Training & Conditioning 20.7 by Momentummedia

October 2010 Vol. XX, No. 7, $7.00

A Light Touch Using specialized massage to help athletes return to play faster

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October 2010, Vol. XX, No. 7

contents 33

25 Bulletin Board 5 Examining face shields in ice hockey ... Latest caffeine research … Left handed pitchers at higher risk for injury? … Effectiveness of drug testing questioned. Comeback Athlete 8 Junior Cadougan Marquette University Sponsored Pages 15 Fitness Anywhere Product News 54 Pain Management 59 Vibration Therapy 59 Web News 60 Hot & Cold 62 More Products

52 Books & DVDs 58 Advertisers Directory CEU Quiz 65 For NATA and NSCA Members 68 Next Stop: Web Site On the cover: Patricia Archer, MS, ATC, LMT, demonstrates lymphatic facilitation massage, the focus of our cover story, which begins on page 16. Photo by Sherry Loeser TR AINING-CONDITIONING.COM

45 16

Treating the Athlete

A Light Touch

A form of massage called lymphatic facilitation is gaining followers in athletics as it has been shown to help cut down on injured athletes’ recovery time. By Patricia Archer Nutrition

25 Could your athletes’ nutrition be the final piece of the puzzle for The Final Hurdle

success? As the Texas A&M University track and field team found out, time spent creating individualized diet plans was well worth it. By Amy Bragg Optimum Performance

It Up 33 Shaking As whole body vibration continues to catch on in weightrooms and

with athletic trainers, researchers are shedding new light on how it works and what its benefits are. By David M. Bazett-Jones Leadership

39 Staff evaluations may be one of the most overlooked opportunities Watchful Eyes

for athletic training departments to improve their services. The key is making evaluations a learning tool, not a critique of past mistakes. By Jon Almquist Sport Specific

Run Power 45 Home Explosive lifts breed explosive hits. That’s why Olympic lift variations are a major component of the University of Georgia softball team’s strength and conditioning program. By Tyler Jorgensen

T&C octoBER 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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T&C OCTOber 2010

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

October 2010 Vol. XX, No. 7 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 Watch the Face: Hockey Visor Debate There is a movement in college hockey that may eventually lead to another option in facial protection on helmets. Players are currently required to wear helmets equipped with full face shields, made of either metal or Plexiglas. But in June, officials from College Hockey Inc., the marketing arm for the five NCAA Division I hockey conferences, asked the NCAA Ice Hockey Rules Committee to allow players to wear half shields. The Committee declined to support the proposal, but called for further research on the topic. Part of the argument for allowing the visors, which professional players wear, is that by reducing facial coverage, skaters will be more likely to play under control. “We’re concerned about the fact that kids at the college level who wear full cages play the game with a certain level of recklessness because they feel invincible,” Paul Kelly, Executive Director of College Hockey Inc., told USCHO.com. “We actually think that by making the switch from full cages to half visors that you’ll actually make the game safer,” Kelly added. “You’ll change the mindset and the culture of the player and you’ll increase the visibility of the player and his peripheral vision.” However, there is no current data indicating that players are safer when wearing visors. In a 1999 study conducted by researchers from the University of Calgary, a survey of Canadian Interuniversity Sport players found that wearing a visor did not change the rate of severe injuries such as spine trauma and concussion. Instead, researchers found that wearing half shields led to an increase in injuries to players’ faces. “For intercollegiate ice hockey players wearing half shields compared with full face shields, we found that the risk of sustaining a head injury (excluding concussions), facial laceration, and dental injury was 2.52, 2.31, and 9.90 times greater, respectively,” the study concluded. “We found no evidence in this study to support the speculation that full face shield use increases players’ risk of sustaining a neck injury or concussion.” According to Robert Cantu, MD, Chief of Neurosurgery Service and Director of Sports Medicine at Emerson Hospital in Concord, Mass., neither visors nor full shields have much effect on reducing concussions. “If you’re asking [the current helmet] to protect against a stick or something, they do their job,” Cantu told USCHO.com. “But the visor or the mask don’t protect against concussion—if anything, they torque the head more ... The cages don’t, though, in any way decrease head trauma. They just give the players a feeling of invincibility and they play a little rougher.” Because the NCAA rulebook is re-examined every two years, the next time a rule change could go into effect would be prior to the 2012-13 season. The NCAA’s decision to gather more data has Kelly optimistic. TR AINING-CONDITIONING.COM

“We will be working together with the NCAA and members of the committee to collect and study additional data, and possibly to use visors in some college exhibition games to obtain feedback from players, coaches, and officials,” he said. “Given the new technology in visors, and the very positive experience and safety data from the USHL and other leagues, I am hopeful that it is only a matter of time that we see visors in NCAA college hockey.”

Caffeine In the Headlines Again Though research has shown that consuming caffeine could mean a boost in performance, a recent study indicates that it needs to be taken in very high doses to have a noticeable effect. Results from the study, conducted by scientists from Coventry University in England, were presented in June at the Society for Experimental Biology annual meeting. Using mice, researchers tested the effect of caffeine on both power output and endurance, focusing on the animals’ soleus muscles during both maximal and sub-maximal activities. (Maximal activities are when muscles are pushed to full capacity, such as in sprinting or weight lifting, while sub-maximal covers all other activity.) Researchers found that a caffeine dosage of 70 micromols per liter of blood enhanced power output by approximately six percent during both types of activity. Although the same amount of caffeine was shown to improve endurance during sub-maximal activities, it significantly reduced endurance during maximal activities. The effect in humans is likely to be very similar, according to the researchers. “Seventy micromols caffeine concentration is the absolute maximum that can normally be achieved in the blood plasma of a human,” Rob James, PhD, the study’s lead researcher and a professor in Coventry’s Department of Biomolecular and Sports Science, told Medical News Today. “However, concentrations of 20 to 50 micromols are not unusual in people with high caffeine intakes.” To James, the research provides a convincing argument for caffeine as a potential performance enhancer. “A very high dosage of caffeine might prove attractive to a number of athletes wishing to improve their athletic performance.” James said. “A small increase in performance via caffeine could mean the difference between a gold medal in the Olympics and an also-ran.” To download an abstract of the study, “Physiological Concentrations of Caffeine Cause Muscle Performance During Both High and Low Frequency Activation,” go to: www.sebiology.org/meetings/Past_ Meetings/prague/Prague.html. T&C octoBER 2010

Bulletin

Board Lefty Pitchers And Injury Risk Left-handed pitchers have long been considered a valuable asset in baseball. But beyond their penchant for success against left-handed hitters and exaggerated stereotypes for quirkiness, there is new evidence of differences in throwing motions between southpaws and their right-handed counterparts.

The data revealed that left-handed pitchers put more stress on the humerus than right-handers—and too much stress can lead to fractures. Scientists from the Center for Sport and Motion Analysis at the Texas Metroplex Institute for Sports Performance say the mechanics of left-handed pitchers could actually make them more prone to injury. Published in the August issue of The American Journal of Sports Medicine, the study analyzed the pitching motions of 84 collegiate baseball players—both right- and left-handed—by evaluating the shoulder rotation of their pitching arms compared to their non-pitching arms,

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the angles of their elbows and shoulders during the pitching motion, and their arm speeds. Researchers also cross-matched 28 left-handed throwers with 28 righties, comparing pitchers with similar ages, sizes, and throwing speeds. The data revealed that lefthanded pitchers put more stress on the humerus than righthanders—and too much stress can lead to fractures. Researcher Sherry Werner, PhD, Director of the Center for Sport and Motion Analysis, told Reuters Health the stress was shown to be highest when the pitcher had his throwing arm extended behind him as he wound up for a pitch, before he accelerated toward the plate. Based on her group’s findings, Werner hopes larger, more in-depth studies of pitching injuries are on the horizon. “It’s kind of remarkable to me,” she told Reuters. “I never would have expected significant differences ... We need to understand the differences and know that if we’re looking at a lefty, we’re not expecting them to look like a righthander.” To read an abstract of the study, “Throwing Arm Dominance in Collegiate Baseball Pitching,” go to: ajs. sagepub.com and type “Throwing Arm Dominance” into the search window.

Bulletin

Board Evaluating Drug Testing’s Effectiveness As mandatory recreational drug testing continues to make its way into high schools across the country, new research reveals both good and bad news about the effectiveness of testing programs. According to a study from the U.S. Department of Education, mandatory testing is having some short-term success in reducing drug use among high schoolers involved in extracurricular activities, but does not appear to be effective in discouraging future drug use. Researchers surveyed students at 36 high schools where drug testing programs are funded by federal grants. Of that sample, half of the schools were already testing for marijuana, amphetamines, and other drugs, while the other 18 had not yet begun testing students. Nearly 22 percent of students at the schools that hadn’t begun testing reported using drugs within 30 days of the survey. Meanwhile, at the schools that did test, 16.5 percent reported using during the same period. Researchers also found that implementing a random drug testing program had no negative effect on participation numbers. One in three students from both sets of schools said that they would “probably” or “definitely” use drugs in the following year. This news was particularly troubling to Daniel Domenech, Executive Director of the American Association of School Administrators, who told USA Today that he’s disappointed testing had no effect on high schoolers’ intentions to use drugs. “The question is, was anything learned?” he said. “But at the same time, that finding suggests that it’s not necessarily addressing the real issue, which is that we have to change behaviors ... The behavior here should be, ‘Whether I’m playing football or not, I shouldn’t be using drugs.’” To download the study, “The Effectiveness of Mandatory Random Student Drug Testing,” go to: http://bit.ly/DrugTestingStudy. TR AINING-CONDITIONING.COM

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ComebackAthlete

Junior Cadougan Marquette University By Patrick Bohn

His 2009-10 stats might lead you to believe that Marquette University point guard Junior Cadougan had a disappointing freshman season. In reality, the fact that Cadougan was able to play in 12 games for the Golden Eagles was an eye-popping achievement as he worked his way back from a ruptured Achilles tendon in just four months. During a September 2009 workout, everything seemed normal and Cadougan was feeling good. He was running sprints when out of nowhere Cadougan says his right Achilles tendon “just shredded.” Pain or hot spots around the Achilles can be warning signs of an impending rupture, but in Cadougan’s case, there were no such signs. When he received word the injury would keep him out six to eight months, possibly costing him the entire season, Cadougan was understandably upset. “I came to Marquette wanting to have an immediate impact,” he says. “I put in all the hard work and suddenly this freak injury happened. At first I thought, ‘How am I going to walk again?’ But my next thought was, ‘How am I going to get back on the court?’” It was a job for Ernest Eugene, MS, ATC, NASM, PES, CES, Athletic Trainer for men’s basketball at Marquette. But there was one major hurdle: Eugene had never overseen an Achilles rupture rehab. Undaunted, he embarked on a rigorous research kick to help formulate his protocol. “Sports medicine and rehab techniques are always evolving and you’ve got to make sure you’re on top of it,” he says. “Our entire staff, including athletic training students, team physicians, and the orthopedic surgeon, read articles and share information with one another. That’s how you learn in our profession.” Eugene had to study up quickly because Cadougan was itching to get to work. “Three to four days after the surgery, I was asking Ernest if it was time to start rehabbing yet,” Cadougan says. “I wanted to do something as soon as possible. I was in pain and on medication, but I wanted to work hard so I could get back on the court soon.” Eugene and Cadougan had met only weeks before, but they began working together seven days a week, sometimes meeting more than once a day. “It wasn’t that we needed to meet that often,” Eugene says. “It’s that Junior always wanted to do more. He now calls himself the King of Rehab.” Eugene’s general rehab philosophy is to utilize a model of 8

T&C OCTOBER 2010

With the help of Athletic Trainer Ernest Eugene, Marquette University point guard Junior Cadougan returned to play just four months after suffering a ruptured Achilles tendon. integrated training to get all the muscle groups working together. But for an Achilles rupture, that wasn’t going to be easy because Cadougan would be unable to put any weight on his right foot during the first four to five weeks of his rehab. Eugene spent the first few weeks working out Cadougan’s hip flexors and extensors, as well as his abductors and adductors. For example, to work Cadougan’s quads, Eugene would have him sit on a low table with a half foam roll beneath his heel to raise his knee slightly. Cadougan would then push down into the roll and try to get the back of his knee touching the table. Going into the second and third weeks, Eugene added toe pickups. Cadougan would pick up a cotton ball or a marble with his toes and move it to the other side of his body before placing it down. Patrick Bohn is an Assistant Editor at Training & Conditioning. He can be reached at: pb@MomentumMedia.com. TR AINING-CONDITIONING.COM

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ComebackAthlete Eugene says the main goal of the early exercises was simply to get Cadougan’s muscles to resume doing what they had always done. “Junior wasn’t weight-bearing, which meant he wasn’t walking up stairs using his quads or down stairs using his hamstrings, so we were trying to get those muscles to know that they still needed to do work,” he says. “It only takes 24 hours of immobilization for atrophy to occur.” The exercises were designed to lay the foundation for Cadougan’s next rehab steps. “From zero to three weeks, we built up those muscles,” he says. “Once they were strong, we incorporated them into our weight-bearing activities and then into functional, return-to-play activities.” In the fourth and fifth weeks of Cadougan’s rehab, Eugene began adding manual resistance, which allowed the muscles to strengthen both concentrically and eccentrically. When working on hip flexion for concentric strength, Cadougan would try to raise his leg from the table while Eugene pressed down on it. To build eccentric strength, Cadougan held his legs up off the table while Eugene applied pressure to push them down. It was around this time Eugene began to notice Cadougan was progressing ahead of schedule. “At week five, we placed Junior in a walking boot, and that doesn’t usually happen until week six,” says Eugene. “Rehab protocols are used as a baseline, but every athlete is different. Junior was

in front of the protocol at that point, and I felt that with his attitude, he would be able to remain in front of it.” To ensure that Cadougan stayed ahead of the curve, Eugene stepped up his work on range of motion (ROM) exercises around week six by having Cadougan sit with his legs in front of him, wrap a towel around the bottom of his foot, and pull it back toward himself. Eugene would then push his foot back even further for greater ROM. After five weeks, the initial muscle strengthening had supplied a solid base, but Cadougan was going to need more than a strong ankle with decent ROM to return to the court. So Eugene added a few more layers to his rehab program. One new goal was improved muscle control. To address this, Eugene had Cadougan sit in a chair with his legs bent at 90 degrees and do calf raises. “He’d come up on the balls of his feet as high as possible, then lower his heels until they barely touched the ground,” says Eugene. “I tell athletes to pretend there’s an egg underneath their heel and that they just want to tap it, not break it. That shows control of the muscle as well as good strength.” Another goal was to improve Cadougan’s balance by working on his proprioception. This was the part Cadougan struggled with most. “I was scared to stand up on only my right leg,” he says. “I didn’t know if my Achilles was going to pop again.” Eugene massaged Cadougan’s fears by having Cadougan

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T&C OCTOBER 2010

ComebackAthlete

Junior Cadougan Marquette University

Sport: Basketball Injury: Ruptured Achilles tendon Result: Returned to play after four months Quote: “He was getting tired as he progressed through the workout, but he still remembered all the things we had worked on. He kept his core tight and made sure his toes were pointed straight ahead when he landed after a jump shot. Even at his most tired point, I know he started to think, ‘There’s potential.’” –Athletic Trainer Ernest Eugene

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ComebackAthlete first balance on both feet. â&#x20AC;&#x153;The tendency is to shy away from the involved side, but that leads to compensating,â&#x20AC;? Eugene says. â&#x20AC;&#x153;I knew he wasnâ&#x20AC;&#x2122;t going to have the confidence in the right leg immediately, so we re-trained his body to say â&#x20AC;&#x2DC;I can stand on two feet again.â&#x20AC;&#x2122;â&#x20AC;? Eugene had Cadougan stand in front of a waist-high table while trying to keep his balance. (The table was there for support if needed.) That progressed to stork stands in which he stood on just one foot, first on an even surface and then on an uneven surface like a half-foam roll. All the while, the focus was on making steady progress. â&#x20AC;&#x153;Weâ&#x20AC;&#x2122;d set short-term goals every two weeks,â&#x20AC;? Eugene says. â&#x20AC;&#x153;For example, if he could balance for a certain period of time on the uninjured side, weâ&#x20AC;&#x2122;d try to go to at least half that long on the opposite side. As Junior saw those goals being achieved, he wanted to accomplish even more.â&#x20AC;? Two months into Cadouganâ&#x20AC;&#x2122;s rehab, with his balance returning and his right foot strong enough to bear weight again, the next step in integrated training began: getting the various muscle groups to work together. Two of the exercises Eugene utilized were wall-ball squats and modified lunges. With an exercise ball between his lower back and a wall, Cadougan would squat while using his glute-medius muscle and engaging his core. In the lunges, Cadougan would put his trailing foot on a slide board, which allowed the back

knee to drop almost to the board. He would then pull himself up to a neutral position using his front leg, engaging his glutes and core in the process. At this point, Eugene also had Cadougan work out on the AlterG, an anti-gravity treadmill that uses air to displace an adjustable percentage of body weight, making walking or running low-impact. â&#x20AC;&#x153;I think that was a big part of what got us to the next part of the rehab,â&#x20AC;? Eugene says. â&#x20AC;&#x153;We put him in an environment where he was able to do weight-bearing

â&#x20AC;&#x153;He was jumping and landing quickly, and not only did he challenge himself from a basketball standpoint ... but he concentrated on it from a rehab standpoint by exploding off the ground and landing soft.â&#x20AC;? running and walking and we could view his mechanics. This allowed him to progress and gain confidence that his Achilles would hold up under pressure.â&#x20AC;? By early December, Cadougan was still well ahead of schedule and began going to the gym on his own to do some dribbling and stutter stepping. After that went well he began asking Eugene when he could return. â&#x20AC;&#x153;I told him, â&#x20AC;&#x2DC;Letâ&#x20AC;&#x2122;s keep working hard every day and weâ&#x20AC;&#x2122;ll see how

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T&C OCTOBER 2010

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ComebackAthlete it stacks up,’” Eugene says. “He was already convinced he could contribute to the team again.” So Eugene added more basketball-specific exercises like running up and down the court at various speeds, changing directions, and agility drills using ladders. They also began incorporating plyometic exercises into his routine. “One that worked well was the Mikan drill, in which the player starts underneath the basket and makes a layup by banking the ball of one side of the backboard, then catches it out of the net and lays it up on the other,” Eugene says. “He was jumping and landing quickly, and not only did he challenge himself from a basketball standpoint, saying ‘I’ve got to make 25 baskets in 30 seconds,’ but he concentrated on it from a rehab standpoint by exploding off the ground and landing soft.” Eugene attributed Cadougan’s ability to perform these drills to the plyometric work they had done earlier. By doing box jumps on a box six to eight inches off the ground, Cadougan had retrained his body to land correctly after a jumper. In early January, Cadougan participated in a workout with the coaching staff and Eugene saw that the talented freshman was on the verge of completing his comeback. “He was getting tired as he progressed through the workout, but he still remembered all the things we had worked on,” Eugene recalls. “He kept his core tight and made sure his toes were pointed straight ahead when he landed after a 217-431_ExScience_3.4x4.8_4C:Layout 1 1/8/10 11:10

jump shot. Even at his most tired point, I know he started to think, ‘There’s potential.’” Not long after, Cadougan went through a practice and had no trouble keeping up with his teammates. So he met with coaches to discuss his return. “I felt I could really play at this

On Jan. 23, Cadougan made his return against Syracuse University, playing eight minutes. He appeared in 12 contests over the remainder of the season, including the NCAA Division I Men's Tournament. level,” he said. “I told my coaches, ‘I just want to get the experience of practicing and running through the plays, so I’ll be comfortable.’” On Jan. 23, Cadougan made his return against Syracuse University, playing eight minutes. He appeared in a total of 12 contests over the remainder of the season for the team, including its NCAA Division I Men’s Tournament game. “We learned from everything we did,” Eugene says. “The next time I oversee an Achilles rupture rehab, I’ll start the same way. With Junior, because of our extensive research, we were on the cutting edge, and we will be next time as well.” n AM Page 1

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T&C OCTOBER 2010

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Time Effective TRX® Suspension Training® Bodyweight Exercises By Chris Frankel, M.S. Chris Frankel is the Director of Programming for Fitness Anywhere and consults to the US Military, professional and collegiate sports teams and lectures nationally for strength and conditioning professionals.

Every student athlete deals with the pressure of academics, sports, travel, nutrition and recovery to maintain optimal performance. The strength and conditioning specialist has to find the right combination of exercise volume and intensity across multiple components of fitness to keep his or her athletes in the game and ensure time for studying, classes and college life. When a coach comes across a single training modality that can accomplish multiple goals, it’s a win for everyone and deserves a place in the program. Enter the TRX® Suspension Trainer™. Whether the Suspension Trainer is attached to a power rack, bleachers, a fence, tree limb or even the door of the athlete’s dorm room, there are some foundational exercises virtually all athletes can benefit from that only take a few minutes to complete. These movements can be used as a short workout, as a warm up or cool down and even as part of a recovery session between practices. Selecting the appropriate intensity level will individualize the exercises to meet the objectives of the session. TRX Suspension Training bodyweight exercise blurs the line between traditional flexibility, strength, core and cardiovascular conditioning. These functional movements are multi-joint and multi-planar and provide a proprioceptively rich environment for improved athletic performance and durability.

TRX Half Kneeling Hip Flexor Stretch

Performing this variation of a half kneeling lunge with arm reaches using the TRX Suspension Trainer promotes core stabilization and improves distal mobility. Move smoothly in and out of this active integrated stretch and feel a lengthening and strengthening from arm pit through hip flexors. Repeat on both sides.

TRX Low Row

This is one of the basic movements every athlete should master. Performing the TRX Low Row not only builds strength in the pulling motion, but it has the added benefit of integrating active hip extension to maintain proper alignment. This added benefit brings in more of the posterior chain. Want an additional challenge? Perform the exercise on one leg or with one arm.

TRX Side Plank (with Rotation)

Once you are proficient in holding a stable side plank with your feet in the foot cradles, you can progress to incorporating transverse plane movement by reaching under and behind your torso and returning to an extended arm position.

TRX Side Lunge

If the demands of the sport require lateral movement or you want to address different planes of motion in your hip training, this exercise is hard to beat. Because you can unload your bodyweight into the Suspension Trainer, you can maintain a taller, more athletic posture and move safely through a greater range of motion.

TRX Lunge

This foundational exercise builds single leg strength, balance, mobility and power all at once. The integration of core, hip and leg strength provides a great bang for your training buck. Once you can move through a full range of motion, add a faster tempo for power and conditioning or a hop for explosiveness.

TRX Overhead Squat

This is an incredibly effective exercise for core stability and lower body mobility. Maintain tension in the Suspension Trainer by driving arms back into shoulder flexion. This in turn will engage the entire posterior chain. Keep strong core engagement and focus on proper squat mechanics. This is a good standalone exercise or a great way to prep for different traditional squatting exercises and Olympic lifts. As you improve your technique, strength and mobility and you want a greater challenge, try the single leg version of this exercise.

sherry loeser

Author Patricia Archer demonstrates lymphatic facilitation massage on an athlete at her clinic in Seattle.

TREATING THE ATHLETE

A Light Touch A form of massage called lymphatic facilitation is gaining followers in athletics as it has been shown to help cut down on injured athletes’ recovery time.

By Patricia Archer

hat if you could learn a modality that helps athletes return to play faster than expected? I’m talking at least two to three days, and sometimes even a week or more earlier than the typical prognosis for their injury. In the world of competitive athletics, shaving that much time off an athlete’s recovery can be a big boost for not only the athlete, but the entire team. What if I told you that no equipment was necessary for this modality—only your hands—and that a session can add just 15 minutes to an athlete’s treatment? And once an athlete has experienced the proper application and understands the rationale for the technique, they can often be taught how to perform the modality on themselves. Lymphatic facilitation (LF) is an abbreviated form of the complex manual lymphatic drainage techniques used to treat lymphedema (a bodywide edema caused by dysfunction of the lymphatic system). A massage technique that improves edema removal and lymph flow, LF uses a gentle and rhythmic technique to manipulate the superficial tissues. Dale Perry, a licensed massage therapist and certified lymphatic therapist, developed LF in 1994, and he and I began using the technique early on in our eight years as massage therapists for the NBA’s Seattle Sonics (now the Oklahoma City Thunder). We found that adding LF techniques to standard treatment protocols greatly improved athletes’ progress through the healing cycle—sometimes returning them to play as much as two weeks earlier than expected. Dale conceived LF after studying and then becoming certified in both Manual Lymph Drainage (developed by Emil and TR AINING-CONDITIONING.COM

Estrid Vodder) and Comprehensive Decongestive Therapy (developed by John and Judith Casley-Smith). In addition to treating complex lymphedema, he recognized that these techniques could be modified to also effectively alleviate the temporary edemas associated with musculoskeletal injuries. Because athletes have healthy cardiovascular and lymphatic systems, LF techniques do not require the same kind of meticulous attention to detail as the lymphatic drainage techniques used in those with dysfunctions in those systems. Additionally, the positive effects of LF are measurable in the very short timeframe desirable in athletics. I’ve also used LF techniques extensively with the swimming and track and field teams I work with, and again found it helps improve their recovery time. In sports like these where athletes often compete in two to three different heats or events in a single day at meets lasting four to five days, anything that helps keep muscles feeling light and loose is extremely beneficial. THE BASICS Expedited recovery time isn’t very surprising once you understand the physiologic mechanisms of the lymphatic system and how LF stimulates these essential healing processes. The basic anatomy and physiology classes most of us took in college Patricia Archer, MS, ATC, LMP, has been a sports healthcare specialist and educator for over 30 years. She teaches continuing education seminars around the country in advanced therapeutic massage techniques and maintains a private practice at her clinic, Seattle Somatics. Pat can be reached at: pat@seattlesomatics.com. T&C october 2010

focused more on the immune functions of the system, which means we didn’t get a very clear understanding of how the lymphatic system carries out its role of fluid return—and how important this process is to our health. We’ll start with a brief description of how the lymphatic system works. The lymph system is an open network of vessels that operates on the siphon principle to pick up interstitial fluid and return it to circulation. This means there must be negative pressure inside the lymph vessel network in order for interstitial fluid is to be picked up by the capillaries—a process called edema uptake. Negative pressure is created and maintained within the system by emptying the lymph back into venous blood at the subclavian veins. Like sucking on a straw, fluid is pulled into lymphatic capillaries because of the emptying process at the top of the system. Another important influence on edema uptake is the amount of interstitial pressure. When injury and swelling occur, the interstitial pressure increases, which creates the necessary pressure differential for fluid to be siphoned into lymphatic capillaries. Once inside the system, the strongest influence on rate of lymph flow is the rhythmic contractions of the primary lymphatic vessels, called lymphangia. There is a smooth muscle that spirals inside the wall of the lymphangia, and its regular, but infrequent contractions (four to 10 times per minute) are essential to help propel lymph through the system. The autonomic nervous system controls this contractile rate, and research has shown that both the strength and rate of the contractions are increased when edema uptake and the siphon effect are enhanced. The lymph capillaries that pick up interstitial fluid have a unique arrangement of overlapping epithelial cells, looking something like fish scales, and each cell has a small hair-like extension called an anchor filament. These anchor filaments not only hold the lymph capillary in place in the interstitium, but they also open the vessel to let fluid flow in (presuming negative pressure) when the tissue is stretched slightly. These initial lymph capillaries are extremely superficial, located just underneath the epidermis of the skin. Therefore, opening the initial vessels requires a very light touch that stretches the epidermis only. Anything deeper, and the initial vessels will be compressed into a closed position rather than an opened one. ATHLETE CONNECTION The above anatomic and physiologic facts have several key implications for athlete wellness. First is the simple recognition and appreciation of how essential the lymphatic system’s role is in maintaining homeostasis. Even in healthy tissue, the cardiovascular system leaves behind a minimum of 10 percent of the total volume of capillary filtrate in the interstitium. This leftover filtrate then becomes the sole responsibility of the lymphatic system. Our body relies on this system to pick up the interstitial fluid, filter out metabolites, waste products, and cellular debris, and then enrich that fluid with immune cells before returning it to circulation. For the average human, approximately three liters of fluid are filtered, enriched, and returned to circulation every day via the lymphatic system. While our natural tendency is to think about the nutrient-waste exchange as happening directly between blood and cells, in actuality, it occurs between cells and interstitial fluid. Without the lymphatic system, all of our cells, organs, and tissues would be floating around in dirty bath wa18

T&C october 2010

Archer P. Therapeutic Massage in Athletics. © Lippincott Williams & Wilkins 2007. Used by permission.

TREATING THE ATHLETE

Figure 1. The stationary circle applies a light stretch to the epidermis in two vectors: A shows the first stretch is across the vertical axis of the extremity, while B shows the second stretch being in line with lymph flow. The slight tissue stretch is sustained between steps A and B, then suddenly released so that the tissue snaps back into place.

stretch & slide

release & snap back of tissue Figure 2: The traveling long stroke begins with a light stretch of the epidermis, then the stretch is sustained as you slowly slide over the skin. At the next proximal joint, the tissue is released to create the snap back. TR AINING-CONDITIONING.COM

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LF FOR TENNIS For a sport like tennis, which sees many upper-body injuries, here’s what a general recovery sequence of lymphatic facilitation (LF) would look like. The entire sequence should take only 15 minutes once you are proficient in the techniques. Begin with the athlete in a supine position. Start the siphon the same as you would for any treatment session by clearing the axillary catchment with 10 stationary circles. Apply five to eight long strokes to the brachium and five to eight long strokes to the forearm. Clear the axilla again. Apply a series (three to five sets) of stationary circles to the chest (see Figure A) before turning the athlete to prone position and applying another series of stationary circles to the back (see Figure B). Finish with 10 stationary circles at the terminus.

Archer P. Therapeutic Massage in Athletics. © Lippincott Williams & Wilkins 2007. Used by permission.

ter, which is completely inefficient. Cellular transportation mechanisms would be compromised, waste removal and immune responses would slow, and the delivery of nutrients and repair cells would be inhibited. This inefficiency has a negative impact on athletes in particular since the daily load of metabolic byproducts and low-grade inflammation due to microtrauma is extremely high. This escalates the importance and value of using lymphatic facilitation in sports healthcare. By stimulating edema uptake and lymph flow, we enhance the body’s natural fluid refreshing and recovery processes, which should help athletes recover from exertion more quickly. While sufficient research to support this hypothesis does not exist, my experiences and those of my colleagues who use LF show strong anecdotal evidence that it does have a positive influence on recovery from, and reduction of, general muscle soreness. Even when I’m working with non-athletes in my massage therapy practice, I’ve found that finishing a session which included a lot of muscle specific and myofascial techniques with LF greatly reduced the residual soreness for the client. A second implication is that stimulation of the body’s natural edema removal system is key to improving their rate of progression through the injury cycle. Current standard treatment protocols for injury—rest, ice, compression, and elevation—all minimize tissue necrosis and manage initial hemorrhage (primary edema). However, none of these measures stimulate edema uptake or lymph flow. In fact, ice and deep compression together specifically shut down edema uptake and lymph flow. LF, on the other hand, stimulates edema uptake and the removal of protein from the interstitium, which helps limit secondary edema formation and decrease the risk of excessive scar tissue development. The rhythm and movement of LF can also help decrease pain via gate control and by reducing the pressure on nociceptors (sensory receptors that send “pain” signals to the brain). The simplicity of the strokes and sequences in LF makes it easy to employ in athletic environments. Only two basic strokes are used: stationary circles (see Figure 1), which are used to clear the lymph node beds (called catchments in lymphatic terminology)

TR AINING-CONDITIONING.COM

TREATING THE ATHLETE at the site of edema, and traveling long of the tissue creates a slight push, like ment throughout the rest of the sysstrokes (see Figure 2), which clear the slamming a door, that propels fluid tem. Functionally, slow flow through superficial pathways between the ededeeper into the lymphatic network. the catchments is helpful for immunity, ma and the catchment. All LF sequences follow the same but bad for edema removal. So clearing The strokes are similar in that they three steps. First, start the siphon by the catchments is essential for edema are light, rhythmic, and slow. Rememincreasing lymph flow back into the removal but should be avoided during ber, the initial vessels are located just cardiovascular system at the terminus, infection or illness. Finally, site-specific beneath the epidermis, so the correct which is the junction between the two application of LF strokes will promote amount of pressure is essential. You can compare it to the amount of pressure Because lymph flow follows a predetermined path, lymneeded to slide your eyelid over your eyeball. The LF strokes use repetition phatic facilitation treatment sequences are based on the instead of pressure to achieve the debody region rather than the type of injury. So whether sired effect, meaning each light stroke is repeated over the same area of tissue 10 you’re treating epicondylitis, a rotator cuff strain, or a to 20 times to fully absorb edema and/ sprained wrist, the sequence is essentially the same. or move lymph along in the system. The stroke techniques are applied in the same general direction as lymph major lymphatic ducts and the subedema uptake and enhance lymph flow flow—toward the catchment for that clavian veins (at the base of the neck through the superficial vessels in the region of tissue, which is generally (but just above the collarbones and lateral area of swelling. (For an example of a not always) toward the heart. Both LF to the sternocleidomastoid muscle atgeneral recovery sequence, see “LF For strokes start with a light stretch of the tachment point). Next, clear the pathTennis” on page 20.) epidermis and finish with a sudden reway by emptying the catchments and lease of this tissue so it “snaps back” to superficial pathways proximal to the IMPLEMENTING LF its original position. The slight stretch edema. Clearing the catchments is an When LF is used for treatment of injury, of the epidermis pulls on the anchor essential step in improving lymph flow a thorough treatment session averages filaments to open the initial vessel for because flow through the lymph node about 15 minutes. However, allot 20 SpencoSandals_JulAug2010.pdf SpencoSandals_JulAug2010.pdf 6/29/10 6/29/10 9:13:26 9:13:26AMAM edema uptake, and the sudden release beds is 100 times slower than moveto 30 minutes for severe injuries with

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TREATING THE ATHLETE lots of edema because you may have to clear the catchments more than once and work several different points along the periphery of the edema. The further the edema is from the lymphatic terminus the more steps in the sequence. For example, an acute ankle sprain should

er, the patterns of lymph flow are a bit more complicated in the body’s lower extremities, so treatment sequences here require more steps, more strokes, and more detailed knowledge of lymphatic processes that can be found in a book about LF or learned in a class.

Another important consideration when using lymphatic facilitation in conjunction with other modalities is to remember that the lymphatic system “cleans things up,” so it should follow other treatments ... Standard protocols should always be the first step. be given a full 30 minutes because it requires clearing three more catchments and all of the tissue from ankle to groin before addressing the swelling in the ankle. Because lymph flow follows a predetermined path, LF treatment sequences are based on the body region rather than the type of injury. So whether you’re treating epicondylitis, a rotator cuff strain, or a sprained wrist, the sequence is essentially the same. Howev-

Another important consideration when using LF in conjunction with other modalities is to remember that the lymphatic system “cleans things up,” so it should follow other treatments, especially any cryotherapy. Standard protocols should always be the first step in any treatment, and LF is the final step. When using LF to help athletes recover faster after competition, the same physiologic and technique principles

apply, but the pace is a little faster and fewer strokes are applied to each site. The first question to ask any athlete before they get their post-event massage is whether their arms or legs feel heavy or tight. If they say yes to both, you need to do some general massage and muscle-specific work before finishing their session with LF. If they say they just feel heavy, you can have them feeling refreshed and invigorated with a 10- to 15-minute LF sequence. My experience using LF with athletes has shown me the technique is effective for edema removal, pain reduction, prevention of residual soreness, and enhancing recovery from exertion. Hopefully this article has provided you with a better understanding of the importance and physiologic rationale for stimulating the lymphatic system, as well as some basic information on the LF technique itself. If your interest has been piqued, seek out further information and training in this important form of manual therapy. I think you’ll be amazed and delighted at how it enhances the effectiveness of your treatments. n

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NUTRITION

The Final Hurdle

Errol Anderson

Could your athletes’ nutrition be the final piece to the puzzle for success? As the Texas A&M University track and field team found out, time spent creating individualized diet plans was well worth it.

By Amy Bragg

he pieces are in place: A highly decorated and successful coaching staff, beautiful facilities, and most importantly, an outstanding group of elite athletes. When a team is already poised for success, what can you add to make it even better? Not long ago, the Texas A&M University track and field coaches asked themselves this question, and the answer they arrived at was an emphasis on sports nutrition. “Paying attention to nutrition enhances our student-athletes’ opportunities to be successful, and when inte-

TR AINING-CONDITIONING.COM

grated with coaching, it leads to greater achievements,” says Head Men’s and Women’s Coach Pat Henry. “We have great coordination between the coaching staff’s and nutrition staff’s educational message, and we position nutrition as a lifestyle commitment.” Of course, the main challenge in providing nutrition guidance for track and field is the sport’s great diversity— sprinters, distance runners, throwers, and jumpers all have different needs and goals. It may seem impossible to provide customized advice for so many different

types of athletes, but that is exactly what we strive for every day. Doing so means evaluating the demands of each type of athlete, optimizing their eating environment, and formulating nutrition goals that individuals can work toward throughout the year. Amy Bragg, RD, CSSD, LD, was recently appointed Director of Performance Nutrition at the University of Alabama. She previously held the same position at Texas A&M University and can be reached at: abragg@ia.ua.edu. T&C octoBER 2010

NUTRITION FUELING WITH PURPOSE In our program, we want to link daily food choices with performance outcomes. We tell athletes that they train a certain way to achieve a desired result, and they should eat a certain way for the same reason. They need to understand that lifestyle and nutrition habits have a cumulative effect that produce tangible changes in performance, energy level, body composition, and injury recovery. Body comp testing provides a nutritional scorecard we can analyze and interpret along with nutritional habits. We use it regularly along with 24-hour food logs as a starting point for talking with an athlete about making changes. Most track athletes at Texas A&M undergo body comp testing four or five times per year. During a couple of those testing periods, we will also record the student athlete’s nutritional intake over the 24 hours prior to the testing appointment. Accuracy is stressed since a nutrition professional is taking this information directly

from the athlete while prepping the body comp exam. Timing, recovery choices, and sleep and wake time are included along with the quantity and quality of food items. Simply holding this discussion in tandem with the body comp testing is educational, but there’s a wealth of information taken in during those appointments. For instance, if a body comp test reveals that dropping fat would help an athlete improve performance, we’ll look at one or more 24-hour logs to see if there’s an especially problematic time of day or a poor choice in food quantity or quality that needs addressing. Other times, an athlete will tell us that they eat healthy most days, but an occasional “off day” of high fat and calorie consumption throws them off track. Education is another essential part of our approach, so we use team presentations to help convince athletes of the value of optimal nutrition. Food logs might tell us that only 40 percent of the team is getting adequate nutrition at breakfast

OPPORTUNITY THROUGH INJURY Injuries happen. And for a determined sports nutritionist, they could be a blessing in disguise. Even the most noncommittal athlete may finally become receptive to nutrition coaching during rehab or injury downtime. The I-can-eat-whatever-I-want-and-never-gain-too-much-weight guy and the fast-food-got-me-here-so-fast-food-will-fuel-me-here girl may suddenly feel a need to change their nutrition habits. Connecting with the athlete during rehab is not only ideal for a speedy return to play, but also provides a touch point with those athletes who may have viewed nutrition too narrowly in the past. Simply working with an athlete through an injury recovery process offers them support, both psychologically and medically, and in many instances I have found it’s a great entry into working with a resistant athlete. The support you offer during that process will always be remembered, and can completely change the dynamic of how nutrition’s role is integrated in the athlete’s overall performance. Focusing interventions on relevant nutrients is a great way to start, with a more global assessment of calorie and protein needs falling in behind. Are you getting enough vitamin C and calcium? What about protein? Knowledge of weight history easily segues into recommendations for limiting calorie and protein intake, which may even need to be higher to support the recovery process for an injured athlete. In short, the time to improve nutrition is always now, and in whatever mode most resonates with the athlete.

T&C octoBER 2010

and lunch. There’s a target message for a quick team presentation: importance of breakfast in energy level, weight maintenance, and performance, along with 10 easy breakfast options so the athletes can see how simple it is to make an improvement. On other occasions, we may administer a poll over the course of a full day of team body comp tests. This leads to customized team presentations, and allows student-athletes’ interests to drive a portion of the content. For example, armed with that information, I can go to the coaching staff and report that 70 percent of the team members are dining at campus eateries for the majority of their meals and 68 percent of their athletes are interested in learning more about using nutrition to boost immunity, while only 12 percent feel they need guidance in the grocery store. To me, it sounds like this team needs a mini nutrition talk at the start of flu season and a nutritionist to visit a couple of campus dining facilities to show them optimal menu options. The questions that arise from these sessions are always encouraging, because they show us the athletes are taking our message seriously and are truly interested in finding ways to better fuel themselves. Some recent examples include: • Each year at the same time, I seem to struggle with fatigue—why does it happen and what can I do? • I’m focusing on a certain aspect of my performance right now. How can nutrition help me with it? • I had an injury last season. Is there anything I can do with my nutrition to help prevent a recurrence? Fueling for performance means different things to different athletes at different stages of development. So once they’re armed with a foundation of knowledge, we delve into specifics through individual consultation. And if the athletes follow our advice, we let the results speak for themselves. CASE STUDIES The examples below illustrate how I’ve been able to convert broad sports nutrition concepts into targeted advice for different types of track and field athletes dealing with various challenges. Each case is unique, and I find that oneon-one counseling is by far the best way to achieve success. Tired jumper. In the middle of last season, one of our jumpers came to the TR AINING-CONDITIONING.COM

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NUTRITION

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nutrition staff complaining of low energy levels. His food logs revealed that his meal selections were consistently very good, but the overall quantity of food was too low, leaving him with inadequate amounts of total calories, carbohydrates, protein, and fat. In addition, he kept pre-activity nutrition very light due to a preference for feeling “weightless” at practices and meets. His body comp history evidenced a tendency to lose weight and lean mass toward the end of the season, and the lower quantity of food was the likely culprit. Our first intervention strategy focused on increasing food intake and calorie density throughout the day. After discussing the times of day when he didn’t want to eat (particularly before practices), we decided to target breakfast, the recovery period after workouts, and the evening. He added more calorie-dense foods to his breakfast, such as peanut butter and granola. After working out, he had a snack consisting of other calorie-dense options, such as whole grain breads, guacamole, and peanuts to kick-start his recovery. (This was in addition to his normal lunch and dinner.) At night, I encouraged him to eat a snack such as frozen yogurt with toppings. Foods like these support weight maintenance without requiring large portion sizes, which was important for someone who wasn’t interested in adding a lot of food to his diet. It seemed like we had solved the problem, but before long, the athlete came to me again and reported “never feeling good” on this new eating pattern. The breakfast changes weren’t a problem, but he told me that snacks didn’t “sit well” for him. After more discussion, we determined that frequent eating made him feel undisciplined, as if his intake was excessive. The issue was as much mental as it was physical. Because he understood that he still needed more calories to improve his energy level and prevent unwanted weight loss, we decided to try other options besides the calorie-dense ones he had been using. He started snacking on fruit frequently throughout the day. Because it was whole food and not something out of a package, he could snack on things like apples, oranges, and bananas and still feel like a “disciplined” eater. We also increased the amount of 1% chocolate milk he drank after workouts, which boosted his intake of calories, carbs, protein, and fat. As a result, he’s been able to maintain his weight, particularly near the height of his competitive season. This case was a great learning experience for both sides of the consultation. Sometimes the assessment and advice is totally on point, but it just doesn’t work in practice for the athlete. Just as a coach continues to develop the athlete’s workouts, so does the sports nutritionist adjust the nutritional plan. This athlete needed several touch points with the dietitian to build trust and try alternative strategies. His nutritionist needed knowledge of body comp history at her fingertips, a rapport with the athlete, and an appreciation for the psychological aspects of nutrition and performance. Combo platter. Combined-event athletes train and compete in a wide variety of venues. The decathlon, heptathlon, and pentathlon comprise a mix of running, jumping, and throwing events such as the 100 meters, long jump, shot put, high jump, 400 meters, 110-meter hurdles, discus, pole vault, javelin, and 1,500 meters. The athletes compete in multiple events on consecutive days, and in many ways, it is the ultimate test of strength, speed, agility, and endurance. Recently, a young woman joined Aggie track for combined events. She had previously competed exclusively as an endurance athlete, burning a massive amount of calories due to the TR AINING-CONDITIONING.COM

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NUTRITION prolonged aerobic nature of the sport. When she switched to track and field, the lower overall energy requirements meant she was eating too much. In her first year in our program, she was able to maintain her muscle mass but also experienced an increase in fat mass and body fat percentage. The pattern continued the following year, so we scheduled a meeting. Early in the discussion, it was clear that food and weight were sensitive subjects for this athlete. Based on her food log, I observed that she was overusing energy bars, eating three to four each day in addition to breakfast, lunch, dinner, and pre-training and recovery snacks. “But I’m doing what I’ve been told: fueling frequently throughout the day to maximize my energy,” she said. She obviously understood the basics of nutrient timing and consistency, but her eating habits weren’t tailored to her actual energy needs—a common problem for athletes who switch sports but don’t change their diet accordingly. With this athlete, I offered a lot of positive feedback on the good food choices she was making at mealtimes,

and focused on the bars as the source of unwanted extra calories. Because she was used to those frequent energy boosts, we talked about spreading out her calories by eating a little less at breakfast, lunch, and dinner, while adding healthy snacks throughout the day in place of the bars. For instance, instead of having fruit salad as part of her lunch, she would save it for an afternoon snack in place of her usual pre-workout energy bar. At breakfast, she would eat a slightly smaller meal, then have a muffin or bagel with cream cheese in mid-morning instead of a bar. I threw out suggestions, and let her preferences determine the strategies she pursued. Using this approach, we were able to decrease her overall calorie intake without creating periods of the day when she felt tired or hungry. In time, she realized that she ate the same portion sizes at meals whether she had an energy bar or not. For this athlete, the bars didn’t give her any satisfaction, and with her mastery of meal timing, they really weren’t serving any purpose. “I’m just eating them because they’re here,” she realized.

MUCH TO GAIN How far-reaching is nutrition’s role in performance? Texas A&M athletes who sharpened their focus on quality and consistency of nutrition choices have seen benefits including improved energy level, better management of inflammation, higher peaks in training, faster rehab, and even a reduction in injuries. And besides all that, a great nutrition regimen feeds their confidence in competition. When athletes see nutrition as a performance optimizer and know they’ve done all they can to fuel themselves for competition, they get a valuable mental boost that complements all the physical effects. They also start to take pride in their smart decision making. In the words of longtime Assistant Coach Vince Anderson: “The longer I coach, the more I believe it’s impossible to measure how critical nutrition is. I’m fascinated by the fact that it’s so often the ‘last frontier’ for athletes who are struggling to push their limits. So many athletes will do everything else before they truly focus on their nutrition, but once they do and they experience all the benefits, they never go back.” n

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Optimum performance

Shaking It Up As whole body vibration continues to catch on in weightrooms and with athletic trainers, researchers are shedding new light on how it works and what its benefits are. By David M. Bazett-Jones

Author David M. Bazett-Jones works with a University of Wisconsin-Milwaukee soccer player as she performs a squat on a vibration platform.

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hen first presented, the concept sounds a little crazy: Perform exercises while standing on a vibrating plate to help you work out more efficiently or as part of a rehabilitation program to help you return to play faster. But whole body vibration (WBV) is doing just that. And its growing popularity over the past decade has athletes, strength coaches, and athletic trainers wanting to know what the buzz (both figuratively and literally) is all about. The growing curiosity about WBV has been a double-edged sword. On one hand, there are more published studies on how it works and its possible benefits. In the first 10 months of 2010 alone, more than 80 research articles on WBV were published. On the other hand, there are more unsubstantiated claims about its benefits than ever before. An Internet search of the term “whole body vibration” results in almost 200,000 hits. Plus, as the number and type of WBV devices available continues to grow, the practitioner’s decision on which devices to use becomes that much more difficult. With so much to sort through, athletic trainers and strength and conditioning coaches face an uphill battle in deciding if, how, and with whom to use WBV. This overview of the most recent research and some practical applications of WBV in the athletic training room and the weightroom should help cut through the clutter. HOW IT WORKS Let’s start by defining vibration, which is a mechanical stimulation characterized by oscillatory or wavelike movement. It can be applied directly to muscles and tendons or indirectly through the use of vibrating platforms, dumbbells, cables, or even entire vibrating workout machines. Vibration consists of frequency, amplitude, and acceleration. Frequency, in hertz (Hz), measures the number of cycles of the oscillation per unit of time. Amplitude, in mm, is the distance

David M. Bazett-Jones, MS, ATC, CSCS, is a Doctoral Candidate at the University of Wisconsin-Milwaukee and is actively involved with the Athletic Training Program. He has published several studies about whole body vibration and how it relates to athletic performance and rehabilitation. He can be reached at: bazettj2@uwm.edu. TR AINING-CONDITIONING.COM

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Optimum performance between the minimum and maximum displacement values of the oscillation. Together, frequency and amplitude determine the acceleration of the vibration, often calculated in “g”s (one g is the acceleration due to gravity). Most vibration platforms—the most common way to use WBV—provide frequencies of 20-50 Hz, amplitudes of 0.5-5 mm, and accelerations of just over one g up to 10. So what happens when an individ-

form with knees bent—the quadriceps muscles feel tight like they are constantly contracting (like contracting a muscle isometrically). There have been many claims about the mechanisms of WBV, the most common of which is called the tonic vibration reflex. This reflexive muscle contraction has only been found in a relaxed muscle during direct tendon vibration. No studies have yet linked tonic vibration reflex and WBV.

A recent study saw a 22-percent increase in flexibility with four weeks of static stretching during WBV ... The group was able to maintain a significant (11 percent) enhancement in flexibility even after a three-week cessation period. ual stands on a vibration platform? Imagine for a minute that the athlete’s body is a rigid object. During the upward phase of the vibration oscillation, their body accelerates along with the platform until the platform reaches its peak. The body would then become airborne until it again contacted the vibration platform, at which time an impact force would occur between the body and the platform. These impacts could be harmful. Because the human body is not rigid and our muscles and tendons store and release energy to help it act more like a spring, it can safely deal with these forces. Muscles have shown specific properties useful for dampening vibration, one being the linkage design of the musculoskeletal system, which allows a vibration to be transmitted through the legs to the trunk and dampens the vibration as the legs are bent. This is why an individual standing on a vibration platform with locked knees feels the vibration in their head (not a nice feeling), which goes away when they bend their knees. Muscle activations and contractions occur as a result of each vibration. It’s commonly said that WBV causes thousands of separate muscle contractions during a typical training session. However, this theory has not been substantiated through research. A better description of muscle response to WBV is that they go through entire cycles of eccentric (lengthening) and concentric (shortening) contractions during a WBV workout. Again, this can be felt when one stands on a plat3 4

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Tendon vibration does indeed elicit increased muscle spindle contraction. However, it also stimulates the Golgi tendon organ, causing antagonist muscle contraction. Since a muscle cannot contract and relax at the same time, other mechanisms may be present. Those mechanisms could be reflex enhancement or post-activation potentiation. Or it may be that a complex cascade of effects is present and a dampening muscle absorbs energy and generates heat, resulting in increased muscle temperature and blood flow. One thing is certain. The mechanism of WBV is multifaceted and will require much more study, even though researchers are already making headway on the ins and outs of how exactly it works. WHY USE WBV? By now, numerous studies on WBV and its effects have been conducted and published. Here are some of the highlights on the benefits of using WBV: Vertical jump. The recent surge in WBV began in 1998 after a study by Bosco et al. reported enhancement of vertical jump height with use. Since then, acute increases in vertical jump (up to nine percent) have been reported by many authors. Note that these effects may be gender specific, with one group reporting improvements for women but not men. These results may also be specific to training level, with the largest improvements seen in those who are less trained. Strength gains. Using WBV to promote muscle strengthening has also received continued attention over the

past decade. In a 2010 study, Marin & Rhea compared the effects of acute (single-use) and chronic (repetitive use over time) WBV and found that while acute exposure had negligible effects, chronic exposure was consistent with the effects of traditional resistance training. This finding is important because WBV training can typically be performed in much shorter durations than traditional resistance training. More so, individuals who have restricted motion due to age or injury may benefit from static WBV exercises to increase strength or lean body mass. The researchers further reported that WBV programs that included both static and dynamic exercises were more effective than static alone. Muscle warmup. Since muscle temperature increases when absorbing vibrations, WBV may be effective as part of pre-competition warmup. Athletes generally complete some sort of pregame preparation for this very reason— to “warm up” their muscles. Published studies of golfers and softball players who used WBV during their warmups showed improvements in golf club speed and bat speed during competition. Flexibility. Performing stretching exercises while on a vibration platform may help athletes limber up a little more. Research has reported that even simply standing on a WBV platform for five minutes improved flexibility by over 16 percent A recent study saw a 22-percent increase in flexibility with four weeks of static stretching during WBV but only a 14 percent increase when participants did static stretching alone. Furthermore, the group that did static stretching combined with WBV was able to maintain a significant (11 percent) enhancement in flexibility even after a three-week cessation period. A note of hesitation must also be presented here. Many club and professional sports teams are using WBV on the sidelines during competition, similar to the use of a stationary bicycle, to help keep athletes warmed up. This raises the question, “Is there such a thing as too much WBV?” The opportunity for repetitive exposures and intensity of muscle activation that WBV elicits leads me to hypothesize that excessive use during competition may actually cause greater fatigue, possibly leading to greater injury risk. But research into this question is sorely needed. TR AINING-CONDITIONING.COM

Optimum performance While acute performance enhancements have been documented in applications like jumping, WBV has not been shown to improve sprint or agility performances when used as part of a warmup. This may be because the task of sprinting involves the entire body for a longer duration than a movement like jumping. Over time, it’s possible that an athlete’s sprinting may improve, but even after eight months of WBV training, no chronic benefits on agility have been documented. Overall, it seems reasonable to assume that a minute or two of WBV may improve performance of a short, explosive task. Does WBV help fight obesity by improving body composition? While lean body mass has been reported to improve following 10 weeks to 18 months of WBV training, these benefits have mostly been seen in the elderly or untrained. Given the limited number of studies on this subject, WBV seems effective in improving body composition in the elderly, obese, or untrained. However, it may not be effective for young or active individuals.

Does WBV have a cardiovascular effect, thus helping to improve heart health? Recent research indicates that the answer is no. It seems that a semisquat with WBV is no more taxing to the cardiovascular system than without it. Until further research shows otherwise, it looks like bikes, treadmills, or elliptical machines are still integral pieces of equipment to improve health. WBV FOR REHAB Using WBV in a rehabilitation setting is a fairly new endeavor, but rehab patients can benefit from WBV in multiple ways. In fact, I would venture to say that the application of WBV to rehabilitation and populations with limited mobility is the future of WBV. First, since WBV has been shown to increase muscle temperature faster than cycling, it may function as a good pre-rehabilitation warmup. The increased blood flow that occurs with the use of WBV may positively influence swelling and inflammation at a non-acute injury site, but this hypothesis has not been adequately explored via research. WBV might also be beneficial

in rehabilitation by helping to ease pain, possibly by over-stimulating pain receptors in a way similar to the Gait Control Theory (e.g. rubbing your elbow after you hit it). Interestingly, vibration itself has long been linked to low back pain in truck drivers and others in similar lines of work. However, it seems that when WBV is utilized as exercise intervention, those with low back pain experience a drop in pain level. Differences in the vibration application, frequency, and duration, or the posture during exposure could account for this conflict. WBV has even been reported to aid in pain reduction in fibromyalgia—a condition generally accompanied by constant pain. Other specific applications of WBV for rehabilitation have been reported in literature as well. One study reported that patients with knee osteoarthritis saw improvements in muscle strength following eight weeks of vibrating platform work and slightly better balance. Following a total knee arthroplasty, patients who received four weeks of WBVbased rehabilitation showed similar

Add the benefits of WBV training to cage workouts, but with the enhanced safety and convenience of having the vibration plate inside the platform itself. “Balance and viBration in one”

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Optimum performance improvements in strength and function compared to traditional progressive resistance exercise protocols. Anterior cruciate ligament reconstruction patients have reported significant improvements in proprioception when using WBV therapy instead of a conventional rehabilitation program. Improvements were also seen in patients’ non-operative knees as well, demonstrating a possible crossover effect. According to one study, these improvements may be due to the repet-

IMPLEMENTING WBV Before jumping into WBV training with athletes or clients, it is important to do a number of things. Performing a pre-intervention physical and taking a medical history should be at the top of the list. If you don’t feel that doing so is within your scope of practice, have the individual get a written letter of clearance from their physician for WBV use. Some WBV manufacturers provide lists of risks associated with use, but use your best judgment when evaluating an

A WBV program should resemble a traditional resistance training periodization program ... Exercises should progress from easy static moves like a semi-squat to more difficult static moves to more dynamic exercises like a full squat. itive stimulation of the various receptors that provide information needed for proprioception. All in all, WBV may provide rehabilitation professionals with a unique tool to provide multiple benefits within a limited time frame.

athlete or rehab patient for WBV use. I have had individuals with epilepsy and diabetes (two common manufacturer risks) use WBV and they’ve experienced positive results, but that doesn’t mean all epileptics and diabetics will. There may also be unknown risks.

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Two recent case reports of serious reactions to WBV drive home the importance of this point. One patient had a severe reaction because of asymptomatic kidney stones, and another patient experienced a serious case of vertigo. We also don’t know the long-term, chronic use effects at this time. Until we can further understand the longterm effects of WBV, unsupervised or unlimited use (e.g. at home) should be discouraged. Always observe individuals using WBV closely, especially in cases where medical or family history increase risk for complications. Finally, athletes and other patients should be fully informed of the benefits and risks of using WBV. This should include explaining that we don’t know all of the benefits nor all of the risks associated with WBV, and that no research on long-term daily use exists. Using WBV as an acute performance enhancer may require some trial and error on your part when designing a program—and it may differ from person to person. In general, 30 or 50 Hz seems to be effective for acute perfor-

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mance enhancement. You might also want to try pairing low frequencies (30 Hz) with low amplitudes (2 mm) and high frequencies (50 Hz) with high amplitudes (4 mm), according to researchers. It’s important to note that greater rest periods (at least two minutes) between sets are more beneficial to acute performance enhancement than shorter rest times (less than one minute)—especially when multiple (at least six) WBV exposures are used in one session. As for which exercises to perform, a WBV program should resemble a traditional resistance training periodization program. Since neuromuscular adaptations are likely to account for many of the enhancements seen with WBV, periods should be short and change often, approximately every two weeks. Exercises should progress from easy static moves like a semi-squat to more difficult static moves like a squat to 90 degrees, then to more dynamic exercises like a full squat. Some individuals may find static exercises more challenging than dynamic exercises, so this progression can be

adapted to individual needs. Advanced athletes may want the extra challenge of adding weight to their WBV exercises as well. Exercises in the seated or lying positions should only be performed when absolutely necessary and only in younger or athletic populations. Tweaks to a program in search of optimum benefit might include increases in duration, then frequency, then amplitude in order to constantly provide adequate stimulus to the neuromuscular system. You can even use electromyography (a way to evaluate the electrical activity produced by skeletal muscles) to determine the optimal vibration frequency for each individual. Reducing the amount of rest between sets may also increase the intensity of the WBV workout. The duration of WBV work should not exceed 15 minutes of actual vibration time per session, and this time should be much shorter if an athlete is using WBV on a daily basis. Finally, a “washout” period in which an individual discontinues WBV training for a few months to participate in other forms of exercise may be important for long-term safety and avoiding training plateaus.

WBV is an exciting new exercise and rehabilitation modality that may offer substantial benefits to many people, especially athletes. Scientific evidence is available for many of the claims made about WBV, but further research is needed for others. Those who are untrained or elderly have the most to gain from WBV interventions. At this point, the potential benefit of WBV must be coupled with thinking about the potential risks and unknown long-term effects. However, with taking proper precautions and using logical progressions, it seems that WBV is safe for most individuals. n To view full references for this article, go to: www.Training-Conditioning. com/References. To see some of the author’s video examples of WBV exercises, go to: www.Training-Conditioning.com and click on “Video Library” in the top lefthand corner of the page.

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LEADERSHIP

By Jon Almquist

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Staff evaluations may be one of the most overlooked opportunities for athletic training departments to improve their services. The key is making evaluations a learning tool, not a critique of past mistakes.

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everal years ago, while doing workshops across the nation on transferring spine injured athletes and the removal of facemasks, I had the opportunity to present to both certified athletic trainers and emergency medical technicians. Consistently, the groups of athletic trainers would listen and watch the demonstration intently, and then shy away from the opportunity to practice with their peers. The EMTs, on the other hand, would be jumping out of their seats during the demonstration and trample each other for the opportunity to practice. There is probably more than one reason why the two groups reacted so differently. But one thought stayed with me: The certified athletic trainer may not always look at someone scrutinizing their practice as a positive experience. As a group, we seem to not embrace the process of being evaluated. However, as any administrator in any field will tell us, evaluations of one’s work are critical for improvement and moving forward professionally. Without feedback, how can we know if we

Jon Almquist, ATC, is the Athletic Training Program Administrator for Fairfax County (Va.) Public Schools. He serves as Chair of the Athletic Training Advisory Board with Virginia’s Board of Medicine and is a member of the Sports Medicine Advisory Committee for the Virginia High School League. He has received a Most Distinguished Athletic Trainer Award from the NATA and can be reached at: Jon.Almquist@fcps.edu. T&C october 2010

LEADERSHIP are doing a poor, good, or fantastic job? How do we know what our strengths and weaknesses are? Athletes are continually being evaluated and offered suggestions for improvement. Teachers and professors in most educational institutions are evaluated on a regular basis, as are coaches. Yet, in many settings, few certified athletic trainers are offered constructive feedback or formal evaluations in a timely manner. I have the good fortune to work with over 50 certified athletic trainers on a daily basis, and part of my job is to conduct ongoing evaluations of the athletic training programs at each of their schools. I have found this practice to be a critical aspect of both improving the athletic training services we provide and helping individuals grow in their jobs. Work evaluations can be an immensely useful tool, as long as they are structured correctly and have a clear end-goal in mind. GETTING STARTED When instituting an evaluation process, the first thing to consider is how to ensure you will have buy-in from your

staff. The evaluations should not be seen as a way to criticize or call out others on something they’ve done wrong. Instead, they should be presented to staff as something to help them grow and improve the entire athletic training department. When we hire new athletic trainers, we try to identify individuals who are willing to make efforts toward continuous growth as they work in our organization. The ugly reality is that there are certified athletic trainers who are very set in their ways and resistant to any improvement strategies because it takes effort, energy, or simply a change from their routine. We definitely shy away from hiring this type of person. Once the staff is on board, I explain our evaluation process and how it can help them become better in their jobs. We talk about how everyone has areas of weakness and how evaluations can help individuals understand what they need to do differently for their professional growth. I try to emphasize taking the opportunity to learn from their peers, addressing those awkward areas head on, and not falling prey to avoiding areas of discomfort. The idea is to

CHEAT SHEET When conducting an evaluation, it can be helpful to have a reminder of which specific areas you’re evaluating the athletic trainer on. The author’s evaluation sheet includes the following criteria. Goals: Has the ATC met their goals? What are their new goals? Athletic training facility: Is the athletic training room clean and organized? Is equipment properly maintained? Are the handwashing facilities appropriate? Record keeping: Is the ATC’s ITTS status satisfactory? Do they have easy computer access? Do they keep proper injury reports and update them as necessary? What sort of shape is the physician’s report file in? Athlete interaction: Does the ATC welcome athletes with an “I can help” attitude? Do they have good listening skills, take complete histories, and make appropriate recommendations? Coach Interaction: Does the ATC address coaches in a positive manner, with a professional attitude and approach? Co-worker interaction: Does the ATC have professional dialogue with their co-workers? Do they communicate with their co-workers at an appropriate frequency? Do they share the specifics of cases professionally? Parent interaction: Is the ATC professional and polite in their interactions with parents?

T&C october 2010

not just maintain status quo in one’s comfort zone, but to expand it. As a staff, we talk about how evaluations can ultimately improve the overall athletic healthcare we are providing student-athletes. If everyone improves in just one aspect every year, our staff can reach great heights! This explanation can lessen the perception of individual scrutiny by focusing on the level of athletic healthcare being provided. We focus more on “What level of care is the athletic training program delivering?” and less on “What kind of job is the athletic trainer doing?” One great way to get staff buy-in with evaluations is to have them include a self-assessment. This relays the fact that you want your staff member’s opinion on his or her strengths and weaknesses, and that this is a process to help them. It helps them become more conscious of constantly evaluating their own work, which can often be the best way for employees to improve. And it gives you an indication of where they need support and mentoring. Another important element is to structure the evaluations as an ongoing process and not a one-time occurrence. If you only talk about performance once a year, it can be easy to disregard the suggestions and ideas. Instead, the outcomes of the evaluations should be continuously monitored. For example, if one of my staff members needs to work on communication skills, I’ll occasionally listen in on some of his of her interactions with others. Then, I’ll provide feedback once the athletes have left the area. It can be as simple as, “Remember to pause when giving instructions to a student-athlete and ask them if they understand.” And if I see this staff member doing something positive in terms of communication, I want to be sure to point out what a great job he or she did—even if it’s something very small. Knowing the staff members’ personalities and adapting your approach may also prove helpful. It seems the norm has been for employees to recognize the unique personalities of their supervisors and just learn to deal with any negative aspect of them in order to keep their jobs. In keeping up with social changes, as leaders, perhaps we need to make more adaptations to address our staff members in ways that work for them. There are also times where feedback can come in the form of a global anTR AINING-CONDITIONING.COM

LEADERSHIP nouncement or discussion as opposed to individual interaction. We have the good fortune to meet every other week as a group of head athletic trainers. As one can imagine, with the number of helicopter parents representing the more than 9,000 student-athletes each season, we are occasionally confronted with issues. More often than not, the underlying reason for any problem with parents or coaches has to do with communication. The meetings provide an opportunity to address, understand, and learn about the issue while leaving the details of the individuals involved anonymous. You also need systems in place to gather criteria on what you want to evaluate—you can’t personally oversee what staff members are doing at all times. The solution is to think about ways to obtain this feedback on their work through several different avenues. This can include asking coaches (or even student-athletes or parents) to fill out evaluation forms, taking the time to review their record keeping, and assessing outcomes of their rehab. When asking others for their feedback,

I recommend reviewing these responses in the aggregate and not getting hung up on any one poor performance indicator. When a coach, athlete, or parent fills out a survey soon after an athletic trainer indicated less than full participation for the athlete, there is a good chance there

thing positive or negative the staff member is doing, take a moment to write down your observations. You can even do this in a hand-held electronic device, then transfer it to a text file when you get back to your computer. It is critical to maintain quality written documentation

Figure out when you will conduct the sit-down evaluations and where. Do you want to structure the meeting as a discussion or a rundown of your thoughts? Will you give empoyees something in writing? will be a bias in the survey. Look for disturbing trends as opposed to individual criticisms. An athletic trainer’s clinical evaluation skills should only be assessed by a medical professional, and this can be done by a team physician or a veteran certified athletic trainer. Exactly what to evaluate in this area will vary greatly based on the individual’s job responsibilities. Gathering input for an evaluation also requires constantly assessing the job a staff member is doing whenever you work side by side with them. If you notice any-

over time. This may be essential should your employee’s position be in jeopardy of something like a budget cut, or should you need to terminate their employment. It’s also important to have a formal procedure for the evaluations planned ahead of time. Figure out when you will conduct the sit-down evaluations and where. Do you want to structure the meeting as a discussion or a rundown of your thoughts? Will you give employees something in writing, and if so, during or after your discussion? Is there any procedure to follow ac-

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LEADERSHIP cording to your institution’s human resources policies? In our school division, our head athletic trainers work full time with no teaching responsibilities. They fall under the “support employee” evaluation system with our human resources department. There is a formal self evaluation, midyear evaluation, and final evaluation that

BASICS What exactly should you be reviewing in an evaluation? The first step is to take a look at the staff member’s job description. A good job description should outline the scope of practice that the employee will be providing. The evaluation can then assess how the employee is performing these specific functions.

Another area I evaluate is the athletic training facility ... I assess how the equipment is used, not simply that it is there and clean. A whirlpool filled with old pads, boxes of tape, and crutches represents poor utilization of space. must be completed by their school based administrator. To accompany these formal evaluations, as the athletic training program administrator, I provide the clinical competency information to the overall evaluation process. Finally, your evaluation needs to have the right criteria. This will vary depending on your particular situation. I’ll explain some areas to consider in the next sections.

Another document that should be used is the Appropriate Medical Care for Secondary School Age Athletes. With minor modifications, this document may also be appropriate for the college setting as well, since it provides the areas and levels of healthcare that should be provided to athletes. However, the evaluation should also be specific to your school, situation, and the employee. For example, some

athletic trainers may be responsible for overseeing the AED program, including the CPR training of institutional staff, while others are not. Some schools may want the athletic trainer to oversee an emergency medical plan, while others will want a team physician or risk manager to take the lead in this area. Regardless of the specifics, it would be in the best interest of the athletic training profession to have the certified athletic trainer involved in all aspects of their job that fall under the scope of practice of an athletic trainer based on the NATA domains, CAATE curriculum, and/or the state practice act. Another area I evaluate is the athletic training facility. It’s important that each of our athletic trainers maintains an efficient and effective facility. I assess the facility for its cleanliness, physical organization, and equipment. Included is how the equipment is used, not simply that it is there and clean. A whirlpool filled with old pads, boxes of tape, and crutches represents poor utilization of resources and space. I also assess whether the facility is providing equal access to both males and females.

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LEADERSHIP Finally, I critique the staff on maintaining professional responsibilities. Since our profession is constantly evolving and growing, it’s critical for athletic trainers to keep up professionally. Along with making sure they are maintaining CEUs and state licensure requirements (when appropriate), I assess if they are involved with professional development opportunities. If they are not, I might encourage them to start small, getting involved in something locally. It is amazing the transformation of work ethic and productivity that can be achieved simply by empowering someone to get involved with a project involving the institution or professional organization. IN THE RECORDS Along with the above basic areas, a key area to critique is the athletic trainer’s record keeping. This may be the most important area to review in an evaluation, since excellent record-keeping is important for reducing liability risks and making sure the athlete is given the best possible care. First, I assess records for the completeness. Do the records tell a sto-

ry from initial evaluation through discharge? Do they include all the details necessary? Simply having a written record of an athlete incurring a lateral ankle sprain on a particular date and having ice applied is not a complete record. The records should provide a story of what was found during the initial evalua-

A high quality, well maintained record keeping system provides a chronological story from injury to full recovery and return to full participation that makes sense during a review a year or two later. Picture yourself in a court of law defending a staff’s actions regarding a year-old case. Would the records be able to validate enough information regarding what

I have found that record keeping can be an accurate indicator of performance ... Certified athletic trainers must take their responsibilities seriously, and you can often assess this in how well they keep records. tion, how the injury occurred, and what immediate treatment was provided, as well as a plan for the near future. Each visit the patient makes with the athletic training staff should identify and record any changes to the case and all care that was provided during that visit such as any exercises, modalities, etc. All changes to the injury and all treatments that were provided as the athlete recovered must be included.

was done and why within the scope of practice of athletic training? I have found that record keeping can be an accurate indicator of performance. Certified athletic trainers are medical professionals, licensed to practice in many states. They must take their responsibilities seriously, and you can often assess this in how well they keep records. A good record keeping protocol should provide a snapshot of

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LEADERSHIP every interaction and activity regarding each patient, even those who simply need to have a blister covered with a bandage and donut. Record keeping can also provide support for needed changes or additions to the athletic training facility or program. For example, records can provide useful data that can be used to prove the need for additional support, justify the maintenance of funding during tough budget times, and validate the individual needs of the athletic training program. COMMUNICATION One area that is not always in a typical athletic trainer’s job description, but is important to evaluate, is communication skills. I have found that the most common concerns about our athletic training staff can be traced back to a problem with communication. Rarely, if ever, is there an issue with clinical competence. It is not “what was done,” but instead “how it was done” or “how it was perceived” that causes issues. This should not be surprising when we think about all the different people an athletic trainer must commu-

nicate with in any day, from athletes to coaches to parents to each other. What constitutes good communication? It runs the gamut from being well prepared for a parents or coaches meeting with a concise, efficient, clearly scripted presentation, to making the effort to contact a parent (in high school settings) when their son or daughter has consulted with you about a problem. Here are some areas to possibly include in an evaluation: • Does the staff member provide consistent and timely communication with all coaches? • Is the staff member “approachable” in the eyes of students? • Does the staff member listen well? • Does the staff member provide clear and accurate direction to others? • Does the staff member process information before offering an opinion? • Is the staff member aware of when to not share information with others, due to privacy concerns? • Does the staff member support the overall athletic program through his or her communication? • Is the staff member consistently

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positive in their communication skills with others? GOALS Along with evaluating an athletic trainer based on the criteria you’ve developed, it can work well to ask staff members to develop goals every year based on their review. A few times a year I ask our group to come up with ideas on how we can improve our athletic healthcare. It’s also great when athletic trainers come up with their own individual goals. Then, provide the tools and resources necessary to assist the athletic trainer’s improvement. If a staff member needs to improve their record-keeping skills, show them examples of great records and come up with a schedule for you to review their records periodically. Give them specific feedback on what is lacking in their records and how to make them complete. With goals in place and buy-in from staff members, the concept of an evaluation can be a positive experience for all involved. It can help all of us move our profession forward on a daily basis and support each other in our work. n

sport specific

Home Run Power Explosive lifts breed explosive hits. That’s why Olympic lift variations are a major component of the University of Georgia softball team’s strength and conditioning program. By Tyler Jorgensen

hen I took over the University of Georgia softball team’s strength and conditioning program in the fall of 2008, the squad had already built a history of success. The Lady Bulldogs had qualified for the NCAA Division I playoffs every year since 2000, and all signs pointed to the athletes wanting to take the program to the next level—the Women’s College World Series. Since then, the squad has reached the WCWS semifinals each of the past two seasons and is poised for a big season this spring with all of its starters returning and a top-five preseason national ranking. The team is confident and unafraid of the expectations and challenges that await them on the field. And most importantly for me, the players understand it’s the hard work we put in during the fall that will make the difference. Besides the physical work demanded of our players, I believe there are two other critical aspects to our success. One is the buy-in I have received from the entire squad. When everyone is on

Alisa Goler hit 16 home runs for the Bulldogs in 2010, helping the team to outscore its opponents by more than double over the course of the season. John Kelley

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Tyler Jorgensen, MS, SCCC, is Strength and Conditioning Coach for Olympic Sports at the University of Georgia. He can be reached at: tjorgensen@sports. uga.edu. T&C october 2010

sport specific the same page in regard to what we are trying to achieve in the weightroom, we are poised for optimal success. The other key is motivation. It can be tough to find specific ways to motivate a team, but one of the methods that has worked well here is using inspirational quotes that connect with the players. Two favorites that have essentially become team mottos in the weightroom are, “Nobody Outworks Us” and “Do Whatever It Takes, No Excuses.” To keep the players hungry, I tell them to never be satisfied and approach each day as another opportunity to improve even more. BIG PICTURE I developed the team’s strength and conditioning program with four goals in mind: to maximize athletic performance, increase the rate of force development, increase mobility and movement efficiency, and minimize injuries. The last three concepts are vital to the first goal of developing overall athleticism on the field. We can’t improve our athletic performance without all of these goals working in concert.

When addressing the ability to produce power at a high rate, I keep in mind that most plays in softball happen in a matter of seconds. Making a diving catch, hitting at the plate, stealing a base, or driving off the plate when pitching all require the ability to produce power quickly. Also important is the ability to move efficiently and be athletic in space. I want our players to be able to react to a play in any given direction at any given moment in an efficient and effective manner. However, that doesn’t mean we do a lot of sport-specific training in the weightroom. I believe players perfect their sportspecific movement during their daily practices that last two to three hours, so in the weightroom we do just a few supplemental exercises to elicit some specific movement patterns. Manipulating an exercise so that it conforms to a specific movement sometimes puts an athlete at a biomechanical disadvantage, so instead I utilize exercises that enhance entire muscle groups and exercises that utilize similar motor recruitment patterns that are specific to

the sport of softball. For example, I use Olympic lift variations that create a powerful triple extension with the hips and legs, which transfers to our pitchers finishing their pitches and our hitters finishing their swings in a very explosive, but controlled manner. Finally, I keep the health of our athletes’ bodies in mind. Contrary to what some people think about softball, the sport can be very physically demanding. Games typically last between two and three hours with short bursts of energy required and short rest periods between pitches, plus here in the South, we have the added element of grueling heat. I also keep in mind that the most common injuries in softball are associated with the shoulders, hips, knees, and ankles. And because pitching injuries need to be avoided at all costs, some exercises we do are for non-pitchers only. The hang snatch, for instance, is a very safe exercise, but since it involves more of the elbow and shoulder joints, our pitchers don’t do it. One of the first things we do when the players report back to campus in Au-

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sport specific gust is take them through a Functional Movement Screen. It’s a great tool because we are able to see right away if incoming freshmen have any muscular or joint immobilities. At the same time, re-screening our upperclassmen shows us if they developed any problems since the end of the previous season. By starting with the screening test, we are able to attack any issues right away before problems worsen. In throwing sports like softball we often see T-spine immobilities, so we address that by incorporating exercises like face pulls and wall slides for scapular strengthening and mobility. After I examine the team’s screening results, I assess individual, team, and position-specific needs. Prior to preseason, I will have already reviewed game film and notes that I took during the previous season. This helps me identify areas we need to improve on as a team. I also look at individuals to find what each particular athlete needs to improve on. When watching games, I look at why our errors occur. Most times it’s a mental error or miscalculation, but sometimes it’s athletically related. Maybe a player is slow on their first step to a fly or ground ball or a hitter isn’t getting very powerful hip extension while at the plate. POWER TIME By its nature, softball is a very powerful and explosive sport, so I incorporate as many powerful and explosive exercises as I can. I utilize many different Olympic lifting variations with both barbells and dumbbells, including power cleans from the floor, hang cleans from the knees, hang cleans from the box, hang snatches from the knees, hang snatches from the box, and DB snatches. Some strength and conditioning coaches may be skeptical of doing Olympic variations with softball players, but I believe if the exercises are taught properly, technique is enforced, and proper progressions are used, the benefits outweigh any risks. Olympic variations like the power clean and hang snatch increase the rate of force development and improve power in the triple extension phase—which is essential to developing speed and first-step acceleration for runners on the bases and in the field, hitters when they hip shift, and pitchers when they drive toward the plate. TR AINING-CONDITIONING.COM

In addition to creating total-body awareness, Olympic lifts utilize similar joint and muscular recruitment patterns used during play. They develop leg and hip power, load the spine, and force the athlete to keep her core and posterior chain strong. To maximize the benefits of Olympic lifts, I constantly emphasize the importance of bar speed and teach our athletes to be explosive by applying as much force to the ground as possible throughout the full range of motion. Lower-body strength development is an integral part of our power develop-

ment, and we build lower extremity lean mass largely through front and back squats. Max strength is an important quality of this work, though explosive strength is the main goal. This means we not only incorporate exercises to increase strength, but we want the strength exercises to move with speed and authority to increase our explosive strength. Single-leg strength and power variations supplement our main lower-body work, so we use sled pulls for time and single-leg jumps for explosiveness. Sin-

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sport specific gle-leg clean grip forward and backward lunges, DB single-leg lifts, and single-leg squats all help to develop not only strength but leg stability, which aids in prevention of knee, hip, and ankle injuries. A big part of the coaching staff’s philosophy is to move base runners into scoring position as often as possible, so it is crucial that our players have the ability to explode off the bases. During the fall, we set aside two days a week to work on speed, acceleration, and agility. The first day is accelerationbased with most of the work covering five to 10 yards. The second day is speed-focused, and we work in a range of 15 to 30 yards.

I develop two versions of each workout—one for position players and another for pitchers. Many of the exercises are done by both groups, but I always include two exercises to target the specific movements and muscle groups used by each of the two units. On the days we do our acceleration or speed work, we start with running mechanic drills to help assist in the efficiency of running or more accurately, sprinting form. We often do this work on the softball field and incorporate drills where we can use the bases. Keeping our goals of movement efficiency and agility in mind, both days include agility drills. (See “Quick Feet” on page 50 for an example of the team’s speed and acceleration training days.) CALENDAR LAYOUT As I develop our workout plans, I base everything on a year-round periodization model. This allows me to stimulate strength and power gains, prevents overtraining, and helps us peak at the right time. Here’s how we break it all down. When our athletes report for classes in August, we have approximately two weeks before the start of fall ball, which runs for four weeks in September. I essentially use those first two weeks as an introductory or general physical preparedness (GPP) phase where we re-introduce lifting techniques and movements to help prepare the players for the following weeks, which will be more intense and demanding on their body. We train through the fall season with a three-week basic strength phase following our GPP phase. This phase allows us to build a base but not overload the body during fall ball when the practices that precede lifting sessions can last two to three hours and there are games every weekend. The six weeks following our fall season include all of October and the first two weeks in November. This time frame encompasses our max strength and max power phases, which end with our test week before Thanksgiving break. This is the most crucial time for our players to develop strength and power. We break the fall semester program down into three totalbody lifting days per week, with each day having a different emphasis. I develop two versions of each workout—one for position players and another for pitchers. Many of the exercises are done by both groups, but I always

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sport specific include two exercises to target the specific movements and muscle groups used by each of the two units. I do this with two exercises that are specific to each position in regard to movement and muscle groups used. For our pitchers, for example, we have them go through their pitching motion with a resistance band. They’re trying to be explosive against the resistance, which elicits a very specific motor recruitment pattern. They’re utilizing the same muscle groups in the exercise as when they’re on the field. Monday is typically a power day when we emphasize a clean from the floor and a squat variation. Our second day in the weightroom usually falls on Wednesday. This is our speed day when we emphasize speed of movement with a variation of a hang, DB snatch, or a box clean. On day three, we emphasize strength. For moderate upper-body work, we use a bench press variation and include a heavy pull. We also work on singleleg strength by doing a single-leg squat variation, lunge, or step-up. Monday, Wednesday, Friday is our

typical schedule, but obviously these three days can be moved to accommodate practice and travel schedules. I also keep an eye on how the players are responding to workouts—both physically and mentally. We begin each lifting workout with foam rolling and some form of a dynamic warmup that includes sport-specific movements, agility ladders, bikes, and jump ropes, and even bar warmups on some Olympic lift days. I do this to vary the workouts, and I like to pair specific warmups to correspond with each day’s emphasis in the weightroom. On a day we’re doing Olympic variations, for example, we’ll do a barbell complex to warm up. Or on a day we’re doing squats, we’ll do some hip mobility work to warm up. After a dynamic warmup, we move into pre-hab work that includes emphasis on hip and ankle mobility, shoulder mobility and stabilization, and knee (specifically ACL) injury prevention work. This includes proprioceptive plyometrics with mini hurdles and the agility ladder. We get the players to consciously think about activating the

knee joint and quad immediately before landing so the knee is ready to accept the force and stabilize itself before landing. In addition to our lifts, we use supplemental exercises that include posterior chain work to aid in injury prevention and athletic performance, such as core rotational power exercises with medicine balls and Keiser machines. This work assists our hitters in developing the power and control needed for a powerful hip shift. From the day our players arrive in August, up to the week before their first game in mid-February, they are on a three-day lifting program. Unfortunately, there is a time gap between semesters when they will be on their own, but we stress to each athlete that upon their return to campus, they will be expected to show continued strength and power gains. When January arrives, we complete a three- to four-week cycle of lifting three times a week before dropping to two days a week during the season. Early in the season, Tuesday is usually our power and strength day when we continue

QUICK FEET Here is an example of a typical week during the fall in which we are working on acceleration and speed. We always start with a dynamic warmup before progressing to the drills for that day. All exercises are in reps and yards.

Day One: Acceleration with full recovery

Day Two: Speed with full recovery

Dynamic warmup (speed mechanics):

One-leg pops (knee up, toe up, strike ground w/ ball of foot).................... 2x10

Speed skips .............................................2x20

Wall runs..................................................... 3x3

High-knees . .............................................2x20

Speed skips...............................................2x20 High-knee skips........................................2x20 High knees................................................2x20 Build-ups (gradually increase speed)....................... 4x20 Acceleration drills:

High-knee skips .......................................2x20 Build-ups . .................................................. 4x4 Speed drills: Flying 20s (stride 20 yards, sprint 20 yards).........................................3x20 Base starts first to second base ............. x4-6

Tall-and-falls ............................................ 5x10 Get up-and-go’s (push-up start).......................................... 5x10 Tennis ball starts ................................... 2x3-5

T&C october 2010

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sport specific to maintain power with variations of the clean and build upon our strength with a squat variation. Thursdays are typically our speed day when we do a variation of a snatch and an explosive pull for speed or an explosive weighted jump. Once the team gets to conference play, we switch these two lifting days. We want to minimize any muscle soreness our players have as they get closer to game days. Throughout the season, we continue to build upon our strength and power and complete a three-week wave cycle. In the third week, our athletes hit a moderate intensity of around 80 to 85 percent max before we decrease. Volume always stays low, and I believe that’s important to assist in injury prevention. TIME FOR TESTING I believe that tracking our players’ progress is a very important component to our program. Being able to monitor and see gains promotes motivation. Our players love to compete against each other and love to try to beat their old marks. Testing day here has a game day atmo-

sphere and the players come in excited and focused. During the third week of November, we test a one-rep max in the back squat and power clean, and a three-rep max in either a DB or BB bench press. We also test the players in pull-ups and chin-ups in all-out effort max to failure. To test conditioning levels, we do

school year, I test them in the 10- and 20-yard dash three times during the fall season. The first test gives me a baseline, and is usually held two weeks after they report to campus. The second test day is immediately after the fall season, and the third is right before the athletes leave campus for Thanksgiving break. I have been blessed to work with

I believe that tracking our players’ progress is a very important component to our program. Being able to monitor and see gains promotes motivation. Our players love to compete against each other and love to try to beat their old marks. a 150-yard shuttle run in which players run 25 yards down and back three times in 32 seconds or less, with 80 seconds of recovery. We do 10 sets of the shuttle run for our conditioning test. I like to condition in the range of 25 yards or less because this distance is specific to softball. To track the players’ progress on their speed and acceleration work early in the

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an outstanding group of athletes and coaches in the UGA softball program. It has definitely made my job as a strength and conditioning coach much more exciting and challenging. My hat goes off to them because I know it’s the attitude, hard work, and dedication that has helped make us successful. Nobody outworks us and we do whatever it takes, no excuses. 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

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Athletic Management T&C october 2010

Introducing Available through Training & Conditioning!

The Nutrition Edge

Deep Tissue Massage

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

By Jane Johnson, M.S.

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

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

Price: $16.95

Item Number: 111002

Performance Nutrition For Football By Lisa Dorfman, M.S., R.D., C.S.S.D.

This book describes how to use 83 compressive and stretching deep massage techniques in ways that are safe and effective for your athletes. The reference contains step-by-step guidelines and over 165 color photos. Once you have learned about the techniques, you will then learn about incorporating them into effective routines by moving the client from one position to the next. Discover those techniques and treatment positions that appeal to you. Throughout the book, Client Talk boxes present tips for effective dialogue between therapist and patient to ensure expectations are met and the patientâ&#x20AC;&#x2122;s limits for handling deep pressure are not exceeded.

216 pages

Price: $29.00

Item Number: 9780736084703

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

Price: $18.95

Item Number: 111001

To view more books/DVDs, go to the new Training-conDiTioning.com

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

MAG, Inc. 31 Dutch Mill Rd. Ithaca, NY 14850

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Performance Nutrition For Football T&C’s The Nutrition Edge Deep Tissue Massage

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To view more books/DVDs, go to the new Training-conDiTioning.com

Pain Management Target Your Trigger Points

The Original Index Knobber II is a simple device designed to let you apply deep pressure to yourself or others. It’s the ideal instrument for clinic or home use, allowing for firm, sustained pressure on painful trigger points. Its unique, patented design allows it to be used in several hand positions and by the right or left hands comfortably and interchangeably. It’s virtually indestructible and easily cleaned between uses. The Pressure Positive Co. • 800-603-5107 www.pressurepositive.com

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First Aid

2nd Skin has been a staple brand in sports medicine for over 20 years. Using moist woundcare technology, the line showcases advanced first-aid solutions for minor burns, scrapes, blisters, road rash, or any surface skin wound. Its signature highwater gel pads soothe, cool, and relieve pain on contact, while helping speed the healing process. Spenco’s latest product, 2nd Skin Rectangles, offers these pads in quantities of 48, perfect for taking care of any athlete.

Spenco Medical Corporation • 800-877-3626 www.spenco.com Circle No. 501

Alleviating Shin Splints

The Cho-Pat Shin Splint Compression Sleeve has a three-fold approach. It uses compression to support the leg muscles and soft tissue; stimulates circulation and maintains warmth to control fluid build-up; and utilizes straps at the top and bottom of the sleeve to act as shock absorbers, reducing micro trauma to the tendons and soft tissue while maintaining the device in the proper position.

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

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Water World

The “SwimEx Aquatic” four-DVD set gives therapists, athletic trainers, SwimEx owners, and anyone with an interest in water therapy the knowledge to design a comprehensive aquatic rehabilitation program incorporating SwimEx’s unique laminar flow system. The accompanying booklet is a detailed reference for treating surgical and non-surgical orthopedic conditions, with over 30 protocols designed to work various parts of the body in improving your patient’s flexibility, strength, balance, proprioception, and function.

SwimEx, Inc. • 800-877-7946 www.swimex.com

T&C OCTOBER 2010

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Telling Tales

Painful Yarns, written by Lorimer Moseley, PhD, is a compilation of hilarious stories intended to help you communicate the complexity of pain with your athletes, students, and patients. The stories in this soft-cover, 113-page book, are not only entertaining—they serve as metaphors to explain key aspects of the biology of pain. OPTP • 800-367-7393 www.optp.com

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Smarter Delivery

The automated, user-friendly Dupel device provides clinical excellence in iontophoresis with maximum flexibility and control in a non-invasive drug delivery. Two-channel operation allows the clinician to simultaneously treat two patients, two sites, or large areas. Once setup is complete, the device automatically calculates time based on each patient’s intensity settings and the selected dosage. It even adjusts to accommodate intensity changes that occur while treatment is in progress. Constant current stimulation ensures that current/drug ions are delivered regardless of skin resistance. Empi, a DJO Co. • 800-328-2536 www.hybresis.com

Circle No. 505

For Freedom of Movement Biofreeze pain-relieving spray, the numberone clinically used and recommended topical analgesic, can be used as an effective adjunct to the Kinesio Taping Method. After applying the tape, the practitioner simply sprays the taped area. Because the tape is porous, the athlete receives all the pain-relieving benefits of Biofreeze. In addition, Biofreeze allows greater freedom of movement to increase joint range of motion. Performance Health • 800-321-2135 www.biofreeze.com

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Stick with the Original

Kinesio was the company that introduced the world to elastic therapeutic tape under the guidance of inventor and company founder Dr. Kenzo Kase. Today, Kinesio continues to drive the industry by offering a tape utilizing premium materials and over 35 years of research and development: Kinesio Tex Gold. Kinesio also differentiates itself from a growing number of imitation brands through a continuing commitment to customer service, intellectual support, and education. Kinesio • 888-320-TAPE www.kinesiotaping.com

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Pain Management By the Foot

Certified Safe

Joint Health Supplement Cosamin ASU is certified for sports by NSF International, which verifies that the product does not contain banned or prohibited substances. Cosamin ASU is an advanced proprietary formulation that combines avocado/soybean unsaponifiables (ASU) to act synergistically with glucosamine, and has been shown in laboratory research to inhibit components that result in cartilage breakdown.

Nutramax Laboratories, Inc. • 877-COSAMIN www.cosaminforsport.com Circle No. 525

Bar None

The Massage Bar relieves muscle tissue stress. Massage muscle tissue by rolling the four bumpy balls along large muscle areas or along the arms and legs to stimulate tissue and promote blood flow through tired, sore, or cold muscles. The nodules deepen the massage and enhance the function. The 18-inch bar includes four two-inch diameter balls and two handles with firm ergonomic grips for comfort.

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

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Prevention & Treatment

2nd Skin Blister Pads are used for both prevention and treatment of blisters, minor cuts, and scrapes. The soft hydrocolloid center bordered by a thin film keeps blisters from drying out and absorbs perspiration, ultimately promoting a scab free, naturally-healed blister. Five of these sterile pads are available in each box. Blister Pads are easy to apply and last up to five days, making them convenient for any athlete. Spenco Medical Corporation • 800-877-3626 www.spenco.com Circle No. 510

Power to Deliver

The Hybresis Iontophoresis System, a leader in iontophoresis, provides clinicians with an innovative new way to deliver medication to a specific location without the disadvantages of injections or oral medications. Iontophoresis is a clinically-proven, non-invasive method of active transdermal drug delivery. The Hybresis system combines the precise dosing of traditional iontophoresis with the convenience of newer patch-only treatments. Using a proprietary three-minute Skin Conductivity Enhancement (SCE) treatment, Hybresis provides a predictable 80 mA-min dose. Empi, a DJO Co. • 800-328-2536 www.hybresis.com

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The QuadraStep System is a revolutionary new alternative to traditional custom orthotics. An easy-to-learn, four-step assessment process identifies six specific foot types, each uniquely influencing an athlete’s function, performance, and predisposition to particular injuries. The QuadraStep System offers six prefabricated foot orthoses biomechanically tailored to each foot type. Clinicians can now classify a patient’s foot type and dispense prescription-based orthoses within minutes. Nolaro24, LLC • 877-792-4669 www.whatsmyfoottype.com

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Make Muscles Happy

The Tiger Tail Rolling Muscle Massager is a dense-foam covered, muscle-friendly solo massage tool that assists individuals with deep tissue massage, trigger point therapy, and sports massage therapy. The rolling action of the Tiger Tail relieves sore, tight, and cramping muscles by accelerating tissue recovery. It’s great for the neck, shoulders, arms, glutes, IT band, thighs, hamstrings, quads, and calves. The Tiger Tail is recommended and used by athletes, athletic trainers, massage therapists, physical therapists, chiropractors, and doctors worldwide. The Pressure Positive Co. • 800-603-5107 www.pressurepositive.com

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Well Read

Explain Pain, by David Butler, PT, and Dr. Lorimer Moseley, describes the complexities of the central nervous system to chronic pain patients. All pain is real, and for many it’s a debilitating part of everyday life. It’s now known that understanding why things hurt can actually help people manage their pain. Recent advances in fields such as neurophysiology, brain imaging, immunology, psychology, and cellular biology have provided an explanatory platform from which to explore pain. OPTP • 800-367-7393 www.optp.com

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Managing Pain

Gebauer’s Spray and Stretch topical anesthetic skin refrigerant effectively manages myofascial pain and trigger point release in the head, neck, shoulders, and extremities. Available by prescription only, it is used in conjunction with the hands-on spray and stretch technique, a learned modality that includes diagnostic evaluation, spraying and stretching, and post-evaluation. To learn more, visit the company’s Web site. Gebauer Company • 800-321-9348 www.gebauer.com

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T&C OCTOBER 2010

Pain Management On the Mend

Originally designed for use by professional bull riders, PRO 315 Rodeo Wrap provides compression and relief for groin strains and pulls. It is 14 feet long, and its unique elastic contours to the thigh and waist to provide a low-profile wrap.

PRO Orthopedic Devices, Inc. • 800-523-5611 www.proorthopedic.com Circle No. 523

Significant Improvements

Research published in the September 2010 issue of the Journal of Shoulder and Elbow Surgery found that a novel exercise using the Thera-Band FlexBar is effective at reducing pain associated with chronic lateral epicondyliti, a.k.a. tennis elbow. “Compared to patients receiving just PT treatment, those performing the FlexBar exercise along with physical therapy had significantly greater improvements in strength and pain,” says Tim Tyler, PT, ATC, the study’s lead author. The complete study and abstract can be viewed at http:// info.thera-bandacademy.com/flexbarelbow.

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

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The Get-Well Gel

Depend on Flexall 454® topical painrelieving gels from Ari-Med Pharmaceuticals for clinical and athletic training room settings. Flexall gels are used by leading athletic trainers to treat the world’s top athletes and enhance ultrasound, cryotherapy, TENS, and massage therapy. Flexall gels feature unique vitamin E-enriched aloe vera gel formulas with menthol as the active ingredient. They’re absorbed quickly and are greaseless, non-staining, and gentle on the skin. Professional sizes are available.

Ari-Med Pharmaceuticals • 800-527-4923 www.ari-med.com

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Maximum Versatility

The HydroWorx 3500 Series offers innovation and maximum versatility for your facility. This 12’ x 16’ therapy pool comes standard with HydroWorx’s patented underwater treadmill technology and resistance jets in one station. An additional underwater treadmill can be added at the same depth or positioned six inches deeper than the standard treadmill. The large interior space allows greater functionality for multiple patient therapy stations or group classes. The varying depths of the pool floor allow for natural patient progression, and an optional deep well area is also available, adding seven inches of depth. HydroWorx International • 800-753-9633 www.hydroworx.com

T&C OCTOBER 2010

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Deep Down

The Pro-Tec Roller Massager with Trigger Point Release Grips is a great tool to reduce muscle tightness, soreness, and pain. Deeptissue stimulation and massage maximize muscle performance and flexibility. The raised Vynafoam sections “sink” into soft tissue to roll out tightness, and the rounded grip ends provide precision trigger point release to loosen knots in the muscle. A user guide covering 20 massage and trigger point release exercises and techniques is included. Pro-Tec Athletics • 800-779-3372 www.injurybegone.com

Circle No. 527

Cold Comfort

The ZAMST IW-1 Icing Set provides easy wrapping and immobilization of one ice bag. It is perfect for the foot, ankle, knee, wrist, and elbow, and is ideal for R.I.C.E., since the dual-strap design enables accurate placement of the ice bag and adjustable compression of the affected body part. The set is machine washable and includes one medium ice bag. ZAMST • 877-926-7887 www.zamst.com

Circle No. 518

Defy Gravity

The AlterG Anti-Gravity Treadmill is reinventing rehabilitation by advancing recovery from injury or surgery, enhancing performance, and reducing the frequency of injury in athletes. It is the only un-weighting fitness equipment built on patented gravity differential technologies developed by NASA and tested by Nike’s Oregon Research Project. Leading pro sports teams, athletes, and fitness programs use the Anti-Gravity Treadmill as part of their training regimen. Users recovering from surgery or injury can resume workouts more quickly, and athletes routinely use the AlterG to increase performance. AlterG, Inc. • 510-270-5900 www.alter-g.com

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A Softer Touch

SpiderTech Gentle is the newest line of pre-cut and roll kinesiology tape products using Nitto Denko’s Stratagel adhesive, scientifically formulated for sensitive and fragile skin. As with all SpiderTech kinesiology tape products, Gentle is latex-free, hypoallergenic, and based on the same high-grade breathable cotton material as the company’s standard product. It greatly reduces skin redness, itching, and irritation, and it’s perfect for patients with sensitive skin, including geriatric and pediatric applications. NuCap Medical/SpiderTech • 416-494-1444 www.spidertech.com Circle No. 553

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Pain Management Stimulating Tissue

The Massage Peanut’s rigid spike design provides firm but stimulating tissue massage to promote blood flow through tired, sore, or cold muscles. The shape allows a larger surface area to be affected and rolls well on the body’s surface and contours. An excellent tool for self-massage and relaxation, the Massage Peanut is six inches long and three inches in diameter at its widest point. Power Systems, Inc. • 800-321-6975 www.powersystems.com

Circle No. 521

Playing it Safe

Joint Health Supplement Cosamin DS is certified for sports by NSF International, which verifies the product does not contain banned or prohibited substances. Cosamin DS has proven effective in controlled, published U.S. studies to reduce joint pain, and has been shown in laboratory tests to protect cartilage cells from breakdown.

Nutramax Laboratories, Inc. • 877-COSAMIN www.cosaminforsport.com Circle No. 516

Take It With You

The Dynatron Solaris Series offers ultrasound, seven stim waveforms including direct current, and the option of adding light therapy. The state-of-the-art Solaris Series also provides a choice of four infrared light probes, including the D405 infrared/blue light probe and the powerful Dynatron Xp light pad. Along with the latest technology and ease of use, its durable construction and portable size mean Solaris can travel anywhere. Call for a free demonstration. Dynatronics • 800-874-6251 www.dynatronics.com

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Quality & Commitment

AMREX Electrotherapy has been manufacturing therapy equipment for over 75 years. The company is committed to providing the health care industry with the most complete line of products and accessories, serving customers needs by striving to supply the most affordable and the best quality ultrasound, diathermy, and electrotherapy modalities available. Amrex • 800-221-9069 www.amrex-zetron.com

Primal Pattern

Neurodevelopmental Approach to Spinal Pathologies, a 97-minute DVD of a live presentation by Paul Chek, introduces the system of movement analysis and instruction he has developed called the Primal Pattern system. Chek explains how important it is to understand the findings of researchers and clinicians such as De Jarnette, the Bobaths, Margaret Rood, and Jean Ayre to appreciate the effectiveness of neurodevelopmental and movement-based approaches to conditioning in both the athletic and rehabilitative fields. C.H.E.K. Institute • 760-477-2620 www.chekinstitute.com

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Non-Operative Treatment

The Elite Seat by Kneebourne Therapeutic is a portable knee-extension device designed for the non-operative treatment of degenerative knee conditions. By evenly distributing force across the leg, the Elite Seat provides effective full-knee hyperextension and reduces pain in bent knees caused by any of these conditions: acute ACL injury; inadequate post-operative rehabilitation after ACL reconstruction; total-knee arthroplasty; arthrofibrosis; deconditioned knee with a flexion contracture; and arthritis. Kneebourne Therapeutic • 866-756-3706 www.eliteseat.com

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Stop the Bleeding

CELOX First Aid Products have been proven to stop nosebleeds, moderate bleeds, and even severe bleeding in seconds. CELOX products are safe, effective, and easy to use, even with no medical training. CELOX is FDA-cleared, and is used in hospitals and on the battlefields of Iraq and Afghanistan. Go to the company’s Web site and enter order code TC103 to receive free U.S. domestic ground shipping. CELOX • 866-992-3569 www.celoxsales.com

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Circle No. 550

Fast-Acting

Interactive Learning

SpiderTech’s E-Learning is an interactive online program assembled into three distinct modules, allowing a healthcare provider to learn at his or her own pace. All the information reflects SpiderTech’s evidence-led and scientifically-based approach to kinesiology taping therapy and is presented through a combination of detailed animated graphics, video presentations, and voice narration within an interactive interface.

Finally… an effective topical anesthetic. Lido-Gel provides a convenient, safe and effective method for topical delivery of the anesthetic drug lidocaine into areas of inflammation and chronic or acute pain. Lido-Gel is a non-toxic, local anesthetic available as a gel in a fast-acting, non-staining transdermal base readily absorbed through tissue. It leaves no oily or sticky residue, and contains 4 percent lidocaine and 0.18 percent menthol for the relief of itching, pain, soreness, and discomfort.

NuCap Medical/SpiderTech • 416-494-1444 www.spidertech.com

Kustomer Kinetics • 800-959-1145 www.kustomerkinetics.com

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T&C OCTOBER 2010