Training & Conditioning 20.8 by Momentummedia

November 2010 Vol. XX, No. 8, $7.00

Strong Foundation Top strength coaches discuss training the lower body

Tommy John Rehabs Looking at Disordered Eating

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contents 33

25 Bulletin Board 4 Acetaminophen’s asthma connection ... Examining the importance of shoe fit … More kinesiology majors … Betaine for performance enhancement?

Q&A David Andrews Gig Harbor (Wash.) High School

Product News 49 Strength Training & Cardio 54 Power Racks 57 New Product Launch 58 Arm & Shoulder 60 More Products

56 Advertisers Directory CEU Quiz 61 For NATA and NSCA Members 64 Next Stop: Web Site On the cover: Don Decker, Head Football Strength and Conditioning Coach at the University of Mississippi, works with an athlete in the weightroom. Decker is one of the panelists on our roundtable about training the lower body. Story begins on page 12. Photo by Scott Burton.

TR AINING-CONDITIONING.COM

Optimum Performance

Foundation 12 Strong In our roundtable discussion on successfully training the lower body, five leading strength and conditioning coaches share their secrets. By R.J. Anderson Nutrition

the Dark 25 In Most athletes know about the dangers of eating disorders, but they can be in the dark on disordered eating and its negative effects. By Dr. Karen Reznik Dolins Treating the Athlete

Elbows Fail 33 When Helping an athlete come back from an ulnar collateral ligament injury is chock full of challenges. Here is one veteran athletic trainer’s approach to this arduous rehab. By Brainard Cooper Leadership

38 Do club sport athletes warrant the same quality athletic training Full Coverage

coverage as their varsity peers? More schools are saying yes. By Jennifer Chadburn Sport Specific

43 The University of Denver ski team’s off-mountain cross training First to the Finish

program makes all the difference when the skiers hit the racing slopes. By Jason Sanchez

T&C novemBER 2010

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

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Joe Gieck, EdD, ATR, PT Director of Sports Medicine and Prof., Clinical Orthopaedic Surgery, University of Virginia (retired) Brian Goodstein, MS, ATC, CSCS, Head Athletic Trainer, DC United Gary Gray, PT, President, CEO, Functional Design Systems Maria Hutsick, MS, ATC/L, CSCS Head Athletic Trainer, Medfield (Mass.) High School Christopher Ingersoll, PhD, ATC, FACSM Director, Graduate Programs in Sports Medicine/Athletic Training University of Virginia Allan Johnson, MS, MSCC, CSCS Sports Performance Director Velocity Sports Performance Tim McClellan, MS, CSCS Director of Perf. Enhancement, Makeplays.com Center for Human Performance Michael Merk, MEd, CSCS Director of Health & Fitness, YMCA of Greater Cleveland Jenny Moshak, MS, ATC, CSCS Assistant A.D. for Sports Medicine, University of Tennessee Steve Myrland, CSCS Owner, Manager, Perf. Coach, Myrland Sports Training, LLC, Instructor and Consultant, University of Wisconsin Sports Medicine Mike Nitka, MS, CSCS Director of Human Performance, Muskego (Wis.) High School Bruno Pauletto, MS, CSCS President, Power Systems, Inc. Stephen M. Perle, DC, MS Professor of Clinical Sciences, University of Bridgeport College of Chiropractic Brian Roberts, MS, ATC, Director, Sport Performance & Rehab. Ctr. Ellyn Robinson, DPE, CSCS, CPT Assistant Professor, Exercise Science Program, Bridgewater State College Kent Scriber, EdD, ATC, PT Professor/Supervisor of Athletic Training, Ithaca College Chip Sigmon, CSCS Strength and Conditioning Coach, Carolina Medical Center Bonnie J. Siple, MS, ATC Coordinator, Athletic Training Education Program & Services, Slippery Rock University Chad Starkey, PhD, ATC Visiting Professor, Athletic Training Education Program, Ohio University Ralph Stephens, LMT, NCTMB Sports Massage Therapist, Ralph Stephens Seminars Fred Tedeschi, ATC Head Athletic Trainer, Chicago Bulls Terrence Todd, PhD, Co-Director, Todd-McLean Physical Culture Collection, Dept. of Kinesiology & Health Ed., University of Texas-Austin

November 2010 Vol. XX, No. 8 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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Board Acetaminophen Use Connected to Asthma Most people don’t think twice about taking acetaminophen to relieve a fever or the pain associated with an injury. But when the drug is taken by adolescents, it may put them at higher risk for developing asthma symptoms. A study published in the August issue of the American Journal of Respiratory and Critical Care Medicine showed evidence that adolescents who take acetaminophen at least once a month are at more than double the risk for developing asthma symptoms compared to peers who don’t take the drug at all. In addition, adolescents taking acetaminophen at least once a year are at almost 50-percent higher risk. Subjects who used acetaminophen were also found to have a higher prevalence for developing eczema and allergies. Researchers asked over 300,000 13 and 14 year-olds in 50 countries to classify their use of acetaminophen as none, medium (at least once in the past year), or high (at least once in the past month). Then, they asked them to describe any asthma symptoms like wheezing and itchy, watery eyes. While the study reveals an association between acetaminophen use and asthmatic symptoms, it’s unclear how or even if the drug is responsible for the increased risk. Experts say it’s possible acetaminophen may have a systemic inflammatory effect, or it may suppress a user’s immune system response to certain infections that commonly cause asthma in teens. But the acetaminophen use may simply coincide with already-present symptoms. A cold, for instance, is a common trigger for an asthma attack, and people with colds often take the drug to relieve respiratory infection symptoms. Richard Beasley, MD, study author and Professor at the Medical Research Institute of New Zealand, is calling for more research on the topic. “Randomized controlled trials are now urgently required to investigate this relationship further and to guide the use of antipyretics,” he said in a press release, “not only in children but in pregnancy and adult life.” To read the abstract of the study, “Acetaminophen Use and Risk of Asthma, Rhinoconjunctivitis and Eczema in Adolescents,” go to: ajrccm.atsjournals.org/search.dtl and search “acetaminophen use and risk of asthma.”

If the Shoe Fits? Athletes have been told for years that they can help avoid injury by wearing a shoe correctly fit to their foot type. However, recent research is calling into question how important such precautions really are. In three large studies appearing in The American Journal of Sports Medicine, the U.S. military supplied thousands of recruits with one of two types of running shoes. One group 4

T&C NOVEMBER 2010

was given shoes fit to their foot type—flat-footed, overpronating runners were fit with motion-controlled shoes and higharched, underpronating runners were fit with well-cushioned shoes. The other group received shoes fit to an average foot type. Researchers found almost no correlation between fit and injury avoidance. Bruce Jones, MD, MPH, senior author of the studies and manager of the Injury Prevention Program for the U.S. Army’s Public Health Command, told The New York Times that the need to fit running shoes for over- or underpronation is a “myth.” “You can’t simply look at foot type as a basis for buying a running shoe,” he said. “[The problem is that] no one knows whether pronation is really the underlying issue. There is so much that we still don’t understand about the biomechanics of the lower extremities.” Another study published in the British Journal of Sports Medicine supports the military’s findings. In it, more than 80 women were classified as neutral, overpronators, or underpronators. Half of them were given shoes fit to their pronation, and half were given shoes at random. At the end of a 13-week training program, the majority of women who reported missing training days because of pain were those “fit” to their shoes. In light of these studies, what are updated suggestions for purchasing running shoes? “If you feel any pain or discomfort, that’s your first veto,” Michael Ryan, PhD, lead author of the British Journal study and a postdoctoral fellow in the Department of Orthopedics and Rehabilitation at the University of Wisconsin, told The New York Times. “My best advice is, turn on your sensors and listen to your body, not what the salespeople might tell you.” To read an abstract of the study, “Injury Reduction Effectiveness of Assigning Running Shoes Based on Plantar Shape in Marine Corps Basic Training,” go to: ajs.sagepub.com and search “running shoes based on plantar shape.” For the abstract of the study, “The Effect of Three Different Levels of Footwear Stability on Pain Outcomes in Women Runners,” go to: bjsm.bmj.com and search “three different levels of footwear.”

Interest in Kinesiology Growing Kinesiology is increasingly becoming a major of choice for undergraduate students in the U.S. The American Kinesiology Association (AKA) reports that the number of students earning degrees in the field grew 50 percent from 2003 to 2008 and included more than 26,000 students in 2008. TR AINING-CONDITIONING.COM

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Board The Bureau of Labor Statistics says the growth is translating to an increased number of physical therapists and athletic trainers in the workforce. The number of physical therapists in the United States will rise by 30 percent in the 10-year period from 2008 to 2018, reports the Bureau, and the number of athletic trainers will increase by almost 37 percent in the same time frame. “Right now I see nothing in the future that would dull the interest of students

in studying this rather exciting area of physical activity,” Shirl Hoffman, Executive Director of the AKA, told Inside Higher Ed. But while the number of kinesiology undergrads increases, it may be more difficult for them to continue studying in the field. Kinesiology master’s and doctoral programs have also seen an increase in enrollment—20 percent and 29 percent, respectively—but there are far fewer post-grad programs today than there

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were 20 years ago. Inside Higher Ed found that in the three West Coast states, there were once 10 doctoral programs. But now there is only one each in Oregon and Washington and none in California.

Betaine For Better Performance The nutrient betaine, found in many foods, including shellfish, spinach, beets, and whole grains, has been shown to help keep people’s hearts, livers, and kidneys healthy for years. Now researchers say the body of evidence supporting its performance enhancement abilities is also growing. A study appearing in the July issue of the Journal of the International Society of Sports Nutrition found that supplementing an active person’s diet with betaine for two weeks helped improve subjects’ strength. The small-scale study involved 21 men who had been strength training for at least three months prior to the study, and were randomly given either 1.25 grams of a betaine supplement or a placebo daily. After two weeks of continued strength training, the subjects who had been taking the betaine supplement showed a larger increase in vertical jump power, isometric squat force, bench throw power, and isometric bench press force when compared to the placebo group. No difference was observed in jump squat power. In past research, betaine has been shown to reduce inflammation, which may explain the study subjects’ ability to improve power and force, since less inflammation in the muscles aids the recovery process and muscle building. The nutrient is also fairly easy for athletes to add to their diets since it’s available in many grocery store foods. To read the abstract of the study, “Ergogenic effects of betaine supplementation on strength and power performance,” go to: www.jissn.com/content/7/1/27/ abstract. TR AINING-CONDITIONING.COM

Q&A David Andrews Gig Harbor (Wash.) High School

To say David Andrews, LAT, ATC, has a wide-ranging body of experience would be an understatement. Since graduating from Washington State University in 1984, Andrews has been honing his skills at almost every level of the athletic training and rehabilitation world. As Head Athletic Trainer at Gig Harbor (Wash.) High School for the past 10 years, he not only provides coverage for hundreds of athletes and oversees athlete rehabilitation at the school, but also runs an athletic training student aide program. Outside of the school, he has spent over 20 years working as an Aide and Clinical Manager at the Northwest Physical Therapy Clinic, which Gig Harbor contracts its athletic training coverage from. Andrews has also served as a certified examiner for the NATA clinical boards exam for the past dozen years. Prior to arriving at Gig Harbor, he spent almost a decade as Head Athletic Trainer for two different professional soccer teams. In what little free time Andrews has left—which even he admits isn't much—he makes sure the country’s top soccer players are prepared to compete on the international stage. Andrews took on Head Athletic Trainer duties for the U.S. men’s soccer team following the 1998 World Cup and has traveled with the team to the last three Cups. He also worked with the U.S. Olympic team at the Beijing Olympics in 2008. In this interview, Andrews talks about his many roles and how he sees the athletic training profession evolving in the future. He also addresses the recent spotlight on two major issues facing athletic trainers at all levels: concussions and heat illness. T&C: How did you get started as an athletic trainer? Andrews: I was an athlete in high school, so I was around athletics a lot from a young age. When I got to college, I walked onto the baseball team and met the athletic trainer. After watching him, I thought it would be an interesting career, especially since I didn’t think I was very good at baseball—so I went with it. What are the differences between working with high school and professional athletes? The way you progress athletes returning from injury is very TR AINING-CONDITIONING.COM

Andrews, who is also Head Athletic Trainer for the U.S. men’s soccer team in addition to his role at Gig Harbor and Northwest Physical Therapy, helps a player on the field. different. All athletic trainers worry about sending athletes back to play too soon, because you never want to put them at risk for re-injury. But with high school athletes, this concern is magnified. I’m more conservative with that age group, because we all know there’s more to their lives than athletics at that level, and the chances of a high school athlete going pro are slim. I know that if I push kids into situations they’re not ready for, there’s a greater chance they’ll get hurt. What do you do when a parent disagrees with your return-to-play timeline? I have to rely on my confidence, experience, and reputation when I make my decision. I communicate my timeline to the athlete and their parents early, so it doesn’t become a “me vs. them” situation. I let them know I’m not there to stop their child from playing. I’m there to keep them healthy and safe so they can continue to play. If you don’t assure them of that, they can lose confidence in your abilities, and it can turn into a confrontation. I ask parents what their expectations are for their child’s return, and explain to them that together with their child, they need to balance risk and reward. If a player has an ankle injury and the parents want to push them to return sooner than T&C NOVEMBER 2010

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Q&A some of the easy stuff. But overseeing the program involves a lot of up-front work. I have to teach students how to do things like taping and evaluating injuries—and then trust those evaluations. I need to do a thorough job of teaching them because those students are performing tasks under my license. If I send them to a game and they mis-evaluate an injury, I’m liable for that injury. How did you start the student aide program? Support is crucial. It takes years to develop a complete program, so I needed to have everyone’s buy-in. Not only did I have to create a multi-faceted curriculum and have classes like Anatomy and Sports Medicine I, II, and III, but I had to

“You can't keep an eye on 100 kids at once. You need to discuss preventative measures with coaches early in the season, like the importance of taking frequent breaks and having cold tubs on the field.”

David Andrews

Head Athletic Trainer Gig Harbor (Wash.) High School Education: BS, Washington State University, 1984

find people who could teach those courses. At Gig Harbor, the football coach teaches a few of ours and members of the community teach others.

Other Responsibilities: Head Athletic Trainer, U.S. men’s soccer team Aide and Clinical Manager, Northwest Physical Therapy Clinic Certified examiner for the NATA Clinical Boards Exam I think is safe, I tell them I think they’re putting their child’s safety in jeopardy. Sometimes, I’ll go so far as to film an athlete doing a sport-specific drill. I’ll show the athlete and their parents how they look doing the drill, which drives the point home when they see that they can’t do something they need to do to play effectively. Has athletic training changed during your time at Gig Harbor? At the high school level, athletic training has become very popular. If you’re the only athletic trainer at a school, especially if there is a high number of athletes like we have here, you get incredibly busy. It used to be that the athletic trainer put bandages on players, did some rehabilitation, and covered a football game once a week. People didn’t view us as a critical part of athletics. Now, the word is out that athletic trainers are here to treat the athletic population and prevent injuries. How have you adapted to the increased workload? I created an athletic training program at the school for students interested in sports medicine. This gives me additional time to rehab athletes by having students cover TR AINING-CONDITIONING.COM

Where do you see athletic training at the high school level in 10 years? It’s going to continue to grow, especially with the recent spotlight on concussions and heat illness. High school athletic training specifically is also going to benefit because there aren’t as many employment opportunities at the collegiate and professional levels. At those levels, there is generally a head athletic trainer who stays with the school or organization for a long time. I also see many high school athletic trainers taking on additional responsibilities, such as teaching. How do you work with coaches to prevent heat illness? Coaches and athletic trainers have to work together because one person can’t keep an eye on 100 kids at once. You need to discuss preventative measures with coaches early in the season, like the importance of taking frequent water breaks and having cold tubs on the field. You also need to make sure coaches are aware of the signs and symptoms of heat illness so they take out players who are exhibiting those signs. What are the challenges in dealing with concussions? The main concern I have is making sure kids realize how serious they are, because at this age they often hide their injuries so they can continue playing. The other challenge is with diagnosing concussions. It seems like any time a kid goes to a doctor with a head injury, it’s automatically diagnosed as a concussion without any diagnostic testing.

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Q&A This is often because the tests are expensive, which I understand. But it means doctors are giving kids who just have some symptoms of a concussion a diagnosis, and the kids are coming back to me asking what they should do and what their limitations are. Those are difficult situations. If I think an athlete has indeed had a concussion, I have to reiterate to them that I’m not trying to be a bad guy and keep them off the field. I’m just trying to keep them safe.

has had a concussion, but also to back up what we tell coaches and athletes after a concussion. One of our soccer players recently sustained three head injuries and both the athlete and her parents wanted her to play, even though her doctor told her she couldn’t head the ball. When I tested her on the computer, two of the seven tests were too far from her original baseline for her to safely play. It was easy to show that to the athlete and tell her why she couldn’t play.

“I think our patients all appreciate that we treat them the same. My goal when working there is to get everyone back to their normal life, whether that’s playing sports, working, or just being grandma.”

How did you get involved with the U.S. men’s soccer team? In 1989, I was an athletic trainer for the Tacoma Stars, a professional indoor soccer team, and one of the players also competed for the national team. He gave my name to people at a national team camp and they called me. So I went to Bradenton, Fla., with an under-17 team and served as its athletic trainer for a few weeks, during which time I was evaluated by the team and staff. I was asked to come back year after year and in 1998, one of the national team athletic trainers stepped down, which allowed me to take that spot.

What can an athletic trainer do to help with diagnoses? We have to objectively evaluate cognitive abilities, because there’s no real way to objectify what it means if someone has a headache. Here at Gig Harbor, we have all athletes take a computerized pre-test before the start of the school year to establish a baseline for their cognitive ability. This gives us data, not only to evaluate if a player 217-431_ExScience_3.4x4.8_4C:Layout 1 1/8/10 11:10

What kind of work do you do at the Northwest Physical Therapy Clinic? At the clinic, we do outpatient rehabilitation of surgeries. AM Page 1

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Q&A I work as an aide in the clinical setting, technically as a clinical manager, which I like a lot because it’s a way to connect with patients and share my expertise. We see a lot of different types of people at the clinic, from professional and college athletes to geriatrics. I think our patients all appreciate that we treat them the same no matter their age or activity level. My goal when working there is to get everyone back to their normal life, whether that’s playing sports, working, or just getting grandma back to being grandma. Why did you become a certified examiner for the clinical boards exam? I wanted to give something back to my profession because it’s given so much to me. I don’t have a lot of free time to give anything else, but I thought I could take a few weekends out of my year and help athletic trainers who are trying to learn and get licensed. Over the years, I’ve done this at both the high school level and the state level, and it's been a good experience. How do you balance all of your responsibilities? It’s become my way of life. I don’t want to say I live to work, but this is who I am. And I can’t complain because I’ve created something very interesting. It is tough for me to find a good work/life balance because the time constraints really get a hold of me, but all athletic trainers have to figure out what works for them in their own way. I’ve had my family come to games as spectators just to see me work and see what I do when I’m not at home. I think it has helped them understand my work ethic and see that being involved in sports is a huge part of my life that I love and that is important to me. What do you find rewarding about your job? It’s seeing grandma throw out her walker and walk on her own, or seeing an athlete get closer to 100 perTR AINING-CONDITIONING.COM

cent so he can play in the World Cup, or seeing a high schooler overcome an injury to make it to a state championship game. Those things are what drive me. It’s also rewarding knowing people are willing to help you. I don’t know everything, but it’s a blessing to know people all over the world who can help me if I need it. What’s next in your career? I’m at a crossroads when it comes to

whether I will continue working with the national soccer team. On the one hand, I’m past the point where it’s going to help boost my career and resume, but on the other hand, it’s a part of my life that I really enjoy and if I step back, I know I won’t get the chance to return to the team. Either way, I feel blessed having been able to go to three World Cups. It may be time for someone else to boost their career. n

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Panelist Don Decker, Head Football Strength and Conditioning Coach at the University of Mississippi, works with an athlete in the Ole Miss weightroom.

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In our roundtable discussion on successfully training the lower body, five leading strength and conditioning coaches share their secrets.

FOUNDATION By R.J. Anderson

n performance training, great athletes are built from the ground up. For just about every sport, improving leg strength and explosiveness will allow an athlete to excel on the field or court. The good news is that today’s strength and conditioning coaches have a wide range of tools at their disposal when working on lower body training. But with so many choices, it can be difficult to figure out what works best. That’s why T&C asked five elite strength and conditioning coaches to share their ideas and approaches to lower body training. In this article, they discuss their philosophies, new trends, and incorporating flexibility and balance training into their programs.

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T&C: What is your philosophy on training the lower body? Boyle: Like a lot of coaches, my approach has evolved from a body building perspective to power lifting to Olympic lifting to where we are now, which many call functional training. From an evolution standpoint, we’ve gone from the back squat to the front squat to different versions of a singleleg squat. At this time, we don’t really do back or front squats, but instead focus on versions of one-legged squats.

Hudy: We train the lower body at least four days a week using non-linear periodization. We vary the intensity on each day and instead design our training—whether it is resistance training or conditioning—based on synchronous or asynchronous activities. I define synchronous activities as those that require high muscle recruitment for muscle power-max effort training and asynchronous activities as more muscle endurance-submaximal effort training done over a longer period of time. For example, on a Monday we might condition synchronously using plyometric activities and short acceleration and agility drills, then we will resistance train asynchronously using a total body work capacity circuit. The next day we switch, but always start with the synchronous activity. We perform a high power output synchronous resistance-training workout, then an asynchronous conditioning activity. Gallucci: The exercises we use may have changed, and the athletes we get here have certainly changed over the years, but our philosophical approach R.J. Anderson is an Assistant Editor at Training & Conditioning. He can be reached at: rja@MomentumMedia.com. T&C november 2010

Optimum performance hasn’t. We focus on injury prevention through sound technique first, and then work on improving performance.

OUR PANEL Michael Boyle, MEd, ATC, is a strength and conditioning coach and consultant based in Boston and co-founder of Mike Boyle Strength and Conditioning. He has been training athletes, from amateurs to Olympians and professionals, for over 25 years and is the author of Functional Training for Sports.

Don Decker, MS, CSCCa, CSCS, is Head Football Strength and Conditioning Coach at the University of Mississippi.

Jason Gallucci, MS, SCCC, CSCS, is Director of Strength and Conditioning/Head Varsity Strength Coach at Princeton University. He works with the school’s football, baseball, men’s lacrosse, women’s ice hockey, and field hockey teams.

Andrea Hudy, MA, CSCS, USAW, LMT, is Assistant Athletics Director for Sport Performance at the University of Kansas where she handles the strength and conditioning responsibilities for the KU men’s and women’s basketball teams.

Robby Stewart, CSCS, is Director of Strength Development at Competitive Edge Sports based in Atlanta, Ga., where he has worked with over 1,000 NFL players, as well as Olympic, collegiate, and high school athletes.

Stewart: Twenty years ago, we were trying to get people stronger and in better shape. Now it’s about evaluating the sport’s movement requirements, seeing how the athlete performs those movements, then correcting their deficiencies and weaknesses. In general, it’s about making the athlete more explosive, not just stronger. Explosiveness is what builds quickness. Now we do more cleans, more step-ups, and more explosive hip and hip flexor-oriented movements as opposed to just trying to get bigger and stronger. Decker: The principles remain the same: You’re going to pull, and you’re going to squat in some fashion. At the same time, if you’re not learning in this profession, you’re falling behind. Al Miller, a longtime NFL strength coach, used to say that the evolution of your philosophy means adding arrows to your quiver. The more arrows you have, the better chance you have of hitting your target. This is especially true when you’re dealing with a range of athletes who all have different strengths, weaknesses, and needs. What new trends in lower body strength and conditioning are you seeing? Gallucci: Trends come and go, but I think the functional movement screen is here to stay. It’s caused a lot people in the profession to go back to basics—especially when training younger athletes—and focus on building fundamental strength through correct movement patterns. I hope to reap the benefits in the next few years with fewer athletes coming to me with injuries, deficiencies, and functional issues. Too many times, people move too fast when training young athletes—I think we need slow things down and develop better movement patterns. Decker: The trends have led strength coaches to do more functional training, prehab, and mobilizing of joints so when they’re put under a load, the body is able to respond properly. The hip and ankle mobility work that came from athletic training and physical therapy has made it into our warmups, which has been a good thing. Boyle: We’re moving toward building single-leg power using the rear foot el-

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Optimum performance evated squat as our central exercise. Based on the same idea, we’re also modifying that exercise to include movements like single-leg rear foot elevated jumps. Stewart: Kettlebells have been around for a long time, but people are jumping back on them again for unilateral type

grip strength that measured right-hand strength, left-hand strength, and combined strength, it was found that the sum of the right hand plus the left hand strength was greater than the strength level for the combined grip. In extrapolating that idea toward lower body training, we’ve found that right leg strength plus left leg strength is greater

“Our corrective work comes down to old fashioned technique work—breaking down and building up their movements in the squat and the lunge and making sure our athletes truly know how to perform them properly.” movements such as one-arm snatches, cleans, and single-leg squats. We also see more isolated single-leg work to train specific sports movements. How has research validated or caused you to re-evaluate your training programs? Boyle: There is some older research on bilateral deficit that I’ve really paid attention to since concentrating on singleleg work. For example, in a study on

than the sum of both legs. It affirms where we were going empirically. Decker: I saw one study about an Olympic rower who took four weeks off after the Olympic Games and it took him 21 weeks to get back to his peak performance level. Of course, that ratio is not the same for all athletes, but the takeaway is that there will be a significant drop in performance the longer an athlete is on a break.

So if you give an athlete two or three weeks off before starting summer workouts and you have nine weeks in the summer to train, in some cases you’re spending the majority of that time getting the individual back to their previous levels. In response, we’re looking at different ways to break up their time off to avoid having a long period when they’re not training. But that’s proving to be tough with NCAA rules on discretionary time. Gallucci: As a staff, we meet twice a week to cover some form of research. Each meeting is run by a different person in the department who is responsible for choosing the research article for us to talk about that day. We’ve covered everything from jump training to squat technique. It allows us to sit back and evaluate what we’re doing as a group. We like to read all of the research to see what’s going on around us, but we take everything with a grain of salt. We know from a practical standpoint what has been working for us.

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Optimum performance What lower body deficiencies are you seeing most often in young athletes who enter your program? Hudy: Our basketball roster is comprised of many different body types, so we deal with different types of deficiencies amongst all athletes. But generally speaking, with the amount of lateral movement that occurs in basketball, I like to put an emphasis on the external rotators of the hip. I believe that mechanically, the external rotators can help athletes maintain good body position. By strengthening the external rotators we can also improve knee mechanics. Hip, groin, hamstring, and posterior chain strengthening are also at the top of our list of target areas. Gallucci: Now, more than before, there is a lack of strength in athletes’ gluteham complexes. We see a very high rate of quad dominance in our young athletes. I don’t know if it’s a result of the glutes and hams being under-trained as much as that they aren’t being trained properly. Our young athletes often come in overly concerned about the

amount of weight they’re pushing as opposed to how they’re pushing it. The focus needs to be on how they’re moving the weight, not how heavy it is. Boyle: For us, it’s the glutes and hamstrings. Most coaches and trainers are still living in a squatting dominated world. We try to make sure we’re striking a balance between our anterior and posterior chain work. For every squattype exercise, we’re also doing a deadlift-type exercise. Stewart: Hands down it’s hips and hip flexor strength and overall body flexibility. So many of today’s athletes are home sitting around instead of out playing and doing the everyday things that build hip and hip flexor strength. I’m seeing a lot of kids who don’t have explosiveness in their hips and are tight in the hamstrings. I also feel there are too many cases in which the emphasis is being placed on the amount of weight lifted rather than proper technique. Decker: In our culture, athletes like to train what they can see. In many cases,

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there is a lack of hip and ankle mobility, and a lack of hip, hamstring, and glute strength. The majority of guys who come into our program have not put a lot of time into activating and using those muscles and developing those areas. So we spend a lot of time working to balance out their lower bodies so they’re not so quad-driven. What lower body corrective exercises do you use most often? Gallucci: We do glute-specific training and also incorporate a lot of core work because the core is often a big part of a glute deficiency. Flexibility is also important, so we try to pinpoint issues there. But really, our corrective work comes down to old fashioned technique work—breaking down and building up their movements in the squat and the lunge and making sure our athletes truly know how to perform them properly. For example, after a functional warmup, we’ll have athletes do functional isolation work that targets the glutes, such as a single-leg bridge. We’ll also modify exercises like a squat to focus on building glute strength.

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Bonus Question T&C: What was the most important thing you learned at a conference this year? Decker: I attended the Collegiate Strength and Conditioning Coaches Association conference and a presentation from Mike Gittleson, former head football Strength and Conditioning Coach at the University of Michigan, jumped out at me. He talked about concussions and what we can do in terms of building mass in the neck and trap area to disperse a blow and help prevent concussions. Gallucci: I like to find something that’s specific when I go to a conference. For example, I recently heard Brad Pantall, Strength and Conditioning Coach for the Penn State men’s and women’s basketball teams, talk about grip strength and it was outstanding. The way he broke it down from opening grip to closing grip and his thoughts about stabilization grip and the different things he does with odd objects showed a very innovative approach. Hudy: At Kansas, we have the unique opportunity to host the Midwest Sports Performance Conference, which is held each May. We design the conference specifically for the

needs of our athletes and department and bring in some of the top researchers, coaches, physical therapists, and athletic trainers in the field of performance training. It’s fun because most of the presenters are not only professional mentors and colleagues but also friends of our staff. We also have a Research and Coaching Performance Team that consists of our strength and conditioning staff and Dr. Andrew Fry’s research team. We work together to answer questions that we have regarding our training methodologies. I also attend sports nutrition and massage conferences. We are always looking for new ways to keep the athletes’ attention and keep them learning. Boyle: The guy who got the most attention from me was Thomas Myers, who wrote a book called Anatomy Trains. He talked about how our whole idea of anatomy is probably wrong and that the fascia are more continuous structures rather than individual muscles. In reality we may not be stretching muscles—we’re likely manipulating fascia. Listening to him made me think that we don’t really know as much about flexibility as we think we do.

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Optimum performance Hudy: We have a lot of movement variations and intensity changes in our system that allow us to implement a high number of super, complex, and/or compound exercise sets. This provides us with a high degree of variability, so we have the opportunity to examine movement in each plane. We perform as many groundbased movements as we can while understanding the importance of specific hip, groin, hamstring, and posterior chain strengthening. Exercises such as fire hydrants, hip circles, poor man ham curls, and hypers are implemented daily. Boyle: For us, it’s some form of a split squat and some form of a single-leg straight-leg deadlift. For a beginner, we would start with body weight split squats with both feet on the ground in order to build hip mobility. As we progress our athletes, we use a lunge matrix as a warmup. We want them to master the pattern before loading a movement so as not to add strength to dysfunction. Decker: We spend a lot of time teaching young athletes how to activate

their lower bodies properly. One of the things we start them out with is plank holds, which are a good indicator of deficiencies in their core. We also do two-leg and single-leg hip bridges and a hip series with bands to show them the areas they need to activate. Those simple body positions allow them to see their deficiencies. We also use Romanian Dead Lifts (RDLs), glute-ham raises, single-leg dumbbell RDLs, one-foot balance reaches, and a variety of single-leg and body weight squat movements. We want them to be very efficient in those movements. Stewart: I like squats, lunges, and cleans as multi-joint exercises that translate to building sport explosiveness effectively. Also, the glute and ham machines that are on the market today really target those areas well. I like using machines to help correct certain muscle imbalances, but whenever possible I try to use exercises that closely simulate the actual movements the athlete will be performing in his or her sport.

What is your preference for lifting splits when addressing the lower body? Gallucci: We typically train total body. Still, one day a week our primary focus is on the squat, another day we focus on a single-leg movement like a lunge or a step-up, and then we’ll have another day that’s a complementary leg work day depending on how our athletes’ bodies are reacting to the training. For example, we might do single-leg body weight stuff if they’re a little run down, or if we think they can get aggressive, we might have them do a front squat, deadlift, or tire flip. If we’re in a four-day routine, I like to have two days that focus more on lower body. We base upper body-lower body splits more on how we can run our room most efficiently. We like to pair a lower body push with an upper body pull. It helps the flow of our room and allows the muscle groups to recover a little between lifts. Decker: We have a lot of variety in our program based on the position-

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Optimum performance al requirements of the football players. For example, in the off-season, our skill players do squatting movements on Tuesdays and Fridays. These players do heavy work later in the week because we don’t want to affect their speed work by having them sore or tight when they run. They are on a four-day routine. With the linemen, we hit legs three times a week. We may do a one-legged squat on one day, then come back with a back squat another day, and then finish out the week with some

front squats or step-ups. We vary our intensities and our volume. Hudy: For us, it is not about splits, but rather intensity. Monday is our higher volume day, and what we do on Mondays can change from one week to the next. On a daily basis, we are implementing sagittal, frontal, transverse, and multi-planar lower body exercises. Tuesday is a high load, low volume day. Thursday is our strength day, and Friday is our speed-strength day with low to moderate loads.

For example, with basketball athletes, on Tuesdays we’ll start with squat jumps with a bar and pair it with rapid fire box jumps, then do a basketball movement using resisted cables. So we’re getting an explosive movement, a plyometric exercise, and a basketball movement in our superset. From there, we’ll move to snatches and do in-depth jumps and an overhead rip—which is a basketball movement. Then we’ll go to cleans and do more of the same thing along with front squats, incline seated rows, and raises.

“We’ve gone back to static stretching. We foam roll and static stretch before every game, every practice, and every workout, then we warm up. In my mind, stretching has a strong correlation with injury prevention.” Where does flexibility training fit into your program? Gallucci: It’s everywhere. Flexibility training, unfortunately, has kind of been pushed to the side a little in today’s training landscape, but it shouldn’t be. There has been a big push toward dynamic flexibility, but at the same time you have to have functional flexibility in your training movements. Boyle: We’ve gone back to static stretching. We foam roll and static stretch before every game, every practice, and every workout, then we warm up. In my mind, stretching has a strong correlation with injury prevention. Whenever I take an injured athlete to a doctor, they tell me they need to stretch more—so why shouldn’t all our athletes stretch?

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Decker: We work on flexibility by starting with balance activities and muscle activation work. Then we move to dynamic movements to get the blood flowing—from a backward run to forward and backward lunges, to an easy shuffle. Then we’ll go into stationary dynamic movements like leg swings, Frankenstein walks, and some hip moTR AINING-CONDITIONING.COM

Optimum performance bility movements. I’ve also learned that you have to implement some static stretching because if you don’t, some won’t think you’ve done enough to get them loose. Hudy: With proper resistance and movement training, one can increase flexibility or gain functional flexibility. All of our workouts follow a progressive warmup until we get to the heart of the work. If our athletes want or need to increase flexibility, they come in pre-workout and stay post-workout. There is a minimal amount of static stretching. What role does balance training play in developing the lower body? Stewart: If you’re working on balance and flexibility at the same time, you’ll see fewer injuries and a more wellrounded athlete with less bilateral discrepancies. However, I do believe some coaches overdo it with unstable surface work. You need to make sure you’re concentrating on improving balance when you use those modalities. The push for strength should not overshadow the athlete’s safety and physical well-being.

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Decker: We start every workout by warming up with a balance training activity. We start with single-leg movements on a stable surface with their eyes open, and progress to eyes closed. After mastering that, we move to a more unstable surface. We also do exercises on Bosu and physio balls. Hudy: I usually get players pre- or postpractice so they are already wearing ankle braces, which are required in our program. So performing exercises on an unstable surface might not be as beneficial at that point. We do, however, implement balance exercises on a balance beam and perform many single-leg rotational exercises using our functional power-speed cable columns. Boyle: With the exception of what we get from our single-leg work, we do very little specific balance training work. A lot of us got caught up in the thought that balance training meant using unstable surfaces, and we may have gotten a little circus-like because of it. We do some one-legged squatting on an Airex pad—that’s about as unstable as we’ll get. n TR AINING-CONDITIONING.COM

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NUTRITION

chris murphy

In the Dark

Most athletes know about the dangers of eating disorders, but they can be in the dark on disordered eating and its negative effects. By Dr. Karen Reznik Dolins

he lean and fit-looking track athlete came into my office with a smile. Her college coach had suggested she see me after telling him she felt her times would improve if she lost a few pounds. Our first visit went smoothly. She told me about her eating and exercise patterns, I calculated her energy and macronutrient requirements, and then I made some suggestions designed to improve the balance of her intake with expenditure. She left as she came in—with a smile, expressing confidence in her ability to follow through with the recommendations.

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During subsequent visits she reported feeling stronger and more energized, although unhappy that the scale didn’t budge. I reassured her that the numbers on the scale were not the most important indicator of success and she seemed to understand. But on our fourth visit, our

discussion triggered a different response. As I asked her more personal questions about eating and tried to uncover why the scale numbers were more important to her than performance gains, she burst into tears. “I just don’t know what to eat,” she said, “I’m so afraid.”

Karen Reznik Dolins, EdD, RD, CSSD, CDN, is Coordinator of the Nutrition and Physical Activity specialty program and Adjunct Associate Professor at Teachers College, Columbia University. She is also the Sports Nutritionist for Columbia Intercollegiate Athletics. Recipient of the Sports and Cardiovascular Nutritionists (SCAN) Achievement Award in 2005, she has been a nutrition consultant for USA Gymnastics, USA Swimming, the U.S. Tennis Association, the New York Knicks, and the WNBA. She can be reached at: karen.dolins@gmail.com. T&C NOVEMBER 2010

NUTRITION This scenario, with variation, is repeated over and over again in my work with young athletes of both genders. Our athletes have gotten the message that they need to eat to power their bodies, but they still don’t have a clear concept of how to eat to fuel themselves while maintaining an optimal body weight. They are confused about how strict a diet should be, and they don’t understand the balance between eating healthy and “fun” food. They believe they have a lack of self-control if they

ticing disordered eating. This can be detrimental to them physically, athletically, and psychologically. When it is recognized and skillfully handled by an athletic trainer, coach, or nutritionist, these athletes can be steered back to an enjoyment of eating and the benefits of a healthy diet. WHAT’S THE DIFFERENCE? Disordered eating is recognized as a spectrum, with eating disorders heading the end. Strict criteria is required for the diagnosis of an eating disorder,

An individual with disordered eating may fight to limit food intake during the day until finally losing their “willpower” later in the day ... Giving in to urges late at night may cause the athlete to feel a loss of self worth. don’t consume only the healthiest meals and snacks. They restrict what they eat, and often restrict the wrong foods at the wrong times. Many have obsessive thoughts about food and eating. These athletes do not have fullblown eating disorders, but are prac-

which can be found in the Diagnostic and Statistical Manual (4th Edition). The U.S. Department of Health and Human Services offers a summary for defining a formal diagnosis: Anorexia nervosa: Weighs at least 15 percent below what is considered

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normal for others of the same height and age; misses at least three consecutive menstrual cycles (if a female of childbearing age); has an intense fear of gaining weight; refuses to maintain the minimal normal body weight; and believes he or she is overweight though in reality is dangerously thin. Bulimia nervosa: At least two binge/ purge cycles a week, on average, for at least three months; lacks control over his or her eating behavior; and seems obsessed with his or her body shape and weight. Binge-eating disorder: At least two binge-eating episodes a week, on average, for six months; and lacks control over his or her eating behavior. Eating disorder NOS (not otherwise specified) catches those who meet some of the above criteria but not all. For example, an individual who is underweight, fearful of weight gain, and misses occasional menstrual cycles but not three consecutive cycles would fall into this category, as would an individual who binges and purges weekly as opposed to twice a week. Many athletes, though, have more

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NUTRITION subtle gradations of disordered eating and generally fly under the eating disorder radar. With these individuals, there is rarely a dramatic change in weight to signal its presence, but there is an unhealthy relationship with food that is significantly affecting the health and well-being of the athlete. The restrained eating and unhealthy eating patterns characterizing disordered eating are accompanied by rigid cognitions, and the athlete’s self-esteem is tied into the amount of food consumed. The athlete’s poor relationship with food may not be visible to friends, coaches, parents, and others around them. An individual with disordered eating may fight to limit food intake during the day until finally losing their “willpower” later in the day and digging into a big bag of cookies or chips. This pattern leaves the athlete feeling hungry, tired, often light-headed, irritable, and having difficulty concentrating throughout the day. Giving in to urges late at night may cause the athlete to feel a loss of self worth as they are unable to recognize that their

energy deficit has left them more susceptible to binge behaviors. Individuals with disordered eating may avoid certain food groups they believe contribute to excess body fat. For example, because starchy foods are often associated with weight gain, athletes may shun breads, cereals, rice, pasta, and even fruit, not realiz-

mind and body become united in their movement away from health, as anxiety regarding food is accompanied by multiple nutrient deficiencies and often forms the basis of life-long issues with weight management. It is difficult to know the prevalence of disordered eating among athletes. Surveys used to evaluate eating disor-

There are a number of warning signs an athletic trainer should look for: Athletes may express an excessive concern about ideal body weight, weigh themselves frequently, or eat little at team meals. ing that these carbohydrate-containing foods should form the basis of an athlete’s diet. Because disordered eating is less extreme than eating disorders and doesn’t necessarily result in changes in weight, individuals may not recognize that they have crossed over the line from “normal” eating to disordered eating, and that their eating behaviors are motivated by an underlying unhealthy mindset. Their

ders do not adequately capture this population since self-reports of behavior are not always accurate. It’s clear, though, that high school and collegiate athletes can easily lose perspective on normal eating as they juggle their need for fuel with concerns about appearance, athletic performance, and the stresses of academic life. EFFECTS OF DISORDERED EATING All individuals need energy (calories)

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NUTRITION to meet their basal metabolic needs, process foods, and allow for baseline levels of movement. Athletes need significantly more energy to support their high level of activity. Scientists have coined the term “energy availability” to define the number of calories needed to maintain life processes once exercise is accounted for. It is expressed as total calories consumed minus those used for exercise. Athletes who may easily be burning 500 to 1,000 calories or more daily during training often fail to accommodate for their ex-

hormone, which stimulates the ovary to produce eggs, is inhibited. This occurs within days of the initiation of an overly restrictive diet, well before it is apparent by the absence of the menstrual cycle. The Female Athlete Triad is a term used to describe the link between disordered eating, amenorrhea (absence of the menstrual cycle), and low bone mineral density. Recent research, though, has demonstrated that inadequate energy availability impacts the integrity of bones well before amenorrhea occurs. Bones are continually remodeled

Athletic success and mental and physical health will best be achieved by teaching student-athletes to focus on diet as a way to support their athletic goals, not as the driving force behind their success ... They also need to clearly understand that cutting calories comes at a cost. tra energy needs with a corresponding increase in calories consumed, resulting in low energy availability. The brain receives a continual stream of signals to keep it apprised of the level of energy availability. As more calories are used to run, row, perform training drills, or work out in the weightroom, fewer are available to keep the millions of body cells alive, keep the body warm, build muscle and other tissues, and support the reproductive system. When confronted with too few calories, the brain responds quickly by orchestrating a cascade of physiological responses designed to preserve the organism. Many of these physiological responses greatly affect athletic performance. Muscles with sub-optimal fuel stores will fatigue prematurely. Inadequate protein will limit the body’s ability to grow and repair tissue in response to training sessions. The many vitamins and minerals involved in bone integrity, the immune system, cardiovascular function, and other physiological functions will be lacking. The result is an athlete whose body is continually breaking down, unable to recover from the stresses imposed by workouts and competition. Sub-par performance, frequent injuries, infections, and an inability to focus will eventually follow. Beyond its outward effects, disordered eating can alter the functioning of the reproductive system in females. With a lack of calories coming in, leutinizing 28

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through a process of breakdown and buildup of bone cells. Energy restriction minimizes the formation of new bone cells even when women are menstruating normally. For female athletes, this increases the likelihood of musculoskeletal injuries. RECOGNIZING THE PROBLEM Athletic trainers are in an ideal position to identify individuals with disordered eating cognitions and behaviors before health and performance is impaired. There are a number of warning signs an athletic trainer should look for: Athletes may express an excessive concern about ideal body weight, weigh themselves frequently, or eat little at team meals. They may also exercise beyond what is normally required for their sport in an attempt to burn more calories. It is important that athletic trainers understand the psychological factors behind disordered eating in order to better recognize the problem. Athletes have a higher incidence of poor relationships with food than their non-athletic peers for a variety of reasons. One of the biggest causes is misinformation about improving performance by modifying body weight. Many athletes incorrectly believe that their performance will always improve if they can lose weight. They strive to achieve this at all costs, not realizing the potential negative effects. The same personality traits that make an athlete successful—intense fo-

cus, perfectionism, persistence, and an ability to push beyond their comfort zone—can contribute to disordered eating. While most would start eating at the first signs of hunger, an athlete with an inclination for toughing it out may forge ahead down the path toward disordered eating. In some cases, athletes may find that their body type is not appropriate for the sport they have selected, and believe weight loss is a solution. They use restriction of food as a way to achieve what may be an impossible goal: altering their body to try to meet the ideal standard of a given sport. In other cases, the focus on food actually comes before participation in athletics. Some are initially attracted to sport, especially endurance sports, as a way to burn calories. Their reason for being on the team is more about weight loss than anything else. A final, but very important factor, is that body weight can be an anxietyprovoking issue for many young people. Our society touts thinness in females and six-pack abs for males as the ideal. Coaches (and parents) can make an offhand remark about an athlete losing weight under the guise of it being “good for them” while not understanding the ramifications. And peer pressure can be a huge problem for some individuals. Disordered eating occurs in males as well as females, although male athletes’ goals are usually different. Men are more likely to link a desire for decreased body fat with a desire for increased lean mass while women tend to focus more on the numbers on the scale. You might wonder if there is a qualitative way to differentiate between healthy and unhealthy behavior when it comes to athletes’ eating patterns. Unfortunately, there are few validated screening tools for this population. However, the Female Athlete Screening Tool has been validated on the collegiate population. It can be administered by a certified athletic trainer, sports dietitian, or sports physician. (See the “Resources” box at the end of this article for more information on where to find the screening tool.) PROVIDING HELP Once disordered eating is identified, an appropriate treatment strategy must be implemented. A multi-disciplinary team, which can include the team physician, athletic trainer, and a sports diTR AINING-CONDITIONING.COM

NUTRITION etitian whose scope of practice includes nutrition assessment, calculation of dietary needs, and nutrition counseling can best provide the necessary interventions. It is critical that all members of the team are delivering the same message: food is fuel, and inadequate fuel will compromise health, physical performance, and school performance. Athletic success and mental and physical health will best be achieved by teaching student-athletes to focus on diet as a way to support their athletic goals, not as the driving force behind their success. Athletes should be taught to approximate the amount of fuel used in the course of their normal day, and the additional fuel needed for their sport. Athletes also need to clearly understand that cutting calories comes at a cost—by definition, any energy deficit is accompanied by a reduction in the body’s ability to respond to exercise and training. In considering body weight goals, athletes should be reminded that there are no “ideal” body types associated with any sport. Successful competitors come in a variety of shapes and sizes—just think of Serena and Venus Williams!

Athletes at risk for disordered eating are often those who are particularly anxious and critical of their own athletic performance, and who express these concerns by being critical of their bodies. The challenge is to help these athletes regain their trust in themselves

food choices define self-worth. As noted in the 2009 ACSM Position Stand on physical activity and body weight, effective behavioral recommendations will include training in problem solving, social support, goal setting, stimulus control, and self-monitoring of

The NCAA cautions that weight loss goals should be determined by the student-athlete and medical and nutritional personnel in consultation with their coach rather than dictated to the student-athlete directly by the coach. and allow their bodies to tell them how much food they need to eat. The goals for this athlete are to: • Have the confidence to eat when they feel hungry and stop when they feel satisfied. • Understand that eating is primarily done to provide nutrition, but is also pleasurable and it’s okay to eat something simply because it tastes good. • Be aware of the need for energy balance, but not consumed by the fear that you are exceeding it. • Be able to eat without feeling that

eating and exercise behavior. Registered dietitians are trained to help individuals critically evaluate their food logs, evaluate the nutritional adequacy of their diets, find patterns that may make it more difficult for them to eat well, and help guide the individual through the necessary behavior changes. The NCAA cautions that weight loss goals should be determined by the student-athlete and medical and nutritional personnel in consultation with their coach rather than dictated to the student-athlete directly by the coach, and that weight

THE DIFFERENCE BETWEEN ATHLETES AND CHAMPIONS

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NUTRITION loss plans should be individualized. Body weight goals must acknowledge the desire of the athlete to achieve a degree of leanness for sports performance, but need to be realistic as well. CASE STUDY SW is a 19 year-old swimmer. She swam well during most of her freshman year at college, but by spring her coach had become concerned by her poor times and fluctuating weight. She was referred to me for help with weight management. During our initial assessment, I asked SW about her weight history and she admitted that she had struggled with her size since puberty. When she was 13, she and her mom attended Weight Watchers

I estimated that SW used about 2,200 calories a day for normal body functioning and activity, and an additional 1,000 to 1,200 calories to support her exercise. I explained to her that she needed to provide her body with fuel before jumping into the pool in the morning in order to get an effective workout, and that she needed to eat within an hour after activity to promote recovery. She also needed to distribute the calories she ate in a way that mirrored how she was using them instead of eating more calories at the end of the day when she was less active. We discussed the role of carbohydrate, protein, and fat in athletic performance, and I told her how much she needed of each based on the ADA/ACSM guidelines.

Over the years, she had learned to ignore her body’s signals of hunger and satiety. She needed to relearn how to trust her body’s signals so she could avoid becoming overly hungry and eating until stuffed. together and she lost 20 pounds. She then became involved in swimming. She performed well, but her mom was concerned about her appetite. She would come home from swim practice ravenous and eat large portions. However, her mom encouraged her to eat less. SW admitted to becoming a closet eater, sneaking candy and cookies and eating until she felt sick. She denied purging. By the end of her senior year of high school, she had regained the weight she lost. She dieted that summer and felt good when she went to college. During her freshman year, SW was on the school’s meal plan and had difficulty navigating the cafeteria and figuring out how much to eat. She struggled to manage her hectic schedule of academics, two hours of daily swim practice, and two hours of strength and conditioning three times a week. She would often skip breakfast, run from swim practice to her first class, and not eat until mid-afternoon when she had a break. By that time she’d be ravenous and eat anything from a turkey club with chips and a sweetened iced tea to several slices of pepperoni pizza. She would have a salad at dinner, but around 10 p.m. she would take a break from studying and have ice cream or cookies. She would feel so guilty about this that she told herself she didn’t need breakfast the next day, and the cycle would continue. 30

T&C NOVEMBER 2010

SW was nervous about being given permission to eat. This was so different from what her coaches and mom had always told her! She thought for sure she would get fat if she ate 3,000 calories a day. Over the years, she had learned to ignore her body’s signals of hunger and satiety. She needed to relearn how to trust her body’s signals so she could avoid becoming overly hungry and eating until stuffed. I worked with SW through the rest of the semester. She learned that fueling herself before and after practice made her feel better and allowed her to put more energy into her practice sessions. She added nutrient-rich calories to her lunch, and carried a homemade trail mix of dry cereal, raisins, and almonds for an afternoon snack. She ate a healthy dinner with one-third of her plate consisting of a lean protein, one-third carbohydrate-rich starch, and one-third vegetables. She balanced out her calorie needs with healthy oils, and ate a healthy evening snack like half a peanut butter sandwich on whole grain bread with a glass of skim milk. Most importantly, she learned to trust herself to know when and how much she needed to eat to keep her body well fueled. Over the course of her sophomore year, SW’s swim times improved and her weight stabilized. She didn’t eat perfectly but she ate well, and she no longer felt guilty if she indulged in some ice cream

just because it tasted good. She received continued encouragement from her coach and her athletic trainer. She slips up at times, but recognizes that she pays a price by feeling more sluggish. That motivates her to quickly get back on track. Athletes deserve to take pride in their accomplishments. Body dissatisfaction should not be used as a motivator for change. Rather, coaches and athletic trainers can play a key role in the development of healthy eating behaviors by motivating athletes to take care of their bodies, understand the nutritional demands of their sport, and acknowledge the need to provide the best fuel possible. n

What about when it would be beneficial for an athlete to lose weight? For the author’s advice on how to handle this sensitive situation, look for “When It’s Okay to Lose” in the blog section of our Web site at: www.trainingconditioning.com/blogs.php.

Resources The Female Athlete Screening Tool can be found through this citation: McNulty KY, Adams CH, Anderson JM, Affenito SG. “Development and validation of a screening tool to identify eating disorders in female athletes.” Journal of the American Dietetic Association 101(8):886-892, 2001. The National Institute of Mental Health provides resources on eating disorders at: www.nimh.nih.gov/health/ topics/eating-disorders/index. shtml. Sports Dietetics USA provides Sports Nutrition Fact Sheets on a variety of topics of interest to exercise professionals and the general population. The fact sheets are reproducible and available in PDF format at: www.scandpg.org/sportsnutrition/sports-nutrition-factsheets.

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TREATING THE ATHLETE

When Elbows Fail

Jason Ayer

Author Brainard Cooper works with University of South Carolina pitcher Drake Thomason, who underwent Tommy John surgery earlier this year.

Helping an athlete come back from an ulnar collateral ligament injury is chock full of challenges. Here is one veteran athletic trainer’s approach to this arduous rehab. By Brainard Cooper

ommy John surgery—three scary words no baseball pitcher wants to hear. But the reality is, more players are having the procedure than ever before. And while the surgery is the focus of most athletes’ fears, the intensive rehabilitation, which can take up to 18 months to fully complete, is equally as challenging. Though athletes in any sport that involves overhead throwing motions—think of a javelin thrower or tennis player—can sustain an ulnar collateral ligament (UCL) injury, baseball pitchers have the highest rate of injury. Critics have called for pitch counts and inning limits in Little League, high school and college coaches have been berated for allowing pitchers to stay in a game too long, and pro prospects are placed on strict pitch limits. Still, UCL injuries continue unabated. Over the course of my 25-year career, I have chosen to concentrate on rehabilitation of the upper extremities. In this article, I will explain not only the nature of the injury and dispel some misconceptions about it, but also provide insight into the intricacies of the rehabilitation process. TR AINING-CONDITIONING.COM

THE INJURY I cannot count the number of times a baseball player with an elbow injury has asked me, “It’s not the Tommy John ligament, is it?” Despite this common misconception in the baseball community, there is no such thing as a Tommy John ligament. The surgery, named after the pitcher who in 1974 was the first professional athlete to undergo the procedure, involves replacing or repairing the ulnar collateral “ligament,” which is actually a complex. There are three separate bands involved, similar to the deltoid “ligament” in the ankle. When the injury occurs, one or more of the bands of the UCL complex—which includes the anterior and posterior portions and the transverse band—tear as a result of overhead throwing activities. Brainard Cooper, ATC, is the Associate Athletic Trainer at the University of South Carolina, where he provides coverage for the baseball and men’s soccer teams. He can be reached at: BRAINARD@mailbox.sc.edu. T&C NOVEMber 2010

TREATING THE ATHLETE The injury can be either acute in nature or gradual in its onset. When we see elbow injuries in the collegiate ranks, more often than not, it shows up via gradual onset. A baseball player will often describe a history of non-specific elbow issues that have bothered him for a period of time. These are rarely serious enough to stop him from playing, but never fully dissipate after starting. In this scenario,

can begin formulating a rehabilitation plan. When I performed my first rehab on a UCL reconstruction about 15 years ago, we always kept the athlete’s elbow immobilized for two weeks after surgery before starting any rehab exercises. Now, rehabilitation begins the day following surgery—working not only on distal and proximal muscle group exercises, but also on range of motion (ROM) of the elbow.

If a pitcher returns to play only nine months after surgery, he will not recover as quickly between outings as his injury-free teammates, so he needs to be on a restricted pitch count ... Ideally, the pitcher would gradually increase from 75 pitches. which I call “smoldering elbow,” it’s only a matter of time until the elbow fails. Another scenario could involve an injury to a totally different region of the body—the back, opposite shoulder, or hip, for example. It is not uncommon for an athlete to suffer an injury to another region of the body, yet still participate in activity. The problem occurs when the deficient body part puts additional stress on the elbow in an attempt to maintain accuracy and velocity when throwing. For example, with a shoulder injury, the pitcher could subconsciously change his throwing mechanics to compensate for pain. I have seen several athletes have to undergo shoulder surgery after recovery from elbow surgery because the shoulder injury surfaced only after their UCL was fixed. Heavier than normal fatigue, which often occurs with an injury, can also lead to a change in mechanics. Lower-body injuries are a common trigger for elbow problems. We all know that a pitcher does not get his power from the shoulder or arm. He generates power through his legs, hips, and abdomen. When anything happens to negatively affect these sources of power, additional stress is again placed on the upper extremity in an effort to maintain accuracy and velocity, and the athlete will alter his mechanics to compensate. When mechanics fail, it is only a matter of time before there is a breakdown— and for throwing athletes, that breakdown usually occurs in the elbow. PICKING A PLAN Once the decision has been made that the athlete will undergo surgery, you 3 4

T&C NOVEMber 2010

Despite the advances we’ve seen in rehabilitation techniques like the above, and in surgical techniques aimed at aiding post-op recovery time, it still generally takes 12 to 18 months for the injured athlete to get that special “it” back. That may sound like a long time, but the recovery from the injury and resulting corrective surgery doesn’t take nearly that long. Following surgery, the UCL and surgery site is technically healed within six to seven months. But that doesn’t mean the pitcher is ready to start pitching competitively. While the new “ligament” is technically healed, the healing structure has not had time to mature. The tendon that was harvested to construct the new ligament needs time to take on the properties of a ligament, and that ligament then needs time to be acclimatized to the stress of throwing. Under the most pressing circumstances, I will allow a pitcher to return to competitive pitching after nine months. This could include a scenario in which the competitive season is right around the corner and the injured player has only one year of eligibility remaining. Or the player may see himself as a draft-eligible pitcher and want to get back on the mound to show professional scouts that he is not only able to pitch for a game here and there, but for an entire season. Though coaches don’t make return-to-play decisions, I do take their concerns into consideration. Does the team really need the injured pitcher back? All of these things factor into rehab time. However, if a pitcher returns to play only nine months after surgery, he will not recover as quickly between out-

ings as his injury-free teammates, so he needs to be on a restricted pitch count. I will also ask that he be kept on a limited count should he experience lingering elbow pains that “nag” at him during the competitive season. I suggest to our coaches a 50-pitch count in all preseason scrimmages and a 75-pitch count in the player’s first three outings of the regular season. Ideally, the pitcher would gradually increase from 75 pitches so that by the end of the regular season, he is throwing 100 to 110 pitches per appearance. If we are fortunate enough to make the postseason, I give the coaches and pitchers the green light to pitch with no limits. The ideal time frame for return to participation is a 12-month rehab program. On this schedule, the athlete is almost assured of a problem-free return. When taking less time than this, I’ve found the athlete can be apprehensive and less confident upon his return. I also believe a restricted pitch count early on only adds to this lack of confidence. I’d much rather have the athlete “chomping at the bit” to get out there and throw. Regardless, a quicker return is often demanded. Right now, for example, we have a catcher with only one year of eligibility remaining who had Tommy John surgery in October. He is concerned that if he waits an entire year until the fall of 2011 to return, he will have lost his “edge” and won’t make the 2012 roster. So he’d like to come back in time to play summer ball in 2011—that gives us just nine months to get him ready. REHAB TIME UCL surgery rehabilitation is broken down into four basic phases. Here is what my nine-month rehab program looks like: Phase one. The acute post-surgical phase lasts from weeks zero to six, and the basic goal is to protect the surgical site and increase ROM. During this time the athlete is restricted in a hinged brace (such as the DJ Ortho ROM Elbow Deluxe) and keeping the surgical site protected is paramount. Only gentle ROM work can begin, and only if it doesn’t interfere with the healing site. The athlete can perform gentle wrist and forearm work as well as light shoulder and scapula stabilizer work. Initial exercises should be static or isoTR AINING-CONDITIONING.COM

TREATING THE ATHLETE

MENTAL GAME When any injury occurs, there is a mental challenge that accompanies the physical setback. Generally, an athlete is angry or sad after they are initially hurt and those feelings can stick with them until they are back on the competition field. But with an ulnar collateral ligament (UCL) injury that requires Tommy John surgery, those feelings can be magnified because of the arduous rehabilitation process. It is a long and even boring road to recovery and it can be a great challenge for athletes to remain positive over their months of rehab. Some athletes can become despondent or exhibit signs of depression following a UCL injury if their sense of worth is tied to their ability to perform. Many times I’ve seen an athlete’s schoolwork suffer or some other sign of disassociation. Here at the University of South Carolina, we try to combat those negative feelings. Our coaching staff, for example, makes an effort to keep the injured player involved with team activities. And I play a support role, too.

I find, as I am sure many other athletic trainers have, that keeping the athlete involved in team activities has a huge positive effect on his psyche. I always encourage the athlete to take part in weightroom training with his teammates. The coaches make sure they have jobs for the injured player during scrimmages and regular practice sessions. And I also believe that getting the athlete active as soon as possible is critical to helping him maintain a positive outlook during the rehabilitation process, so I print a calendar up for every athlete I work with following Tommy John surgery. The calendar contains a start date (date of surgery) and a target completion date (generally nine months later). Together, we then write down each day’s activity so the athlete has something to look at and refer to when he has questions regarding his progress. It allows them to see the progress they’re making and there is an end goal they can look toward as well—getting back to the mound.

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TREATING THE ATHLETE metric, and shoulder isometrics in the neutral position can be performed in flexion, extension, and/or abduction. For the forearm, I like to do isometric exercises by applying manual resistance in flexion and extension of the wrist. I never do any internal or external rotation in phase one—there is plenty of time to work on these muscles in the coming weeks. Toward the later part of the six weeks, you can progress to some more dynamic exercises such as the Jobe’s or Thrower’s 10 program. (These programs can be found by simply typing “Thrower’s 10” or “Jobe exercises” into any Internet search engine. A variety of different programs are at your disposal.) Phase two. The chronic or intermediate post-surgical phase covers weeks seven to 16, and the goal is to increase strength in the musculature of the upper extremity and maintain ROM gains. After six weeks the brace is removed and the athlete should begin dynamic strength training in earnest. This increase can be achieved by adding weight and repetitions to the

exercises the athlete is already performing. A modified, limited weightroom workout can also be implemented at this time to prevent de-conditioning in the rest of the body. Shoulder and forearm exercises that were initiated in phase one should continue with heavier weight to build strength. After 12 weeks, we begin using the Plyoback and other plyometric exercises. At about the 12-week mark I like to begin using the BioDex. Not only does the BioDex give you finite numbers to refer to when gauging strength and power, but it also breaks the monotony of performing the same type of exercise day after day. During this phase, the athlete can begin performing sport-related activities such as swinging a baseball bat or playing golf, but not throwing. For a position player, batting practice would also be okay at this point, and I allow athletes to start running. Phase three. The advanced phase runs from week 17 to 32, and here we continue increasing strength and power, maintaining ROM gains, and gradually start return-to-sport activities. Exercises in phase three should alternate

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between the elbow, shoulder, and core from day to day. A typical week might look like this: Monday and Friday we do a dumbbell shoulder and wrist/forearm workout based off of the Thrower’s 10 program. Tuesday and Thursday are BioDex days with a Plyometric ball program. Wednesday is a light day when I have the athlete perform a Theraband program. The weekend is “free time” when he can do whatever exercises in the program he wants to, or none if he chooses. All the while, he is participating in a modified weightroom program with his teammates. This is an exciting time for the athlete since we begin rehab throwing with the Interval Throwing Program. There are precautions to be taken, however. Recovery time must be built in between each step, and I like to repeat each step twice before moving on. Allowing at least two days between each throwing episode is also a good idea. Remember that the purpose is to introduce the new “ligament” to the stress of throwing. One issue to stress is the importance of the clinician observing the athlete

TREATING THE ATHLETE

while he is performing this throwing. If I do not monitor the athlete, he invariably will throw too long or too hard, which can damage the healing site and delay recovery. Phase four. The final phase can be modified to begin anywhere from the 32 to 36 week mark, and its goal is to return to regular activity. This phase can begin as early as 28 weeks postop and last up to week 54, depending on the athlete’s progress. The athlete now begins preparing his body for re-entry into athletic competition. By now, he should be performing all of his strengthening and endurance exercises at a high level. The elbow is ready for work off the mound, starting with an interval throwing program. A progressive interval pitching program is not geared toward power, but to reintroduce the athlete’s elbow to proper mechanics. This routine needs to be performed under the guidance of the team’s pitching coach so he can see the pitcher’s mechanics. When this phase is completed without complication, the athlete is ready to return to full participation. FOUR KEYS A successful recovery following Tommy John surgery is dependent on four major aspects: ROM, time, direct observation, and outside factors. I believe the most important immediate postop goal should be the reestablishment of ROM—something I learned from renowned orthopedic surgeon Dr. James Andrews. If an athlete has full ROM prior to surgery, he should be able to regain that range following surgery and rehab. Time and again, whenever I see athletes who have recently had UCL reconstruction I advise them to tell their therapist or athletic trainer to push ROM because they are almost always lagging behind. When I see an athlete who is eight to 12 weeks postsurgery and he is carrying his elbow at a 30-degree bend while walking around, I know he needs to work on ROM. I begin every workout for a Tommy John patient with 15 minutes in a 110-degree whirlpool to begin activating ROM. The next factor critical to a successful outcome is time. The repaired UCL needs time to heal. Though the injury is technically healed in six to seven months, that doesn’t mean the healing site has matured enough to withstand throwing activities—tossing a ball maybe, but not significant throwing. The new UCL needs time to mature, take on the properties of a ligament, and develop the tensile strength necessary to withstand the rigors of pitching. Direct observation ensures that not only is the athlete’s technique in performing exercises correct, but it also ensures that the athlete doesn’t do too much too soon. When in physical therapy facilities and other athletic training rooms, I often see patients who are unattended, just going through the motions and not performing the exercises correctly. It makes me wonder how good their outcome will be. Finally, we must look at outside factors that might have contributed to the failure of the elbow in the first place. Was the injury caused by too much pitching? Was there a physical condition that predisposed the athlete to being injured? Was another injury at fault? I am very keen on monitoring pitchers with shoulder, back, knee, or ankle injuries. During Tommy John rehab, I look at these areas closely to see if there was a condition that may have been overlooked. If as athletic trainers, we address the whole kinetic chain and not simply focus on the elbow while addressing these four aspects of rehabilitation, I believe the chances for a successful outcome are greatly improved. n TR AINING-CONDITIONING.COM

T&C NOVEMber 2010

Circle No. 127

LEADERSHIP

Full Coverage

Lee Feiner

By Jennifer Chadburn

n ankle sprain is an ankle sprain. A quad contusion is a quad contusion. No matter who the injury happens to, treatment is necessary in order for that athlete to return to their previous level of function. When I took the position as Head Athletic Trainer for Club Sports at Boston University over 10 years ago, this was the answer I gave people who asked, “Why do you want to cover club sports?” In my mind it was just that obvious. And as the years have

T&C november 2010

Do club sport athletes warrant the same quality athletic training coverage as their varsity peers? More schools are saying yes. gone on, my response has remained the same. After being appointed at BU, it became clear that club sport athletes need athletic trainers just as much as the varsity athletes do. The types of injuries I see now are no different than

those I saw during my undergraduate clinical education training that had me working with varsity athletes at NCAA Division I and II schools. Still, the position proved to be a challenging one—especially early on in my career. Sure, I travel with our club teams to opposing schools, but unlike our varsity athletic trainers, I’m Jennifer Chadburn, EdM, ATC, is the Head Athletic Trainer for Club Sports at Boston University and an Adjunct Instructor in BU’s Sargent College. She can be reached at: jlchad@bu.edu. TR AINING-CONDITIONING.COM

LEADERSHIP not greeted by the home team athletic trainer, nor is there a cart full of supplies waiting for me. I was forced to become self-sufficient very fast. With all the good and very little bad, providing coverage for club sports at BU has been a great experience. As more colleges find the same answer I did when it comes to their club sport athletes, I think more positions like mine will become available. PART OF THE CLUB When I started here at BU, a graduate assistant athletic trainer was providing coverage for club teamsâ&#x20AC;&#x201D;me. I was trying to juggle both school and my position working with all the club sport athletes. I think this is still a common scenario at colleges across the country, but itâ&#x20AC;&#x2122;s certainly not an ideal one. With the support of my supervisor, the Director of Physical Education Recreation and Dance (PERD), I was elevated to a full-time position after obtaining my masterâ&#x20AC;&#x2122;s degree and demonstrating to the department that the large workload I was taking on by myself could not be carried by just one per-

son. Communicating the needs of our club athletes helped prove that it wasnâ&#x20AC;&#x2122;t working as a one-person job. I kept track of the number of patients I saw each day, and I made sure the director of PERD knew how many injuries I was diagnosing and treating. I was

of opportunities to play club sports in a safe environment and with access to an athletic training department. And then there were two. My arguments were persuasive enough that I was also able to get PERD to support keeping the graduate assistant position

I wrote a letter of justification explaining why I thought there was a need for more athletic trainers. Using treatment data and detailing a few examples of excellent care that were initiated by our services, we were eventually given approval for the second position. also in constant contact with our coordinator of club sports, who oversees the daily operations of the club teams. Educating these two individuals went a long way in helping to establish the need for a full-time athletic trainer. My main selling point wasnâ&#x20AC;&#x2122;t necessarily the sheer number of patients I was treating, but how increasing the quality of care BU could offer its active student population would create positive value for the university. More students may want to attend BU if they knew there were lots

in addition to my new full-time spot. Our primary goal was to make sure that the collision sports were covered: menâ&#x20AC;&#x2122;s and womenâ&#x20AC;&#x2122;s rugby and menâ&#x20AC;&#x2122;s lacrosse. Besides giving these three teams full coverage, we were also able to accommodate more of the other club athletes during expanded walk-in office hours. With three collision sports and only two athletic trainersâ&#x20AC;&#x201D;just one fulltimeâ&#x20AC;&#x201D;I felt the quality of care was still lacking. And as the need for more services continued to grow, so did my concerns.

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LEADERSHIP During my first year as a full-timer, there was talk of BU building a large recreation complex that would house PERD (and our athletic training room). But that was years off, so in the meantime, our demand for more space had to be met by altering some basement offices. The club sport athletic training room went from a small room with two tables to a large enough space for several more treatment tables and a rehabilitation area. With a bigger room, we were able to accommodate more patients, which was great, but as a result, we were in need of more clinicians. If you build it, they will come, right? We were then able to demonstrate our need for a second full-time position by providing the department with details on the large number of patients we were

to athletic training services not only for our club sport athletes, but also for our varsity athletes. The welcome change was a vision from our director of athletic training services and director of the athletic training education program. They both wanted to move all of BU’s athletic training services under a medical supervision model as they thought it was best for the quality of care we offer our athletes. After a year of lobbying, the partnership was approved. Since then, I no longer report to the director of PERD, but to the director of athletic training services and a physician. Altogether, BU now has two head athletic trainers (including myself), one senior athletic trainer, five staff athletic trainers, and seven graduate assistants.

I often get asked whether working with a club sport athlete is any different than working with a varsity athlete. My answer is usually no. Do they want to get back to their respective sport and playing level? Do they want to be pain free? Of course! seeing and pointing out the number of practices and games that were going on with no medical supervision. However, it was a bit more difficult this time around because most of the final decision makers didn’t really know what an athletic trainer did, let alone the role we play in preventive care. I was able to help the director of PERD do some convincing by writing a letter of justification explaining why I thought there was a need for more athletic trainers. Using treatment data and detailing a few examples of excellent care that were initiated by our services, we were eventually given approval for the second position. After only two years, club sports now had the support of two full-time athletic trainers and a part-time graduate assistant. ONE UNIT The most recent development in how we cover club sports here at BU occurred two years ago when there was a move to house all athletic training services under one umbrella. Now, all of BU’s athletic trainers work under one medical director (one of our team physicians). Our unit is technically housed in student health services, yet athletic training is still its own entity with a separate operating budget. Combining our departments has resulted in better access 40

T&C november 2010

One of the best things to come out of the move is that I can now collaborate with or seek the opinions of a dozen fellow athletic trainers if I want to. If I’m stuck on a diagnosis in an athlete who is experiencing back pain, I can go to our athletic trainer who specializes in back injuries and say, “I really need a second opinion on this diagnosis. What do you think?” Another major benefit is that we’ve all been able to obtain a better work/life balance. With more athletic trainers available for coverage, we are able to balance the workload, grant people days off in the middle of a season, and keep our average hours worked at a reasonable level. If our graduate assistant who coordinates coverage for club men’s lacrosse has been at every team practice in a certain week and really needs to take Thursday afternoon off to study, she can. One of the other 14 athletic trainers can do it. In the past, that would have been really tough to finagle because there were only three of us to cover club sports. And besides the staff, the benefits for our club sport athletes have been phenomenal. When I started as a graduate student, I was only able to hold athletic training room hours for two to three hours a day. As we grew, we were able to expand to five hours per day before heading out to practices and games.

OUR CLUB TEAMS We have quite the variety of club teams here at Boston University. Though some are obviously much more physically intense than others, we do see athletes from all of the following programs. Badminton Ballroom Dance Baseball Cycling Dance Theater Group Equestrian Fencing Figure Skating Golf Gymnastics In-Line Hockey Jiu Jitsu Kendo Kung Fu Lacrosse Rugby Sailing Shotokan Karate Ski Racing Snowboarding Squash Synchronized Skating Synchronized Swimming Table Tennis Triathlon Ultimate Frisbee Volleyball Water Polo

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LEADERSHIP Now, our open hours are very similar to most other varsity athletic training facilities. Over the years, BU’s club sports program has grown from a dozen to a total of 32 teams (including co-ed squads). Luckily for our club sport athletes, our coverage system has grown and developed right along with their programs. CLUB VS. VARSITY I often get asked whether working with a club sport athlete is any different than working with a varsity athlete. My answer is usually no. Do they want to get back to their respective sport and playing level? Do they want to be pain free? Do they play because they love it? Do their coaches want to win? Of course! There are no scholarships available for club sports, so it may be true that there is less pressure on the athletes as a result. But in the same way as it is for varsity athletes, club sport athletes often play because it’s part of how they relieve the stress associated with attending a rigorously academic school. Club sport athletes were likely playing in high school, and a lot of them take their games just as seriously as our varsity athletes. One major difference between club and varsity athletes is access to strength and conditioning. Club sports don’t have their own strength training staff, and I believe that’s why I see plenty of injuries that could have been prevented with maintaining a regular strength and conditioning program. At BU, we are aiming to improve this situation. We have an athletic enhancement center, which is a strength and conditioning unit run by BU’s college of health and rehabilitation sciences, Sargent College. Though there is a cost associated for anyone who uses the athletic enhancement center, a number of the club teams have joined over the past few years and subsequently seen an improvement in injury rates and boosts in performance—including the men’s rugby team, which in its second year utilizing the strength and conditioning services has seen its injury rate dramatically lowered. One of the downfalls when it comes to covering club teams is their scheduling. Club sports are lowest on the totem pole, so gym space and turf time comes at a premium. Men’s lacrosse practices are often from 8 to 10 p.m., so our graduate assistant who covers the team sees some pretty late nights in the spring. When this sort of scenario occurs, we make sure to schedule the grad assistant’s morning off to give her a break. We don’t work longer hours than the varsity athletic trainers, just later hours sometimes. It’s also not uncommon to see a last-minute game schedule change, or have a game delayed because a referee is late. This is a very rare occurrence during an NCAA team’s season. For the covering athletic trainer, we just have to be willing to roll with the punches. It can be easy to forget that not all schools employ a full-time club sports director who does all the teams’ scheduling—it’s often the students doing their own scheduling, and mix-ups do happen. I will also add that our club sport athletes don’t take the athletic training staff for granted one bit. Most varsity athletes expect they will have access to athletic training services when they arrive on campus, but club sport athletes don’t. When our athletes see an opposing team has no athletic trainer on its sideline, they take note. It’s a regular occurrence for an athlete I’m treating on a Monday morning to just say, “Thank you for being here.” That’s all I need to know we make a positive difference for these athletes. n TR AINING-CONDITIONING.COM

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First to the Finish

Ida Dillingoen helped the Pioneers be first to the finish at the NCAA Skiing Championships in 2010—the third year in a row the squad has captured a national title.

Rich Clarkson & Associates

The University of Denver ski team’s off-mountain cross training program makes all the difference when the skiers hit the racing slopes.

By Jason Sanchez

ver the past decade, alpine skiers have seen tougher course designs and rougher terrain than ever before as race organizers strive to continually challenge racers. Giant slalom races, for example, are being skied in “straighter” lines, giving racers less transition time between turns. But the skiers aren’t the only ones who have had to adapt to the tougher conditions. Strength and conditioning coaches have had to step up to the plate, too. Never before has there been such an emphasis on developing sound, yearround training programs for skiers. Here at the University of Denver, I think it’s safe to say we’ve met the challenge. The team is fresh off capturing the 2010 NCAA Skiing Championship—its third consecutive NCAA title and its seventh since 2000—and is rarTR AINING-CONDITIONING.COM

ing to go again in 2011. In this article, I share my approach to putting together the team’s strength and conditioning program, the importance of guarding against injury through strength training, and how cross training has been a major key to our success. PROGRAM DESIGN I focus on three key points in training a championship caliber ski team: mobility, movement preparation, and power endurance. I believe these are the most important goals to keep in mind when working with skiers. Mobility is often an overlooked aspect of training alpine skiers. These athletes race down hills on an unstable surface—snow—which can be extremely bumpy and/or icy on a given race day. Though skiers’ ankles are encased in a hard boot that allows for little flexibil-

ity, the ankle becomes a high point of stress in a slalom or giant slalom event. An athlete who lacks mobility in the ankle has a recipe for injury. To target this issue, we take a few specific steps. As soon as a skier walks into the training center for a session, they are required to use the wobble board to complete single-leg, 360-degree rotations. In this exercise, the athlete supports their weight by bracing themselves against the wall, steps one leg onto the wobble board, and tracks Jason Sanchez, USAW, is Assistant Strength and Conditioning Coach at the University of Denver, where he designs and implements performance programs for the alpine and nordic ski teams, as well as swimming and diving, women’s soccer, and tennis. He can be reached at: jason.sanchez@du.edu. T&C NOVEMBER 2010

sport specific

DYNAMIC WARMUP The proper warmup is essential for our athletes. Here are three examples of warmup progressions I use. I try to do a different warmup workout each day of the week so it’s not a monotonous task for our athletes. Warmup Workout I Mountain climber Stride, twist, and reach High-knee run Lateral hip swing T-shoulder rotation Inch worm Body weight squat Pressing snatch balance Warmup Workout II Half-kneeling dowel twist Single-leg bridge Lean, rock, and reach

Lateral lunge Spiderman crawl Dynamic hip swing Backward long reach Warmup Workout III Leg-lowering progression Dynamic hurdle stretch Hip open lunge twist X-behind Dyno walk Duck walk High-knee step over

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the edge of the board in a complete circle—in both directions. After the wobble board, our skiers’ dynamic warmup consists of sagittal, frontal, and transverse dynamic movements. Many of my warmup exercises come from Gray Cook, and the goal is to engage mobility in the ankle, stability in the knee, and mobility in the hips. (See “Dynamic Warmup” at left for examples.) We also want to activate the thoracic spine and stabilize the lumbar spine. Mobility in the thoracic spine and stability in the lumbar spine are key to reducing pain in the lower back, shoulders, and neck during the upcoming workout session. Warmup exercises such as deep squat reaches, single-leg supermans, and single-leg bridges are great for this. Next, we move to a turf surface to continue mobilizing the ankles and hips, and begin activating the hamstrings, quadriceps, and glutes with knee hugs, arched-back lunges, and single-leg squats with a low reach. Finally, we finish our warmup work with a series of hops, bounds, and sprints to pre-

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sport specific pare the athletes for plyometric work. With mobility taken care of, movement preparation is tackled next. I develop a ski-specific plyometrics program because skiing asks muscles to reach maximal force in the shortest amount of time possible. Plyometrics are a fundamental part of the ski team’s program and are performed during each workout. The team begins with a simple set of plyos such as single-response ankle flips or rocket jumps. We progress to singleleg rocket jumps, tuck jumps, bounding, and skaters, then move to lateral hops combined with a broad jump progression. After this plyo progression, the team moves on to box work. A basic box work progression throughout the season includes starting with a forward step up and step down on a high box (at least 29 inches) with an emphasis on safely accelerating and decelerating. Next, we move to a 24inch box for lateral step-ups. The goal here is to improve lateral technique and agility. Then the athletes perform a box forward step up into a depth jump or a lateral step up into a depth jump (we use depth jumps to excite the stretch-

shortening cycle). Finally, the athletes do depth jumps while working on sticking their landings and lateral hops to both sides. During the off-season, the athletes do 100 to 160 foot touches per week at low to medium intensity. During the preseason, we kick it up a notch to no more than 450 foot touches per week at moderate to high intensity. I consider the in-

massive amount of power in order to stay in control while turning. They also need to be strong enough to stabilize themselves and hold the desired line of travel until the next turn—and be able to seamlessly shift their weight and power from one side to the other. We develop muscle strength by creating an overload on elite skiers’ legs eccentrically, isometrically, and concen-

I perform a movement analysis of the body weight squat on all of our skiers. Starting from the ground up, I watch the motor pattern of the ankles, knees, and hips. I want to see them avoid posterior rotation in the pelvis, and I make sure their pelvic rotation is in a slight anterior position. season a maintenance period, and the athletes only do plyos as a light warmup once a week—40 to 60 foot touches at moderate intensity. During the championship season, we back off even more and only complete 20 to 40 foot touches per week at moderate to high intensity. Finally, not everyone realizes that alpine skiing demands power endurance. A racer needs to be able to produce a

trically. Overloading muscles gives us the explosive power needed in the giant slalom and slalom. Over time, the muscles respond by adapting to the work imposed. Then, once the muscle has reached the overload threshold, a systematic approach that involves progressive increases is necessary to continue producing great results. One of the ways I do this is through

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NO OFF-SEASON For strength coaches, the off-season is when the season really begins. Workouts are voluntary, which means it’s a time the athletes must commit to their teammates, coaches, and support staff to make gains. Lucky for them, the University of Denver is an ideal place for any athlete to train during the summer. The weather is perfect, and we have a one yearold 12,000 square-foot weightroom. However, the ski team’s six-week off-season program is very intense and a great test of the athletes’ selfmotivation. The following are lists of the exercises athletes complete during their sixweek off-season. I set them up as stations, and the athletes rotate around the circuit five times, decreasing the amount of time they spend at each station each time around, with a constant work-to-rest ratio of one-to-three. Exercises we use in weeks one through three: Plyometric box work Squats (overhead and front) Lat pulldowns Clean technique work DB walking lunges Cleans DB lunge matrix (anterior, lateral, posterior) DB pullovers Squat technique work (body weight and DB single-leg variations) Trunk stability work Cable chops (low, medium, high) Dead lifts Body weight exercises 30 minutes on the bike, treadmill, or ARC trainer Exercises we add during weeks four through six: Clean variations (clean dead lift, clean jump shrug, clean and jerk) DB lateral split squats DB bench presses DB Arnold presses Medicine ball mountain climbers Sprints Medicine ball overhead throw downs Sledge hammers Kettlebell swings

T&C NOVEMBER 2010

the neutral squat and the front squat. When performed correctly, full squats strengthen the muscles, ligaments, and tendons surrounding the knee. Because this movement is so important, I perform a movement analysis of the body weight squat on all of our skiers. Starting from the ground up, I watch the motor pattern of the ankles, knees, and hips. I want to see them avoid posterior rotation in the pelvis, and I make sure their pelvic rotation is in a slight anterior position. The hamstrings should also lengthen during the descent when the move is being performed correctly. Most of our skiers have no issues reaching the correct depth of the squat. As the athlete ascends, I watch for red flags such as a valgus movement in the knees (caving in toward each other), a knee dominant squat, and rounding of the back. Characteristics of a quality squat that I look for include knees tracking over the toes, shoulders over the knees, head in a neutral position, and the knees and hips moving at the same pace. A lack of mobility in the squat can create lower back pain and thoracic spine limitations. Some exercises to assist an athlete who cannot perform a neutral squat correctly are DB singleleg squats, DB squats with a physio ball positioned on the thoracic spine, DB lunges, and barbell lunges. REDUCING INJURIES The first step to evaluating how to reduce injuries is to determine the specific characteristics of alpine skiing that could put athletes at risk for injury— immobility in the ankle as I mentioned above, for example. Analyzing the nature of the sport allows me to design a sophisticated program that builds strength and power in the right areas and at the same time creates an environment where injuries are minimized as much as possible. My goal with the DU ski team is to implement prehabilitation consciousness. It’s also essential to understand why an injury or soreness is present. Once I know why there is pain, I can determine which muscle or joint is being overworked or is not activating properly. Direct communication with the athlete is the best way I know to address soreness, fatigue issues, and injuries affecting the team. It can be as simple as asking questions like, “How are you feeling? What hurts? Are you getting enough sleep? Do you have enough calTR AINING-CONDITIONING.COM

sport specific ories on board to perform today’s training session?” All of our athletes are aware of my rule that says if pain is present, stop! If a muscle or joint hurts at any point during an exercise’s range of motion, they stop doing it. We can find another exercise to tackle the same area, so there is no need to execute movement that creates pain. Incorrect technique is a major injury risk and a big red flag in the weightroom. When I see something that looks “off,” it leads me to take a good look at the athlete’s mechanics. For example, in a squat, do the ankles provide mobility to the full range of motion? Is there stability in the knee to prevent a valgus motion? Is there mobility in the hips? As strength and conditioning coaches, we must also provide enough recovery for our athletes, as sufficient recovery time is a large factor in injury reduction. Direct communication with the head ski coach, our sports medicine staff, and the athletes themselves provides me with an accurate timeline of how much rest the team may need. It’s also important to understand that

as strength and conditioning coaches, we cannot prevent all injuries—athletes will get hurt. However, what I can influence is the rate athletes sustain injuries and how fast they can return to the mountain. Each DU alpine skier has different needs and goals to sustain his or her elite level of skiing, but all of the skiers share the common goal to prevent, decrease, and overcome injuries as much as possible. CROSS TRAINING Because of our location, the DU ski team is one of the first in the country to begin training on the slopes each season, but even with this advantage, it is paramount that we are training off the slopes as well as on them. A cornerstone of our off-slope work is the use of other sports in our cross training regimen. Ice hockey is the team’s favorite sport, so we play every Tuesday evening. We may look like a rag tag bunch—some will suit up in complete pads, and the rest of us wear whatever we can get our hands on for safety protection—but it’s a lot of fun and a great workout. Skiers stand to gain a lot from play-

ing hockey. They get a great workout for lateral leg strength, anaerobic endurance, developing force applications for explosive speed, and developing turns and transitions for multidirectional movements. Our training and conditioning goals through hockey are flexibility, endurance, strength, power, quickness, and agility. Beyond the physical benefits of these other sports, the skiers get a big mental boost as well. The games encourage a sense of camaraderie among the athletes while at the same time creating a competitive environment. I think it helps that for these games, the head ski coach, assistant ski coach, and myself play, too. It puts us all on an even playing field, and lets us see our athletes’ competitiveness at a more intimate level. Cross training is definitely the final piece to the puzzle for skiers. Due to weather and time constraints, it’s essential for success on the slopes. Luckily, skiers like to be outside no matter the season, which makes my job that much easier as I strive to keep up with the demands of this ever-evolving sport. n

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Perform Better offers a full lineup of nylon Training Ropes to help athletes and clients generate strength and increase cardio. The rope material will not shed, and is easier on the hands. Training Ropes are available in lengths of 30, 40 and 50 feet and in one- and two-inch thicknesses. With your shipment, receive a free instructional CD-ROM. For more information, check out the 2010 Perform Better catalog, which can be ordered by calling the company’s toll-free number or visiting its Web site.

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

Circle No. 504

Support for Muscles

All-Pro Science Complete 100-percent Grass Fed Whey Protein packs 23 grams of allnatural protein into a great-tasting blend fortified with vitamins and minerals to support optimal muscle synthesis. When you choose grass fed whey, you’re selecting a product that is better for you and the environment. It’s perfect for athletes and individuals looking to build lean muscle mass. Flavors include vanilla, Bavarian chocolate, strawberry creme, and banana creme. All-Pro Science • 949-222-1009 www.allproscience.com

Circle No. 505

Goes Down Like Milk

Egg Whites International’s 100-percent pure liquid egg whites are heat-pasteurized and tested for salmonella, making them “liquid” but not “raw.” They are doublefiltered to achieve the smooth consistency of milk, and they’re completely tasteless and odorless for making the perfect protein drink. An eightounce serving supplies 26 grams of protein with no fat, no cholesterol, two grams of carbs, 120 calories, and all the essential amino acids. Egg Whites International • 877-EGG-WHITES www.eggwhitesint.com

Circle No. 506

Steady Progress

On the Ropes

Perform Better • 888-556-7464 www.performbetter.com

The PowerForce Free-Standing Bag is designed for kicking and punching without the need for hanging. The removal foam collar increases or decreases pivoting of the bag from its heavy-duty rubber coil. The 77inch overall height and 16.5-inch diameter striking surface allow for any size user. The bag and collar are covered in smooth, durable fabric backed with nylon canvas and open cell padding. The two-piece base holds up to 280 pounds of water, and the 33.5-inch diameter base can be filled with water or sand for stability. Some assembly is required.

Circle No. 503

Thera-Band stability products offer some of the best solutions on the market for sports performance enhancement, balance training, and rehabilitation. The product family is based on Thera-Band Trusted Progression: a broad, complete spectrum of challenge levels that provides athletic trainers and therapists with the tools they need to progress patients and improve their conditoniing. Product offerings include the Rocker and Wobble Boards, three densities of oval-shaped Stability Trainers, and the Stability Disc. The Stability Disc can also be used for active sitting/core development. Performance Health • 800-321-2135 www.thera-band.com

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T&C NOVEMBER 2010

Strength Training & Conditioning The Right Ratio

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

The TRX Suspension Training Pro Pack is a complete total-body training system. It includes the TRX Suspension Trainer, a highly portable performance training tool that leverages gravity and the user’s body weight to enable hundreds of exercises for every athlete, and a 65-minute basic training DVD and guide for efficient highquality workouts anywhere. Fitness Anywhere, Inc. • 888-878-5348 www.fitnessanywhere.com

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Special Delivery

On the Go

Built to enhance sport movement and athletic performance, the Portable VersaPulley combines speed, power, and functional mobility through any range of motion with accommodating inertial resistance at any speed. Its lightweight, compact design and ease of mobility makes it ideal for on-field or on-court training, and though the Portable VP weighs just 70 pounds, it produces up to 800 pounds of explosive force resistance. VersaPulleyAthleticBusiness.ai • 800-237-2271 www.versapulley.com

Total-Body Training

7/22/10

2:00 PM

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Complete Casein delivers 25 grams per serving of anti-catabolic, slow-digesting protein from micellar casein and calcium and sodium caseinates. Because casein protein digests slower, it provides amino acids over a longer period of time than whey protein. This prolonged amino acid availability is what makes Complete Casein anti-catabolic. Complete Casein contains aminogen (digestive enzyme) to help promote efficient and complete protein utilization and uptake. Complete Casein is lactose- and gluten-free, so it is suitable for almost anyone looking to increase protein intake. CytoSport • 888-298-6629 www.cytosport.com

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

• Control cost and contamination • Kills 46 pathogens including H1N1, CA-MRSA, HIV • Safe & effective on equipment

CMY

800 – 1200 ct Lowest Prices GUARANTEED TEED

gymwipes.com m

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

Strength Training & Conditioning Fully Loaded

The Plate Loaded Seated Leg Press is one of the newest innovations from Power Lift. Standard features include a ratchet seat mechanism that accommodates all user sizes; low start resistance; standard counter balance; three-inch thick pads for user comfort and support; movable joints that feature ball bearings; standard weight horns; and standard rubber feet. The press is finished using Power Lift’s state-of-the-art power coat paint system.

Power Lift • 800-872-1543 www.power-lift.com

Circle No. 537

Powerful Motivation

Austin Plastics’ off-season strength and conditioning board is a great way to motivate athletes and give them an incentive to accomplish their goals. The company offers a printing program that makes changing records a quick and easy process, and its boards allow users to display records for all to see. Go online today to view a large selection of Austin Plastics boards.

Austin Plastics & Supply • 800-290-1025 www.athleticrecordboards.com

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Quality, Safety, Performance

Incorporating the same high standards used in manufacturing UCS track and field equipment, the company is proud to offer the UCS Strength and Speed equipment line. This advanced line consists of racks, benches, platforms, glute-hams, leg presses, and towers, as well as the renowned Plyo-Safe™ equipment. UCS Strength and Speed is dedicated to bringing you the finest engineered and manufactured products, made in the U.S.A., with customer service unequaled in the industry. UCS Inc. • 800-526-4856 www.ucsspirit.com

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To the Max

Infinity Max 1.25-inch thick tile stands up to the constant abuse of heavy weights being dropped directly on the weightroom floor without denting, tearing, or splitting. The tiles, which contains up to 95-percent recycled content, may qualify for up to eight LEED points. Custom logos are available, and tiles are offered in 10 standard colors and an unlimited number of custom colors. Backed by a 10-year warranty, the flooring can even be used as an Olympic lifting platform.

Infinity Performance, Inc. • 888-479-1017 www.infinityflooring.com TR AINING-CONDITIONING.COM

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Balancing Act

G Series Pro Protein Recovery Shake provides balanced nutrition for consumption after exercise to help jump-start recovery. With carbohydrates for glycogen restoration and an effective amount of protein containing all the essential amino acids needed to help support muscle recovery after training or competition, G Series Pro Protein Recovery Shake provides a nutritional bridge between an athlete’s workout or competition and their next meal. Gatorade • 800-884-2867 www.gatorade.com

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Knowledge Is Power

Informed-Choice is committed to helping ensure the purity of nutritional supplements, and it relies on HFL Sport Science to conduct product tests. HFL Sport Science has been testing supplements for banned substances against the World Anti-Doping Agency list to ISO17025 standards since 2002. The lab tests more than 5,000 samples annually, and currently works with more than 100 companies worldwide. HFL works closely with supplement manufacturers and suppliers to reduce the risk of contaminated products finding their way into sport, thus helping ensure that athletes know exactly what they are putting into their bodies. This track record has earned HFL the support of UK Sport, the United Kingdom’s equivalent to the U.S. Anti-Doping Agency. Informed-Choice • 720-289-2401 www.informed-choice.org

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Certified Safe

Joint Health Supplement Cosamin ASU is certified for sport 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. 538

Durability & Reliability

The Hammer Strength V-Squat machine provides Iso-Latreal technology that replicates the body’s natural movements. Athletes can perform a natural squatting motion on the V-squat since it is designed to reduce back and knee strain through a curved arc of motion. Standard counter balance provides lower starting resistance and dual selectorized weight stacks preserve the integrity of independent leg action. Hammer Strength • 800-634-8637 www.hammerstrength.com

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Strength Training & Conditioning Agility Training

The 15-foot-long SPRI Premium Agility Ladder features 10 adjustable hard plastic rungs. Large ladder spaces reduce the risk of ankle strains and provide more room for foot placement than traditional agility ladders. For varied training applications, athletes can use two ladders. SPRI Products • 800-222-7774 www.spri.com

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Into the Water

The SwimEx 900T Pool is the ultimate in flexibility. With an overall depth of five-and-a-half feet, the 900T can be adapted with a second floor to offer a second water level anywhere from three-and-a-half to four-and-a-half feet, with or without an integrated Woodway treadmill. Patients gain the benefit of shallow workstations, an optional integrated motorized treadmill, and deep water exercise all in the same pool. SwimEx • 800-877-7946 www.swimex.com

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Body Fuel

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

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

Circle No. 539

Protein Shot

It takes more than sweat to keep fit. Today, more athletes are discovering the importance of a nutrition program that is balanced and provides an adequate supply of protein. Timing is critical, too. The best time to consume protein is right after a workout. That’s why Healthy Shot delivers 100 percent of all the essential amino acids in just a 2.5-ounce drink. It comes in two concentrations, providing 12 or 25 grams of protein in a fruit-flavored drink without fat and with only 100 calories. It won’t fill you up or slow you down. Hormel Health Labs • 800-866-7757 www.healthy-shot.com

Circle No. 556

Monitor Everything

Since 1976, Creative Health Products has been a leading discount supplier of rehabilitation, fitness, exercise, and athletic equipment, as well as health, medical, and fitness testing and measuring products, all available at reduced prices. Creative Health Products offers heart rate monitors; blood pressure testers; pulse oximeters; body fat calipers; scales; strength testers; flexibility testers; stethoscopes; pedometers; exercise bikes; ergometers; stopwatches; fitness books and software; exercise bands; step benches; hand and finger exercisers; heating pads; and more. Creative Health Products, Inc. • 800-742-4478 www.chponline.com Circle No. 555

No Fat or Fillers

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

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Healthy Balance

The Vibrosphere offers a unique combination of balance and vibration to enable effective and functional training. Tactile stimulation works in concert with balance training to rapidly improve proprioception, alleviate pain, strengthen and stabilize the muscles surrounding joints, reduce the risk of future injuries, and increase blood circulation. The Vibrosphere is suitable for a wide variety of treatment and training needs, and the three soft pad designs make it possible to alter the difficulty to meet individual goals. Accent Ventures • 610-812-9134 www.accentventures.com

T&C NOVEMBER 2010

Circle No. 553

Explosive Power

The Keiser Air300 Squat combines lowimpact technology with the ability to move safely at higher speeds. The result is unmatched, explosive power—the key to superior athletic performance. Thumb buttons are conveniently positioned on the ends of the handgrips for greater resistance control and stability during exercise. In addition, a range-limiting feature helps prevent ligament and joint injury to the knee. Keiser • 800-888-7009 www.keiser.com

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Strength Training & Conditioning Locked In

PuzzleLock tiles stand up to the punishment of fitness and workout areas, protecting your existing floors and equipment from damage. Installation is simple and quick, and the seams virtually disappear when the flooring is installed. If you need to change a tile, it can be done quickly and easily. PuzzleLock is ideal for use in weightrooms or cardio areas, home gyms, and performance training facilities. It is available in seven colors and comes with a five-year warranty. Infinity Performance, Inc. • 888-479-1017 www.infinityflooring.com

Circle No. 533

Online Instruction

NASM is proud to announce the release of “Corrective Exercise Strategies for Basketball,” a new course developed in partnership with the National Basketball Athletic Trainers Association (NBATA). The online course teaches health and fitness professionals across a variety of occupations how to correct common lower extremity dysfunctions caused by playing sports. While the primary focus of this course is basketball, the information and techniques shared in it can be applied to athletes in any sport. The course includes exercises modeled by NBA AllStar Grant Hill. To learn more about the $99 course, go to: www.nasm.org/NBATA. National Academy of Sports Medicine • 800-460-6276 www.nasm.org Circle No. 513

Safety & Efficiency

Whole Body Vibration training is here to stay. Scientific white papers say so, and the benefits go beyond body weight exercises. Legend Fitness is the first to introduce a weightlifting platform designed to house a VibePlate unit inside for safer, more effective routines. The platform is also compatible with bench exercises, as the VibePlate is sold separately. Contact the company by telephone or online to learn more about its revolutionary platform. Legend Fitness • 866-753-4363 www.legendfitness.com

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Fortified Refueling

Water Power

If you are seeking the ultimate in an unstable training aid, Perform Better suggests its new lineup of Aqua Bags and Slosh Balls. Fill them with water to change the instability—the fuller they are, the heaver and more stable they will be. Less water makes them lighter and more unstable. They are great for all Olympic movements as well as swings, curls, step ups, rows, and cardio training. Aqua Bags are available in small and large sizes, and Slosh Balls come in small, medium and large. Perform Better • 888-556-7464 www.performbetter.com

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Software Solutions

Advanced Fitness Designs LLC is a technology design company that develops innovative software solutions used by athletic trainers, strength and conditioning coaches, physical education instructors, and health professionals around the world. Information about the company’s industry-leading products can be found at www.fitstatsweb.com, a state-of-the art, webbased fitness assessment, physical activity monitoring, and reporting system, and at www.athletemonitoring.com, the most comprehensive injury tracking and athletic training monitoring system available today. Advanced Fitness Designs LLC • 302-384-9936 www.af-d.com Circle No. 544

Sprinting Toward Strength

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

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Battling Electrolyte Loss

Shamrock Farms Rockin’ Refuel is a top choice for your post-game ritual. This protein-fortified chocolate milk has 20 grams of protein to refuel athletes’ muscles with the great taste you can only get from 100-percent real milk. With naturally occurring electrolytes, nine essential nutrients, and no high-fructose corn syrup, it’s the healthy way to recover after a workout. Check out the latest discovery in muscle recovery today at the company’s Web site.

UMAX was developed by pharmaceutical scientists at the request of professional athletic trainers, who discovered they needed another option in their battle against electrolyte loss. After extensive research and collaboration with sports medicine doctors, the team concluded that sodium was critical to improved performance, magnesium was important for energy production, and the carbohydrate source makes a big difference. Armed with this information, and with athletes as their only focus, UMAX was designed.

Shamrock Farms • 602-272-6721 www.rockinrefuel.com

Unique Sports Science (UMAX) • 866-788-8629 www.umaxsports.com Circle No. 560

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T&C NOVEMBER 2010

Power Racks

Double Power Station

Samson’s Double Power Station comes standard with weight storage, two pairs of cups and safety catches, and chin-up bars on one or both sides. A wide range of paint and upholstery colors are available for no additional cost with a custom logo on an 8’ x 6’ platform. Tubing: Diameter/Width: 3” x 3” Gauge: 7 gauge steel on all frames Warranty: Lifetime Customizing options: Design, team logo, team colors. All units (width, height, overall design) are completely customizable. Unique accessories:

• Dip attachments • Step-up attachments • “Malak” attachments

components, 90 days on grips Customizing options: Design, team logo, team colors, 16

standard paint colors, 87 standard upholstery colors Unique accessories:

• Single and dual landmine attachments for versatile, ground-based exercises • Octagonal insert platform with three frame pieces • Fully welded technique trays with chrome plated rest area Recent installations:

• D1 Sports Training, Savannah, GA • Florida Panthers • The Ohio State University Legend Fitness • 866-753-4363 www.legendfitness.com

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Wide Base Monster Rack

Recent installations:

Oregon State University McClymonds High School, CA Trinity Christian High School, TX Samson Equipment Inc. • 800-4-SAMSON (800-472-6766) www.samsonequipment.com Circle No. 532

X-40 Rack

The X-40 Rack System is a powerful piece of equipment that has the ability to adapt to any activity, making it a valuable addition or central component to any strength facility. Dimensions: 96” tall x 75” wide x 77”

deep (also available in 108” height) Tubing: Diameter/Width: 3” x 3”

Gauge: 7 Warranty: Lifetime Customizing options: Design, team logo, and team colors Unique accessories:

• Reverse dip attachment for added versatility • P-883 platform (96” x 96” Olympic platform) • Three types of pull-up bars UCS Inc. • 800-526-4856 www.ucsspirit.com

Gauge: 11 Warranty: Limited lifetime warranty on frame, one year on

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Pro Series Half Rack

The Pro Series Half Rack comes standard with a fully-welded frame with 12 frame bolts, a seven-gauge chrome racking system, chrome-plated Olympic storage, bar storage, long-reach hooks with replaceable polymer contact surfaces, resistance band pegs, and band storage.

The Wide Base Monster Rack features a specially designed non-slip diamond plate covering to protect athletes’ feet, self-locking jumbo steel pins and “J” hooks, a deep-knurled chinning bar in front, a side-mounted chinning bar, and 33 inches of space between the front and rear posts. An extra-wide base increases versatility by allowing for stretching and rowing movements. Dimensions: 84” tall x 84” wide x 76” deep

(also available in 84” and 96” heights) Weight: 464 pounds Tubing: Diameter/Width: 3” x 3” Gauge: 11 New York Barbells • 800-446-1833 www.newyorkbarbells.com

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Pro Series Half Cage

The space-saving Power Systems Pro Series Half Cage requires only 12 frame bolts, but includes dozens of features and accessories. Monster Hooks with advanced polymer contact surfaces, seven-gauge chrome racking, a multi-grip chin-up bar, resistance band pegs, Olympic bar storage, 3” x 2” adjustable bar catches, chin-up ropes, dip attachments, and landmine attachments are included. Dimensions: 99” tall x 64” wide x 58” deep Weight: 425 pounds Tubing: 3” Gauge: 11 Warranty: 12 years on structural welds and frames, five

years for bushings and bearings Customizing options: Team colors Recent installations:

Dimensions: 104” tall x 64” wide x 58” deep Weight: 630 pounds Tubing: Diameter/Width: 3” x 3”

T&C NOVEMBER 2010

• US Embassy in Afghanistan Power Systems, Inc. • 800-321-6975 www.power-systems.com

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Power Racks Performance Power Rack

As standard features, the Nine-Foot Performance Rack includes five-peg weight storage, bumper plate storage, safety catches, spotters’ platforms, space for a “lever action” bench, and a pulley unit. This combination makes it the perfect weight-training station for any facility.

Signature Full Rack The Williams Strength Signature Full Rack features UHMW protection on all wear areas, three-inch adjustment slots, rubber feet, and a chambered pull-up bar. Raised bottom supports allow an extra-wide squat stance. Dimensions:

104” tall x 49” wide x 72” deep Dimensions:

Weight:

108” tall x 104” wide x 122” deep

1,430 pounds

Weight:

Tubing:

1,500 pounds

Diameter/Width: 4” x 3” Gauge: 7

Tubing:

Diameter/Width: 4” x 3” Gauge: 7

Warranty:

Lifetime

Warranty:

Lifetime conditional warranty on frame components, one year on bearings, 90 days on items not specified Customizing options:

Unique accessories:

Design, team logo, team colors Unique accessories:

• Patented “lever action” bench • Patented “rhino hook” bar catches • Adjustable cable columns with 600-pound weight stack Recent installations:

• University of Connecticut • University of Northern Colorado • University of Kansas Power Lift • 800-872-1543 www.power-lift.com

Customizing options:

Design, team logo, team colors, two-tone paint

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Keiser Power Rack

Keiser Power Racks allow users to train at any speed, from controlled to explosive, for improved power development. Unlike standard racks, the company’s unique hybrid design combines pneumatic and free weight resistance, emphasizing not only strength but stability training as well. Dimensions:

• Removable and adjustable band pegs • Chain and band storage • Four pull-up bar options Recent installations:

• Clemson University • Radford University • Coastal Carolina University • Ohio Northern University Total Strength and Speed • 888-532-8227 www.fatbars.com

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Power Rack

Hammer Strength Heavy Duty Racks are ideal for athletic fitness facilities that take strength to the next level, and are available in six-, seven-, and nine-foot systems. Dimensions:

110” tall x 66” wide x 76.5” deep Weight:

868 pounds Tubing:

108” tall x 73” wide x 103” deep

Diameter/Width: 3” x 3” Gauge: 7

Tubing:

Diameter/Width: 4” x 2” Gauge: 11

Warranty:

10 years on frame

Customizing options:

Team logo, team colors

Design, team logo, team colors

Unique accessories:

• Dual displays satisfy both the user and the athletic trainer • Foot pedal controls allow users to adjust resistance in 1/10-pound increments • Built-in bar and weight storage • Secure locking system allows the addition of accessories for increased versatility

• Band pegs at the top and bottom on the rack • Multiple chin-up handles • 10 Olympic weight plate holders

Keiser • 800-888-7009 www.keiser.com

Life Fitness • 800-634-8637 www.lifefitness.com

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Recent installations:

• University of Louisville • Baylor High School, TN • Canton High School, MA Circle No. 515

T&C NOVEMBER 2010