass as well, but it’s less pronounced. That said, in my experience it is most often male athletes who are interested in making large gains in mass to enhance sport performance. Timing. This may be the most overlooked of all factors related to successful and healthy weight gain. Before an athlete makes a serious attempt at adding mass, you should discuss these five questions with them: • Do you have the time and motivation to commit at least six months of consistent hard work to reach your goal? • Throughout that time, will you have consistent access to resources (lifting facilities and control over food quality and quantity) to support your goal? • Is your goal healthy and realistic? • Will reaching your weight goal help you achieve the performance improvement you want? • If a coach is involved, does he or she agree that gaining this amount of muscle mass is an appropriate goal for your sport and position? For a plan to succeed, the answer to all those questions must be yes. If not, TR AINING-CONDITIONING.COM

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NUTRITION this isn’t the right time to pursue weight gain. Otherwise, we can move on to the next steps in creating a plan. CRITICAL COMPOSITION Before we talk about eating, it’s important to first determine the athlete’s baseline body composition. There are several good methods for determining body comp. A BodPod or hydrostatic weighing test are two very accurate methods, but aren’t always readily available. A seven-site skinfod test using Harpenden, Lange, or AccuFitness cali-

pers can work well—AccuFitness also offers digital body fat calipers. Other options include bioelectrical impedance or a body comp scale, but research has shown these methods to be less reliable. There are several reasons why an initial body comp test and regular followups are important during a period of planned weight gain. The extra calories that the athlete will consume are almost certain to produce weight gain—body comp will reveal whether it’s the kind of weight they want. For instance, if an athlete isn’t following his dietary plan

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carefully but still sees higher numbers on the scale, he may think he’s doing fine, even if he’s actually gaining adipose tissue (fat) and little or no muscle. Likewise, some athletes with higher initial body fat see no progress on the scale in the first several weeks of a quality training and nutrition program aimed at weight gain. This is because they’re simultaneously gaining muscle tissue and losing fat, so their overall body weight barely moves. Body comp tests will show that they’re still making good progress and just need to be patient and stick to the plan—the weight gain will come eventually, and the strength gains have already begun. One other reason body composition is such a valuable tool during planned weight gain is that it helps guide nutrition strategies. For example, if someone starting a weight gain program is very lean—say, with less than eight per-

The body needs regular fueling througout the day to support muscle growth. But this is an area in which many athletes are inconsistent, negligent, or downright lazy ... Going long periods of the day without taking in any calories at all must be discouraged when seeking weight gain. cent body fat for males or 16 percent for females—they’re actually better off gaining a small amount of body fat along with the muscle mass. This is because individuals with very low body fat probably already have energy expenditure greater than energy intake due to existing dietary habits, activity level, and metabolism. Such an energy deficit (too few calories coming in) while training will result in difficulty gaining significant muscle, and even worse, possible muscle loss as the body becomes “starved” for energy. Meanwhile, people in the healthy initial body fat range of around eight to 15 percent for males and 16 to 24 percent for females probably have energy in-

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NUTRITION take fairly well matched to expenditure. These individuals are in the best position to gain muscle mass without additional body fat. Their bodies can draw on fat stores as needed to cover some of the energy costs of exercise, but they don’t have excess fat standing in the way of their health and performance goals. For males with body fat levels above roughly 20 percent and females above 25 percent, it may be best to follow a weight loss plan to decrease body fat before focusing on significant muscle growth, because the stress of strength training for hypertrophy on already overloaded joints could increase injury risk. Plus, adding extra muscle to a body that’s already laden with heavy fat stores can result in a slower, less responsive athlete with decreased overall performance in their sport. In these cases, it’s wise to seek personalized advice from a registered dietitian (RD) or physician who specializes in sports nutrition before proceeding. LET’S EAT Calories are the currency of weight gain, and the body needs regular fu-

eling throughout the day to support muscle growth. But this is an area in which many athletes are inconsistent, negligent, or downright lazy. The busy schedules of today’s high school and

do, you’ve gone too long between meals. • Don’t drink a lot of liquid at meals, as this fills you up faster and displaces whole food. • When drinking between-meal liq-

A salad of fresh veggies is very healthy, but to boost the calorie content, a weight-gaining athlete should be encouraged to add cubed cheese, lean meat, croutons, dressing, and perhaps almonds or walnuts. Likewise, a baked potato at dinner should never be eaten plain. college student-athletes often provide an easy excuse for going long periods of the day without taking in any calories at all, and this must be discouraged when seeking weight gain. Nutrition planning is most effective when tailored to an individual athlete’s needs, training habits, schedule, and other unique factors. But here are some basic points of advice that can help you advise them properly: • Eat small meals every two to three hours throughout the day. • You should never feel hungry. If you

uids, choose high-calorie shakes or healthy beverages that contain calories, such as chocolate milk, fruit juices, and vegetable juices, instead of water. • Start eating early—have breakfast before 9 a.m. This will allow you to take in more energy in the form of a mid-morning snack before lunch in the early afternoon. • Plan ahead and be prepared by having an ample supply of food available at all times. As for the composition of meals, there is no universal secret to eating

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NUTRITION for weight gain—the standard rules of healthy food selection apply, with a greater emphasis on choosing calorie-dense options over lower-calorie “fillers.” For example, a salad of fresh veggies is very healthy, but to boost the calorie contentof a salad, a weightgaining athlete should be encouraged to add cubed cheese, lean meat, croutons,

mentioned lowest range (below eight percent for males and 16 percent for females) should focus on adding more unsaturated fats to their diet in addition to carbohydrates and protein. They should include higher-fat snacks throughout the day, such as trail mix, mixed nuts, sandwiches with mayo, and tortilla chips with guacamole.

Athletes in the middle range of body fat ... don’t want to take in lots of extra fat, but shouldn’t look for nonfat options either—for instance, a turkey or chicken burger on a whole wheat roll is a better choice than regular ground beef on a white roll. dressing, and perhaps almonds or walAthletes in the middle range of body nuts. Likewise, a baked potato at dinfat (eight to 15 percent for males and ner should never be eaten plain—add 16 to 24 percent for females) should fixings such as low-fat chili or refried increase total calorie intake mainly by beans, low-fat sour cream, and grated upping their consumption of complex cheese. carbohydrates and lean proteins. They In terms of more specific advice, don’t want to take in lots of extra fat, guidelines vary based on the athlete’s but shouldn’t look for non-fat options initial body fat as determined by the either—for instance, a turkey or chickquarter_page_ad_Layout 7/8/10 PM Page body comp test. Those1 in the 5:21 aforeen1 burger on a whole wheat roll is a

better choice than regular ground beef on a white roll, and great snack choices throughout the day include milkshakes, fruit smoothies, and bagels with light cream cheese. (See “Sample Menu” on page 14 for an entire day’s food choices for athletes with low and medium-range body fat.) As mentioned earlier, those with high body fat (above 20 percent for males and 25 percent for females) should receive individualized attention before actively attempting to gain weight. In most cases, they’ll want to bring their body fat into a healthier range before adding significant muscle mass. Gaining “positive weight” is one of the most challenging goals for a competitive athlete to achieve. It involves increasing overall food intake and usually accompanies heavy strength training, so carelessness can easily result in too much fat in the daily diet or too few calories to support the high activity level. But with proper planning and regular monitoring of body comp progress, athletes can eat smart, lift hard, and get bigger. n

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Boils: tender, red lumps that swell and get pimple-like white heads. They can form on oily or moist skin such as neck, armpits, groin, and buttocks.

Small red bumps that look like spider bites or ingrown hairs.

Pain out of proportion to skin conditions.

USE HIBICLENS TO HELP PROTECT YOUR ATHLETE. Hibiclens and Hibistat are FDA regulated antimicrobial skin cleansers that contain chlorhexidine gluconate (CHG). CHG not only kills germs quickly, but it also continues to kill germs for up to 6 hours1 after use making Hibiclens and Hibistat an integral part of effective protection against MRSA and other skin infections. Hibiclens and Hibistat can help with effective infection prevention in your facility - helping prevent skin infections that could potentially take key athletes out for a game or an entire season. When washing with Hibiclens is not an option, continue infection prevention with Hibistat, available in convenient towelette packets.

You can ﬁnd Hibiclens in the ﬁrst-aid aisle at CVS, Walgreens, Rite Aid, Wal-Mart, and Target. Hibistat is available at CVS, Rite Aid, and Stop & Shop. Hibiclens and Hibistat are also available through your athletic distributor. 1 Study #030917-150. The Mölnlycke Health Care, Biogel®, Hibiclens® and BARRIER® names and logos are registered globally to one or more of the Mölnlycke Health Care Group of Companies. Distributed by Mölnlycke Health Care US, LLC, Norcross, Georgia 30092. ©2010 Mölnlycke Health Care AB. All rights reserved. 1.800.843.8497 www.hibiclens.com

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LEADERSHIP

CRY FOR HELP

©GETTY IMAGES

An athlete’s mental well-being is just as important as their physical health. Athletic trainers are in a great position to recognize the signs of anxiety and depression, and to step in if need be.

By Dr. Nicki Moore

any people work with student-athletes on a daily basis: coaches, tutors, academic advisors, compliance personnel, strength coaches, and plenty of others. I feel fortunate to have been among them as an in-house psychologist for the University of Oklahoma athletic department for the past six years. The student-athletes I’ve treated and the range of issues they’ve presented has made for a rich and interesting career—one that’s rewarding in many of the same ways I imagine athletic training is rewarding. While the typical athletic trainer is concerned mainly with athletes’ physical health, you are also well positioned to recognize when student-athletes are

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struggling with anxiety, depression, or a host of other mental health problems. At early morning workouts, you’re there. On long bus rides, you’re there. In the depths of despair following a career-altering injury, you’re there. It’s not always easy knowing how to proceed when you observe the signs of a mental health issue in an athlete under your care. But the costs of doing nothing can be great, and the benefits of intervening can mean as much as— or even more than—any other form of treatment or service you provide. This article will familiarize you with anxiety disorders and clinical depression in athletes, and give you a blueprint for helping them through some of the most challenging health problems life has to offer.

MISUNDERSTOOD ILLNESSES Several myths about anxiety disorders and depression persist, and one of the most prevalent is that these illnesses are rare. The truth is that over the course of one year, about 16 percent of the U.S. population develops an anxiety disorder, and about seven percent of men and 12 percent of women develop some degree of clinical depression. Athletes, of course, are a special population, with factors that can both Nicki Moore, PhD, is a licensed psychologist, AASP-certified sports psychology consultant, and Senior Associate Athletic Director at the University of Oklahoma, where she serves as in-house psychologist for the athletic department. She can be reached at: nmoore@ou.edu. T&C SEPTEMBER 2010

LEADERSHIP increase and decrease their predisposition to these forms of illness. On the positive side, the sense of self-worth, inclusion, and accomplishment provided by training for and competing in sports provides a measure of protection for some. But on the other hand, the stressors associated with competitive athletics can easily negate the protective factors. For that reason, anyone who works with athletes on a regular basis is very likely to encounter individuals who are facing anxiety or depression in some form. Another common myth is that anxiety disorders and depression are transient things that an athlete just needs to “snap out of.” No doubt, every athletic trainer with more than a day under their belt has dealt with grumpy, irritated, stressed out, or dejected student-athletes—it comes with the territory. In most cases, a few encouraging words and a sympathetic ear are enough to help them through a bad day. But when the symptoms are especially pronounced and don’t go away with time, they may indicate an underlying disorder and not just a situational mood or reaction to specific events. When anxiety or depression reach the disorder level, it means daily overall functioning has become impaired for an extended period, usually lasting at least two weeks without relief. With anxiety disorders, the main symptom is abnormally high anxiety with no apparent reason or anxiety that’s out of proportion with the circumstances at hand. Besides those self-reported feelings, anxiety-related symptoms may include an increased heart rate, muscle tension, upset stomach, sleep disturbances such as insomnia, and difficulty focusing on or engaging in normal life activities. There are at least seven specific types of anxiety disorders, including obsessive-compulsive disorder, phobias, and post-traumatic stress disorder, but all of them share at least some of the above symptoms. If you observe them in an athlete to a degree or duration that seems abnormal, they will most likely benefit from referral to a mental health professional. Depression, which falls under the clinical category of mood disorders, is typically characterized by excessive, unexpected, prolonged feelings of sadness, emptiness, or hopelessness, often accompanied by diminished interest in or ability to carry out normal activities, lack of energy or motivation, difficulty concentrating, sleep disturbances, and possibly even suicidal thoughts. Physically, it can lead to significant weight loss or gain in a relatively short period. Having a few symptoms of depression is quite normal. For student-athletes, it can be triggered by the doldrums or struggles of rehabilitation from injury, pressure surrounding a big game, disappointment after a loss, or something not related to sports at all—a break-up, a family death, or academic problems. But like with anxiety, the key factors that determine whether these feelings reach the disorder level are depth and duration. If the withdrawn, sad behavior lasts longer than seems reasonable given the circumstances, or if it’s so paralyzing that it interferes with daily life, the athlete should be steered toward seeking help. (To better understand the line between the subclinical and clinical range for depression-like symptoms, see “Sad or Depressed?” on page 26.) BARRIERS TO OVERCOME If an athlete has a sprained ankle or torn ligament, there’s not much argument over the fact that they’re not healthy and need TR AINING-CONDITIONING.COM

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LEADERSHIP treatment. Mental illnesses are different because they’re more subjective and carry a stigma that makes acknowledging the problem and seeking help more difficult. In addition, the perceived consequences of a mental illness diagnosis are especially great for athletes. Besides the usual pressures of student life, an athlete whose performance is hampered by anxiety or depression may worry about things like reduced playing time and loss of a scholarship. Some of the main obstacles that stand in the way of prompt intervention for athletes with anxiety disorders and/or depression are: Recognition barriers. When immersed in an athletic culture, it’s easy to attribute symptoms to known and assumed stressors rather than to a diagnosable psychological issue. Studentathletes tend to have a “suck it up” mentality, so symptoms can be ignored, masked, or misinterpreted for long periods of time. Furthermore, team strength is frequently built on a “no excuses” mantra, so there is a tendency to attribute

pecially—their teammates and coaches. Some choose to suffer in silence rather than acknowledge something that others may perceive as weakness or fragility. Furthermore, some symptoms of anxiety and depression can be mistaken for a normal response to sports-related stressors. For example, significant or rapid weight loss is one of the most objectively observable warning signs of depression, but in a competitive athlete, it may be attributed to the pursuit of a performance goal. Likewise, ongo-

ing “moodiness” might be dismissed as frustration with a slow rehab or lack of on-field success, when it may in fact be caused by mental illness. Sometimes, sports is among the last places that compromised mental functioning manifests itself. For many student-athletes, it is their escape—a refuge where they can leave behind everything that’s bothering them. Thus, it’s not unusual for a student-athlete’s school work, social life, and relationships to be “falling apart” while their athletic life appears fairly normal.

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deficiencies in attitude, motivation, or desire to character problems. An athlete might find him- or herself accused of not being a team player or not giving 100 percent out of selfishness or laziness, when in fact they may be suffering from a disorder that’s addressable through treatment. The machismo associated with both men’s and women’s sports is another barrier, as it encourages athletes to display an exaggerated sense of toughness. Even if an athlete knows something is wrong, they may go to great lengths to avoid admitting the problem to anyone, even—and sometimes es-

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LEADERSHIP Referral barriers. Compared to the extensive and trusted referral network of medical doctors athletic departments use to address physical problems, the network of mental health professionals is usually much less developed. It’s also often less accessible to someone on the front lines, such as an athletic trainer, who may observe an athlete struggling

stigma associated with anxiety disorders and depression, and you may find it’s difficult to take an athlete aside and tell them you think you’ve observed a problem and would like to refer them to a counselor or psychiatrist. Student-athletes are accustomed to many people knowing about and keeping tabs on their medical conditions,

Athletes may set unrealistic expectations about how quickly they should make progress ... It’s important for them to understand that treating depression or anxiety isn’t like healing a sprained ankle—it’s an ongoing process that takes time and effort to succeed. with mental health. While athletic trainers are generally quite aware of what it’s like to work with a physician and comfortable talking to student-athletes about what to expect in treatment, they often have little to no personal experience with mental healthcare. Add in the aforementioned

but they’re frequently hesitant to discuss anything related to their mental health. They worry about coaches and teammates finding out, and fear repercussions that can make their condition even worse, such as diminished responsibilities on the team, further isolation, or a loss of trust in their

SAD OR DEPRESSED? Everyone goes through periods of sadness brought on by life circumstances. But when those feelings persist for a long time or are severe enough to affect the ability to function, they may indicate clinically diagnosable depression. The line between “normal” sadness and clinical depression is sometimes difficult to discern. Applying adjectives to the moods and behaviors of others is an inexact science, but the comparisons below can help you determine whether an athlete might be struggling with depression. If you suspect they are, or even if you’re unsure, consider referring them to a counselor or other mental health professional, who can use tools to evaluate whether the individual is clinically depressed.

6 2

Subclinical Range

Clinical Range

Temporarily sad

Consistently sad

Nervous

Persistently anxious

Somewhat isolated

Truly withdrawn

Irritated

Explosive

Unmotivated

Apathetic

Frustrated

Having emotional outbursts

Angry

Raging

Minor sleep disturbance

Insomnia

T&C september 2010

ability to perform or lead others. Treatment barriers. Competitive athletics has a subculture all its own, with unique languages, sets of rules, costumes, and rituals. For participants, it’s often a source of personal identity. If a mental healthcare provider isn’t familiar with this culture, providing counseling to student-athletes can be akin to working with someone from a foreign country. If they overlook, devalue, or simply don’t understand the cultural differences, they can create an unintentional barrier in the therapeutic relationship that’s difficult to overcome. That’s why it’s important to connect athletes with a professional who understands the culture and pressures of sport—if your athletic department and campus don’t have a counselor or psychologist on staff, an off-campus referral may be the best option. Another potential issue is that studentathletes may have heightened concerns about confidentiality that make them less forthcoming than typical counseling clients. Some, particularly higher-profile athletes, understand their personal value as a “sports property” and feel they must carefully guard their public image. Other times, they worry about their parents’ insurance being billed for therapy sessions and their families finding out that they are in counseling. Additional reassurances and the explanation of strict privacy rules counselors must abide by can help athletes to openly engage in the process. Time is another concern. Studentathlete schedules are generally rigid, overbooked, and both physically and emotionally draining. The idea of adding therapy appointments as another commitment may seem like a burden. There’s no easy answer to scheduling issues, but if a need arises, remember that an athlete may need assistance in this area—you might be able to tailor their athletic training room appointment times, get your campus counseling center to make special arrangements, or set up quick and easy transportation to off-campus appointments. Once they do start counseling, athletes may set unrealistic expectations about how quickly they should make progress, especially if it’s during their competitive season. It’s important for them to understand that treating depression or anxiety isn’t like healing a sprained ankle—it’s an ongoing process TR AINING-CONDITIONING.COM

LEADERSHIP that takes time and effort to succeed, but the results are well worth it. TREATMENT OPTIONS What happens after you refer an athlete for mental healthcare? Decisions are always made on an individual basis, but the most common forms of intervention are counseling, also known as psychotherapy, and prescription medication. Practitioners often choose to treat a patient using both methods simultaneously. Psychotherapy. While psychotherapists vary in their training, credentials, and models for treatment, the first session for most types of counseling or “talk therapy” will have some common components. The student-athlete will likely complete some paperwork in advance, and from the outset, most counselors will explain that confidentiality will be strictly followed except in a few specific circumstances, such as when a patient appears to be homicidal or suicidal.

and stressful thoughts and feelings. Over time, the patient develops a set of internal tools for mental health and coping mechanisms they can use for the rest of their lives. Prescription medication. As with talk therapy, approaches to psychoactive medication vary from one practitioner to the next. There are many types of drugs on the market to address psychological disorders, each with its own potential benefits and side effects. There’s sometimes an element of trial and error before a patient finds the drug that

works best with their biochemistry to address a mental health issue. With most medications, side effects are mild and last for only the first couple of weeks. There is usually no negative impact on athletic performance, and patients often find medication to be of great help, especially at first as they work to develop better coping skills and healthier supportive behaviors. In some cases, long-term medication use provides the best outcome. Common problems in the studentathlete population related to pre-

Options such as herbal remedies, meditation, yoga, and acupuncture have varying levels of scientific support, but if they bring an athlete comfort, they may be worth exploring as a complement to traditional therapy. From there, most therapists will ask the client to describe what brought them to counseling and encourage discussion of short- and long-term symptoms and concerns. The first session usually includes direct questioning by the therapist to ascertain individual and family history and various factors that may impact diagnosis and treatment planning. A trusting and caring relationship is usually established rather quickly, and more often than not, patients leave the first session already feeling a bit better, as if a weight has been lifted. In subsequent sessions, the therapist will help the patient explore the underlying causes for their anxiety and/or depression. Together, they will seek new ways to gain perspective on troubling issues and process negative TR AINING-CONDITIONING.COM

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Circle No. 119 T&C SEPTEMBER 2010

LEADERSHIP scription medication use include lack of strict compliance, consuming alcohol or other drugs while on the medication, and lack of sleep, which may exacerbate side effects. If an athlete has been prescribed medication to deal with anxiety or depression, it’s a good idea to talk with them about avoiding these potential hazards. Besides those two mainstays of mental healthcare, alternative methods are sometimes used if the athlete or practitioner feels they may be helpful. Options such as herbal remedies, meditation, yoga, and acupuncture have varying levels of scientific and anecdotal support, but if they bring an athlete comfort and relief, they may be worth exploring as a complement to traditional therapy. YOUR ROLE There’s no specific formula for how you should act if you suspect a student-athlete may be experiencing depression or have an anxiety disorder. The best course depends on your relationship and comfort level with them, the resources available in your department and at your school, and many other factors. Here are some tips that may be helpful if you’re ready to step in: • To broach the subject, tell the athlete about your concerns in a private setting using objective, non-judgmental language. Use specific examples of what you have observed, and emphasize that if they are willing to consider treatment, you will help them find the best possible arrangement for mental healthcare while respecting their privacy. • Research the mental health resources available on your campus and in your community in advance, so you are already familiar with the available options when an athlete needs services. If your athletic department doesn’t already have a standing relationship with a mental healthcare provider or at least a referral list, work toward creating one. • Before using any mental health professional for the first time, meet with them to assess their ability to provide care for student-athletes. Someone with experience in sports psychology is better prepared to understand the unique culture and its role in an athlete’s mental health. • If the best available mental healthcare professional is not familiar with the culture of sports, take some time to educate them. Enhancing their sensitivity to the student-athlete worldview can go a long way in fostering a positive therapeutic relationship. It may be helpful to remember the Four A’s, a set of concepts developed by Dr. Don O’Donaghue for team physicians that’s also applicable to other professionals who interact with student-athletes. A professional should be Affordable, Available, Amiable, and Accepting of the value of athletics to the athlete. • This may sound like common sense, but it’s worth a reminder: If a student-athlete makes comments that lead you to believe they are considering suicide, your top priority is making an appropriate referral and taking whatever steps necessary to ensure their immediate safety, even at the expense of your relationship with them. As an athletic trainer, you have an excellent opportunity to help athletes not just with physical maladies, but mental ones as well. If you take on this responsibility, you can positively impact the lives of your athletes in ways you might never have imagined when you chose this profession. It’s just one more avenue for achieving the goal of helping student-athletes be at their best. n

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TR AINING-CONDITIONING.COM

Pilates and the Back By Ken endelman

What’s the main reason an athlete develops back problems? Many trainers say that it’s a direct result of muscular imbalances, particularly if an athlete’s training focuses more on the repetitive motions of his or her competitive sport and less on a well-rounded cross-training regimen. It’s inevitable - certain muscles get built up, other muscles weaken and something as simple as a rudimentary movement can result in a back injury.

what muscles should be recruited for a specific movement. Injured muscles will heal instead of getting hurt repeatedly. Pilates teaches an athlete to support his or her body throughout a wide range of motions while lying, sitting, standing or kneeling. The exercises can be done on a mat or on Pilates equipment, and emphasize proper breathing and complete concentration on smooth, flowing movement.

Reformer The Reformer is the main piece of equipment used in Pilates exercise. Extraordinarily versatile, it is basically a carriage that glides inside a rectangular frame. Resistance is provided by springs, and the user moves the carriage by pushing or pulling with arms or legs, from a supine, sitting, kneeling or standing posture. Trapeze Table a.k.a. Cadillac The Cadillac is a horizontal table-top surrounded by a four-poster frame with an assortment of bars, straps, springs and levers attached. A tremendous variety of exercises can be performed on the Cadillac, from gentle, spring-assisted sit-ups to advanced acrobatics hanging from the upper bars. Reformer with Tower This apparatus combines the Reformer and the Trapeze Table, with the “Cadillac” portion represented by a “tower” on one end The Reformer can be covered with two removable tabletop mats, and greatly increases the number of exercises possible.

Pilates Chairs like the EXO Chair can strengthen the back and provide a challenging workout in a small footprint.

The lower lumbar spine is the site of frequent injury because it is the source of much of our mobility. This area has a lot to do with how we put together movements in our body.

To increase back strength or treat an injured back, Pilates equipment really comes into play. Apparatus like a Reformer or Chair are great because of the assistance the springs and ropes provide.

Pilates teaches athletes how to access other spinal segments and then to more easily redistribute the load that goes through the spine, as opposed to movements being dependent on one or two segments of the spine. With more segments to move through, less force is applied to each one. This is especially true in a chronic back injury. For example, the body of an athlete with a herniated disc will compensate for the injury by overusing other muscles in order to function. And thus, an imbalance is born.

By selecting and appropriately modifying exercises on the equipment, a trainer can make the initial sessions very supportive and assisted. Athletes can learn to organize their bodies and put principles of Pilates into play. As they progress and strengthen, they can move on to more challenging movements.

Pilates focuses on creating an even musculature, correcting these muscle weaknesses and re-educating the body as to

What equipment is best for strengthening the back? Each type of apparatus offers benefits. Part of your decision could depend on space and budget. Some of the more well-known pieces of Pilates equipment are:

Chairs Chairs provide a challenging strength workout within a small floor space footprint. They resemble a stool with single or split steps at the bottom. You can add handles, chair backs, rotation discs and other accessories for increased variety. Balanced Body’s latest chair - the EXO Chair – has attachments for resistance tubing that give trainers the ability to offer many Reformer exercises in a fraction of the space typically required. Arcs Arcs are great tools for mobilizing the spine, shoulders and hips, as well as for core, abdominal, rotation and back extension work. They are also affordable and, in the case of Balanced Body’s Pilates Arc, are lightweight and easy to move around. Ken Endelman is a contributing writer for Training and Conditioning and the Founder and CEO of Balanced Body®.

What Happens next?

Illinois Sports Information

SPECIAL FOCUS

In most contact sports, concussion risk comes with the territory. After the injury, safe and complete recovery depends on ample rest time—both physical and mental—followed by a gradual return-to-play protocol. By Dr. Steven P. Broglio

very year, an estimated 1.6 to 3.8 million concussions occur as a direct result of sports and recreational activity. As the sports medicine community has learned more about this type of injury, we have become more sophisticated in our approaches to prevention and treatment. Evaluation and symptom recognition are better than ever, using powerful tools such as neurocognitive testing, balance assessments, and in some better-funded programs, high-tech instrumented football helmets that predict injuries by gauging impact force and location. We also know more than ever about the serious consequences of ignoring a concussion or letting an athlete return to activity too soon after sustaining one. There’s still more work to do—it’s been estimated that over half of all concussions sustained by athletes in the U.S. go unreported—but this growing awareness has no doubt prevented many more serious injuries, and in some cases saved lives. If you work with high school or college student-athletes, you must be prepared to manage the post-concussion period. And thanks to ongoing research in this area, we now understand this means much more than just holding an athlete out of competition until symptoms resolve. From their degree of physical activity in the days after a concussion to how much they mentally exert themselves while the brain heals, there are several factors that may determine the success of post-concussion recovery. AFTER THE HIT You’re most likely already familiar with what a concussion looks like. FollowTR AINING-CONDITIONING.COM

ing the moment of impact, the athlete may or may not lose consciousness. In fact, only 10 percent of all concussions involved a loss of consciousness. Once brought to the sideline, they can typically complete a given task, but slowed reaction times, impaired memory function, and personality changes are all common clinical signs that result from impaired neuronal signal transmission. The full spectrum of changes that occur at the cellular level following a concussion are not fully understood, but it is thought the brain recruits pathways that bypass the injured areas to perform basic tasks and functions. Thus, reaction times may be slowed because the new pathway is simply longer or less efficient than the original. It’s sort of like highway traffic being diverted to country roads after an accident. During the recovery process, physical healing within the brain eventually allows normal pathways to be restored— after a while the highway is cleared, and traffic can resume its usual pattern. Recovery time varies based on the severity of the injury and individual factors such as brain chemistry, but this takes an average of seven to 10 days in adults and roughly two weeks in children and adolescents. If an athlete returns to activity before fully healing, a second concussion can lead to second-impact syndrome, uncontrolled cerebral swelling, and permanent brain damage or even death. During the healing process, there is a progression from functional brain recovery to true recovery. You might think of it like a grade one lateral ankle sprain: By one week post-injury, the athlete may be taped and sent out

to practice where he can perform at a functional level, but the ligament continues to heal for some time afterward before returning to pre-injury integrity. Functional recovery is achieved when the athlete can perform at pre-concussion levels on tests of reaction time, memory, and other basic functions. But this does not mean the neural pathways have yet been completely restored. Indeed, while functional recovery typically occurs within two weeks, true metabolic recovery from a concussion may take twice as long. What an athlete does in the post-concussive period— both physically and mentally—plays a major role in their overall outcome. PHYSICAL REST Holding an athlete out of activity following a concussion isn’t just about removing the risk of a second blow to the head, though that’s critical. Any physical exercise in the days after a concussion redirects glucose away from the healing processes occurring within the brain—it slows the restoration of neural pathways and may exacerbate symptoms. For the athlete’s health and comfort during recovery, they should be held out of not only practice and competition, but also weightroom work, physical education classes, and anything else involving physical exertion. Why does the brain require this influx of energy? That answer is complicated, but it essentially has to do with Steven P. Broglio, PhD, ATC, is Director of the Neurotrauma Research Laboratory at the University of Illinois. He can be reached at: broglio@illinois.edu. T&C SEPTEMBER 2010

SPECIAL FOCUS ion imbalances generated by the injury. During the post-injury period, ions are actively moved across cell membranes in a process that requires fuel provided by glucose. This activity is accompanied by a phase of vasoconstriction in the brain, which may be a protective mechanism against cerebral bleeding. Under normal circumstances there is plenty of glucose available for optimal function of both skeletal muscles and the brain, but in the post-concussion phase, the brain must have additional glucose to maximize energy availability.

Both animal and human studies have helped us understand the negative effects of exercise on the post-concussive brain. One such investigation found that if rats were allowed to exercise immediately after a concussion, their ability to learn and remember new information was impaired when measured against rats who were withheld from exercise immediately following injury. Likewise, a study of high school football players published in 2008 noted that those who were concussed and allowed to return to the same game or practice showed

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the greatest declines in cognitive performance in the days after the injury. In both these studies, the authors suggested that the cognitive impairments were a direct result of blood and glucose being directed away from the brain and thus delaying the healing process. In short, the message was that optimal recovery depends in part on the body’s ability to focus its energy on repairing the brain instead of fueling muscle activity. MENTAL REST Many people first heard about postinjury mental rest during the 2009 college football season, when University of Florida quarterback Tim Tebow sustained a concussion in a game against the University of Kentucky. Tebow was subsequently removed from all physical activity, had his academic load temporarily reduced, and was even instructed not to read or watch television for several days after the game in which he was injured.

Concussed athletes often report difficulty concentrating, trouble staying awake, headaches, and other symptoms that get worse throughout the day. This all appears to result from working an injured body part—the brain—without accounting for the healing that must occur. The concept of resting the brain is relatively new to concussion management, so there is less data available and fewer evidence-based recommendations to rely on. The basic idea is that the cognitive demands of school work, reading, and other mentally taxing activities (those requiring attention and problem solving) pull metabolic resources away from the brain’s ion restoration process. Think of an athlete’s typical experience after sustaining a concussion during a high school or college sporting event. They are usually held out of practice and competition until symptoms resolve, but they almost always TR AINING-CONDITIONING.COM

SPECIAL FOCUS remain in the classroom. They may even treat the time away from sports as an opportunity to bear down on school work to catch up or get ahead. Anecdotally, these athletes often report difficulty concentrating, trouble staying awake, headaches, and other symptoms that get worse throughout the day. This all appears to result from working an injured body part— the brain—without accounting for the healing that must occur. Not all student-athletes have the same luxury as a high-profile college quarterback like Tebow, but the sports medicine staff should work with athletes and their parents and teachers to make accommodations. Part of this process is educating everyone involved about what a concussion really means: You may understand that it is a traumatic brain injury, but others might not, and some still have the outdated mentality that having one’s “bell rung” is no big deal. Once they understand the seriousness of the injury, they’re more likely to be receptive to

The NATA recommends that athletes completely abstain from alcohol consumption post-concussion ... There is virtually no research showing a relationship between food and drink choices and concussion recovery, but alcohol is known to impair oxygen delivery to the brain. your suggestions on mental rest. There are no established “return to cognitive activity” guidelines for the post-concussion period. In a perfect world, you would have an athlete completely eliminate cognitive work until they are asymptomatic, but this is obviously not realistic. A reasonable compromise is to reduce academic load as much as possible in the first few days after the injury, with an emphasis on eliminating especially demanding tasks, such as test taking, difficult reading, and mathematical problem solving. As the first week progresses, the athlete can slowly return to normal coursework. For instance, they might be limited to one to two hours TR AINING-CONDITIONING.COM

of school work the first couple of days, with an additional hour added each day until their workload is back to normal. Just like with physical recovery, the recurrence of symptoms is the best guide for whether an athlete is returning too quickly. In other words, if headaches, sleepiness, or other symptoms emerge prior to the end of the day’s mental work, the activity should be scaled back. Not surprisingly, an athletic trainer making the case for postponing homework, reading assignments, and tests

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will carry more weight with teachers than athletes themselves asking for these special consideration. To reinforce the idea that this is part of an important post-injury treatment plan and not simply an impromptu vacation, you can emphasize the fact that all forms of mentally challenging activity—even the recreational ones, such as text messaging and video games—will be curtailed during this time as well. In general, the athlete should be instructed to spend as much time in a mentally relaxed state as possible.

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SPECIAL FOCUS OTHER INTERVENTIONS Nothing is more important than rest after a concussion to promote the healing process and avoid disruptions that may cause discomfort and complications. But there are a few other approaches worth mentioning as part of the postinjury management discussion. Hyperbaric chambers. Very recently, some elite athletes have experimented with the use of specially designed chambers that deliver oxygen at a pressure level higher than in the normal atmosphere. A few studies involving animals suggest that these chambers may improve metabolic activity that aids in recovery, but some scientists have speculated that the human brain and its

as long as the athlete follows all physician instructions and uses the drugs only as directed. However, one important note in using these products is that the athlete must be able to stop taking them and remain symptom-free before beginning a return-to-play protocol. A headache medication, for instance, may mask pain that indicates the brain is not yet healed, which would mean the athlete is not ready to return to workouts. The second category includes medications such as corticosteroids, free radical scavengers such as vitamin C, glutamate receptors, calcium channel inhibitors, and drugs that affect the arachidonic acid cascade. All these

No athlete should ever be permitted to return to their sport until completing a progressive return-to-play protocol. Such a protocol should only begin once the athlete is no longer experiencing any functional deficits caused by the injury. recovery patterns are so complex that hyperbaric chambers do not help after a concussion. Interestingly, the use of hyperbaric chambers to address the long-term effects of concussion may hold greater promise. Two recent studies found that high-pressure oxygen delivery to concussed soldiers well after their injury—three years in one case—resulted in improved cognitive functioning and sleep patterns and a marked decrease in symptoms that extended eight to nine months after the treatments ended. It’s difficult to interpret how findings like these might apply to athletic populations. But given the mixed results of research and scholarly inquiry into the use of hyperbaric chambers, and the lack of any large-scale randomized studies focused on athletes specifically, the use of these devices does not seem prudent at this time. Pharmacology. The use of medication in the post-concussion period can be differentiated into two distinct categories: drugs used to treat post-concussion symptoms, and those used to improve or accelerate the healing process. In the first category, a physician may prescribe medication to control sleep disturbances or reduce headaches. This is fairly common in cases where such problems are prevalent, and it does not appear to pose significant health concerns 3 4

T&C SEPTEMBER 2010

have been studied to various degrees without producing consistent positive results. The most promising pharmacological agent for boosting recovery appears to be progesterone. The exact mechanism of how this hormone may improve concussion recovery isn’t fully understood, but it is thought to decrease the post-injury inflammatory response in the brain. Progesterone treatments for concussion are entering large-scale clinical trials later this year, so we may have firmer answers on the value of this type of treatment in the near future. Dietary adjustments. In its position statement on managing sports-related concussions, the NATA recommends that athletes limit fat intake, eat a high-carbohydrate diet, and completely abstain from alcohol consumption in the post-concussion period. There is virtually no research showing a relationship between food and drink choices and concussion recovery, but alcohol is known to impair oxygen delivery to the brain, and production of energy from fat molecules requires an abundance of oxygen. The carbohydrate recommendation was most likely added because carbs aid in the production of glucose, which may help provide the brain with needed energy for healing.

PROGRESSIVE APPROACH No athlete should ever be permitted to return to their sport until completing a progressive return-to-play protocol. Such a protocol should only begin once the athlete is no longer experiencing any functional deficits caused by the injury, including self-reported symptoms, physical balance issues, or cognitive impairment. At that point, the return to pre-injury activity level must be gradual. According to a consensus statement adopted at the Third International Conference on Concussion in Sport in 2008, the newly symptom-free athlete should start with light aerobic exercise that keeps the heart rate below 70 percent of the typical max for their age. If the athlete can complete this step without a return of any concussion symptoms, light sport-specific exercise can begin a day later. As a next step, the athlete can advance to more stressful non-contact work, such as running pass routes, walk-throughs of planned plays, and resistance training. At this point, a physician should re-evaluate the athlete before final clearance to participate in contact drills, full training, and finally, competition. Each step in this process should take roughly one full day. If even minor concussion-related symptoms re-emerge, the athlete must return to the previous stage following 24 hours of rest. Using this strategy, depending on the age of the athlete and the severity of the injury, most will be cleared for a return to competition in one to two weeks. Concussion remains one of the most difficult and complex challenges faced by sports medicine personnel. Injury to the brain doesn’t produce easily visible or tangible symptoms, and relying only on athletes’ own assessment of their readiness to return is not acceptable. Ultimately, each concussed athlete must be managed individually, and it’s impossible to predict how long recovery will take. But with a comprehensive plan that focuses on both physical and mental rest and provides for a gradual return to activity, you can help any concussed athlete return to their sport safely and ready to perform at their best. n REFERENCES To view full references for this article, go to: www.Training-Conditioning.com /References.

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TREATING THE ATHLETE

GAME THEORY In more and more athletic training rooms, video game systems are being used for active rehab and injury prevention. This author has found creative ways to make gaming both fun and functional. By Dr. Kirk Brumels

uring a typical day in our athletic training program, some injured athletes snowboard down huge mountains as part of their rehab. Some compete in intense dance competitions. And others use their feet to stomp on moles as they emerge from their

holes. Sound ridiculous? It would be, if these activities occurred in actual reality instead of virtual reality. Here at Hope College, we use video gaming as an integral part of our athletic training and rehabilitation programs. There are no video games on the general market today that specifically target rehabbing athletes. But with some creativity and willingness to experiment, many commercially availTR AINING-CONDITIONING.COM

able games can be adapted to add value to an athletic training program. The technology in today’s systems has brought gaming far beyond the days when it was only a workout for the thumbs—with some games out there today, playing is truly a total-body experience. Of course, there’s more to it than buying the latest game console, setting it up with a TV in the corner, and telling your athletes to have at it. But with clear goals in mind, video gaming can be fun and functional at the same time. Kirk Brumels, PhD, ATC, is Associate Professor of Kinesiology and Director of the Athletic Training Program at Hope College. He can be reached at: brumels@hope.edu. T&C september 2010

TREATING THE ATHLETE WHY USE IT? The goals of typical injury prevention and rehab exercises are relatively simple. They need to improve flexibility, strength, endurance, and functional characteristics such as balance, agility, and coordination. Every athletic trainer knows a battery of exercises and movements that can do all of those things, but sometimes the very best exercises are, for a lack of a better word, boring. Repetitive drills can be laborious for even the most dedicated athlete, de-

spite our efforts at inspiration. When attention wanders, form and mechanics deteriorate and effort is less than we want. Thus, making an exercise fun and engaging is about more than helping the athletes have a good time. It’s an important way of promoting compliance, and getting athletes to view rehab as something they want to do instead of something they have to do. Video games are designed for entertainment, and there’s no denying they’re very good at that. But when using them as a rehabilitation tool, the

main goal isn’t for the user to have fun—though that’s a pleasant side effect. Video games in the rehab setting must be evaluated just like any new exercise or piece of equipment, with a few key questions in mind: • Do they help meet our rehab objectives? • Do they provide a challenge for the injured athlete that he or she is physically capable of handling? • Do they present minimal risk for re-injury or injury aggravation? • Do they achieve a specific benefit, and do so more effectively than other available methods? In my experience, a well-designed rehab protocol incorporating video games can answer “yes” to all those questions.

Light-hearted competition for high scores develops among athletes who are prescribed similar activities during their rehab programs. And though they often don’t realize it, they push themselves harder and perform the exercises with greater precision as a result.

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In particular, I have found video games can help bridge the gap between static and functional movements and specifically target weight acceptance, muscular control, balance, coordination, core stability, strength, endurance, and proprioception. In addition, video game-based rehabilitation offers great versatility, as it can be modified for both the athletic training room and the athlete’s home or dorm. I recently conducted a study along with several of my athletic training students at Hope College to compare the effectiveness of video game-based rehabilitation exercises and traditional exercises. We looked specifically at lower-leg and ankle balance programs, and found that athletes who participated in the video game program not only showed a statistically significant improvement in ability relative to the non-video game users, but also

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TREATING THE ATHLETE reported that their training was “more enjoyable” and “less strenuous,” even though both groups performed the same amount of work. This backs up our growing body of anecdotal evidence showing that—big surprise here—college students enjoy working with video games. Lighthearted competition for high scores develops among athletes who are prescribed similar activities during their rehab programs. And though they often don’t realize it, they push themselves harder and perform the exercises with greater precision as a result. Some even come in for extra rehab and inju-

body fatigue, and facilitates performance improvement. We’ve modified game play in many ways to achieve specific training results, sometimes mimicking the demands and benefits of well-known exercises and movements such as the Star Excursion Balance Test. See “DDR Breakdown” on page 43 for several examples. The 2008 introduction of another gaming platform, the Nintendo Wii Fit bundle, greatly enhanced our options for video gaming in rehabilitation. Anyone who has used a Wii knows it’s different from any other gaming experience. The controller is handheld

Because these exercises require minimal supervision once learned, there are countless opportunities to fit them in. For instance, we encourage athletes who are waiting for ankle taping to participate in Wii-assisted balance improvement exercises for extra injury prevention at a time when they’d otherwise sit around and socialize. ry prevention work, in order to defend their “record high score” against another rehabbing athlete. GETTING IN THE GAME We have been using video game-based rehabilitation exercises in our athletic training program for nearly five years. Our first foray into this method utilized the game Dance Dance Revolution (DDR) as a way to improve balance and agility in healthy athletes and those rehabbing from injury. DDR was at the forefront of the “active gaming” movement, being one of the first games to require weight bearing physical activity instead of the typical handheld controller. The interface is a floor mat with a grid of pressuresensitive pads activated by the user’s feet. During play, visual commands are presented on a television screen accompanied by auditory cues. The player must respond to a scrolling series of arrows pointing left, right, up, or down by moving their feet and touching the corresponding arrow on the game mat at just the right time. The tempo and difficulty of the patterns increase as the player progresses through the levels, ultimately leading to an experience that stimulates metabolism, creates general and specific 40

T&C september 2010

like with older game consoles, but it is highly sensitive to motion and acceleration in all directions. Depending on the game, it can be swung like a golf club or tennis racket, thrust like a boxing glove, or tilted and turned like a steering wheel. The Wii Fit system comes with a balance board, which is critical to many of the exercises and features we use with our athletes. It’s essentially a force plate that responds to changes in body position and center of balance, providing constant feedback about the player’s performance. When we purchased the Wii gaming system and the Wii Fit bundle, we immediately found several applications for them. Many Wii games provide auditory and visual stimulation and competitive situations that force the user to concentrate on changing body position and performing challenging movements. And because these exercises require minimal supervision once learned, there are countless opportunities to fit them in. For instance, we encourage athletes who are waiting for ankle taping to participate in Wii-assisted balance improvement exercises for extra injury prevention at a time when they’d otherwise sit around and socialize.

Some Wii games can be used just as designed by the manufacturer. For instance, the yoga, strength, and balance activities in the Wii Fit and Wii Fit Plus game bundles provide ample challenge just by following the on-screen prompts and directions. However, we have also increased the difficulty by adding dumbbells, tubing, or other implements and rehabilitative tools. Some other games can be used simply to promote movement and diversion during traditional exercises, such ankle and knee stability work. HOW WE DO IT So what exactly do our video gamebased exercises look like? One of our (and our athletes’) favorites is performing step-up, wall sit, or squatting exercises (See Figure 1 below) on a BOSU apparatus while playing a game like the Duck Hunt game from the Wii Play program (Duck Hunt is just what it sounds like—the player aims the controller like a gun at small ducks flying against a sky background on the screen). To make this exercise more difficult, the athlete plays while performing wall sits or squats and squeezing a Pilates ring or weighted ball between their distal thighs.

Figure 1 TR AINING-CONDITIONING.COM

TREATING THE ATHLETE That’s just one way we get the most out of a game. Here are some more examples of successful adaptions we’ve used. • Shaun White Snowboarding and Wii Fit balance games both use the Wii’s balance platform, which we place on an upside-down BOSU. We sometimes have athletes play Snowboarding while in a plank position, with their hands instead of their feet on the balance platform.

Figure 2

• Various Wii games, including boxing and tennis, can be played while the athlete performs pike exercises on a BOSU (See Figure 3 at left). • In Wii boxing, which involves holding a game controller in each hand and “punching” an on-screen opponent with full arm extension, we have attached surgical tubing to an athlete’s hands or given them dumbbells to hold in addition to the controller (See Figure 4 below).

Figure 3 • Both DDR and Mole Stomper from the Active Life Outdoor Challenge program are based on foot movement patterns (though we don’t only use them for foot work). They can be played with surgical tubing around the ankles to add resistance. We’ve also had athletes play these games with their hands. The athlete places their feet are on a physioball or has them held and perturbed by a practitioner, which indeed is just as hard as it looks (See Figure 2 at left).

Figure 4

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THE ESSENTIALS What equipment is necessary to add video game protocols to your athletic training room? Here’s the rundown:

compatible with the Wii. In my opinion, the Wii is by far the most suitable gaming system for athletic training use.

Television. You definitely don’t need a fancy wall-mounted bigscreen HDTV. We use an old TV set discarded by our school’s Information Technology office, and the only thing fancy about it is the exquisite faux wood veneer on the sides. If your set doesn’t have the correct audio/visual jacks to connect the game console, you can usually find an inexpensive adapter.

Games. The possibilities are extensive and continually growing. The ones I most highly recommend for the Wii are Dance Dance Revolution, Wii Fit or Wii Fit Plus (this game is packaged with the pressure-sensitive balance platform), Wii Play, and Outdoor Life Challenge.

Our television is on the top shelf of a rolling cart for easy movement, storage, and visibility during both “high” (standing) and “low” (near the floor) exercises. For extra visibility, we’ve added a second, smaller set on the lower shelf of the cart. This way, an athletic trainer or other observer can follow the activity on the larger screen while the athlete in a low position looks at the smaller one. Gaming System. We started out with the Nintendo Game Cube system, but we now use the Nintendo Wii. Our old Game Cube games (such as the Mario Mix version of Dance Dance Revolution) are still usable because they’re

Memory Device. This is critical for storing data created by each user’s participation in various games. Many games have certain activities or levels that need to be “unlocked” via repetition or obtaining a high score. Once they are unlocked, you want the ability to save them for future use and play. In addition, a memory device makes it easier for athletes to repeat a previously used routine. Accessories. Most of the implements we use to add an extra challenge to the games can be found in any athletic training room or rehab center. We’ve used surgical tubing, physioballs, dumbbells, cuff weights, step-up platforms, and unstable surfaces. 217-431_ExScience_3.4x4.8_4C:Layout 1

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TREATING THE ATHLETE

DDR BREAKDOWN As we have grown more sophisticated using the Dance Dance Revolution (DDR) game, we’ve learned to improvise by adding implements and “activity distracters” to make the game more demanding. Here are some ways we’ve applied DDR to assist with specific aspects of rehab: LOWER EXTREMITIES Weight Shifting • Stand on both feet in the middle of the control pad. Step onto direction arrows as directed by game, then return to the middle (normal game play). • Same as above, but instead of returning to the middle, stay on each direction arrow until the next movement command. Single-Leg Balance • Use a single-leg stance in the middle of the pad with the knee slightly bent. Respond to game commands with the opposite foot, without unloading the standing leg. • Increase difficulty by utilizing an unstable surface for the standing leg, such as a foam roller, foam disc, wobble board, or balance disc.

• Same as above, but also engage the upper extremities with matrix patterns using dumbbells, tubing, or a BodyBlade, or with partner-assisted catching, throwing, or swinging activities. • With a single-leg stance on an elevated platform at the center of the pad, use squat movements to touch the directional arrows with the non-standing heel as directed by the game. Mini-squats can be performed while waiting for the next directional prompt. UPPER EXTREMITIES • Starting in a push-up position, respond to game commands by tapping the correct directional arrow with either arm. Use this progression to increase difficulty: 1. Begin with knees in “modified push-up” position 2. Progress to full push-up position 3. Elevate the legs onto a platform, table, or physioball • While performing the above, do push-ups in between directional arrow commands and tap the arrows with one hand when prompted.

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Figure 5

• For various Wii games that require manipulating the handheld controller either through punching or swinging, we have the athlete play while performing different exercises on a physioball (See Figures 5 and 6 at left). This is a “freestyle” form of exercise that varies greatly based on the chosen game, our rehab or conditioning goal fort he athlete, and any injury limitations they may have. It can also include balance or strengthening work specific to the injury rehab program they have been given. We’re very pleased with the new dimension video gaming has added to our bag of tools for our athletes’ rehabilitation and skill development. Besides getting athletes excited about coming to the athletic training room, which we all know can be quite a challenge at times, it has produced functional benefits for the many of them who have embraced using it. And as we continue experimenting with new games and new ways to adapt video gaming to our training and rehabilitation goals, it will only get better. Play on. n

Figure 6

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Are your Players Ready for Game Day? By Chris Frankel, M.S. Director of Programming, Fitness Anywhere

As the resident TRX Professor, Chris Frankel draws from over 25 years of experience as a trainer and strength and conditioning coach. He earned an MS in Exercise Physiology from the University of New Mexico, where he is currently completing his doctorate in Exercise Science. Before taking the position of Director of Programming at Fitness Anywhere, Chris was an instructor in the Department of Health, Exercise and Sport Sciences at the University of New Mexico.

TRX® Suspension Training® bodyweight exercise provides an excellent way to integrate multiple components of movement for football strength and conditioning. Using Suspension Training to load and unload movements using resistance and stability provides obvious applications for strength, mobility, range of motion and metabolic challenges. In addition, there are exercise progressions unique to Suspension Training to develop movement quality directly transferable to traditional strength training and field performance for football athletes. The following TRX movements fall into a category termed “self limiting” exercises. These exercises demand greater engagement and greater physical awareness. The athlete receives immediate sensory feedback on performance because they will be unable to maintain balance, alignment and posture or simply lack strength, mobility or stability in specific areas.

TRX Overhead Squat

(extend arms overhead, back of hands in foot cradles, feet hip width apart. Pull arms back, lower hips down and back, weight in heels) This exercise can be used as a standalone exercise or as movement preparation before and during a squatting or snatch program depending on the needs and abilities of the athletes. Many players are not able to perform an effective overhead bodyweight squat while maintaining a stable core, mobile hips and ankles. Using the TRX to provide stability and to activate the posterior chain most athletes can demonstrate improved movement quality and therefore can train stability and mobility in the appropriate places. If the athlete is able to perform a good bodyweight overhead squat this exercise can be used to activate the posterior chain and strengthen an already strong movement pattern. An advanced progression would be to perform the overhead squat with both foot cradles on one hand which makes the exercise more challenging because the athlete has to resist rotational forces.

TRX Single Leg Chest Press

(Lower chest in push-up motion. Extend one leg to the side. Switch extended leg) Often athletes of all levels are “disconnected” when performing pressing exercises. Using a single leg stance for a chest press requires integration of upper, core and lower body to maintain alignment, resist rotation while generating strength and power in the press. The important coaching point here is to maintain a stable core and focus on hip extension in the grounded leg throughout the entire range of motion. Bringing the opposite leg up into triple flexion replicates an acceleration position, reinforcing extension in the drive leg and often “fixes” excessive lumbar extension often seen in pushups and other exercise where core stability is lacking

TRX Sprinter Start

(Walk back into 45 degree angle, step back into lunge with right leg. Bring right knee up and forward. Perform complete set then repeat on other leg) Another powerful way to exploit the unique benefits of Suspension Training takes a different approach to a step up pattern to improve single leg balance, strength and explosiveness. It is not uncommon for athletes to focus on the knee drive during starts and acceleration at the expense of contralateral hip extension and core stability. By initially relating the TRX Sprinter Start to a “step up” exercise where triple extension is the focus the knee drive can be trained without sacrificing force production or unwanted spinal flexion. Focus on having the athlete earn their appropriate level of progression from slow controlled movements with short isometric holds at the start and midpoint of the movement to continuous movement and finally to explosive movements always driving from hip extension and not “short stroking” from the knee and or ankle. This progression translates extremely well to sled work.

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Circle No. 133

sport specific

Strong as Bulldogs Make no mistake—Butler didn’t get lucky as the Cinderella team of the 2010 NCAA Division I Men’s Basketball Tournament. The Bulldogs’ conditioning program was a key element of their run to the championship. By Jim Peal

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n athletic department-wide philosophy that demands commitment, the “Butler Way” denies selfishness, accepts reality, and seeks improvement every day while putting the team above all else. It is practiced by every Bulldog athlete and coach— including the strength and conditioning department. As the men’s basketball strength coach, I believe I play a vital role in the team’s fate and am blessed to have sport coaches who promote a yearround commitment to strength and conditioning. They trust me to design and implement a program with the goal of keeping our team strong all year long. Our players are never “out of shape.” The program we use allows our players to compete at high levels throughout the season and maintain their fitness into the NCAA tournament, including last year’s historic run to the championship game. What follows is an inside look at the year-round strength and conditioning program that helped launch Bulldog basketball into national prominence. Jim Peal, MS, CSCS, is Head Strength and Conditioning Coach at Butler University. He can be reached at: jpeal@butler.edu. T&C september 2010

sport specific SUMMER SETUP Our summer program is completely voluntary, but we have great attendance from athletes who spend those months in and around Indianapolis (those who don’t receive simplified, written training instructions before they leave). I tell the players that how much they improve over the summer is up to them—all I ask is that they give their best and make an effort to do the work. However, effort usually isn’t an issue—most players strive to get better because they are driven by the Butler Way.

coaching staff pays close attention to each player’s progress in the bench press, setting individual goals for both one-rep max and 185-pound rep max. These workouts typically begin with a basic upper-body warmup and then proceed directly to the bench. We typically prefer to use flat bench or flat close-grip bench presses, especially when using heavy weight, and primarily train with sets in the four- to six-rep range. But in the last few weeks before fall testing, we will add more weight and lower the reps to two or three to prepare for the upcoming max-out.

We do a 15-minute agility program ... Our agility work focuses first on body control, then speed. The phrase “Agility is the ability to control your mass and change direction” is posted in our weightroom to serve as a reminder of how important body control is to success. From June to August, our athletes perform a four-day upper-body/lower-body split routine. The big-picture goal is for players to meet individually assigned benchmarks for strength and fitness. On Sunday evenings, the players train their legs after a 90-minute open gym session. We consider this our moderate leg day, with each player spending a total of about 30 minutes in the weightroom. During these workouts, the key lifts involve the leg press machine and hamstring strengthening. The leg presses begin with four sets of 10 at 60 to 70 percent of personal max in the first three weeks, then proceed to clusters of 10 to 15 sets of two to three reps each at 75 percent of max and up—the players are free to decide for themselves how high they go. For the hamstrings, partner gluteham work is a staple. We also mix in stiff-leg deadlifts, single-leg deadlifts, Romanian deadlifts, and leg curls. Players round out these workouts with 10 minutes of core work and stretching using Swiss balls and bands. Sunday is very important to us because it’s usually the only time we are in the weightroom together as a team. The other weekly sessions are more openended, scheduled around each player’s class and internship commitments. Monday is an upper-body day, and the sessions last about 50 minutes. Our 50

T&C september 2010

Next come cleans, presses, and/ or use of a push-movement machine called the Hammer Strength Jammer. My assistant Ross Bowsher and I like the Jammer because it’s biomechanically safe on the shoulders and the motion is very similar to the jerk movement, which promotes triple extension of the ankles, knees, and hips in a way that transfers very well to the explosive demands of basketball. After that, the next 30 minutes of the Monday workout is less structured, with the athletes performing prescribed exercises for the shoulders, lats, and upper back. We usually assign one or two exercises for each muscle group, such as DB shoulders, alternate presses, shrugs, seated rows, standing bent-knee rows, lat pulldowns, and my favorite, chin-ups. The combinations vary greatly—perhaps the only constant is that we never do movements behind the head because the injury risk associated with them is too high. The last five minutes of the session include several different stations, from partner resistance exercises to running the stack on biceps curls and triceps extensions. Finally, I like to challenge the players with a different finisher at each workout. For this, we frequently use chin-ups to exhaustion, partner push-ups, partner towel pulls, or planks. Wednesday is usually our second

leg day of the week. We consider it our heaviest day, and the session lasts about 45 minutes. We start with a total-body warmup, then do three to four sets of five reps of hang clean to squats followed by two to three more sets of hang cleans with two to four reps. Next, we move on to heavy squats. After a three-week acclimation period, our players perform timed clusters of eight to 12 sets with two to three reps each. This squat work is very similar to our leg press progression, except that the squats are never performed to max effort. I have found sub-max clusters of squats are the best way to train legs for basketball, mainly because they force the athletes to really push themselves and their teammates. We keep it simple by starting each set on the minute, at around 72 to 75 percent of the player’s estimated one-rep max. Last summer, 12 of our 14 players were able to squat 335 to 365 pounds for multiple sets of three reps. After that, we spend roughly 20 minutes on various exercises designed to correct strength imbalances between the right and left legs. Lunges are a staple of our program and we include many variations, such as twist, side, reverse, and overhead for three to four sets while holding 45 pounds and walking 20 yards (the length of our weightroom). Because basketball involves dynamic multi-planar movements, our players do at least four sets of single-leg exercises in addition to their lunge work. Examples include one-legged leg presses, heel touches while standing on a bench, split squats, step-ups, and onelegged RDLs. The last five minutes of the Wednesday workout are dedicated to hamstring-specific work. With a partner, players perform glute-ham exercises and leg curls. To finish up, we do superset hamstring work and lunges with core exercises such as V-ups, sit-ups, and Russian twists. Thursday is our final lifting day of the week. We begin these sessions with an upper-body warmup, then go straight to the Jammer or to barbellbased jerk exercises. Players typically perform five sets of five reps, starting each lift on the minute to set a tempo for the workout. Next, we move on to chest work using two of my favorite exercises: flat dumbbell bench presses and 10-degree incline TR AINING-CONDITIONING.COM

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sport specific bench presses with a barbell. I keep the reps high (eight to 10) and weight in the range of 65 to 80 percent of max. For a new progressive challenge, we are currently experimenting with the addition of chain-resisted bench presses. To avoid overtraining, and because this is our second chest workout in five

conditioning and agility components into our workouts. In this part of our training, we mainly want to overload the energy system to a greater degree than typically happens on the court. After a 15-minute active warmup consisting of movements like high knees, butt kicks, lunges, slides, and

Players who enter our program can already run and jump proficiently, but they often do not understand the importance of decelerating under control and landing in a position they can react from ... You must control your body before you can control your opponent.. days, I carefully monitor the players to make sure they stay within my recommended ranges for sets, reps, and effort percentages. The final 20 minutes of Thursday workouts are similar to our Monday upper-body routine, but with a greater emphasis on the posterior chain. For example, I like to finish with partner-assisted towel rows, chin-ups, and side deltoid raises. Thursday is also when we implement

various types of skips, we do eight to 10 sets of simple plyos. I prefer using bleacher bounds to lessen the impact on the players’ joints, and we avoid high-stress plyos such as depth jumps. Then, after a brief water break, we do a 15-minute agility program emphasizing proper defensive positions. During these exercises, I want players to concentrate on maintaining a slightly lower knee bend than they’re

used to—Coach Brad Stevens is very fond of telling players to “stay lower, longer.” Our agility work focuses first on body control, then speed. The phrase “Agility is the ability to control your mass and change direction” is posted in our weightroom to serve as a reminder of how important body control is to success. Changing direction on the court usually involves unbalanced, dynamic one-legged movements. For that reason, we perform a lot of deceleration drills on Thursdays to complement the single-leg work we do on Wednesdays. Players who enter our program can already run and jump proficiently, but they often do not understand the importance of decelerating under control and landing in a position they can react from. To be clear, we work on both acceleration and deceleration, but body control always comes first. You must control your body before you can control your opponent. To improve agility, we employ an agility ladder and various footwork drills. The body’s positioning during

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sport specific the drills is of prime importance—I always stress quiet feet. After agility work, we finish with 200-meter and 100-meter runs for roughly one mile of total distance. We then wrap things up with a cooldown jog and band stretching. FALL INTO PRESEASON During the fall, we stay with the same basic four-day lifting schedule. It has been my experience that basketball players do best when the workouts are short (35 to 45 minutes) and frequent. We also stay with one conditioning-based workout each week. By this time, coaches have begun individual skill work with players twice a week for 40 minutes at a time. These are very intense sessions in which the player works on sport-specific skills. Before we implement any fall workout programs, our players undergo a battery of baseline body composition and strength and conditioning tests. A staple of these is the mile run, which is held as soon as players return for the fall semester. Though not overly sport-specific, the run gives our

coaches a pretty good idea of where each player is in his conditioning and helps us adjust his workouts accordingly. Our expectation is that post players can complete the mile in under six minutes, wing players in under 5:45, and guards under 5:30. However, we adjust expectations for certain

line and back, half court and back, far foul line and back, and far baseline and back. We want them to average between 27.5 and 29.5 seconds. This is an excellent gauge of speed, acceleration, and ability to change direction. With the exception of a body fat test, all our test results are evaluated against

We strive to make our conditioning sport-specific, emphasizing elements such as posture, change of direction, and sustaining a high energy level. Our players train to become better basketball players— not to do well on cardiovascular tests. players upward or downward based on their ability. To measure strength, we use the 185-pound bench press max rep test as well as one-rep max. Last season, six players benched over 300 pounds. Additionally, we test players on sit-up reps and the leg press. During the preseason, players must also pass our four-line test: Starting on the baseline, they must run to the foul

teamwide goals set by the coaches. The team has until the season starts to reach those goals, and we have succeeded in each of the past four years—a span during which the team’s overall record was 118-22. If we have an athlete who is behind in his test results, we will include one to two special workouts with a focus on conditioning only. We strive to make our conditioning

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sport specific sport-specific, emphasizing elements such as posture, change of direction, and sustaining a high energy level. Our players train to become better basketball players—not to do well on cardiovascular tests. STRONG IN-SEASON When official practices begin and the season is around the corner, we cut down to three days a week in the weightroom. We also back off on leg work because the players’ legs take such a pounding during practices and games. For instance, squats are phased out in favor of body weight work, lunges, and step-ups with reps in the 10 to 12 range. We continue to hit the upper body hard, and most of our work is performed in the five- to eight-rep range. In a typical workout, we ask players to work at 72 to 80 percent of their one rep max if doing five reps, and 62 to 70 percent if doing eight reps. Once the game schedule begins, we pare down our weightlifting even more. When playing two to three games and practicing three to four times per week, there isn’t much time left for strength

work. Still, our goal is to get in two weekly lifting sessions. Because we are focused on winning games, not building weightlifters, the last thing I want to do is wear a player down in the weightroom. That’s why our basic approach is to perform total-body lifts for 30 to 40 minutes during these sessions, supersetting

Based on our past success, including last season’s championship game appearance, I consider our approach to in-season lifting very successful. In fact, eight days after that game, we administered the 185-pound bench press rep test and found that the team maintained just over 90 percent of its preseason strength baseline.

I consider our approach to in-season lifting very successful. Eight days after last season’s championship game appearance, we administered the 185-pound bench press rep test and found that the team maintained just over 90 percent of its preseason strength baseline. opposing muscle groups. We work the upper body at 85 to 95 percent intensity in-season, and stick to 75 to 80 percent intensity on the lower body. As the season advances, we back off another 10 percent or more. And in the postseason, we do almost no leg work other than some step-ups, lunges, and hamstring curls—usually totaling no more than six sets.

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At Butler, we are blessed to have athletes who accept their responsibility to prepare for the upcoming season all year long. Our sport coaches and conditioning staff all contribute by maintaining a 12-month commitment to physical preparedness, so on any given day, our team is never too far from game shape. Add it all up, and you have the Butler Way. n

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.com who are we? Aluminum Athletic Equipment Co. wanna stop by? 1000 Enterprise Drive • Royersford, PA 19468 phone ? 800-523-5471 • 610.825.6565 fax? really? 610.825.2378 what’re our games? Track & Field • Football • Soccer Lacrosse Field Hockey • Baseball • Softball

Made in USA

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Athletic Management TR AINING-CONDITIONING.COM 1/6-Page Vertical

Nutrition Introducing P3™ TecHnology

EAS is a team of scientists, researchers, and all-around fitness fanatics who are passionate about getting the most out of the human body and helping people run faster, jump higher, and kick harder. EAS Peak™ is the world’s only pre-performance beverage with P3™ Technology for sustained energy, increased workout capacity, and reduced muscle breakdown. EAS • 800-297-9776 www.eas.com/peak

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Balancing Act

G Series Pro Protein Recovery Shake provides balanced nutrition for consumption after exercise to help jump-start recovery. With carbohydrates for glycogen restoration and an effective amount of protein containing all the essential amino acids needed to help support muscle recovery after training or competition, G Series Pro Protein Recovery Shake provides a nutritional bridge between an athlete’s workout or competition and the next meal.

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

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Complete Casein delivers 25 grams per serving of anti-catabolic, slow-digesting protein from micellar casein and calcium and sodium caseinates. Because casein protein digests slower, it provides amino acids over a longer period of time than whey protein. This prolonged amino acid availability is what makes Complete Casein anti-catabolic. Complete Casein contains aminogen, a digestive enzyme, to help promote efficient and complete protein utilization and uptake. Complete Casein is lactose-free and glutenfree, so it is suitable for almost anyone looking to increase protein intake. Circle No. 502

Egg Whites International’s 100-percent pure liquid egg whites are heat-pasteurized and tested for salmonella, making them “liquid” but not “raw.” They are doublefiltered to achieve the smooth consistency of milk, and they’re completely tasteless and odorless for making the perfect protein drink. An eight-ounce serving supplies 26 grams of protein with no fat, no cholesterol, two grams of carbs, 120 calories, and all the essential amino acids.

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Hormel Health Labs • 800-866-7757 www.healthy-shot.com

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High Protein

All-Pro Science Complete Veggie Protein combines 23 grams of all-natural protein from three high-protein sources—brown rice, peas, and hemp—into a great tasting blend that’s fortified with vitamins, minerals, and flaxseed. It’s perfect for athletes or vegetarians who wish to add more protein to their diet, and comes in vanilla and berry blast. Circle No. 501

Nature’s Protein Drink

Research suggests that low-fat chocolate milk, with its unique mix of nutrients, is a naturally nutrient-rich protein drink that can help athletes refuel and rehydrate within the critical two-hour recovery window after exercise. Drinking low-fat chocolate milk after exercise not only provides the carbohydrates and protein to refuel and repair muscles, it also helps replenish fluids and electrolytes that are lost in sweat, such as calcium, magnesium, and potassium. Milk Processor Education Program info@milkdelivers.org

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BUILDING A BETTER BODY

Goes Down Like Milk

Egg Whites International • 877-EGG-WHITES www.eggwhitesint.com

It takes more than sweat to keep fit. Today, more athletes are discovering the importance of a nutrition program that is balanced and provides an adequate supply of protein. Timing is critical, too. The best time to consume protein is right after a workout. That’s why Healthy Shot delivers 100 percent of all the essential amino acids in just a 2.5-ounce shot drink. It provides high protein (12 grams) or double protein (25 grams) in a fruitflavored drink without fat and with only 100 calories. It won’t fill you up or slow you down.

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

Special Delivery

CytoSport • 888-298-6629 www.cytosport.com

Protein Shot

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Ready to take your workout to the next level? Start off with Pro Science Push. It’s an advanced combo of carbs, creatine, and beta-alanine that’s been clinically shown to increase workout capacity and boost muscle strength. Then, end your routine with Pro Science Finish, a high-protein recovery formula that’ll help you build muscle and increase lean body mass. Safe and effective, it’s real science working for you. EAS • 800-297-9776 www.eas.com/pro-science

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Nutrition No Fat or Fillers

Over the Bridge

G Series Pro Nutrition Bar and G Series Pro Nutrition Shake are a convenient bridge between meals that help elite athletes meet their daily calorie needs. With a mix of highquality protein, simple and complex carbohydrates, fat, and a blend of 15 vitamins and minerals, G Series Pro Nutrition Bar and G Series Pro Nutrition Shake help keep athletes’ bodies fueled and nourished for training and competition. Gatorade • 800-884-2867 www.gatorade.com

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The Right Ratio

All-Pro Science Recovery Advanced Sports Formula replenishes the body after a grueling workout so athletes can rebound faster and continue training hard. This unique 3:1 carbohydrate-to-protein ratio drink rehydrates and refuels athletes and exercising individuals alike. Taken after workouts, 3:1 drinks can help reduce fatigue, soreness, and recovery times while assisting muscle synthesis. Flavors include fruit punch, pineapple, orange, and lemonade. All-Pro Science • 949-222-1009 www.allproscience.com

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Whey Isolate is a premium-quality, lactose-free whey protein supplement with amazing taste satisfaction. Each serving provides 25 grams of pure whey protein isolate. Fat-free, sugar-free, lactosefree, and gluten-free Whey Isolate provides more of what athletes want and none of what they don’t. It’s available in six great-tasting flavors: vanilla creme, chocolate, sour apple, pineapple banana, tangy orange, and blue raspberry. CytoSport • 888-298-6629 www.cytosport.com

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Knowledge Is Power

Informed-Choice is committed to helping ensure the purity of nutritional supplements, and it relies on HFL Sport Science to conduct product tests. HFL Sport Science has been testing supplements since 2002. The lab tests more than 5,000 samples annually, and currently works with more than 100 companies worldwide, including over 40 American and Canadian brands. HFL works closely with supplement manufacturers and suppliers to reduce the risk of contaminated products finding their way into sports, thus helping ensure that athletes know exactly what they are putting into their bodies. Informed-Choice • 720-289-2401 www.informed-choice.org

Rolling Muscle Massager

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“Thank you for making great tools— your company is the only one I trust and recommend to my patients/colleagues." – Haley N. Masbruch, LMP

• Massage and soothe tired or overworked muscles • Prepare conditioned muscles for action • Save fingers and hands from fatigue

Use with

• Dense foam roller spins smoothly • Easy to clean with antibacterial gel/spray • Completely portable • For best results, use with The Original Backnobber® II

• Press deeply into over stressed muscles • Self treat daily wear and tear of muscles

www.pressurepositive.com

• Comes apart for easy travel and storage • Four colors available

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Lower-Body Strengthening Ergonomically Correct

The Hammer Strength Linear Leg Press was developed through years of collaboration with athletes and coaches to simulate the most natural, ergonomically-correct paths of motion. The machine’s long-lasting linear bearings create a smooth feel, and the intuitive flip-in, flip-out weight racking mechanism is easy to use. Hammer Strength • 800-634-8637 www.hammerstrength.com

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Jump-Start Training

The high-impact TurfCordz Jump Belt, used by professional sports teams and international Olympians, strengthens leg muscles to enhance vertical leap. With five resistance levels, it’s ideal for basketball, football, and track training. Designed to meet the extreme demands of high-level athletic training, the easy-to-use Jump Belt features an adjustable cam buckle closure that fits up to a 36-inch (90-centimeter) waist and two 30-inch (75-centimeter) rubber tubes that connect to foot straps. Circle No. 513

REDUCING RECOVERY TIME

i-Shape’s unique Tonic Vibration Reflex (TVR) technology offers whole body vibration training featuring a distinctive stretching cage, dual vibrating platform, and intuitive virtual LED coach to guide users through multi-level, full-body workouts. Athletes can utilize i-Shape to stimulate stretch-reflex muscle contractions with targeted lower-body exercises to quickly and effectively reduce recovery time post-injury and increase muscular strength, explosive power, flexibility, and range of motion. efi Sports Medicine • 800-541-4900 www.efisportsmedicine.com

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OPTP • 800-367-7393 www.optp.com

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Gaining Power

Sled Dawg provides outstanding leg strengthening results. It was redesigned this year with added push handles for powerful hip and leg drive and new flat bottom rails for more consistent resistance. Sted Dawg is built with 11-gauge steel to create an extremely strong frame, and comes with a shoulder harness attachment that allows for an even load.

NZ Manufacturing • 800-866-6621 www.turfcordz.com

The Multi Challenge Board provides two levels of balance challenges. Simply pull out and turn the sphere base to adjust the board angle from 14 to 17 degrees. Regular use provides improved balance and coordination, increased leg strength and ankle range of motion, better proprioceptive awareness for injury prevention, and more.

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New and Improved

Perform Better • 800-556-7464 www. performbetter.com

Agility and Reaction

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Specifically designed for the athletic performance market, the Keiser Runner focuses on starting strength and acceleration—two skills that are crucial for sports that involve explosive power. The Runner allows athletes to train the lower body by using the components of speed and resistance, and can improve the performance of any individual looking for a competitive edge. Keiser • 800-888-7009 www.keiser.com

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Two Machines in One

The Leg Curl and Extension features a contoured rear seat back to promote proper body alignment and an extra-wide front seat. It’s made with heavy-duty 2” x 4” construction and designed for Olympic and standard plates. Hold-down rollers, an adjustable and removable T-bar, and easy pull-pin adjustment let you switch from leg extensions to leg curls quickly and conveniently. There’s also a rotary range-of-motion adjustment to enable various starting positions. New York Barbells of Elmira, Inc. • 800-446-1833 www.newyorkbarbells.com Circle No. 517

Good Vibrations

Exervibe is a whole-body vibration stepper that provides athletic enhancement when used in either the static (standing) or dynamic (stepping) position. Vibration stimulation is applied simultaneously to the feet, hands, arms, and core. The Exervibe is a cardio stepper and a vibration trainer in one. It has a step range from one to 18 inches, an adjustable seat, and a control module with four different settings. It is an extremely versatile device that efficiently and effectively implements the benefits of vibration. VersaClimber • 800-237-2271 www.versaclimber.com

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T&C SEPTEMBER 2010

Directory

Advertising Directory Circle #. Company. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page #

Circle #. Company. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page #

138. .AAE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

100. .Empi. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . IFC

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

111. .AccuFitness. . . . . . . . . . . . . . . . . . . . . . . . . . 18

102. .Gatorade. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

133. .Power Lift. . . . . . . . . . . . . . . . . . . . . . . . . . . 48

110. .All-Pro Science. . . . . . . . . . . . . . . . . . . . . . . 17

135. .Hammer Strength. . . . . . . . . . . . . . . . . . . . . 52

120. .PRO Orthopedic Devices. . . . . . . . . . . . . . . . 28

119. .Balanced Body . . . . . . . . . . . . . . . . . . . . . . . 27

112. .Healthy Shot. . . . . . . . . . . . . . . . . . . . . . . . . 19

131. .Pro-Tec Athletics. . . . . . . . . . . . . . . . . . . . . . 43

122. .Biodex. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

116. .Hibiclens & Hibistat. . . . . . . . . . . . . . . . . . . . 22

129. .RX24 QuadraStep System (Nolaro24). . . . . . . 42

130. .California University of Pennsylvania. . . . . . . 42

124. .ImPACT Applications. . . . . . . . . . . . . . . . . . . 35

136. .Samson Equipment. . . . . . . . . . . . . . . . . . . . 53

113. .CeraSport. . . . . . . . . . . . . . . . . . . . . . . . . . . 20

114. .Informed-Choice. . . . . . . . . . . . . . . . . . . . . . 20

139. .Save-A-Tooth . . . . . . . . . . . . . . . . . . . . . . . . 62

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

105. .Keiser. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

107. .STOTT PILATES. . . . . . . . . . . . . . . . . . . . . . . 10

121. .Concussion Vital Signs. . . . . . . . . . . . . . . . . . 32

142. .McDavid. . . . . . . . . . . . . . . . . . . . . . . . . . . . IBC

141. .The Pressure Positive Company. . . . . . . . . . . 56

125. .Cramer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

109. .MilkPEP. . . . . . . . . . . . . . . . . . . . . . . . . . . 14-15

118. .Thera-Band速/Performance Health . . . . . . . . 25

140. .Creative Health Products. . . . . . . . . . . . . . . . 62

103. .Mueller . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

137. .TurfCordz/NZ Mfg.. . . . . . . . . . . . . . . . . . . . . 54

126. .DJO/DonJoy . . . . . . . . . . . . . . . . . . . . . . . . . 38

143. .Muscle Milk (CytoSport). . . . . . . . . . . . . . . . . BC

132. .UCS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

108. .EAS/Abbott Nutrition. . . . . . . . . . . . . . . . . . . 13

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

117. .VersaClimber. . . . . . . . . . . . . . . . . . . . . . . . . 24

127. .efi Sports Medicine/Total Gym. . . . . . . . . . . . 39

134. .New York Barbells of Elmira. . . . . . . . . . . . . . 51

115. .Egg Whites . . . . . . . . . . . . . . . . . . . . . . . . . . 21

128. .OPTP. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Product Directory Circle #. Company. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page #

Circle #. Company. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page #

556. .AccuFitness. . . . . . . . . . . . . . . . . . . . . . . . . . 62

506. .Gatorade (G Series Pro Protein Recovery Shake). . 55

546. .Performance Health (Thera-Band Foot Roller). 63

501. .All-Pro Science (Complete Veggie Protein). . . 55

511. .Hammer Strength (Linear Leg Press). . . . . . . 57

548. .Power Lift (Body Weight Leg Curl). . . . . . . . . 59

509. .All-Pro Science (Recovery Advanced Sports Formula).56

524. .Hammer Strength (V-Squat). . . . . . . . . . . . . . 60

549. .Power Lift (Pro Select Reverse Back Extension).60

529. .Balanced Body (CoreAlign). . . . . . . . . . . . . . . 61

503. .Hormel Health Labs (Healthy Shot). . . . . . . . . 55

523. .Power Systems (Adjustable Lateral Plyo Box). 60

527. .Balanced Body (EXO Chair) . . . . . . . . . . . . . . 61

555. .Hydrate. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62

531. .Power Systems (Pilates Versa-Tube) . . . . . . . 61

544. .Biodex. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61

563. .ImPACT Applications. . . . . . . . . . . . . . . . . . . 61

542. .PRO Orthopedic (ice wraps). . . . . . . . . . . . . . 64

554. .CeraSport. . . . . . . . . . . . . . . . . . . . . . . . . . . 62

550. .Informed-Choice. . . . . . . . . . . . . . . . . . . . . . 56

539. .PRO Orthopedic (latex tubing units). . . . . . . . 60

532. .Cho-Pat . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62

519. .Keiser (Air300 Squat). . . . . . . . . . . . . . . . . . . 59

540. .Pro-Tec . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63

557. .Concussion Vital Signs. . . . . . . . . . . . . . . . . . 63

516. .Keiser (Runner). . . . . . . . . . . . . . . . . . . . . . . 57

537. .RX24 QuadraStep System (Nolaro24). . . . . . . 61

545. .Cramer (Cohesive Stretch Tape). . . . . . . . . . . 64

533. .McDavid (True Compression Leg Sleeves). . . 62

561. .Samson (Belt Squat). . . . . . . . . . . . . . . . . . . 59

547. .Cramer (Sideline Emergency Kit). . . . . . . . . . 63

543. .McDavid (True Compression Recovery Suit). . 63

560. .Samson Equipment (Sprinter) . . . . . . . . . . . . 60

502. .CytoSport (Complete Casein). . . . . . . . . . . . . 55

505. .MilkPEP. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

541. .Save-A-Tooth . . . . . . . . . . . . . . . . . . . . . . . . 64

510. .CytoSport (Whey Isolate). . . . . . . . . . . . . . . . 56

535. .Mueller . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61

528. .STOTT PILATES (Split-Pedal Stability Chair). . 61

500. .EAS (P3 Technology). . . . . . . . . . . . . . . . . . . 55

517. .New York Barbells (Leg Curl and Extension). . 57

530. .STOTT PILATES (Workout Kit). . . . . . . . . . . . . 61

507. .EAS (Pro Science Push). . . . . . . . . . . . . . . . . 55

521. .New York Barbells (Premier Leg Press) . . . . . 59

513. .TurfCordz/NZ Mfg. . . . . . . . . . . . . . . . . . . . . 57

514. .efi Sports Medicine (i-Shape). . . . . . . . . . . . . 57

515. .OPTP (Multi Challenge Board) . . . . . . . . . . . . 57

553. .UCS (Elite Plyo-Safe boxes). . . . . . . . . . . . . . 59

520. .efi Sports Medicine (Total Gym). . . . . . . . . . . 59

526. .OPTP (Thera-Band Band Loops). . . . . . . . . . . 59

552. .UCS (Plyo-Safe G2 boxes). . . . . . . . . . . . . . . 60

504. .Egg Whites . . . . . . . . . . . . . . . . . . . . . . . . . . 55

522. .Perform Better (Plyo Boxes). . . . . . . . . . . . . . 59

518. .VersaClimber (Exervibe). . . . . . . . . . . . . . . . . 57

551. .Fyrst USA . . . . . . . . . . . . . . . . . . . . . . . . . . . 64

512. .Perform Better (Sled Dawg). . . . . . . . . . . . . . 57

525. .VersaClimber (Portable VersaPulley). . . . . . . . 60

508. .Gatorade (G Series Pro Nutrition Bar/Shake). . 56

538. .Performance Health (Biofreeze fall promotion).64

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Lower-Body Strengthening All in One

Total Gym enables free, unrestricted movement through multiple planes of motion for more than 250 functional exercises on a single machine: the Total Gym GTS or Total Gym PowerTower commercial models. A groundbreaking study published in the North American Journal of Sports Physical Therapy proved Total Gym provides a reliable, accurate measure of lower extremity functional performance in individuals with restricted weight-bearing ability at an earlier stage in the rehabilitation process. efi Sports Medicine • 800-541-4900 www.efisportsmedicine.com

Hamstrings & Glutes

The Power Lift Body Weight Leg Curl is the newest hamstring and glute training apparatus from Power Lift. The Power Lift Body Weight Leg Curl features thick pads for user comfort, angled footplate, ankle pads with four height adjustments, wheels, and a handle to assist with movement. Band pegs are included and can be used to assist the user with the movement. The Bodyweight Leg Curl is a great complement to any strength training facility. Power Lift • 800-872-1543 www.power-lift.com

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Circle No. 520

Built to Last

Plyometrics Made Safer

New York Barbells of Elmira, Inc. • 800-446-1833 www.newyorkbarbells.com Circle No. 521

UCS, Inc. • 800-526-4856 www.ucsspirit.com

The Premier Leg Press is mounted on eight heavy-duty rollers and features an extra-wide steel deck foot plate. The deluxe three-inch thick stitched padding and heavy-duty stoppers ensure athlete comfort and safety. This unit is 49” wide x 47” deep x 75” high and weighs 196 pounds. It has a 1,000-pound capacity to accommodate all levels of strength training by serious athletes in all sports.

High Performance

The Keiser Air300 Squat combines lowimpact technology with the ability to move safely at higher speeds. The result is unmatched, explosive power—the key to superior athletic performance. Thumb buttons for resistance are conveniently positioned on the ends of the handgrips for greater control and stability during exercise, and a range-limiting feature helps prevent ligament and joint injury to the knee.

Keiser • 800-888-7009 www.keiser.com

Circle No. 519

Plyo Boxes are great for developing explosive leg power, leg strength, and dynamic balance. Designed for safety with a large landing surface, they are durable enough to hold the largest and most powerful people in athletic and clinical settings. Plyo Boxes are made from 1 1/4” 14-gauge tubular steel with a 3/8” polyurethane rubber stop, and are available in six-, 12-, 18-, 24-, 30-, and 36-inch heights and from 18” x 18” to 36” x 36”.

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Circle No. 522

Circle No. 553

Ideal for Everyone

The Samson Belt Squat’s brand new design limits the amount of floor space needed for this unique piece while making it easy for athletes of all different sizes to use. It features adjustable handles, a unique load release that brings the athlete’s hands closer together while performing the exercise, an adjustable yoke that allows the athlete’s hips to stay in their natural range of motion, and an adjustable chain with three different size belts. Samson Equipment • 800-472-6766 www.samsonequipment.com

A Step Up

Perform Better • 800-556-7464 www. performbetter.com

UCS Strength and Speed’s fully padded Elite Plyo-Safe boxes offer the ultimate combination of durability, stability, and safety, providing protection from common plyo box injuries. The understructure is made of 3/4-inch oak covered in a dense foam and upholstered in tough 38-ounce vinyl. A raised lip on all the boxes allows for stacking and locking of the lids. The 24-inch box is bottomed with 3/4-inch high-density rubber for stability.

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Strength and Balance Available in four resistance levels and three diameters, Thera-Band Band Loops can be used for a variety of applications, particularly in lower-body exercises to increase strength and balance. These continuous loop bands are available in the same colors and resistances as the Thera-Band Progressive Resistance System. OPTP • 800-367-7393 www.optp.com

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T&C SEPTEMBER 2010

Lower-Body Strengthening Durability and Reliability

The Hammer Strength V-Squat machine provides Iso-Lateral technology that replicates the body’s natural movements. Athletes can perform a natural squatting motion on the V-squat since it is designed to reduce back and knee strain through a curved arc of motion. Standard counter balance provides lower starting resistance and dual selectorized weight stacks preserve the integrity of independent leg action.

Hammer Strength • 800-634-8637 www.hammerstrength.com

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Select Choice

The Power Lift Pro Select Reverse Back Extension is the latest Pro Select lower body piece. All Power Lift Pro Select machines feature extra large pads for user comfort, 7-gauge steel construction, weight stack guards, and instructional placards. Key features for the Reverse Back Extension include a 400-pound weight stack, an adjustable start position, adjustable ankle pad, and multiple hand grip positions to accommodate a wide range of user sizes. Power Lift • 800-872-1543 www.power-lift.com

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A Step Up

Athletes can achieve explosive lateral movements and strong, quick direction changes with the Adjustable Lateral Plyo Box. The highly durable platform adjusts to 25, 35, or 45 inches tall to target all the muscles of the ankle, leg, and hip, and the reinforced non-slip platform provides a stable, secure contact area for the user. Each side can also hold a 45-pound plate, which is sold separately. Power Systems • 800-321-6975 www.power-systems.com

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Safety That Lasts

UCS Strength and Speed’s Plyo-Safe G2 boxes provide a lightweight, safe, and sturdy option for your plyometric routines. An extra-large landing surface (30” x 36”) is covered in durable 21-ounce vinyl. The 100-percent foam core will not break down, delaminate, or soften over time. Handles allow for quick repositioning. Each box has three two-inch strips of Velcro™ to enable stacking and prevent slipping during use. UCS, Inc. • 800-526-4856 www.ucsspirit.com

T&C SEPTEMBER 2010

Providing Resistance

Supplementing a rehab or conditioning program is easy with PRO’s variable resistive latex tubing units. Available in three resistances, each unit has a handle/foot stirrup attachment at each end with a moveable door jam attachment in the center, and comes with a webbed running belt, basic exercise booklet, and nylon travel bag. PRO Orthopedic Devices • 800-523-5611 www.proorthopedic.com

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Performance Enhancer

The Portable VersaPulley combines speed, power, and functional mobility through any range of motion with accommodating inertial resistance at any speed. Its lightweight, compact design and ease of mobility is ideal for on-field or on-court training by simply securing with adjustable straps. While the Portable VersaPulley weighs just 70 pounds, its patented technology can produce up to 800 pounds of explosive force resistance. Athletic trainers now have the ability to hand carry this unit to a field and apply a multitude of safe, sport-specific training drills. VersaClimber • 800-237-2271 www.versapulley.com

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Sprinting Toward Strength

The new Samson Sprinter is yet another way Samson Equipment is leading the way in heavy-duty custom equipment. This unique piece allows your athletes to perform a sprint motion while in a biomechanically sound running position. Adding resistance is made easy with the plate-loaded weight horns that are designed to prevent any plate movement. Created with comfort, durability, and adjustability in mind, the new Samson Sprinter will fit every athlete comfortably, and just like any other Samson piece, it will last a lifetime. Go online for a video demonstration. Samson Equipment • 800-472-6766 www.samsonequipment.com

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Looking for a fast, easy way to get CEUs?

You can now take CEU quizzes of T&C issues online! ➤ No pencil, envelope, or stamp needed. Just fill in the easy-to-use online form. ➤ Your results will be tabulated immediately, and your CEU certificate of credit will be made available as a PDF within minutes. ➤ You can also take CEU quizzes from back issues online. Read past issues and take the quiz all in one sitting! Click on “CEUs & Courses”

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More Products

Pilates Expanding the Possibilities

The EXO Chair delivers a unique and challenging Pilates-based workout. Athletic trainers can now get a wider range of options with a split-pedal version that allows both reciprocal and rotational exercises. And by adding a functional resistance kit, they gain even more possibilities, including many exercises that could previously be done only on a Reformer. Balanced Body • 800-745-2837 www.pilates.com

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A Total-Body Focus

Improve athletic performance and reduce the risk of sports-related injuries by incorporating the Stott Pilates® Split-Pedal Stability Chair™ into any athletic training program. This multifunction Pilates machine targets almost all muscle groups to build on the strength, power, and agility of the whole body. It enables athletes to condition both the core and periphery, and balance stability with mobility while improving focus, awareness, control, and coordination.

Stott Pilates® • 800-910-0001 www.stottpilates.com

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The Power of Resistance

Athletes can strengthen the core muscles while improving flexibility and postural awareness with the Pilates Versa-Tube. This compact tool simulates Reformer- or Cadillac-style workouts without the heavy equipment, and is available in four resistances to meet the needs of any user. Four equal-length resistance tubes with two handles and two ankle/foot cuffs allow for full range of motion movement in the arms and legs.

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

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Combination Approach

The CoreAlign combines cardiovascular work and integrated, full-body exercises with a mind-body approach. It stimulates core stability muscles to fire while performing exercises, stretches, and core-controlled aerobic training. The CoreAlign’s sliding carts move independently, with variable resistance/assistance possible in both directions. Balanced Body • 800-745-2837 www.pilates.com

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Upping the Ante

Looking for a new way to add challenge to your training regimen? The Pilates for Athletic Conditioning Workout Kit is equipped with everything athletic trainers need to increase strength, boost stamina, prevent injury, and increase variety in any workout.

Stott Pilates® • 800-910-0001 www.stottpilates.com TR AINING-CONDITIONING.COM

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What is ImPACT?

ImPACT is a sophisticated, researchbased software tool developed to help sports-medicine clinicians evaluate recovery following concussion. The program is a 20-minute test battery that can be administered in the pre-season for a baseline and post-injury to track a concussion. The ImPACT program evaluates and documents multiple aspects of brain functioning including memory, processing speed, reaction time, and post-concussive symptoms. In addition, the ImPACT program provides a user-friendly injury documentation system. ImPACT • 877-646-7991 www.impacttest.com

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Feel the Wave

Designed to help increase the natural blood flow around muscles, Mueller Kinesiology Tape features a revolutionary wave pattern adhesive that moves with skin and muscles to reduce muscle pain, increase mobility, and enhance recovery. Applied to the skin in patterns that mimic muscles, it aids in the treatment of ligament injuries, muscle conditioning, fascia repositioning, and even carpal tunnel syndrome. The 100-percent cotton tape is latex-free and is available in four colors. Mueller Sports Medicine • 800-346-9522 www.muellersportsmed.com

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Concussion Management

There is strong evidence demonstrating the impact of balance deficits on functional performance and increased risk of re-injury. Play It S.A.F.E. is a concussion management system that combines cognitive and functional assessment using the Biodex BioSway Portable or the Biodex Balance System SD and the cognitive tool of choice. It’s a “single source” program that adds vestibular and objective balance assessment, which are critical in concussion management. Biodex Medical Systems • 800-224-6339 www.biodex.com/concussion

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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 patients throughout their lives. 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 www.whatsmyfoottype.com

Circle No. 537 T&C SEPTEMBER 2010

More Products

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

Recovery for Runners

From McDavid, the innovators of muscle compression technology, True Compression Leg Sleeves reduce the buildup of lactic acid and increase the circulation of the blood. They compress calves and shins for effective muscle recovery, while HydraVent hDc moisture management keeps lower legs dry and comfortable. McDavid • 800-237-8254 www.mcdavidusa.com

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Greater Relief

Save-A-Tooth gives you time to treat more serious injuries and get athletes to the dentist or emergency room. Call (888) 788-6684 or visit www.Save-A-Tooth.com for more information Circle No. 139

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Cho-Pat’s patented Dual Action Knee Strap provides an extra dimension of relief for painful and weakened knees. First, it applies pressure on the patellar tendon below the knee to reduce instability and improve patellar tracking and elevation. Then, it applies pressure on the patellar tendon above the knee to further strengthen and provide an additional level of support and stability for the joint. It is easy to apply and comfortable to wear, and the fabric-covered neoprene construction allows for full mobility. In addition, this American-made support is available in five sizes to provide more specific and effective results. Cho-Pat • 800-221-1601 www.cho-pat.com

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Sustained Hydration

CeraSport and CeraSport EX1 rice-based hydration and performance drinks, developed along with doctors from Johns Hopkins, are 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 several flavors and in powder, concentrate, and ready-to-drink, CeraSport can be delivered to your home or office. CeraSport • 866-237-2770 www.cerasport.com

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Water Wherever Needed

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

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Body Composition Measuring & Tracking Measure, calculate, track, and chart body fat, lean body mass, and body composition results using the FatTrack Gold Premium Digital Body Fat Caliper with free Body Tracker software and MyoTape. The Caliper is compact, portable, and accurate. It calculates body fat percentage on the spot, making it perfect for athletic trainers. Enter information for each athlete into Body Tracker software to calculate with multiple formulas, track and chart results over time. Photos can also be uploaded for visual progress comparisons. AccuFitness provides outstanding fitness tools for training and conditioning professionals. AccuFitness • 800-866-2727 www.accufitness.com

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Testimonials

On a Roll

The Pro-Tec Foam Roller is a great tool for stretching, promoting flexibility, and myofascial release. The high-density Foam Roller alleviates muscle and soft tissue tightness of the upper and lower back, IT band, hamstring, adductors, upper arm, and much more, helping increase blood flow and circulation. To facilitate use of the Foam Roller, a color exercise program is included with stretching exercises, techniques, and photos. The foam rollers come in four sizes: 4” x 12”, 4” x 35”, 6” x 18”, and 6” x 35”. Pro-Tec Athletics • 800-779-3372 www.injurybegone.com

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COOL Roller

The Thera-Band Foot Roller is an ideal tool for athletes seeking temporary relief from pain associated with plantar fasciitis and over-activity. Following the illustrated exercise instructions, athletes can use the roller to stretch the plantar fascia and toes to increase flexibility. Those experiencing soreness from tired feet will find the massaging benefits of the roller pleasant and therapeutic. In all applications, the Foot Roller can be chilled or frozen to help reduce inflammation.

Performance Health • 800-321-2135 www.thera-band.com

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Essentials On Hand

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Concussion Testing Platform

Concussion Vital Signs is an easy-to-use sports concussion testing platform that enables the rapid assessment of neurocognitive function, concussion symptoms, and sports concussion history to help you efficiently evaluate and manage concussion injuries. Your annual subscription provides unlimited use for both baselining and postinjury testing. For more information or for a free demo, call or go online.

Concussion Vital Signs • 888-750-6941 www.concussionvitalsigns.com

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Train, Compete, Recover

Designed to be worn after grueling workouts or heavy competition, McDavid’s True Compression Recovery Suit utilizes true compression fabric to increase blood circulation and reduce the amount of lactic acid buildup in the muscles, which promotes faster, more complete recovery of torn and damaged muscle tissue. Large muscles groups are targeted with compression to promote fast recovery, while reducing pressure on knees, shins, and groin muscles to allow comfort and unrestricted movement during recovery. Designed to reduce stitches at inner thighs and eliminate hot spots, the TCR Suit includes a Spandex elastic waistband and hemmed legs for comfort and firm fit.

McDavid • 800-237-8254 www.mcdavidusa.com TR AINING-CONDITIONING.COM

Lebert Equalizer™: “Surprisingly effective—even for hard-core athletes. My initial skepticism over the bare-bones devices disappeared with an opportunity to do real dips, push-ups, one-legged squats, kneeraises, and weird but hard supine pull-ups. A laminated chart offers several more body-weight exercises, stretches, and even an upright row (using one support as the weight). Dislikes: None.” —Product review, Los Angeles Times

With a heavy-duty PVC tarpaulin shell, the Cramer Sideline Emergency Kit is designed to bring together all the necessary emergency management tools into one easily identifiable and easy-to-organize wheeled bag. The four interior bags can be labeled for a variety of specific needs, and they’re color-coded for fast visual recognition in an emergency.

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

Your Body Is the Driver

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Lebert Buddy System™: “I’m just wondering if you received my last order for four more Buddy Systems. The product is fantastic! What a complete workout! There is nothing you can’t do with this piece of equipment. I have introduced it to my exercise science students, and they all love it. Talk about conditioning for athletes—you won’t find a better piece of equipment. From working the core to strength, stamina, and cardio, you get it all.” —John Krentz, Department Chair, Exercise Science, Bay Mills Community College

Lebert Stretch Strap™ : “Very rarely does a product come into my training studio that is found to be highly useful by all of my trainers. The simple Lebert Stretch Strap is one of those exceptional products. My studio’s most experienced trainer mentioned several times how much he thought the Stretch Strap added to his sessions. It is a must-have tool for any trainer, but especially those who train less flexible or reduced-mobility clients.” —Product review, PFP Magazine Lebert Fitness • www.lebertfitness.com 905-785-0626 www.lebertequalizer.com www.lebertbuddysystem.com www.lebertstretchstrap.com T&C SEPTEMBER 2010

Company News

More Products Cold Comfort

The evolution of the Waterboy There are photos of football games in the early days of the sport showing a water bucket on the sidelines beside the old leather helmets and leather shoulder pads. There was no ice in the buckets and they held only one-two gallons of water that was dispensed with a ladle. But, of course, back then only the weak drank water. Once coaches and athletic trainers understood the importance of keeping their players hydrated, coolers were created offering five and 10 gallons of ice water dispensed into cups. However, the process of filling, refilling and carrying the coolers was extremely cumbersome. Then the portable water fountain came onto the scene, with several models introduced. But in 1997, the business of hydrating football players all changed. That’s when Waterboy Sports began selling hydration units to meet the changing needs of football players, athletic trainers and coaches. Waterboy Sports’ innovations in the industry include the following: • Integration of 20-, 40-, and 65-gallon (nonleaking) tanks to store the water and wagons instead of dollies to transport the water • Creation of the “Chiller,” enabling the athletic trainer to add ice to the water and not have to refill the water unit for the entire practice • Design of inline systems with individual shut off valves to take the place of the old coach built PVC pipes with holes drilled in them and to design. “Gravity” units that allow a trainer to adapt his inexpensive coolers to hydrate four players at one time • “Quick- Fill” bottles that eliminate lid removal and deter dipping into coolers, and “Safety Spouts” to combat contamination • Hydration unit models offered in a price range that smaller schools and youth leagues can afford

PRO ice wraps are an excellent way to apply cold therapy to most minor injuries. Made with quality neoprene for durability, these wraps are designed for treatment of pulls and strains, and are available for the shoulder (#439), knee (#103), or back (#208). The wraps are quick and easy to use, allowing for adjustable compression to keep ice packs in place. PRO Orthopedic Devices • 800-523-5611 www.proorthopedic.com

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Wrap It Right

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. The stretch tape contours easily to the body, allowing athletic trainers to effortlessly wrap any appendage. Cramer Products, Inc. • 800-345-2231 www.cramersportsmed.com

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Because Time Matters

Without proper care, a knocked-out tooth begins to die in 15 minutes. The Save-A-Tooth® emergency tooth preserving system utilizes Hank’s Balanced Salt Solution (HBSS) to not only preserve, but also reconstitute many of the degenerated cells. The patented basket and net container are designed to protect tooth root cells. This is the only system that keeps tooth cells alive for up to 24 hours. Save-A-Tooth® • 888-788-6684 www.save-a-tooth.com

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No Limits

The Biofreeze 2010 fall promotion offers free products and discounts. When customers buy 10 patient-size Biofreeze products, they get two free, plus an additional 15-percent discount off any Hands-Free Applicator or Max Strength Wipes deal. There are no deal limits, and this offer is valid until September 30, 2010. Pre-orders are accepted. Performance Health • 800-246-3733 www.biofreeze.com

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Emergency Help

The evolution of the “Waterboy” is an example of a product being created and expanding to solve the needs of its customers. And Waterboy Sports will continue to evolve as these needs change, because, unlike in the “old days,” it’s known that hydration and football performance go hand in hand.

The #911 Sport Medical Kit and Refill Pack have antimicrobial skin wipes to kill MRSA and flu viruses and a blot-blood-off cloth that removes blood quickly from uniforms. Pre-packed sport wound care kits for field injuries, a blister kit with second skin and pressure pads, antiseptic pads, large instant cold packs that remain at 33 degrees for up to 30 minutes, a cold pack holder with a hook and loop, and an ID tag for emergency information complete this refillable kit.

Waterboy • 888-442-6269 www.waterboysports.com

Fyrst USA • 800-782-1355 www.fyrstusa.com

T&C SEPTEMBER 2010

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CEU QUIZ

T&C September 2010 Volume XX, No. 6

uic You c an no ker & w tak and g Easi e our et yo er! ur CE CEU q U uizze r esult C s onli li c sa ko www .train n “CEUs & C nd credit ins ne... tantly ou ing-c . ondi rses” at: t ionin

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

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

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Instructions: Go to www.training-conditioning.com and click on “CEUs & Courses” to take the quiz online. You may also mail

your quiz to us: Fill in the circle on the answer form (on page 67) that represents the best answer for each of the questions below. Complete the form at the bottom of page 67, include a $25 payment to MAG, Inc., and mail it to the following address: MAG, Inc., ATTN: T&C 20.6 Quiz, 31 Dutch Mill Road, Ithaca, NY 14850. Readers who correctly answer 70 percent of the questions will be notified of their earned credit by mail within 30 days.

Bulletin Board (pages 4-6)

A Weighty Issue (pages 12-20)

1. Jon Sekiya says the most common reason ACL repairs fail is _____. a) Athletes returning to play too soon b) Technical error c) The wrong rehabilitation program d) Poorly-made knee braces

6. Which body type has a stocky build and tends to gain both muscle mass and body fat easier than other body types? a) Endomorphs b) Ectomorphs c) Mesomorphs d) Massomorphs

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

2. An American Board of Orthopedic Surgery survey found 85 percent of surgeons who perform ACL reconstructions do _____ or fewer per year. a) 10 b) 15 c) 20 d) 25 3. Subjects in the IUPUI study who participated in the hip-strengthening program reported a pain level of _____ after a six-week trial period. a) 10 b) Seven c) Four to five d) Two or lower 4. What serving sizes of milk did the women in the McMaster University study drink? a) 500 milliliters b) A half-gallon c) One liter d) Eight ounces 5. Study researchers who presented at the ACSM Annual Meeting said around _____ of the athletes they evaluated were misclassified as overweight or obese according to BMI. a) 20 b) 30 c) 40 d) 50

Objective: Get advice on how you can help athletes gain weight in a healthy and effective way.

7. Which body type has tall, naturally thin and lean bodies? a) Endomorphs b) Ectomorphs c) Mesomorphs d) Massomorphs 8. During periods of weight gain, around _____ percent of overall energy should come from carbohydrates. a) 20-30 b) 35-45 c) 50-65 d) 70-80 9. Males have the most success gaining muscle mass at what age? a) Late teens and early 20s b) 13 c) Over 21 d) Late 20s and early 30s 10. A healthy initial body fat range for males is _____ percent. a) 16 to 24 b) Eight to 15 c) 25 to 30 d) Less than 5

Answer sheet is on page 67...or take this quiz online and get instant results: www.training-conditioning.com click on CEUs & Courses

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T&C SEPTEMBER 2010

CEU QUIZ 11. A healthy initial body fat range for females is _____ percent. a) 16 to 24 b) Eight to 15 c) 25 to 30 d) Less than 5 12. One of the author’s points of advice is to have athletes eat small meals every _____ throughout the day. a) Half-hour b) Hour c) Two to three hours d) Five hours

Cry for Help (pages 23-28)

Objective: Learn to spot the signs of anxiety and depression in athletes. 13. Over the course of one year, about _____ percent of the U.S. population develops an anxiety disorder. a) 4 b) 8 c) 12 d) 16 14. Over the course of one year, about _____ percent of women develop some degree of clinical depression. a) 5 b) 8 c) 12 d) 20 15. Anxiety-related symptoms may include: a) Increased heart rate, muscle tension, upset stomach b) Increased heart rate and low blood pressure c) Muscle tension and normal heart rate d) Upset stomach, weak muscles, ease falling asleep 16. Why is it not unusual for a depressed student-athlete’s athletic life to appear normal? a) They “suck it up” at practices and games b) Sports is their escape or refuge where they can leave behind anything that’s bothering them. c) They have a “no excuses” mantra d) Athletes are often “moody” on the athletic field anyway 17. Examples of behaviors that fall into the clinical range of depression include: a) Irritated but not explosive, frustrated b) Persistently anxious, apathetic, insomnia c) Minor sleep disturbances, sometimes sad d) Nervous, somewhat isolated, angry 18. When seeking a mental healthcare professional to work with an athlete, the author says it may be helpful to remember the Four A’s, which are: a) Affordable, Available, Angry, and Accepting b) Amiable, Accountable, Asking of questions, and Affordable c) Apathetic, Accepting, Affordable, and Available d) Affordable, Available, Amiable, and Accepting 66

T&C SEPTEMBER 2010

What Happens Next? (pages 30-35) Objective: Learn how to safely return a concussed athlete to play. 19. It’s been estimated that _____ of all concussions sustained by athletes in the U.S. go unreported. a) A quarter b) About 30 percent c) Just under 50 percent d) Over half 20. Post-concussion, physical healing within the brain takes an average of _____ days in adults. a) Seven to 10 b) 14 c) Four to five d) 21 21. What is the most promising-looking pharmacological agent for boosting recovery after a concussion? a) Corticosteroids b) Progesterone c) Calcium channel inhibitors d) Vitamin D

Game Theory (pages 37-44)

Objective: See how one athletic trainer is using video game systems in the athletic training room for rehab and injury prevention. 22. What is the name of one of the video games the author has used for rehab purposes? a) P90X b) Mario Brothers c) Dance Dance Revolution d) Wii Bowling 23. To get more out of Wii games like boxing and tennis, the author has athletes perform what type of exercises on a BOSU ball? a) Chest presses b) Pike c) Toe curl d) Single-leg squat

Strong as Bulldogs (pages 49-54)

Objective: Get an inside look at the Butler University men’s basketball strength and conditioning program. 24. The coaching staff’s expectation for the mile run test is that post players complete it in less than _____. a) Six minutes b) 5:45 c) 5:30 d) Five minutes 25. How many players benched over 300 pounds in last season’s one-rep max bench press test? a) Six b) Seven c) Eight d) Nine TR AINING-CONDITIONING.COM

CEU QUIZ Answer Form Instructions: Go to www.training-conditioning.com and click on “CEUs & Courses” to take the quiz online. You may also

mail your quiz to us: Fill in the circle on the answer form below that represents your selection of the best answer for each question. Complete the form at the bottom of this page, include a $25 payment to MAG, Inc., and mail it to the following address: MAG, Inc., Attn: T&C 20.6 Quiz, 31 Dutch Mill Road, Ithaca, NY 14850. Readers who correctly answer 70 percent of the questions will receive 2.0 BOC Athletic Training and 0.2 NSCA (two hours) CEU’s, and will be notified of their earned credit by mail within 30 days. Questions? Problems? E-mail: CEU@MomentumMedia.com.

Bulletin Board

1. 2. 3. 4. 5.

m m m m m

A Weighty Issue

6. 7. 8. 9. 10. 11. 12.

m m m m m m m

Cry for Help

13.

m m m m m

m m m

m m

14. 15. 16. 17. 18.

What Happens Next?

19. 20. 21.

m m m

Game Theory 22. m

23.

Strong as Bulldogs

24. 25.

m m

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OVERTIME

Next Stop: Web Sites You can find more editorial coverage, including Web exclusives, at:

www.Training-Conditioning.com

Also, be sure to visit our social networking sites to keep up with the latest news and trends.

Follow T&C on Twitter for daily news updates on stories affecting athletic trainers and strength coaches. Get plugged in at: www.Twitter.com/TrainCondition. Connect with other sports medicine and strength training professionals and keep up with recent industry happenings by visiting the T&C Facebook page at: www.Facebook.com/ TrainingandConditioning and become a fan.

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l i v 3 o / f e ar n

Straps can be adjusted anytime without re-lacing

Lightweight and non-Invasive

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Elastic Heel and Sewn-in Tongue Dwyane Wade - shown wearing McDavid HEXPAD® Ultralight Ankle Brace w/ Strap, Item 195

Figure “6” Straps simulate athletic tape

Ultralight Laced Ankle Brace Excellent protection with lightweight construction for the best combination of protection and ergonomic movement.

Enh anced Performance www.McDavidUSA.com

The original protective apparel

featured products 7862 HexPad® HexMesh™ V-Hex™ Body Shirt

757 HexPad® Thudd Short™

Circle No. 142

6440 HexForce™ Knee/Elbow/Shin Pad

6500 HexPad® Shooter Sleeve

Circle No. 143