Training &Conditioning 21.2

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Circle No. 100

March 2011, Vol. XXI, No. 2

contents 32

39

27 Bulletin Board 4 Inviting the media to a workout … Short jump training program may prevent knee injuries … Virginia bans energy drinks at practices and games … Partnering for coverage.

7

Q&A Jeanne O’Brien Bridgewater State University

Sponsored Pages 16 Power Systems Product News

46 Antimicrobial Products 48 Catalog Showcase 50 Aquatic Exercises 51 More Products 52 Advertisers Directory CEU Quiz 53 For NATA and NSCA Members

56 Next Stop: Web Site On the cover: Tahlia Smoke is one of thousands of United States Air Force Academy student-athletes to benefit from the school’s sports vision training program.

Story begins on page 11.

Photo by Mike Kaplan/DenMar Services

TR AINING-CONDITIONING.COM

Optimum Performance

On The Prize 11 Eyes Just like any other muscle in the body, extraocular muscles in

the eye get stronger with training. Athletes at the United States Air Force Academy have been reaping the benefits of a sports vision training program for more than a decade.

By Dr. Michael Zupan & Al Wile

19

Nutrition

Cases Solved

Four athletes, four performance problems. Cases solved through nutrition.

By Beth Wolfgram Treating the Athlete

27 Overuse injuries are commonplace in the competitive running Back On Track

world. The more you know about these injuries, the better you can help your athletes get back on their feet.

By Elisha Cusumano Leadership

It On 32 Passing If teaching a sports medicine class is in your future but you’re not sure where to start, we have a step-by-step guide for the course approval and development process.

By Bart Peterson Sport Specific

39 Unlike working with land-based athletes, training water polo From The Top Down

players means starting at the shoulders instead of the legs.

By Dr. Brandon Marcello

T&C MARCH 2011

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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

Dual Action Knee Strap Patented strap provides relief from knee pain caused by degeneration and overuse. Easy to use, comfortable, allows full mobility.

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 Associate Professor Dept. of Physical Therapy Chapman University Gray Cook, MSPT, OCS, CSCS Clinic Director, Orthopedic & Sports Phys. Ther.

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Keith D’Amelio, ATC, PES, CSCS Strength & Conditioning Coach for Men’s Basketball, Stanford University

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www.cho-pat.com 1-800-221-1601 Circle No. 101

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T&C march 2011

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.

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

Boyd Epley, MEd, CSCS Director of Coaching Performance, National Strength & Conditioning Association

Bonnie J. Siple, MS, ATC Coordinator, Athletic Training Education Program & Services, Slippery Rock University

Peter Friesen, ATC, NSCA-CPT, CSCS, CAT Head Athletic Trainer/ Cond. Coach, Carolina Hurricanes

Chad Starkey, PhD, ATC Visiting Professor, Athletic Training Education Program, Ohio University

Lance Fujiwara, MEd, ATC, EMT Director of Sports Medicine, Virginia Military Institute

Ralph Stephens, LMT, NCTMB Sports Massage Therapist, Ralph Stephens Seminars

Vern Gambetta, MA President, Gambetta Sports Training Systems

Fred Tedeschi, ATC Head Athletic Trainer, Chicago Bulls

P.J. Gardner, MS, ATC, CSCS, PES Athletic Trainer, Liberty High School, Colo.

Terrence Todd, PhD, Co-Director, Todd-McLean Physical Culture Collection, Dept. of Kinesiology & Health Ed., University of Texas-Austin

March 2011 Vol. XX1, No. 2 Publisher Mark Goldberg Editorial Staff Eleanor Frankel, Director Abigail Funk, Managing Editor R.J. Anderson, 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, Trish Landsparger Business Manager Pennie Small Special Projects Natalie Couch 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© 2011 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.

TR AINING-CONDITIONING.COM

Jason Tindal, Head Coach

Eugene Ashley High School Wilmington, NC

After drills, his team chills.

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

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Circle No. 102

Bulletin

Board Challenging the Media When journalists attend a sports team’s practice, their job is usually to sit, observe, and take notes. But for one day last fall, media members covering the Indiana University men’s basketball team did none of those things. Instead, they ran, jumped, lifted, and sweat—a lot.

The event was the Cream and Crimson Survivor Media Challenge, developed by the team’s Strength and Conditioning Coach, Je’Ney Jackson, CSCS, SCCC, and IU’s Assistant Athletic Director for Media Relations, J.D. Campbell.

The two were putting together a video about the players’ offseason conditioning program when they wondered what it would be like to give the media an up close look at a workout.

“We thought putting journalists through a workout would give them an idea of not only what a strength and conditioning coach does, but what players have to go through,” Campbell says. “We also have a new basketball practice facility, and this was a great way to give the media an opportunity to see it.”

Organizing the event was fairly simple. While Campbell found a day that worked well with the team’s schedule, Jackson created the workout regimen. “It was key for Je’Ney to put together a comprehensive program,” Campbell says. “We wanted the media to get an idea of the different aspects of the conditioning and training program and how many different parts of the body our players have to work.”

There was a great turnout, with participants ranging from local beat writers and television reporters to a journalist from the Big Ten Network and ESPN.com’s Pat Forde. The media members went through a typical day of strength and conditioning for the team, including a warmup, a plyometrics circuit, sprints, a tire roll, sled work, and a trip up the Memorial Stadium stairs carrying another person on their back.

“The media’s response was unbelievable,” Campbell says.

“Everyone looked forward to it and had a great time doing it, although more than a few were sore the morning after.”

Jump Training For Prevention A handful of ACL injury prevention programs that focus on jump training have proven successful in recent years, but a common criticism is that they take too long to complete. Now, a recent study shows promise that a shorter program—both in session length and number of weeks needed to complete— may be just as effective.

Published in the December issue of The Journal of Strength & Conditioning Research, the study followed 15 female basketball players who received coaching on appropriate landing technique for 15 minutes three times a week over a four-week period. The goal of the program was to decrease the athletes’ knee valgus angle when landing, which is thought to reduce the risk of knee injury. ­ 4

T&C MARCH 2011

The players had their knee valgus angles measured while performing a depth drop, a jump shot, and a crossover hop test. After the four weeks of instruction, each participant showed an improvement in valgus angle. In the jump shot test, the average improvement was 4.5 degrees in the left knee and 4.3 degrees in the right. While performing the depth jump, the athletes’ left knees improved by an average of 9.8 degrees and the right knees by an average of 12.3 degrees.

On the crossover hop test, an average improvement of almost 75 percent indicated stronger and more stable knees.

Study author Lee Herrington, PhD, CSCS, Lecturer at the University of Salford in England, noted in the abstract of the study that the results are comparable to other jump training programs that require longer sessions over more weeks. While the research addressed only knee valgus angles and not ACL injury risk specifically, the results hold promise for reducing the chance of experiencing this season-ending injury.

To read the abstract of the study, “The Effects of 4 Weeks of Jump Training on Landing Knee Valgus and Crossover Hop Performance in Female Basketball Players,” go to: journals.lww.com/nsca-jscr/pages/default.aspx, click on “Previous Issues,” select “2010” from the drop-down menu, and click on “Volume 24, December 2010.”

Banning Energy Drinks In light of reports about unsafe levels of caffeine in energy drinks, the Virginia High School League (VHSL) has banned the consumption of such beverages at its member schools’ practices and games. The move was recommended by the VHSL’s Sports Medicine Advisory Committee (SMAC) and implemented in late September.

“The safety of the athletes was the overwhelming rationale for approval of the recommendation,” Tom Dolan, Co-Director of Athletics for the VHSL, told the Baltimore Sun. “We’ve been fortunate up to this point [that nothing has happened to our athletes], but is it prudent for us to wait to see if we have an issue before we do something about this? For me the answer is absolutely not.”

The new rule is meant to educate and protect Virginia high school athletes who may not understand the effects of caffeinated energy drinks. The SMAC told the executive committee that energy drinks are not intended for hydration purposes and should not be consumed by athletes who are dehydrated. It also said that with no regulatory control over the various brands of energy drinks, “their contents and purity cannot be ensured” and potentially harmful side effects could result. In addition, many athletes are unaware of the problems associated with consuming high levels of caffeine and sugar.

TR AINING-CONDITIONING.COM

Bulletin

Board A violation of the rule results in an official warning issued by the VHSL, and stricter penalties could follow for repeat violations. “The warning carries multiple meanings in our organization,” Dolan told the Sun. “If a coach intentionally distributes energy drinks at this point, then I think we would put that particular team from that particular school on warning for a year, which means if it happened again during that year, they could be put on probation, which would keep them from going to the playoffs.”

Partners In Care Most high schools would love to provide more athletic training coverage for their student-athletes, but tight budgets tend to get in the way. The Columbus (Ohio) City School District found a solution by partnering with Ohio State University Sports Medicine (OSUSM).

In December, the two groups signed a five-year contract providing Columbus’ 24 high schools with increased levels of sports medicine services for their student-athletes without any additional cost to the school district. The school system will pay OSUSM $240,773 in 2011, with an annual threepercent increase each of the following four years. Previously, Columbus City Schools employed five full-time athletic trainers and OSUSM provided two more for free. Salary increases

At first, I thought it was just a bug bite… but after three surgeries, my life hanging in the balance and over three months of lost training which ended my season

MRSA was the “injury” no one saw coming.

Prevention is the key.

for the athletic trainers would have eventually totaled more than the cost of the OSUSM contract.

“This is a win-win that allows Columbus City Schools to enhance the care of its student-athletes,” says Tom Caldwell, PT, SCS, ATC, Administrative Director of OSUSM. “At the same time, it’s a way for OSU Sports Medicine to pursue all three areas of our primary mission: patient care, education, and research. This agreement gives us the opportunity to grow together for the future of sports medicine in Columbus.”

Through the partnership, OSUSM provides team physicians and seven full-time athletic trainers, including three previously employed by the school district, to cover high school varsity games and help with injury prevention and rehabilitation. In addition, working for OSUSM allows the athletic trainers to branch out and work as researchers, physician extenders, or rehab specialists. They also have greater access to continuing education at OSU. “We’re in the business of sports medicine, so we provide a wide range of opportunities for career development,” Caldwell says. “Instead of being a group of five athletic trainers, they’ve become part of a broader network of more than 20 athletic trainers working for OSU Sports Medicine. That gives them the unique opportunity to pursue work beyond the traditional high school setting, and I think they see a lot of value in that.” n

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Circle No. 103 TR AINING-CONDITIONING.COM

T&C MARCH 2011

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Circle No. 104

Q&A Jeanne O’Brien Bridgewater State University

When it comes to working with athletes, there isn’t much that Jeanne O’Brien, MS, LAT, ATC, Head Athletic Trainer and Clinical Support Supervisor for Athletic Training students at Bridgewater State University, hasn’t seen. And there is no age group she hasn’t worked with.

From teams in high school to NCAA Divisions I, II, and III, to athletes competing in senior games, O’Brien has worked in a variety of settings and interacted with many different populations during her 20-plus years in the field. Throw in her work at home raising four children—ages 10, seven, five, and three—and it all adds up to a perspective well suited for mentoring and educating students who choose the athletic training profession.

As Head Athletic Trainer, O’Brien oversees three assistant athletic trainers and a graduate assistant at Bridgewater State, a Division III school. O’Brien got her start after receiving her bachelor’s degree in Health/Fitness and Athletic Training from Springfield College in 1986 and a master’s degree in Sports Injury Prevention and Management from the same school in 1992. She went on to work as an Assistant Athletic Trainer and Instructor at East Carolina University for a year and then returned to Springfield as the school’s Head Athletic Trainer and an Assistant Professor, working there as it transitioned from NCAA Division II to Division III. In the fall of 2001, she also served as Outreach Athletic Trainer for Plymouth (Mass.) South High School.

In her five years at Bridgewater State, O’Brien has provided coverage for the NCAA Division III men’s and women’s basketball championships, and she spearheaded athletic training services for the NCAA Division I volleyball championships and a variety of NCAA Division II championships during her time at Springfield. O’Brien has also lent her sports medicine expertise to the Boston Marathon, the U.S. Men’s National Wheelchair Basketball team, and various youth sport events. She prides herself on more than a dozen years teaching in athletic training education programs.

We talked to O’Brien about her career experiences and how she strikes a healthy work-life balance. She also shares her views on the differences between the various levels of the NCAA and dispenses advice on working with athletes, coaches, and athletic administrators.

T&C: How is working at a Division I school different from Divisions II and III and high schools?

O’Brien: High schools and Division III teams don’t have TR AINING-CONDITIONING.COM

O'Brien (far left), who has provided coverage at every scholastic level over her 20-plus year career, attends to a Bridgewater State football player last fall. the resources to afford the number of strength and conditioning coaches that Division I schools have. So the athletic trainers often have to spend time putting together the strength and conditioning programs.

But based on what makes sports fun, I prefer Division III, Division II, and high school because at those levels, the athletes are playing for the love of the game—it’s not a job for them like it is for some D-I athletes.

What is your role with strength and conditioning at Bridgewater State?

We use screening techniques to find the athletes’ weakest links and figure out ways to improve their imbalances and strength deficits. Then, we provide teams with programs they can use to help their players become better athletes and prevent injuries—which is our top goal.

In your position, what does it mean to be resourceful?

It means you have to capitalize wherever you can and get good people working with you. For example, in Division I, physicians want to be a part of the athletic program and are tripping over each other to work with you. In Division III, you need to go out and find doctors who love sports and want to T&C MARCH 2011

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Q&A Jeanne O’Brien MS, LAT, ATC Head Athletic Trainer and Clinical Support Supervisor for Athletic Training students at Bridgewater State University During her career, O’Brien has worked at the NCAA Division I, II, III, and high school levels.

Has four children—ages 10, seven, five, and three.

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work with athletes—they’re not banging down the door to work with your teams.

It’s a little more work to find these people and you have to keep your eyes and ears open. That means when you’re talking to a doctor and they seem really excited about athletics, try to think about how you can develop a relationship with them.

An example of that is how we utilize chiropractors here at Bridgewater State.

Chiropractic work is very much like athletic training in that it’s a profession not a lot of people understand. We have great relationships with a couple of chiropractors in the area. We send athletes to them and they spend time on our campus helping out—they take care of us and we take care of them.

How do you strike a balance between athletic training and your administrative duties?

It can be challenging, but I’m lucky to have three great assistant athletic trainers and a talented graduate assistant. We have two facilities and I dance back and forth between them. I take time earlier in the day for administrative and policyrelated stuff. I can also delegate some of my administrative duties, so I’m very fortunate.

What is the time commitment like?

In the fall, I work about 45 to 50 hours a week. I work with the football team then, so about 80 percent of my time is spent providing coverage and 20 percent is for the administrative stuff. In the winter and spring, I’m able to cut back closer to 40 hours a week and I spend about 30 to 40 percent of that time doing administrative tasks. The quieter seasons allow me more time to work on tasks like Web site development, our handbooks, or updating our emergency plan.

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What is your approach to working with administrators?

It starts by having an understanding of what their job entails. There are all sorts of variables they deal with and we have to understand that they’re probably juggling a lot of different things—just because I want something to change, it doesn’t mean that’s my athletic director’s top priority at the time.

If I have an issue that deals with safety, my communication is direct and the problem is taken care of immediately. But if it’s something that’s not so serious, I’ll ask for a meeting or send an e-mail about it. I have bi-monthly meetings with my athletic director to make sure the lines of communication are open between us.

They’re usually very short and we just fill each other in on what’s going on.

TR AINING-CONDITIONING.COM

Q&A What are the keys to building effective relationships with coaches?

It’s getting to know the coach and understanding their needs and where they come from. Another big part is helping them understand that I’m not here to be an obstacle and sit their athletes out. I let each coach know that I want athletes participating, but if it’s not safe for them to play, then they won’t play. It’s about building trust so the coach understands that if I’m holding someone out, there’s a good reason for it.

However, building that trust takes time—it’s not always there when you show up on the job. And depending on if a coach had negative experiences with a previous athletic trainer, you may have to do damage control at first. Or, they may have worked with who they considered the best athletic trainer ever, and then you showed up so they’re not sure about the change yet.

What do you tell young athletic trainers about working with coaches?

Sometimes it’s hard work. And there are some coaches who you’re not going to win over. You have to be diligent and constantly educate coaches and athletic directors about the role of the athletic trainer.

You also need to set boundaries.

When you’re younger, it’s hard to be confident and self-assured all the time, which makes it harder to win some coaches over. But even if you can’t win them over, you just do the best you can and do your job.

How do you find a healthy worklife balance?

It’s very challenging because even though I can temper my hours, I cover a lot of weekend events. Meanwhile, my kids always have stuff going on during the weekends, so it can be very stressful for our family. But I do make sure that the people I work with know how important spending time with my family is to me. If I’ve met my hours, my work is done, and I don’t need to be there, I’ll be with my family instead.

TR AINING-CONDITIONING.COM

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Q&A Before I had a family, I was the type of person who would be at work all the time and when I socialized, I hung out with my athletic training friends. Now, that’s not the case. Having a family also makes it important for me to choose my employers wisely, and make sure they understand that I will do my job and do it well, but family is the most important thing to me. This also means that I won’t be able to work in every athletic training setting out there.

What are the keys to providing good coverage at NCAA championship events?

Really, it’s working closely with the athletic administrators on site and people from the NCAA who are in charge and just doing whatever they ask. Don’t try to do things your way—it has to be their way. Service is the key. When we host an event, I want all of the athletes to feel welcome and know that they’re special. Whatever they need, we’re here for them.

What’s the biggest challenge facing the athletic training profession?

Even though our membership is doing a really good job of educating the public about athletic training and what we do, I think our name is still a big problem. There are people, even in the healthcare profession, who still say “trainer” instead of “athletic trainer.”

I think we’re doing everything we can, but we need compliance from the membership and to have the education programs be adamant about teaching students that it’s the “athletic training facility,” not the “training room,” and stuff like that. Yet, even when we do that, there are athletes and coaches who still yell “trainer” when they need something.

It’s hard to overcome.

Are there any newer modalities you’re excited about?

I do a lot of manual therapy and am certified in the Graston Technique—a soft tissue instrument-assisted mobilization technique. It uses stainless steel instruments to break down scar tissue and restrictions in soft tissue, which helps athletes heal faster.

What are the keys to keeping the profession fresh and exciting?

I really believe in reading and seeing what other professionals are doing to continue advancing their skills. I tell my students they need to constantly think about what they can do to make themselves better athletic trainers after they enter the workforce. It’s something I’m always thinking about and it’s why I believe in manual therapy and learning from chiropractors, osteopaths, physical therapists, orthopedists, and other athletic trainers. n

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Circle No. 107

HUMAN KINETICS The Premier Publisher for Sports & Fitness

Eyes On The Prize

Just like any other muscle in the body, extraocular muscles in the eye get stronger with training. Athletes at the United States Air Force Academy have been reaping the benefits of a sports vision training program for more than a decade.

United States Air Force Academy junior tennis player Tahlia Smoke saw the school’s sports vision training program pay off last year when she became the program’s first nationally ranked player since it moved to NCAA Division I. Mike Kaplan / DenMar Services

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Optimum performance

By Dr. Michael Zupan & Al Wile

H

ow much can sports vision training improve an athlete’s performance?

This is by far the most common question we receive here in the Human Performance Laboratory at the United States Air Force Academy. Unfortunately, we cannot quantify exactly how much sports vision training will increase a baseball player’s batting average, a basketball player’s shooting percentage, or a goalie’s save percentage.

But we can tell you that in 1995, the first year we implemented a six-week training program for our baseball players, the team led the nation in hitting and slugging percentage. We can also tell you that the data we’ve collected show anywhere from 24 to 114 percent improvement in athletes’ visual-motor performance over the course of their playing career at the USAFA. Finally, we can tell you what our athletes and coaches think about it. Our baseball players say that they are able to pick up the spin of the ball coming out of the pitcher’s hand earlier, other athletes say that their eyes don’t fatigue as quickly, and our coaches end up wanting their players to start coming in year-round instead of only during the off-season because they’ve noticed a dif-

Michael Zupan, PhD, is Director and Al Wile, MS, is Assistant Director of the United States Air Force Academy’s Human Performance Laboratory. For more information about the Lab, go to: www.goairforcefalcons.com and click on “Performance Lab” under the “Inside Athletics” drop-down menu.

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Optimum performance ference in their athletes’ performance.

Here at the USAFA, vision training is an integral part of performance enhancement. In our mandatory six-week off-season program, athletes train for 15 to 20 minutes at least three times a week. After each training session, we update each athlete’s file. Currently, we have a vision training database that includes data from over 2,000 athletes— some with over 100 training sessions throughout their four-year playing career—and it shows tremendous improvements in all of our athletes’ visualmotor performance.

Although there are a variety of different sports vision training programs in which an athlete sits down at a computer to use a software program, we feel the best results come when athletes most closely mimic the specific demands of their sport. Having athletes engage in sport specific behavior while training the eye establishes neural connections between the brain and the body’s large muscle groups, which is very important for making improvements on the field, court, or ice.

Walk into the Human Performance

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Lab, and you might see one of our athletes training in their playing stance—for example, a soccer goalie in a crouched position anticipating a shot on goal. Training in this life size, sport-specific mode allows the athletes to better integrate all their peripheral sensory inputs, including the vestibular system (which helps the body maintain good balance) and muscle proprioceptors (which help promote spatial awareness).

Think of sports vision training as an extension of athletic motor skill development. To increase performance, athletes must develop visual motor skills throughout their careers to allow the eyes to perform effectively and efficiently. The idea is similar to motor skill development for a baseball swing. A baseball player develops his swing throughout his career based on visualization and motor input from his last game, batting practice, or coach’s advice. This same progression occurs in the eyes.

Most of our work strives to increase the endurance of the six extraocular muscles, which results in a decrease in eye fatigue that may occur during

a game or over the course of a long season. The extraocular muscles, like any other striated muscles, tire when stressed. All athletes work their eyes during practices and games, but our 20-minute vision training session specifically overloads the extraocular muscles. These muscles then respond by getting stronger and becoming more resistant to fatigue.

As athletes progress and begin to master the exercises, distractions are added to increase the level of difficulty. These include having several athletes training at the same time call numbers out loud, playing loud music in background (sometimes music they like, sometimes music they don’t), having people walk around and in front of athletes, and using modalities such as a BOSU ball, mini trampolines, or balance boards.

The exercises we choose for our athletes concentrate on six areas: saccadic (rapid) eye movement; eye-hand speed and coordination with central peripheral awareness; stereopsis and depth perception; dynamic visual acuity; accommodation; and visual memory, focus, and concentration. In all

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Optimum performance six areas, we use established exercise physiology principles such as individuality, specificity, and progressive overload with the overall intent to fatigue the eyes so they will recover and be stronger.

Saccadic eye movement: Saccade ex-

In our drills, an athlete stands in their athletic position eight feet from a wall. On the wall directly in front of them are two vertically-aligned letter charts placed 10 feet apart. Looking at the chart on the left, the athlete reads the first letter out loud, then

horizontal charts as well, with one placed 10 feet above the other.

The athlete must do this exercise without moving his or her head—only their eyes. As the athlete progresses, we move the charts further apart, forcing the eyes to span a greater distance.

Our program at the USAFA has been so successful improving depth perception that our base optometry clinic sent us 10 cadets who failed the depth perception portion of their pilot qualification test. In all 10 cases, we were able to get the cadets proficient enough to pass the test. ercises improve muscular endurance and help athletes improve their ability to focus on a single spot or object, like a baseball coming out of a pitcher’s hand or a lacrosse ball coming toward them. We use both horizontal and vertical saccade exercises to train athletes to move their eyes quickly and efficiently from target to target while enhancing their visual processing abilities.

quickly moves his or her eyes to read the first letter on the right chart. The athlete then repositions their eyes back to the left chart to read the second letter, then the second letter on the right chart, and repeats the sequence for two 60-second intervals. Calling each letter out loud ensures the athlete is reading the correct letter and fully processing the image. The athletes do this with

We’ll separate the horizontal charts up to 16 feet and the vertical charts as far as we can before they hit the ceiling.

Eye-hand speed and coordination with central peripheral awareness: A skill vital to all athletes, especially goalies, eye-hand coordination needs to continually be developed. And for the athlete on the soccer field or ice rink, peripheral awareness allows them

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Optimum performance to be aware of teammates open for a pass or opponents coming toward them while maintaining concentration on handling the ball or puck.

Our athletes use several eye-hand training devices, all similar in nature.

They include the Accuvision 2000, Dynavision D2 Sport Vision Trainer (SVT), Wayne Saccadic Fixator boards, and the Makoto Arena. These boards have targets to strike when they light up: The D2 has raised buttons, the SVT has a 2.5-inch target, and the Accuvision has a one-inch target.

We start each exercise at a low speed and increase the pace once an athlete hits 80 percent of the targets at a given speed. During these exercises, we emphasize the importance of keeping the head still and the eyes fixated on the

One of the simplest exercises to improve stereopsis and depth perception is the Brock string exercise. The Brock string is a 20-foot length of string with colored beads on it spaced four feet apart. While the athlete holds the string at the tip of their nose and the other end is attached to a fixed point in front of them, they begin by looking at the first bead. If they have excellent depth perception, they should see two strings coming into the bead at the vertex and two strings exiting directly behind the bead. It should look like an X with the bead right in the middle.

An athlete who sees the strings meeting three inches short of the bead needs to train his or her eyes to relax and gaze further into the distance. When they do this, they will actually see the

perception portion of their pilot qualification test. In all 10 cases, we were able to get the cadets proficient enough to pass the test and they are now all pilots in the Air Force.

Dynamic visual acuity: As athletes move up the ranks from high school to college to the professional level, the game gets faster in every aspect. Therefore, having excellent dynamic visual acuity is just as important as having 20/20 static visual acuity.

Dynamic visual acuity is the ability to track moving objects, often while the athletes themselves are in motion.

Picture a receiver running across the field while tracking the ball with the stands in the background.

To improve our athletes’ tracking abilities, we use a variable speed rotator scanner, which has random num-

A skill vital to all athletes, especially goalies, eye-hand coordination needs to continually be developed. And ... peripheral awareness allows them to be aware of teammates open for a pass or opponents coming toward them while maintaining concentration on handling the ball or puck. center of the boards. We ask them to do this because it increases their peripheral awareness for the distance lateral targets.

Stereopsis and depth perception: Several of our exercises work to improve binocular vision, which results in better stereopsis and depth perception. Stereopsis is the processing of the slightly different images each eye sees while looking at something to determine depth. For example, a righthanded batter standing at the plate may have his right eye three inches behind his left eye when looking at a pitch, yet the brain decodes the two slightly different images and allows him to determine where the ball is in flight. The batter then decides exactly where to swing the bat.

Good depth perception allows athletes to judge where objects are in space, including estimating distances accurately. Have you ever wondered why some great running backs never return punts or kickoffs? It may be because they have difficulty following the football over a long distance due to poor depth perception and/or tracking skills. ­4 1

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X will move toward the bead. If this athlete were a basketball player, the initial visual input would have caused him to perceive the hoop to be closer than it actually is. If he trains on this exercise long enough, his eyes will become “retrained” to focus on the hoop at the right depth.

This exercise gives immediate feedback to athletes on how well their eyes are “working” that day. And we’ve found that accuracy varies based on how much sleep an athlete has gotten during the week or how much stress their eyes have been under.

We have also modified this exercise to be sport specific. For example, our basketball players use longer strings that are attached 10 feet in the air (the height of a regulation basketball hoop) to help with their shooting accuracy. And baseball infielders and soccer players hook the string near the bottom of a wall and do the exercise with a downward gaze.

Our program at the USAFA has been so successful improving depth perception that our base optometry clinic sent us 10 cadets who failed the depth

bers and letters on a 24-inch rotating disc. The letters are attached with Velcro so we can change their location each week. Athletes stand eight feet away from the rotating disc and identify as many digits and letters as they can per one-minute session. They need to move their eyes at the same speed as the disc to pick out the correct letter.

We don’t allow athletes to just fixate on one location and wait for the letters to come into view.

Results are recorded on a daily workout sheet, and once an athlete has correctly identified eight or more letters in a minute, they will train at a faster speed at their next session.

We’ve found significant disparity in dynamic visual acuity performance among our athletes. Some of them rarely reach eight correct responses over multiple sessions, while others quickly improve their tracking ability and progress to higher speeds. Not surprisingly, most of the athletes in the latter group are our better on-field performers.

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Optimum performance cess, which requires the eyes to maintain focus as they look back and forth from an object in the distance to one close to them, or as they track an object coming toward them. The accommodative system is important for any athlete who plays with a ball or puck, including a wide receiver running a route downfield who quickly turns his head to find the football or a hockey player trying to keep the puck on his stick as he looks up for a teammate to pass to.

One simple exercise we use is the near-far drill. A chart with 36-point type is posted on the wall while the athlete holds another chart with 9-point type. The athlete stands 20 feet from the wall while keeping the small chart four to six inches from their eyes, positioned directly below the wall chart in their path of vision. The athlete reads the top left letter from the wall chart out loud, then quickly refocuses to read the top left letter on the hand-held chart, and continues going back and forth between the charts for two 60-second sessions.

Visual memory: We believe sport-specific visual memory exercises develop more efficient processing of available visual information, which improves athletes’ focus, concentration, and reaction skills. These drills are also fun because athletes can compete with one another.

One of our most competitive training exercises is the tachistoscope, which works to improve our athletes’ focus and concentration. The tachistoscope consists of videos that flash action photos with sets of numbers embedded in them. The photos are flashed on a large screen for varying amounts of time, ranging from 130 to 1,000 milliseconds, and our athletes have to correctly identify and record the numbers they see.

A follow-up slide with the same image is shown with the answers so the athletes can immediately score their responses.

Entire teams view the images together, making it a competitive situation in which teammates try to best one another.

This is another exercise in which we see a wide disparity among athletes. The tendency is for them to scan the screen from left to right rather than relax their eyes and take in the entire image at once. With practice, they learn to view the entire image and see the embedded numbers, and our best athletes are capable of processing three- or four-digit numbers at a flashing speed as fast as 130 milliseconds per image.

We also recently began using strobe glasses, which allow athletes to perform sport-specific activities (quarterbackreceiver routes, basketball passes, baseball bat swings) with discontinuous visual input. This means they will only see the ball at various points in space, not continually. This forces an athlete’s eyes to project where the ball is headed. They start at a quick LCD strobe speed and continue to slow the strobe down, which disrupts the visual image for longer.

So why should vision training be part of your athletes’ regular training program? Well, why do athletes train for strength and power in the weightroom? Why do we stress proper nutrition to them? The answer is improved performance.

Do basketball coaches want their players shooting free throws that fall four inches short? Do volleyball coaches want their liberos to react late to high velocity spikes? Do ice hockey coaches want their goalies to be slow in picking up slap shots? Of course not! But remember, the body reacts only after the eyes send the proper information to the brain.

Your athletes cannot hit, catch, or block something they don’t see clearly. n TR AINING-CONDITIONING.COM

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START - Begin by sitting on the floor with your legs extended. Your trainer or coach should be standing at the end of your legs facing you. Lean your upper body back approximately 45 degrees on to your hands or elbows. Lift your legs off the floor and flex your knees toward your chest.

ACTION - The trainer or coach should controllably push the ball toward your feet and in a forceful manner extend your legs kicking the ball back to your trainer or coach.

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Your trainer or coach should be standing to the right or left of your legs and facing you ACTION - Have your trainer or coach toss the ball into your hands. Catch the ball and touch it to floor on the opposite side of where you caught the ball. Toss the ball back to your trainer or coach.

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NUTRITION

Cases Solved Four athletes, four performance problems. Cases solved through nutrition.

By Beth Wolfgram

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In this article, I’ll recount the stories of four athletes who came to me for help with a need, goal, or challenge.

As you’ll see, each athlete took a unique path, and it wasn’t always easy. (Note that aliases are used to protect the athletes’ privacy.)

EXTREME FATIGUE Sasha, a Nordic skier at an NCAA Division I school, was experiencing extreme fatigue after her summer workouts, which included bicycling, running, roller skiing, and hiking. She also felt her energy level was low during training sessions and it seemed that recovering from workouts was becoming more difficult.

The team physician referred Sasha to me after her ferritin Beth Wolfgram, MS, RD, CSSD, CD, CSCS, is a sports dietitian in the University of Utah athletic department and for the NBA’s Utah Jazz. She is also an adjunct faculty member in the University of Utah’s Department of Nutrition. She can be reached at: beth.wolfgram@hsc.utah.edu.

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joanne andrews

I

f an ice hockey coach sees that a player needs to perfect his puck handling skills, he may spend some extra time with him on the ice after practice. If a basketball player is looking to improve her jump shot, her coach may give her a set of drills designed to help her meet that goal. If an offensive lineman is getting pushed around more times than he’s able to stand his ground, his strength and conditioning coach may add certain exercises to his workout program.

As these examples illustrate, each athlete’s performance needs, goals, and challenges are unique. It’s clear that an athlete’s work on the ice, court, field, and in the weightroom is a big factor in helping them perform their best. And since food is critical for fueling performance, building muscle mass, delaying fatigue, and enhancing recovery, nutrition also plays a big role. In many cases, it is the final piece to the puzzle for optimum performance.

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NUTRITION was measured at 25 nanograms per milliliter (ng/ml). Ferritin is a protein in the body that binds to iron, and low levels often indicate an iron deficiency.

Normal levels vary, but the university where Sasha competed had an iron protocol in place that aimed for a ferritin level of at least 35 ng/ml for female athletes.

On the surface, Sasha had a pretty healthy diet for a college student. She ate cereal with milk for breakfast, a sandwich or leftovers for lunch, and vegetables with some type of meat for dinner. But after completing her nutrition assessment, I was concerned because she wasn’t taking in enough protein, iron, and overall calories.

As a female endurance athlete, Sasha was also at greater risk for an iron deficiency—which can have a negative impact on an athlete’s performance and overall health. On the positive side, her menstrual cycle was regular and not heavy, and she was sleeping about eight hours a night.

Strategy: We set a goal of improving Sasha’s ferritin level to at least 30 ng/ml. She had a history of low fer-

ritin and had been using iron supplements off and on for a few years. Right away, I had Sasha focus on improving her dietary intake of iron to get her closer to consuming the recommended 18 milligrams per day. We focused on heme sources of iron since they are absorbed by the body better than nonheme sources.

To do that, I recommended she incorporate beef (which has between 2.5 and 4.5 milligrams of iron per threeounce serving) into her diet four times a week and chicken or turkey (which both have about 1.0 milligram of iron per three-ounce serving) daily. This also helped increase her overall daily protein intake.

I also suggested she start eating cereals fortified with iron every morning.

Grape Nuts, Kellogg’s Complete Bran Flakes, Quaker Oatmeal Squares, and Post Trail Mix Crunch all have more than 24 milligrams of iron per cup.

Since studies have shown that vitamin C helps to improve the absorption of iron, Sasha added orange juice to her breakfast meals as well.

Finally, in addition to the long-

term dietary changes, I asked Sasha to commit to taking an over-the-counter ferrous sulfate supplement of 325 milligrams daily. This would help her deficiency immediately and was something she most likely could discontinue after her ferritin level was in the desired range. We scheduled a follow-up appointment for three months later, and I checked in with Sasha regularly during the fall semester to ensure she was following the recommendations.

Outcome: At her three-month checkin, Sasha’s ferritin level was 30.90 ng/ml. And most importantly, she was feeling better. She said she had more energy during and after training sessions and felt she was training well.

Sasha continued following the dietary recommendations I had given her throughout the winter and had a successful ski season. When she reported for her physical the following August, her ferritin level was measured at 47 ng/ml—a great improvement in just one year.

POOR TIMING Mike was a running back who came

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NUTRITION to me during the off-season before his senior year in high school. He wanted to make sure he was doing everything he could to maximize his performance and be healthy, including eating right.

He also wanted to lose about 10 pounds before the next season began.

I learned that a typical weekday for Mike meant skipping breakfast, having an energy bar or sandwich for lunch because of his class and practice schedule, then eating a large family dinner late in the evening, which usually consisted of steak or chicken and rice. Mike also admitted to snacking every night on chips, cookies, and whole milk while studying. On the weekends, he would often go out to eat with his friends.

Mike was six feet tall and weighed 235 pounds. He was working hard in the weightroom—strength training four times a week and running or doing conditioning work two times a week. Based on this information, I calculated his energy needs to be approximately 3,500 calories per day for weight maintenance and 3,200 calories per day if he wanted to lose weight and body fat.

I immediately knew that Mike’s challenge was not just how much food he was consuming, but the timing of when he ate. He was eating very little during the day when his body needed the fuel for classes and practice, and he would overeat at the end of the day because he was so hungry. Then he would go to bed stuffed and frustrated that he ate so much. Rather than focusing on decreasing calories, we focused on fueling his body more evenly during the day and making healthier food choices overall.

Strategy: I showed Mike what a healthy day would look like if he divided his calories into several smaller meals instead of consuming the majority of his calories at dinner and late at night. Initially, he was not eager to add in breakfast, so I suggested a snack or “mini meal” like a peanut butter and jelly sandwich with a piece of fruit or yogurt with cereal mixed in. I explained that the goal was to get him in the habit of eating something in the morning that would fuel his body for the day ahead.

I also suggested making lunch a part of his daily routine. This meant planning ahead and making something the night before so he could grab it from the fridge when he left in the morning. The sandwiches that he was sometimes eating were great options since they were balanced with carbohydrates, protein, TR AINING-CONDITIONING.COM

and some fat—He just needed to eat them on a consistent basis.

Mike added a small snack like a sports bar or container of chocolate milk after practice so that when he got home for dinner or ate out with friends he wouldn’t feel famished and be likely to overeat. (Chocolate milk is also a great recovery beverage, so there was an added bonus to this choice.) His dinners remained similar, just a little smaller.

And I had him switch his nighttime snack to two-percent milk and just a few cookies instead of an entire sleeve.

Outcome: Mike checked in with me several times a week for support. He would often call when he was out to eat and together we would decide what the best options were for him. It took a lot of dedication and discipline for him to get both breakfast and lunch in.

And of course, some days were better than others.

Over the next two months, Mike’s diet improved drastically. He decreased his weight to 224 pounds while maintaining his strength in the weightroom.

It was also important that he didn’t feel

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NUTRITION

MY PHILOSOPHY As a sports dietitian, I try to find the right formula to help each athlete I work with perform their best. This means understanding each of their unique needs, goals, and challenges, then making the right dietary and lifestyle recommendations. To be most effective, I aim to do five things: Include the athlete in the process. They know their body best and typically have great input about what their challenges are and what is realistic for them in their daily life.

Gain the athlete’s confidence. This means being a reliable and trustworthy source for nutrition recommendations that will work for them.

Keep things simple and realistic. All too often, athletes come to me wanting to completely overhaul their diet. But I have found that making multiple drastic changes at once is not manageable for most. Instead, I keep recommendations easy to follow and suggest making only one or two changes at a time.

Take into account the lifestyle of the athlete. This could include their living arrangements, financial situation, if they are working full-time, or if they’re carrying a full class load. The challenges that typically arise for a college freshman living in the dorms are very different from those of a veteran professional basketball player. The more I understand an athlete’s day-to-day life, the better I am able to help them.

Work as part of the multi-disciplinary team. This includes keeping the lines of communication open between coaches, athletic trainers, team physicians, strength and conditioning coaches, sport psychologists, and the athletes themselves. All of us must work together if the athlete is going to maximize their performance.

deprived. We had not eliminated his favorite foods, but instead changed the timing of his meals to properly fuel his body. Mike continued to work on his eating habits during the summer and had a great senior year before earning a scholarship to play football at an NCAA Division I college.

LOSING WEIGHT Greg was referred to me by his college tennis coach at the beginning of his freshman year. His coach felt he had great potential, and that if he could lose some weight and reduce his body fat, an even better player would emerge. Greg was red-shirting his freshman year, which gave us plenty of time to work on these goals.

Weighing in at 190 pounds and registering 17-percent body fat, Greg’s coach wanted to see the six-foot tall athlete lose 15 pounds. Greg’s activity level was already high—he was conditioning three times a week and playing tennis ­22

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six times a week—so it was obvious his diet needed to change.

Living on campus and eating mostly in the dining hall, Greg’s daily diet included eggs and hash browns for breakfast, pasta or a sandwich for lunch, and pasta or sometimes meat and vegetables for dinner. He did not eat snacks during the day and didn’t keep any food in his dorm room.

Greg felt that he was a healthy eater and worked out regularly, so he wasn’t sure if his coach’s goal of losing 15 pounds was realistic. I also questioned the coach’s focus on body weight and was concerned about Greg getting enough fuel for his workouts if we were to lower his caloric intake to stimulate weight loss. So I talked with both Greg’s tennis coach and strength and conditioning coach to ensure we were all delivering the same message. We agreed that if his strength, endurance, or overall performance started to diminish, we would reevaluate Greg’s goals.

Strategy: Greg and I set a goal for him to lose about one pound per week in order to meet the long-term goal of 15 pounds of weight loss by the end of the semester. I calculated his calorie needs to be between 3,200 and 3,400 per day for weight maintenance and between 2,700 and 2,900 per day for weight loss. But I didn’t focus on counting calories. Instead, I gave Greg the simple advice to include fruit with breakfast, vegetables with dinner, and protein at each meal so he wouldn’t be hungry and crave high-fat foods.

We also discussed the pros and cons of keeping a food log. Although doing so is time consuming, Greg felt that it would help him be aware of his intake, make healthier choices, and stay on task with his goals.

Once a week, Greg weighed in with his strength coach and worked on one or two areas of his diet that I recommended he change based on his food log. For example, the first week, I suggested switching from two-percent milk to one-percent or skim and cutting back on fruit juices by instead drinking lowor no-calorie beverages. Every two to three weeks, we met in person to discuss challenges such as knowing an appropriate portion size, eating well in the dining hall, making healthy choices while eating out, and fueling his body for practice.

As the weeks passed, his diet began to include a lot of fruits and vegetables, as well as whole grains and other foods high in fiber. At one point, Greg was so motivated that he told me he wanted to eliminate all junk foods in hopes of speeding up his weight loss. I discouraged eliminating these entirely, which prompted a good discussion about enjoying the food you eat, the concept of moderation, and how depriving yourself can actually backfire. Greg made the smart decision to incorporate some type of small treat daily. (For a more detailed look at Greg’s food log, see “Writing It Down” on page 24.)

Outcome: With simple changes and no intentional cutback on daily calories consumed, Greg lost five pounds in the first month. After 10 weeks, he lost another seven pounds and reported that he was still feeling strong and playing well. There were a couple of times when Greg reduced his daily calories too much, and it was immediately obvious because he reported feelTR AINING-CONDITIONING.COM

NUTRITION ing weak, light headed, and dizzy in his food log. But as time progressed, he became more in tune with his body and knowledgeable about how to fuel it without depriving himself.

After 15 weeks, Greg made amazing progress! He weighed in at 172 pounds and his body fat was down to 10.7 percent. His fruit and vegetable consumption had improved from one to two servings a day to five to six servings per day. And he became very proficient at timing his meals and snacks around workouts so his energy level and performance rarely suffered. Just as important, Greg learned a lot about good nutrition that will stay with him throughout his life.

Julie found the meal plan helpful because it gave her permission to eat and took away the pressure of figuring out what she could eat. She felt a sense of relief. Every few weeks I would also challenge her to try one of the “scary” foods she normally didn’t allow herself to eat.

HEALTHY EATING HABITS While conducting incoming athlete nutrition evaluations one August, I discovered Julie had a history of disordered eating. She had been involved in gymnastics her whole life—a sport in which eating disorders and disordered eating are still very common. Like many gymnasts, her coaches focused heavily on her weight throughout her career. It was

competed for was infamous for having gymnasts with disordered eating and full-blown eating disorders. The coaches weighed their gymnasts frequently and made comments about their bodies and weight. This made it difficult for Julie to be at peace with her own body.

Over the next few years, she struggled with injuries and her weight fluctuated numerous times before she

not acceptable for her weight to fluctuate, even when she was injured.

When I first met with Julie, she was not interested in working on her eating patterns. Although many people had expressed concerns to her previously, she had always ignored them, saying she “didn’t think she had a problem.” The club team that she previously

approached me. She was ready to work on eating healthier and taking care of herself.

Strategy: Julie had many deeply ingrained thoughts and perceptions about her body and nutrition. Like many athletes with eating disorders and disordered eating, she had plenty of rules about how much food she

could consume, what foods she could or couldn’t have, and how much she should weigh.

Julie came to me at the end of the season and we met weekly for four months. Each week we set small, realistic goals for her. The first area we worked on was establishing basic healthy eating patterns and maintaining a healthy body weight.

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Circle No. 116

2/8/11 10:26 AM

T&C MARCH 2011

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NUTRITION

WRITING IT DOWN The following details two daily entries from the food log that Greg started keeping while we were working together.

By comparing week one to week 15, you can see the vast improvements he made in food choices.

-Hot chocolate -Two chocolate chip cookies -Two-percent chocolate milk -Raspberry iced tea From week 15 8:15 a.m. (breakfast) -Raisin Bran cereal with skim milk -Banana -Scrambled eggs -Tea 11 a.m. (snack) -Yogurt -Apple 12:30 p.m. (lunch) -Turkey, ham, and cheese on a whole wheat wrap with lettuce, tomato,

peppers, cucumbers, and a small amount of mayonnaise -Crystal Light -Skim milk -Apple 4:30 p.m. (snack) -String cheese -Grapes 6:30 p.m. (dinner) -Large salad consisting of spinach, tomatoes, cucumbers, carrots, peppers, broccoli, and light dressing -Pulled pork sandwich -Crystal Light -Skim milk -Pear

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From week 1 10 a.m. (snack) -Strawberry milk -Sports bar 12:30 p.m. (lunch) -Turkey, ham, and cheese sandwich with mayonnaise -Cheese quesadilla -Two chocolate chip cookies -Two-percent milk -Sports drink 6:15 p.m. (dinner) -Salad consisting of iceberg lettuce and dressing -Two pieces of chicken cordon bleu, potatoes, and green beans

NUTRITION Together, we developed a modified meal plan that included safe and familiar foods, yet fueled her body with adequate calories and macronutrients.

This plan did not give exact guidelines for types of foods and amounts, but did offer suggestions to show what a “healthy” day of eating three meals and three snacks would look like.

Julie found the meal plan helpful because it gave her permission to eat and took away the pressure of figuring out what she could eat. She felt a sense of relief. Every few weeks I would also challenge her to try one of the “scary” foods she normally didn’t allow herself to eat.

Since the mental health piece was beyond my scope of practice, I referred Julie to a therapist who specialized in eating disorders and disordered eating and she met with him weekly.

The therapist was a sounding board for Julie to discuss her anxieties and fears, as well as self esteem issues and the body image distortion that was so prevalent for her. This was invaluable to helping her develop a healthy relationship with her body.

As we continued meeting, Julie and I discussed the challenges she felt she was facing and wanted to work on. For example, she was weighing herself several times a day when we started meeting, but after several weeks together she agreed to weigh herself only once a week—a major step for her.

As we progressed, I began to address the concept of intuitive eating and how to work with her body, not against it.

Over the years, Julie had learned to tune out her feelings of hunger and satiety, so intuitive eating was a very foreign concept to her. We used the hunger/satiety scale in addition to her food log to help guide her. Much like a pain scale, a hunger/satiety scale allows athletes to rate their level of hunger on a zero-to-10 scale (zero being famished and 10 being uncomfortably full).

The idea was to get Julie to figure out how to honor to her body—to eat when she was hungry and to stop when she was full. Though she was confused at first because she wasn’t used to feeding her body when it was hungry, she eventually figured out how to feed it effectively. (For a downloadable hun-

ger/satiety scale, go to: www.trainingconditioning/HungerSatietyScale.pdf.)

Outcome: Working with Julie was a process that included many steps forward but also some steps backward.

Julie was slowly able to move away from the disordered eating habits that had plagued her for years—like weighing herself frequently and depriving herself of certain foods. She began to focus more on how she felt overall, her energy level, and how her performance correlated to her eating.

Her injuries healed and she began performing very well in the practice gymnasium and the weightroom. Julie continued to work on intuitive eating and listening to her body’s signals while the meal plan provided the structure that she needed. She also kept visiting her therapist, whom she found to be very helpful in dealing with her body image concerns, anxiety, and stress level.

Julie went on to have an excellent gymnastics season and remained injury-free. But more importantly, she developed a much healthier relationship with her body and with food. n

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Circle No. 120

TREATING THE ATHLETE Author Elisha Cusumano helps top runners at the University of Oregon, like Matthew Centrowitz (left) and A.J. Acosta, avoid overuse injuries.

BACK ONTRACK Geoff Thurner

Overuse injuries are commonplace in the competitive running world. The more you know about these injuries, the better you can help your athletes get back on their feet.

By Elisha Cusumano

A

lot of competitive runners and their coaches have come to believe that if 40 miles per week is good, then 80 miles per week must be better.

Many more are of the mindset that a day off is a bad thing. Put those two issues together, and it’s easy to see why overuse injuries have become commonplace in the world of competitive track and field.

And unfortunately, those runners don’t always stop when an overuse injury is sustained. One of the mantras being hammered into the minds of distance runners is that second place hurts more than a stress fracture—a statement any athletic trainer would find wince-worthy.

TR AINING-CONDITIONING.COM

In my position working with the track and field and cross country teams at the University of Oregon, two of the most frequent injuries I see in distance and middle distance runners are plantar fasciitis and Achilles tendinosis. In this article, I’ll explain what these injuries mean for a runner, how you can help them recover as quickly as possible, and how to keep other athletes on the team from suffering the same fate.

PLANTAR FASCIITIS Plantar fasciitis is present when the plantar fascia, the fibrous band of tissue that reaches from the heel to the toes and supports the muscles and arch of the foot, becomes overstretched and tiny tears riddle its surface. Some ear-

ly detection signs include general soreness on the calcaneus and plantar fascia that gradually increases over time. Pain, which can be quite significant, will eventually settle in the plantar fascia near its attachment to the calcaneus (or heel bone).

Sharp pain upon an athlete’s first step out of bed in the morning or after long periods of sitting is a tell-tale sign of plantar fasciitis. This is due to the lengthening and weight loading of Elisha Cusumano, MS, ATC, is an Assistant Athletic Trainer at the University of Oregon, where she works with the men’s and women’s track and field and cross country teams. She can be reached at: cusumano@uoregon.edu.

T&C MARCH 2011

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TREATING THE ATHLETE the plantar fascia after it has spent significant time in a shortened, non-weight bearing state. Since the tissue has been damaged with micro tears, it is not able to appropriately increase in length under the weight load.

Plantar pain can severely limit a runner’s ability to train, especially since the majority of pain is felt at the beginning of a workout, making it hard to progress beyond the first 10 to 15 minutes.

It’s important that runners understand

loading of the lower extremity, which means the foot (and ultimately the plantar fascia) must absorb more shock.

One final significant aspect to evaluate is ankle joint motion, specifically dorsiflexion. A limited amount of dorsiflexion in the ankle joint can cause increased movement through the midfoot, leading to excessive pronation. A tight Achilles tendon is often to blame when dorsiflexion is limited.

Intervention: At the first sign of pain,

A simple and inexpensive way to examine arch height is to wet the bottom of an athlete’s foot with paint and have them walk across a sheet of paper. A high arch will leave a narrow lateral print of the foot, while a low arch will leave a larger print. pain in the heel is a major indicator that’s it’s time to stop activity. If precautionary steps are not taken immediately, this injury can lead to significant rehab and time off.

Contributing Factors: One major cause of plantar fasciitis is prolonged foot pronation. Runners with excessive pronation generally have a more flexible, lower arched foot than other runners. Looking at arch height with the naked eye can be a difficult way to detect a low arch at first, but with practice, watching an athlete’s gait can clue you in to whether they have a high or low arch.

There are also sophisticated tools you can use, such as force plates, to see where the center of pressure is during an athlete’s gait. But a simple and inexpensive way to examine arch height is to wet the bottom of an athlete’s foot with paint and have them walk across a sheet of paper. A high arch will leave a narrow lateral print of the foot, while a low arch will leave a larger print since the foot will make more surface contact with the paper.

The tibialis posterior is another significant contributor to foot pronation because it eccentrically lengthens in an attempt to control pronation, and in turn reduces tension on the plantar fascia. If a runner’s posterior tibialis is weak, he or she will experience above average pronation.

Other muscular causes include proximal muscle weakness in the gluteus medius, gluteus minimus, tensor fascia latae, or quadriceps muscles. Weakness in these muscular structures results in a decreased ability to aid in the force ­28

T&C MARCH 2011

treatment should start with the goal of decreasing the runner’s pain level.

This can be done through therapeutic treatments like stretching and wearing a night splint.

Stretching the plantar fascia involves passively dorsiflexing the ankle and then applying pressure to fully extend the toes back toward the shin.

The movement is simple and the athlete can do it three to four times a day on their own—even while they’re sitting in class—to help keep the plantar fully lengthened.

doing that with eccentric calf raises.

We have the athlete stand on a stair, drop their heels down, raise up on the toes of both feet, then come back down slowly using only one foot (repeat on the other side).

Strengthening the surrounding musculature is another good idea. All proximal hip musculature needs to be strengthened by isolating each muscle.

Isolating the gluteus maximus should be your main focus. One exercise we use has the athlete start by lying in a prone position. They then contract their gluteus without recruiting their hamstrings or lower back musculature. Once the athlete masters this move, have them lay prone with their knees bent at 90 degrees, contract the gluteus, and push their heels toward the ceiling.

In some cases, runners with plantar fasciitis can continue to run on land with slightly reduced mileage. However, others will need to stop running on hard surfaces for one to two weeks until pain subsides. The decision to stop running on land must be made based on the level of pain the athlete is experiencing. Though generally not their favorite thing to do, runners who need to take time off from their usual workouts can incorporate pool workouts to maintain their fitness level.

Case Study: During the middle of

Even with chronic plantar fasciitis issues, the athlete had never experienced such a quick decrease in symptoms.

I attribute it to the treatment of the entire lower leg musculature and not simply focusing on the plantar fascia.

Night splints follow the same idea.

I’ve seen the best success rate with those that look like a low-tech walking boot and fully support the foot while keeping it in dorsiflexion. Though they’re not very comfortable to wear in bed, a splint can be very successful at limiting pain and aiding in healing.

Because excessive pronation is a major indicator of plantar fasciitis, further treatment should focus on controlling pronation. We can’t change the arch of a runner’s foot, but we can help them strengthen the muscles that control pronation.

As mentioned earlier, a weak tibialis posterior could be the reason for excessive pronation, so strengthening this muscle should be a goal of the rehab process. We’ve had great success

last season, a distance runner came to me complaining of pain on the bottom of his foot when walking and running. After palpation, I found a point of tenderness at the attachment site of the plantar fascia to the calcaneus. As we discussed the issue, the athlete explained that the pain had started about two weeks earlier, worsened gradually, and was most painful upon his first step out of bed in the morning.

The athlete hadn’t increased his weekly mileage recently and had only logged about 200 miles in his running shoes— on the lower end for this particular pair. He had a long history of chronic plantar fasciitis and explained the pain felt similar to when he was diagnosed with it in previous seasons.

At this point, I proceeded under the TR AINING-CONDITIONING.COM

TREATING THE ATHLETE assumption that he was having a reoccurrence. Since the athlete came to see me after practice, I had him roll the arch of his foot out on a roller, stretch his gastrocnemius and soleus muscles, and perform ice massage over the area of tenderness for eight minutes twice that evening. I also sent him home with a night splint to start wearing immediately. The next day, I referred the athlete to the team physician, who confirmed a diagnosis of plantar fasciitis and prescribed an anti-inflammatory.

I then completed a further assessment of the athlete’s lower leg mechanics. He presented with overpronation, a tight Achilles, and decreased range of motion in the ankle. Our treatment plan consisted of heating the lower leg and foot and soft tissue massage (using the Graston Technique) of the anterior tibialis, gastrocnemius, peroneals, and plantar fascia. We also worked on joint mobilization in the ankle and around the fibular head.

Therapeutic exercises included toe curls to strengthen the plantar, manual stretching of the anterior tibilalis, and manual resistance to strengthen the peroneal tendons.

I also had the athlete take a week off from land running. He instead used an underwater treadmill for 30 minutes a day and supplemented that with swimming to maintain his cardiovascular fitness level.

After the first week of treatment and a modified running routine, the athlete had a significant decrease in pain. He felt only mild pain upon his first step in the morning and was pain-free for the remainder of the day.

Even with chronic plantar fasciitis issues, the athlete had never experienced such a quick decrease in symptoms. I attribute it to the treatment of the entire lower leg musculature and not simply focusing on the plantar fascia, the athlete’s diligent use of the night splint, and therapeutic exercises to help correct his overpronation. The athlete returned to limited dry land participation after the first week of treatment and was back to his typical mileage by the end of week two.

ACHILLES TENDINOSIS Recently, there has been increasing evidence that overuse injuries to the Achilles are not tendonitis (inflammation of the tendon), but are actually tendiTR AINING-CONDITIONING.COM

nosis—actual degeneration of the tendon. Unfortunately, tendinosis is still often misdiagnosed. A runner will be told they have tendonitis, but subsequent treatment seems to have no effect on the injury because they actually have tendinosis. This lack of response to treatment can often leave the runner and clinician frustrated and at a loss of which direction to go.

You will need to enlist the help of a physician in differentiating between tendinosis and tendonitis. However, if no swelling is present and the injury has

Get Your

lasted beyond two weeks, you should suspect tendinosis.

The chief complaint associated with this injury is pain over the back of the heel, where the tendon inserts into the calcaneus. Runners with Achilles tendinosis usually experience the most pain at the beginning of a run, and not much while walking (unlike plantar fasciitis), though runners have described a “squeaking” or “pinching” feeling at times. Speed or stride work seems to increase pain as well.

Contributing Factors: Similar to

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Circle No. 121 T&C MARCH 2011

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TREATING THE ATHLETE plantar fasciitis, excessive pronation can also lead to Achilles tendinosis in runners. However, the major contributor is usually inflexibility in the ankle joint, which results from shortening of the gastrocnemius and soleus. The lack of flexibility in this muscle group increases strain on the Achilles during running, eventually causing degeneration of the tendon.

Tibialis anterior weakness is another contributor to decreased ankle joint motion. The tibialis anterior is often either over-active or under-active, causing increased or decreased motion about the ankle. Ankle motion and stability are two of the most important factors in keeping the Achilles injury-free.

Achilles tendinosis is gradual and

OTHER FACTORS When a track athlete comes into the athletic training room with an overuse injury, it’s important to talk to them about factors beyond biomechanical influences. These can include (but are not limited to) shoes, running surface, recovery, and diet.

Shoes: Runners should pay close attention to the type of shoes they wear and how often they replace them. However, while some shoes reach their structural limit at about 200 miles, others can push over 300 miles before breaking down, so there is no steadfast rule to tell all the runners on the team—each athlete will have to figure this out individually. Also note that excessive wear patterns can cause a runner to replace a pair of shoes sooner than normal since a wear pattern can lead to biomechanical deficits and injuries.

Running Surface: Keeping the majority of a runner’s mileage on softer surfaces like grass and trails can help reduce overuse injuries by lessening daily impact forces. When a distance runner is training on paved surfaces day after day, cumulative impacts can take a toll on the body.

Recovery: Another consideration is the amount of recovery time the runner is taking. At the college level, it’s not abnormal for a competitive distance runner to train for three weeks without taking a complete day of rest.

While this may work for some, the majority of runners will need a rest day more often—weekly to every 10 days.

The ratio of training load to recovery time can be vastly different for each runner. Thus, keeping detailed training logs (which include mileage, fatigue level, perceived stress, and any injuries) over the period of a season or two can help prevent future problems by comparing injury, stress, and fatigue levels during high and low mileage periods.

Logs can also be used to guide future training plans and mileage goals.

Some runners can be very successful at 30 miles per week of land running and supplementing with swimming, while others are successful at 80 miles per week of land running and no low-impact work. It truly varies based on the individual body’s needs for optimal adaptation gains.

Diet: One last tip would be to recommend runners speak with a dietitian about caloric needs. When runners are increasing their mileage week after week, even slightly, their caloric intake and output ratio is impacted.

Without enough calories to support their training load, the body will not be able to recover between runs. Appropriate type and timing of recovery foods after a run can greatly influence the body’s ability to make optimal gains from the training session.

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T&C MARCH 2011

often goes unnoticed until the classic sign of crepitus—a grinding or popping sensation—is felt. At this point, the injury has probably been present for a couple of weeks. If it has not been caught by this point, it can take upwards of six to eight weeks to completely heal.

Intervention: The first two weeks after diagnosis need to be spent away from impact activity. Treatment during this time should focus on increasing range of motion around the ankle and hip joints by stretching the hip flexor, quadriceps, hamstring, piriformis, gastrocnemius, and soleus muscles.

Strengthening the peroneal tendons and tibialis anterior is also a good idea and can be accomplished with eccentric calf raises and manual resistance ankle exercises for inversion, eversion, dorsiflexion, and plantar flexion.

As soon as pain subsides, start adding reduced-impact activities such as underwater or anti-gravity treadmill running. If you don’t have access to these options, pool walking and elliptical training will work, too.

After two weeks of reduced gravity impact, slowly transition the runner to land training, staying on soft surfaces to start. Be sure the runner begins this phase in a new, but broken in pair of shoes. During the first week of land running, have them run every other day starting at 20 minutes and building to 35 minutes the first week.

If no problems occur during the first week, you can slowly progress the runner from there, but have them refrain from any hill training until the injury has been completely resolved and they are pain-free for approximately one month.

Case Study: Upon returning from winter break last year, a middle-distance runner came into the athletic training room complaining of pain in the midsection of his Achilles that he’d never experienced before. The athlete explained that the pain had started about two weeks earlier, but had increased in the past couple of days and caused him to stop running completely.

He was not able to walk comfortably in any shoe by the time he came in to see me and had cut out the back of his running shoe due to the pressure on his Achilles. The athlete also presented with a limp.

During my evaluation, noticeable swelling was apparent, he had tenderTR AINING-CONDITIONING.COM

TREATING THE ATHLETE ness even to my light touch, and pain with both dorsiflexion and plantar flexion. The athlete was not able to bear all of his weight on the injured leg. Unfortunately, he also was not able to wear a walking boot comfortably.

Luckily, we were able to get the athlete evaluated by a team physician the same day. The physician’s diagnosis was Achilles tendinosis. He prescribed a week’s worth of anti-inflammatory medication to help reduce the pain and swelling, and the athlete was placed on crutches until he was able to walk without a limp—two days in his case.

Immediate treatment consisted of contrast baths, very light flush massage, wearing a shoe with no back, and a compression sock as tolerated. Tenderness and swelling were both significantly reduced in three to four days. At this time, the athlete started to complain of a “pinching” or “catching” feeling in the Achilles and significant crepitus was felt upon dorsiflexion and plantar flexion of the ankle.

We started some therapeutic exercises, including eccentric calf raises, joint mobilization of the ankle, mid-foot mobilization, and gluteus maximus strengthening. The athlete took one week off from all activity, then spent the next two weeks swimming. At this point, he had no pain when walking, no more swelling, and no lingering tenderness.

Only at this point did he start a one-month progression back to his full weekly training mileage. During his monthlong return to land running, the athlete continued with therapeutic exercises to help maintain ankle range of motion and the lengthening gains he had made to his gastrocnemius and soleus. Since his return, he’s been pain-free.

ROOT OF THE PROBLEM When the body does not get appropriate recovery time between training bouts, damaged tissue is not able to rebuild stronger than it was before. The body remains in a state of breakdown, and the accumulation of micro tears in tissues will eventually result in an overuse injury like the two cases detailed earlier.

As I’m sure other athletic trainers have found, adequate recovery time can be a difficult concept for runners and coaches to comprehend. Many athletes don’t understand what is happening to their body as they train and what is required for positive gains, thus not realizing how important a recovery period is.

In order to have some success in talking with coaches and athletes in the running world, I’ve found you need to meet them at their level. That means learning about the sport, understanding what the athletes’ goals are, and being very open in explaining that you’re just trying to keep them healthy so they can continue doing what they love to do.

When you first start working with athletes who run upwards of 90 miles a week, it’s easy to say, “Just decrease your mileage and the problem will be solved.” But that tact hasn’t proven successful for many of us. Instead, you need to find creative ways to modify what the athlete is doing so that they can get some recovery while continuing to do some type of training.

Examples include incorporating underwater treadmill work, aqua jogging, cycling, and if available, an anti-gravity treadmill. While these activities still stress the tissues, allowing the athlete to make gains, they do reduce force. The athlete’s muscles are still working hard, but at least their ligaments and tendons get a bit of a break. n TR AINING-CONDITIONING.COM

Circle No. 122 T&C MARCH 2011

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Dave Cruz Photography

LEADERSHIP

PASSING IT ON

If teaching a sports medicine class is in your future but you’re not sure where to start, we have a step-by-step guide for the course approval and development process.

By Bart Peterson

H Author Bart Peterson works with a student in his sports medicine class at Palo Verde High Magnet School in Tucson, Ariz. Peterson says one of the most rewarding parts about teaching a sports medicine class is that he gets to share his knowledge and passion for the healthcare industry with young students.

ave you been thinking about starting a sports medicine class at your high school? If so, great! If not, maybe it’s time to start contemplating this excellent opportunity for students to expand their knowledge base and for you to grow professionally.

In addition to providing another academic offering, a sports medicine course gives students a glimpse at different healthcare professions and the opportunity to learn new and exciting disciplines they wouldn’t otherwise be exposed to during high school. At a time when teenagers are searching for possible career paths, a sports medicine course may help them make good decisions.

Creating this type of class can also boost your resume and professional career. If you have no plans to leave your current job, adding a course in which you can showcase your expertise shows the administration how valuable you are to the school system. And if you are looking to eventually move on, the added responsibility of teaching a course will look great on your resume.

Whatever your reason for starting this endeavor, the relationships you build while creating the curriculum, teaching the class, and overseeing students’ after school observation hours will create life-long bonds. This is one of the reasons I started teaching sports medicine at my high school, and it’s the main reason I go to great lengths to continue offering the courses.

WORDs OF WARNING A sports medicine course should be offered to provide students with exposure to different healthcare professions, not turn them into athletic trainers, nurses, or physical therapists. Neither you nor a student should expect that upon finishing the class, they would be ready to walk into the athletic training room and start taping ankles and diagnosing concussions.

I initially began developing my class 20 years ago, after students asked me for help getting into college to study medicine. I looked into creating a sports medicine class and realized it would be a great opportunity to provide some help in the athletic training room and on the fields.

At the time, that justification was probably good enough. Today, however, with legislation and licensing regulating the practice of athletic training in almost every state, it’s another story.

I know there are schools where administrators have approved sports medicine Bart Peterson, MSS, LAT, ATC, is Head Athletic Trainer and Athletic Director at Palo Verde High Magnet School in Tucson, Ariz. He currently sits on the NATA Board of Directors and has served on the NATA Secondary School Athletic Trainers’ Committee and as secretary of NATA District 7. He can be reached at: arizatc@cox.net.

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LEADERSHIP

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courses because they think it will help the athletic trainer provide coverage of sports and activities. Though I require my students to spend time in the athletic training room, it is primarily for the experience of watching a licensed athletic trainer at work. It is not to help me perform any of my duties as an athletic trainer.

It is very important to note that the athletic training student aide programs that are often an extension of a sports medicine course should never be created or maintained as a means to provide coverage for sports teams. The NATA Official Statement on Proper Supervision of High School Athletic Training Student Aides says, “Student aides must be under the direct visual supervision of a licensed/certified athletic trainer when assisting with any athletic training services. Coaches and school administrators must not allow or expect student aides to act independently with regards to the evaluation, assessment, treatment and rehabilitation of injuries. Additionally, it is paramount that student aides not be expected, asked, or permitted to make ‘return to play’ decisions.”

The statement also lists five specific tasks that athletic training student aides are not allowed to do. They may not: interpret referrals from healthcare providers; perform evaluations; make decisions about treatments, procedures, or activities; plan patient care; or independently provide athletic training services during team travel.

Allowing your student aides to do any of those five tasks may also be a violation of your state’s practice act. In many states, a student violation of the state practice act is just as bad as the supervising instructor (you) committing the violation. It is vital that you fully understand your state’s practice act in this regard.

SDE isn’t convinced you are qualified to teach the course.

Next, get the details on how courses are approved at your school. For example, in Arizona, a course cannot be offered if it’s not on the SDE master course list. If your state doesn’t have a list like this, it’s important to determine whether courses are approved by district employees or on a school-byschool basis.

COURSE APPROVAL As you begin the process of getting a sports medicine course approved, the first thing you need to determine is your eligibility to be employed as a teacher.

The No Child Left Behind Act requires that all teachers be “highly qualified” in their subject area. Only your district and State Department of Education (SDE) can determine if you fit the bill.

However, a number of colleges have designed post-baccalaureate programs for degree holders to obtain teaching credentials, so there are options if your

• CPR training videos ($250)

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You’ll also need to find the best department for a sports medicine course at your school. Since the class examines different healthcare professions, the science, health, or physical education department might make sense. Many high schools also offer career and technical education (CTE) or vocational programs to their students, so that might be a natural fit.

Here at Palo Verde High Magnet

NECESSARY EQUIPMENT One of the most common questions I am asked about starting a sports medicine class is, “What supplies do I need?” In addition to regular classroom supplies like computers and a projector, here is a list of equipment you might need.

• Tape and wrapping supplies ($30-50 per student) • Examination table(s) ($500 each) • Taping table(s) ($500-$1,500 each) • Exercise equipment (price varies, but you may be able to get some used equipment at reduced price) • Fitness assessment and prescription equipment and software (price and programs vary) • Anatomy software (price and programs vary) • Injury simulation software (price and programs vary) • Reference software ($50-$500) • Custom-fit mouthpiece equipment ($2,000) • Stethoscopes and sphygmomanometers ($30 per student) • Pulse oximeter ($100-$250) • Otoscopes and ophthalmoscope ($350) • Heat illness diagnostic and prevention equipment, including scales and hydration testing equipment ($5,000) • Field trips to cadaver labs, universities, anatomy museums (entry fees vary, but there are often discounts or free entry for student groups) • CPR mannequins ($350) • AED trainer ($400) • AED ($1,500) Note that, unfortunately, equipment is the expensive part of the class, so think about how you might be able to get your hands on some for free. For example, you might be able to get an AED and AED trainer donated by your local hospital. Or if you have a college or university with an athletic program nearby, the head athletic trainer might be willing to bring in his or her department’s heat illness diagnostic equipment for a day so you can spend a class session on heat illness prevention.

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LEADERSHIP School, our Sports Medicine I and II courses are part of our CTE program, which is partially funded by the SDE. This external funding is one of the major reasons the course has survived extensive budget cuts in a district and state riddled by budgetary woes.

As you prepare your proposal, the main thing to keep in mind is how your course will help the school. This is what the people you are trying to convince will be most interested in. For example, if your principal is looking to diversify course offerings, explain how your course will support this endeavor. If your administration wants to expand career options through the CTE program, discuss how the class will cover many different professions in the healthcare field.

In addition, CTE courses often qualify for credit at junior colleges and some four-year universities. That may be an incentive for students to enroll in your class and an opportunity for the administration to say that their school offers a course with college credit.

Try to anticipate issues that may arise in the approval process and be willing

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to listen to decision makers who tell you the class won’t work. Most concerns can be resolved with forethought and good communication. One example might be resistance from other teachers worried that a new course will decrease enrollment in their courses. To combat this concern, I require health, anatomy, and physiology as prerequisites for my class. This helps boost enrollment in the other teachers’ classes, and they see my program as a great addition to the school, not competition.

The quest to begin offering a sports medicine course cannot be done alone— you’ll need help and support along the way. The first person to get on board is the school principal, or if you’re at a larger high school, the assistant principal in charge of curriculum and instruction. They might be willing to assist you in the proposal preparation and help convince other teachers, department chairs, and key decision makers that adding your course would be a positive move.

The athletic director can be another important ally. They have the ear of the administration and can help foster

the process along when you hit a roadblock. A good athletic trainer who has the best interest of students at heart is a valuable commodity, and if your athletic director believes in you, they will do everything they can for you and your position, including pushing for additional work and pay to keep you at the school. Other potential supporters might be found in the CTE program or science, health, or physical education departments since the course may become a part of any one of these departments.

As you make contact with these key players, reach out to other schools in your area that offer similar courses.

You can learn a lot by asking about what did and didn’t work for them as they went through the course approval process.

Perhaps the biggest issue to overcome will be funding—for both your teaching salary and classroom supplies. There is a set amount of funds to be divided up, and you need to prove why your program deserves a slice of the pie. If money is a big hurdle to approval, push to have your course included in the CTE

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LEADERSHIP department since it may receive state funding.

You can also assure the district employees who are deciding on the fate of a sports medicine course that you will seek outside funding. This might mean applying for a Carl D. Perkins Grant, which is administered by the federal government to provide funding for CTE programs. And on the local level, many communities have established vocational education funds to assist CTE and vocational programs that teach career path coursework. In our district, we have the Joint Technical Education Dis-

Development Workbook offer a great overall approach to creating a course curriculum. They suggest considering three main questions: • What are the “big ideas” that convey enduring principles you’d like most of your students to take away?

• What are the concepts which are important to know, but don’t fit into question one?

• What are the things that are worth being familiar with, but not necessary for successful completion of the course?

When developing my curriculum, I

How you present course material is as important as the material itself. It’s easy to get into the rut of lecture, lecture, and more lecture. But if you want to attract future students and keep the ones you have, it’s important to remember that you’ll have auditory, visual, and tactile learners in one classroom. trict, which provides support for salaries, supplies, and capitol equipment necessary for the course.

If in the end, the course is denied due to a lack of funding, be patient. You may be told that the class will have to wait a year, so take that time to make your curriculum even better and more engaging.

BEST CURRICULUMS Once you’ve gotten approval for the development of a sports medicine class, congratulate yourself on a job well done, but know that your work is just beginning. While you may have had a general outline to show others during the approval process, now your task is to fill it out and determine exactly what to teach.

Some of this work may already be done. For example, each course on Arizona’s master list has required topics or competencies that must be included in the curriculum. And if your sports medicine course ends up falling under the umbrella of the CTE program, many states provide a recommended curriculum. Though you don’t have to use it verbatim, the suggestions will give you a good framework to work with.

Whether or not you are fortunate enough to have recommendations, it’s best to start creating your curriculum by looking at the overall picture. Jay McTighe and Grant Wiggins, authors of Understanding by Design: Professional ­36

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felt there were seven “big ideas” that my students should be proficient in by the time they left my class. I also had a number of important concepts that fit into question two, and even more areas that I wanted to touch on briefly. I believe that if I can hit on those smaller concepts once or twice, my students will benefit greatly in college. My “big ideas” include: Good study habits. In a sports medicine class where students are only being introduced to different healthcare professions, what they learn isn’t as important as how they learn. Helping students figure out how to best obtain the information you cover is the most important skill they can develop.

Understanding basic medical terminology. Learning the language of medicine is invaluable to high school students. Going to college with a second language under your belt is usually a requirement, but I believe that going with a third language—medicine— gives students an extra advantage in class, especially early on.

Being able to write at a college level.

It’s amazing how many college students don’t understand how to coherently put words on paper. I believe it’s best for everyone, even non-English majors, to work intensively on writing skills before college.

CPR and first aid training. Any healthcare provider should know CPR (preferably Professional Rescuer CPR).

And first aid should always be taught as part of a CTE sports medicine course.

Understanding basic anatomy and physiology. Because anatomy and physiology are such complex subjects, there’s no way you’d be able to cover everything. I emphasize the importance of knowing the basics.

Basic taping and wrapping skills.

This is an area students can learn and apply in the field. However, mastery of all taping and wrapping skills should not be a requirement of a high school sports medicine course, and some state athletic training legislation prohibits minors from conducting medical procedures on other minors.

Critical thinking skills. Students are capable of learning many complex skills and techniques, and at the high school level we should strive to cultivate that ability. That means giving them a great base of knowledge and then challenging their newly-acquired skills and techniques.

CLASS TIME TIPS How you present course material is as important as the material itself. It’s easy to get into the rut of lecture, lecture, and more lecture. But if you want to attract future students and keep the ones you have, it’s important to remember that you’ll have auditory, visual, and tactile learners in one classroom. I’ve found that a combination of PowerPoint presentations and hands-on work is the way to appeal to all types of learners.

You can find ready-to-use PowerPoint presentations online, and if you choose to use a textbook, many publishers bundle chapter presentation DVDs with their books. PowerPoint makes it easy to follow a set curriculum in lecture form, but keeps it stimulating for students because you can add photos and videos.

I save my PowerPoint presentation lectures as Web-based files and make them accessible online so students can revisit the lecture material at home.

Coupled with classroom presentations, giving students the opportunity to practice techniques allows them to apply the information they learned. For example, during our unit on the head and face, I use dentistry as my focus, and as students learn about making impressions of the mouth and teeth, I have them make custom mouth pieces for themselves or classmates.

I also require students to set up and complete observation hours with myself TR AINING-CONDITIONING.COM

LEADERSHIP and/or other healthcare professionals.

Ride-a-longs with the fire department and observation time in a physician’s office, hospital, dental office, or physical therapy clinic all expose the student to what it’s like to work in healthcare.

You will also quickly learn, as I did, that the Internet can be a teacher’s best friend. Our school Web site has become my personal filing cabinet. I have a class Web page set up with a password, which allows students immediate access to course materials online.

If there is homework, students have the option to complete and return it online instead of printing it out and completing by hand. I’ve also made the site interactive, and extra credit bonuses randomly appear to encourage my students to use it.

Testing has become much easier with the Internet as well. Web sites like ClassMarker.com allow instructors to create tests by typing in questions and answers. When students take the tests online, they are instantly graded. For athletic trainers with lots of responsibilities, this greatly decreases the amount of time spent grading assign-

ments and tests.

While a sports medicine course can be a wonderful addition to a school’s offerings, much care must be taken when developing presentations and

hands-on opportunities. Students in a secondary school are naturally primed to learn, and the opportunities you provide them can be a springboard to a great career. n

RESOURCES The NATA Official Statement on Proper Supervision of High School Athletic Training Student Aides can be downloaded at: www.nata.org/official-statements.

The NATA Position Improvement Guide, which documents how athletic trainers can improve their position at a secondary school by teaching a sports medicine course is available at: www.nata.org/brochures-and-other-informational-materials.

Create instantly graded online tests for students at: www.ClassMarker.com.

My home state CTE program organization, Arizona Tech Prep, provides lots of great info about our state’s sports medicine courses at: www. aztechprep.org. Click on “CTE Programs,” then “Career Preparation,” then “Sports Medicine & Rehab. Services.”

Your sports medicine class students can find more information about the Health Occupations Students of America organization at: www.hosa.org.

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sport specific

The Stanford University women’s water polo team has spent the last decade ranked in the top 10 nationally.

From The Top Down David Gonzales/Stanford Athletics

By Dr. Brandon Marcello

M

ost of the time, sports performance coaches are charged with training land-based athletes. The tried and true philosophy of addressing things from the bottom up works wonderfully since land-based athletes require powerful lower bodies.

But when it comes to training water polo players, this method isn’t applicable. Sport requirements dictate the athletes throw, catch, and play defense—all the while staying afloat in the water.

These athletes don’t have the luxury of being able to push off the bottom of the pool for power. So instead, we must take the opposite approach and train these athletes from the top down.

While the following is a glimpse into our performance training techniques for Stanford water polo athletes, it is important to note that there are thousands

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Unlike working with landbased athletes, training water polo players means starting at the shoulders instead of the legs. of ways to train—many of them very effective. Ours is just one way of doing it, but it’s a method that has helped our women’s team never miss the NCAA Division I Tournament.

No matter the type of athlete a coach is training, development of their regimen should be based on program-wide training methodologies and goals. In the case of Stanford Sports Performance, our methodology revolves around training movements, and we have three overall goals that are followed in a very particular order: Decrease the potential for injury, improve performance, and

educate our athletes about why we train the way we do.

ADDRESSSING INJURY RISK Water polo combines two activities that tend to have high injury rates: swimming and overhead throwing. As a result, our players are at increased risk for upper extremity injuries, making our first training goal a major challenge.

Brandon Marcello, PhD, NASM-PES, NASM-CES, CSCS, USAW, is Director of Sports Performance at Stanford University.

He oversees the athletic performance enhancement programs for Stanford’s 35 varsity teams, and also works to develop sport-specific strength and conditioning, rehabilitation, nutrition, and recovery programs for the softball and women’s water polo programs. He can be reached at: bmarcello@stanford.edu.

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sport specific Since water polo athletes recruit the shoulders for just about everything they do in the pool, including swimming, throwing, catching, and defending, the shoulders tend to be one of the more problematic areas for them.

Many strength coaches give most of their attention to the shooting or passing shoulder, but addressing the sculling shoulder is equally important. Although the sculling shoulder isn’t performing much overhead throwing work, it acts as a stabilizer and constantly assists in keeping the athlete afloat and elevating them out of the water.

In the weightroom, our athletes perform the traditional battery of exercises to strengthen the rotator cuff and surrounding musculature. However, it is important to also implement exercises that ensure soft tissue quality and proper inhibition and activation of that musculature to prevent the development or further development of dysfunction.

Thoracic mobility is an issue that needs to be addressed in almost all ath-

letes, but I believe a big emphasis should be placed on thoracic mobility when working with aquatic athletes especially.

Many of them have hypomobile thoracic spines as a result of the repetitive swim strokes and altered breathing patterns utilized while swimming.

If the thoracic spine is able to achieve its correct range of movement, the body has more lumbar and scapular stability.

But if the thoracic spine is not able to move freely, the body will compensate elsewhere—usually finding that lost movement in the low back and scapulathoracic regions. In some cases, the glenohumeral joint can be impacted and contribute to a rotator cuff or labral injury. Soft tissue work is one way we combat this problem.

I also see a lot of movement deficiencies in water polo athletes. Players are suspended in water and there are no hard surfaces to act as a force generators or stabilizers, so deficiencies are not surprising. And these subtle problems can be hard to spot.

Even when a deficiency is present, an athlete’s body inherently still finds a way to perform the movement. However, problems arise when the deficient movement is repeated over and over.

Left uncorrected, it will create further dysfunction in the body and increase the likelihood that the athlete will sustain an injury.

To find these deficiencies, we analyze our water polo athletes using Gray Cook’s Functional Movement Screen.

But we are looking for different types of deficiencies than we see in our landbased athletes.

Compensatory patterns are some of the most common deficiencies we find in water polo players. Due to the high volume of swimming these athletes do for conditioning, the most common compensatory pattern is front-to-back with an overdeveloped anterior musculature.

To fight this imbalance, the team’s training program is augmented with a number of pulling variations, which work the posterior portion of the body, to “even

SAMPLE WORKOUTS The following are examples of our water polo team’s developmental season workouts in weeks one to two and four to eight of our eight-week program. The players complete three series of paired exercises or supersets three days a week.

Weeks One to Two Day One A Series Single-leg box squats Physio ball leg curls B Series Push-ups DB rows C Series Cable diagonal slides, both up and down Pallof presses Weeks Four to Eight Day One A Series Vertimax Romanian deadlifts B Series Single-leg RFE squats Slide board leg curls C Series 7K or Iso push-ups Single-arm cable rotational rows

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Day Two

Day Three

Goblet squats Romanian deadlifts

Slide board split squats Single-leg deadlifts

Push-pulls Single-arm cable rows

X-pull downs Physio ball rollouts

Single-arm stability lat pulls Cable chops

Cable lifts

Day Two

Day Three

Trap bar deadlifts Single-leg DB

Sled pushes Romanian deadlifts

Push-pulls Single-arm cable rows

X-pull downs Land mines

Single-arm alternating lat pulls Pallof presses

Cable lifts Cable chops

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sport specific things out.” Our athletes generally train at a 2:1 ratio of pulling to pushing.

One of the more obscure imbalances seen in water polo athletes is between their left and right sides. This happens not as a result of the shooting and passing occurring on one side, but rather as a result of the athlete breathing only on one side as they swim instead of both.

Single-sided breathing can contribute to a myriad of compensatory problems, such as increased risk for shoulder injuries and too much stiffness in the thoracic spine.

Using one side of the body more than the other increases the development of that side. Think of what happens if you are always throwing with your right hand. The same principle holds true for swimmers who breathe on just one side.

This can lead to an overdevelopment of the musculature on one side of the body and an underdevelopment on the other side, which can in turn lead to impaired anatomical function and muscle activation through the entire trunk and sometimes even the shoulder. Focusing on breathing work such as proper diaphragmatic breathing is recommended to help offset this imbalance.

OUR PROGRAM Plato said, “The beginning is the most important part of the work.” From a programming standpoint, I couldn’t agree more. I consider the pre-workout routine the most important part of our workouts.

Ours is designed to prepare the athlete by creating an anatomical and physiological environment conducive to accepting the training that is about to take place. The pre-workout program is

quality of their tissue, but also applying pressure to overactive areas such as the pec minor and hip flexors. The goal is to inhibit the muscle slightly before moving on to the lengthening phase.

Increasing the length of the soft tissue is important as the overactive areas generally live in a shortened state and will remain in this position unless forced to do otherwise. To lengthen tissue, we use either traditional static stretching or ac-

One of the great things about mobility exercises is that improving mobility in a restricted joint, such as the hip or thoracic spine, will decrease mobility in typically hypermobile adjacent joints. divided into four segments: tissue preparation, pillar preparation, mobility, and synchronization.

Tissue preparation includes both an activation and lengthening component.

During tissue prep for activation, we employ self-myofascial release techniques like using the foam roller, massage stick, or posture ball. Athletes not only spend time working to improve the

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tive isolated stretching (AIS). Breathing is a vital part to the success of AIS methods because we base our static stretches on cycles of breathing rather than number of seconds an athlete holds the stretch.

The pillar prep phase could be termed activation because the focus is to “turn on” the areas that are often under-active as a result of their over-active counter-

sport specific parts. For example, we might employ gluteal-firing exercises because water polo players often have over-active hip flexors.

This phase also contains exercises to activate the trunk or pillar to ensure proper firing during the workout.

Mobility exercises increase joint motion. It should be noted that these exercises pertain only to joints that are lacking the movement they should otherwise

result in decreased movement in the lumbar and scapula-thoracic joints.

Synchronization ties everything together. During this phase, the entire body is recruited so that proper movement and timing takes place. Synchronization exercises include rolling patterns and medicine ball work when appropriate.

Now that the body is prepared to accept training at a higher level, our

Through the entire eight weeks of our developmental training program, I also keep an “Individual Prescription” (I-Rx) for each athlete. This is how our program can be individualized for each player. have. Two of the main regions we focus on are the hips and thoracic spine.

One of the great things about mobility exercises is that improving mobility in a restricted joint, such as the hip or thoracic spine, will decrease mobility in typically hypermobile adjacent joints.

For example, improving hip mobility should result in less joint movement in the knee and lumbar spine. And improving thoracic spine mobility should

athletes move toward more traditional weightroom exercises and movements.

In general, our program has components of explosive power, lower body strength, upper body strength, core strength, and prehab work.

The team trains in the weightroom three times a week for eight weeks during the developmental season. Each daily program consists of six or seven exercises divided into three series. And with the

exception of explosive, high neural work, exercises are paired together or part of a superset to make a series. (See “Sample Workouts” on page 40 for a more detailed look at the team’s training exercises.)

The first four weeks of the program are designed to build a foundation. I operate under the assumption that every athlete has a training age of zero the first time they walk in the weightroom since they haven’t yet trained in our system. This is something I learned from my longtime colleague and friend Joe Kenn, who was recently hired by the Carolina Panthers.

The first series (A) focuses on lower body strength. Early on in the program, athletes perform a squat variation all three days, and a single-leg variation two of the three days. Later, the hamstrings are emphasized with several deadlift variations.

The second series (B) includes upperbody variations with a unilateral pulling emphasis. Variations of a push-pull exercise on the Keiser functional trainer, as well as single-arm stability lat pull downs, provide a lot of “bang for your buck” as they promote upper body strength and core and shoulder stabilization.

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sport specific The third series (C) emphasizes core strength and stabilization. The exercises in this series are comprised of a lift or chop variation as well as Pallof anti-rotational presses. While the arms are performing the movement, the main emphasis is on the trunk and scapular areas, so I look for aligned posture and very little movement in those areas.

The lift and chop variations follow a very particular progression in difficulty and are not performed under a time constraint. Once an athlete is able to perform the variation with correct and sustainable movement, they are moved on to the next progression.

In the second four-week phase, we introduce the trap-bar dead lift (TBDL) and sled pushing into the program. Because grip is such an important component of playing water polo, the TBDL and its paired partner, the Romanian deadlift, allow for simultaneous development of lower-body musculature and grip strength. I do allow my athletes to use straps, but only for one of the exercises at a time, alternating which exercise they use straps for each week.

We use the sleds for what I call move-

ment facilitated strength. This means that a particular movement (in this case pushing a sled) allows for the facilitation of strength. Heavy sled pushing relies on leg strength and trunk and shoulder stabilization—all of which are extremely important for an aquatic athlete.

For explosive power, which we concentrate on in the second phase, I use the Vertimax with underclassmen. If an athlete is able to safely progress to an Olympic lifting variation when they are a junior or senior, they may do so only at that time.

Through the entire eight weeks of our developmental training program, I also keep an “Individual Prescription” (I-Rx) for each athlete. This is how our program can be individualized for each player.

An athlete’s I-Rx can be used for a multitude of purposes, including concentrating on a particular area that has proven problematic for a certain athlete, like tight external rotators. Or perhaps another player might need an I-Rx for extra rehab with the sports medicine staff for an injury or preexisting condi-

tion. In this instance, the I-Rx portion of the workout can assist in expediting the athlete’s return to play.

Today’s athletes are much more inquisitive then those of the past. It is not often that you find athletes who ask, “How high?” when you say “Jump.”

Instead, they ask, “Why?” I’ve found the best method for athlete buy-in is to take the time to explain to them what they are doing, why they are doing it, and how it is going to make them a better athlete. If you can explain to the athlete your methodology and the process you are taking them through in a way they can understand, they are more likely to comply and achieve better results. n

Though their work in the weightroom is vital, what athletes do after they leave is important, too.

To learn more about Stanford’s athlete self-care program, look for “On Their Own” in the blog section of our Web site at: www.training-conditioning.com/ blogs.php.

Train Through Injuries THE ULTIMATE INJURY RECOVERY AND RE-CONDITIONING TOOL Leading ATC’s and CSC’s love the AlterG because their athletes can train through an injury and return to action fit and ready to compete. Find out how the AlterG can help your athletes be ready to go when they’re cleared to play.

Email us for details at info@alter-g.com.

“The AlterG is unique in allowing the athlete to run or walk pain free, in a more normal gait pattern, when they would normally have been weeks away from such activity.”

www.alter-g.com (510) 270-5900

— Eric Waters, Head Athletic Trainer, Washington Wizards Circle No. 129

Straight Talk

Blue Light Therapy: Another Tool For Battling MRSA

By Douglas Johnson, ATC, EES, CLS

L

ight therapy devices are being used to treat an array of orthopedic, neurological, and wound care applications. With over 4,000 published studies on red and infrared light, the photo-chemical effects of light in medicine are well known. It is no longer a question of whether photo therapy works, but rather what the necessary parameters for optional outcomes are.

Recent advances in light technology have allowed for increased power of continuous wave (laser) diodes, the introduction of super-pulsed lasers, and the development of new colors of light emitting diodes. This has allowed for the investigation of wavelengths (colors) outside the traditional therapeutic window of 632.5 to 1,000 nanometers (nm). Some recent research suggests blue light therapy may be effective in other conditions, such as Staphylococcus aureus (staph), MethicillinResistant Staphylococcus aureus (MRSA), acne, and some hyperproliferative skin conditions.

it took nearly 10 times the exposure length to eliminate 80 percent of the MRSA in culture dishes.

Data from recent studies indicates that blue light therapies have also shown promise in treating acne, and the FDA has cleared narrow-band, high-intensity blue light therapy for treatment. Now widely advertised, this is probably the bestknown light therapy for acne. In 2006, Papageorgiou and colleagues found that combining blue light with red light is even more effective for acne light therapy as it repaired skin cells, reduced acne scars, and healed skin faster.

Studies and clinical work have shown that blue light therapy can help treat bacterial infections, such as MRSA.

It is already known that ultraviolet (UV) light kills bacteria. It has been used for sterilization in hospitals for its microbekilling abilities. Exposure to blue light in the 450 to 470 nm range has been used primarily as a treatment for neonatal jaundice. (Blue light is absorbed by bilirubin and thus undergoes photo-chemical change in this instance.) However, the bactericidal effects of UV may not be unique since recent studies indicate that blue light produces a somewhat similar effect.

In 2006, Guffey and Wilborn found in vitro bactericidal effects on two bacteria: staph and Pseudomonas aeruginosa, with the use of a blue light emitting 405 and 470 nm.

The effects of the blue light produced dose-dependent bactericidal effects on both bacteria. The researchers also found that appropriate phototherapy doses of 405 and 880 nm combined can kill staph and Pseudomonas aeruginosa in vitro, suggesting that a similar effect may be produced in clinical cases of bacterial infection.

In 2009, Enwemeka and colleagues concluded that relatively low doses of blue light using an LED device that emits blue light--about 100 seconds worth--killed off about 30 percent of MRSA in vitro. Longer doses were more effective, however 44

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Experiments have demonstrated that blue light irradiation of up to 453 nm photolytically generates nitric oxide from nitrosated proteins.

Hyperproliferative skin conditions, such as psoriasis, benefit from the fact that blue light penetrates rather poorly due to the almost complete absorption superficially, thereby reducing proliferation dose dependently by up to 50 percent. This can be attributed to differentiation induction as shown by an increase of differentiation markers. A photolytic release of nitric oxide from nitrosated proteins is observed indicating that they are light acceptors and signal transducers up to a wavelength of 453 nm.

C

Some potential considerations of prolonged exposure to blue light therapy should be taken into account. Symptoms can include jitteriness, headache, nausea, skin irritation, eye irritation, and poor vision. Very infrequently, a patient will find that blue light therapy will make them overactive, restless, and irritable, causing difficulty in sleeping. More often, patients will experience a visual glare, which is caused by short wavelength blue light.

To correct this effect, there are specially designed lenses that counteract the intensity of the light.

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CM

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The blue light treatment does not harm the skin tissues at all. Kleinpenning and colleagues evaluated the clinical and histological effects of blue light on normal skin in 2010. They concluded that visible blue light does not cause deoxyribonucleic acid damage or early photo-aging. Also last year, Liebmann and colleagues found that light at 453 nm is only toxic beyond a fluence of 500 joules per square centimeter.

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Straight Talk

While blue light therapy may not replace red light as it has in the case of the DVD, blue light has shown some promise in the lab, as well as clinically, for its use for treatment of bacterial infections. Further studies of single wavelengths and combinations of wavelengths may yield additional treatment options.

Douglas Johnson, ATC, EES, CLS, is a certified athletic trainer with more than 11 years of clinical/industrial experience. He has worked extensively in occupational medicine as the assistant regional physical therapy director of Concentra Medical Center’s Michigan Operations and as the therapy director of Prime-Care Medical Centers before co-founding a practice in 1996. He is co-owner of Sports and Industrial Rehab and founder of the Laser Center of Michigan. He can be reached at: djohnsonatc@ sportsandindustrialrehab.com.

References

Photomedicine and Laser Surgery, _02_11_final.pdf 1 2/23/2011 1:14:44 Volume PM

24, Number 6, 2006, © Mary Ann Liebert, Inc., Pp. 684–688, DOI: 10.1089/PHO.2006.1029, 684.

Effects of Combined 405-nm and 880-nm Light on Staphylococcus aureus and Pseudomonas aeruginosa in Vitro; J. Stephen Guffey, Ed.D., and Jay Wilborn, M.Ed.; Photomedicine and Laser Surgery, Volume 24, Number 6, 2006, © Mary Ann Liebert, Inc., Pp. 680–683; DOI: 10.1089/ PHO.2006.1028, 680.

Two Benefits With One Treatment “Blue light therapy has the capability of wound care pain relief plus the application for antimicrobial treatment,” explains Glenn Streeter, exercise physiologist and CEO of Mountain’s Edge Fitness clinic in Boulder, Colorado.

“There really is no downside to this type of protocol for athletes who have open-skin wounds.”

There are two types of lasers: stimulating lasers and resonating lasers. The type of laser to utilize in treating MRSA-related situations is the resonating type—a cold laser. “The technology of laser therapy for treating open wounds, bacterial infections and even acne is 30 years old, but it’s just starting to take hold in the U.S.,” adds Streeter.

Chukuka S. Enwemeka, Deborah Williams, Sombiri K. Enwemeka, Steve Hollosi, David Yens. Photomedicine and Laser Surgery. April 2009, 27(2): 221-226. DOI:10.1089/PHO.2008.2413.

Papageorgiou, Katsambas and Chu, Photomedicine and Laser Surgery, Volume 24, Number 6, 2006, © Mary Ann Liebert, Inc. J Invest Dermatol. 2010 Jan. 130(1): 259-69.

Photomed. 2010 Feb. 26(1): 16-21.

J Invest Dermatol. 2010 Jan. 130(1): 259-69.

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Antimicrobial Prevention Kills MRSA bacteria

Testing has proven that washing the skin one time with Hibiclens® broadspectrum antimicrobial cleanser will significantly reduce the risk of transfer of MRSA bacteria. Hibiclens contains four percent CHG, which bonds to the skin to create an active barrier that continues to kill bacteria, viruses, and fungi for up to six hours after washing. Hibistat ® wipes also contain CHG, and feature a kill time of up to six hours without the need to rinse.

Molnlycke Health Care • 678-250-7985 www.hibiclens.com

Clean Wounds Quickly

Amerigel® Wound Wash with Oakin® is the first step in skin injury care. This product painlessly cleanses abrasions, cuts, scrapes, and lacerations to promote quick healing. It also inhibits the growth of pathogens. Amerigel® offers safe and effective cleansing action without the use of cytotoxic chemicals or preservatives. It’s portable, easy-to-apply first aid care. Be prepared to treat skin injuries on the spot with Amerigel®.

Amerx Health Care Corp. • 800-448-9599 www.amerigel.com

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Protect Your Equipment

Wipe Away Bacteria

Athletix Disinfectant Wipes kill common bacteria and viruses such as Staph, MRSA, and VRE, and are safe for surfaces such as metals, plastics, Formica, vinyl, glass, wood, porcelain, and paint. EPA registered in all 50 states, Athletix Disinfectant Wipes are orthophenylphenol free, bleach-free, ammoniafree, and alcohol-free. With 800 wipes per roll in a preloaded bucket, these 7x9-inch wipes make cleaning and disinfecting easy, portable, and economical.

Athletix Products by Contec, Inc. • 864-503-8333 www.athletixproducts.com Circle No. 501

GymWipes FORCE is an EPA-registered disinfectant product designed to clean and sanitize health club surfaces and equipment: seat pads, leg/arm rests, benches, hand grips, chrome plating, painted surfaces, steel and rubber surfaces, tanning beds, and electronic panels. FORCE protects against 50 pathogens, including MRSA and the H1N1 virus. They’re pre-moistened and disposable, with no phenol, bleach, or alcohol. The wipes have a fresh scent and can be dispersed on stands or through wall-mounted containers.

GymWipes • 888-977-3726 www.gymwipes.com.

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Antimicrobial Prevention Free Webinar on new portable laser unit

A Different Way To Pain Relief

Avazzia Pro-Sport devices are non-invasive, non-pharmaceutical micro-current biofeedback medical devices for deep stimulation and quick relief for all types of athletes. Its devices and accessories are developed using the latest technological research, from NASA as well as college and universities. The company was founded in 2004 to design, manufacture, and distribute scientifically advanced, innovative FDA-accepted healthcare products and software. Call or go online to learn more.

Avazzia, Inc. • 214-575-2820 www.avazzia.com

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Multi Radiance Medical • 800-373-0955 www.multiradiance.com

Tops for Topical Wounds

Amerigel Wound Dressing with Oakin®, among the top physician-rated topical wound treatments, promotes quick healing for skin injuries while providing an antimicrobial barrier to protect athletes from pathogens, including MRSA, staph, strep, Pseudomonas, and VRE. This product keeps wounds moist and debris-free during healing. It’s available in three easy-to-apply portable treatment options—1-ounce tubes, Daily Dressing Packets, and 2x2-inch or 4x4-inch sterile saturated gauze dressings. ®

Amerx Health Care Corp. • 800-448-9599 www.amerigel.com

®

Multi Radiance Medicale announces the most advanced portable laser on the market--the MR4 ACTIV. Go online for a free webinar at 1 p.m.

Eastern on Thursday, March 31, in which Doug Johnson, ATC, EES, CLS will review technical aspects of Multi Radiance’s new portable laser therapy unit. The web session will discuss: benefits of blue light therapy; advantages of the synergistic light frequencies; and specific features of the MR4 ACTIV laser. Take advantage of a special introductory offer: 10% off and $99/mos; register online at https://www1.gotomeeting.com/register/151767041.

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BLUE LIGHT and MRSA

The Dynatron 405 Infrared/Blue Light Probe is one of three powerful infrared light therapy probes available with Solaris. In April 2009, research in the Journal of Photomedicine and Laser Surgery showed that blue light can help kill MRSA, a topic again addressed in this issue of Training & Conditioning.

Blue Light continues to establish itself as a powerful and indispensable tool for athletic trainers.

Dynatronics • 800-874-6251 www.dynatronics.com

2011 learn-by-doing

SeMinar SerieS For Everyone Who Trains or Rehabs Clients, Patients or Athletes

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For more information on Perform Better Seminars

Call 800-556-7464 RESULTS FITNESS

FunCtionAL movement sCreening & CorreCtive eXerCise Workshop

Business Seminar

• 45 nationally known presenters • 27 lecture sessions and 26 hands-on sessions at each Summit

with Gray Cook and Lee Burton

• Improve functional and athletic performance • Identify imbalances and strengthen them with corrective exercises • Become a certified FMS Specialist

From Counting reps to Counting revenue with Alwyn and Rachel Cosgrove

• Achieve success in the fitness industry • Learn to think like a business owner • Discuss hiring, marketing, sales and leadership

Mark Verstegen

Martin Rooney

Michael Boyle

Stuart McGill

Thomas Myers

Todd Durkin

FOR INFORMATION OR TO REGISTER CALL 800-556-7464 OR VISIT performbetter.com/seminars 530-24984 PB_Seminar_halfPg_AD_TC.indd 1

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CATALOG SHOWCASE Human Kinetics

Martek Biosciences

Perform Better

The 2011 Consumer Catalog contains a complete selection of Human Kinetics’ best-selling resources, and highlights new titles, such as “Full-Body Flexibility, Second Edition,” “Heart Rate Training,” and “The Strength Training Anatomy Workout.” There is a free shipping offer good on all orders placed by March 31, 2011. Request or view catalog online for details.

Brain Armor™ helps support an athlete’s brain and cardiovascular health by delivering 1,050mg of DHA per serving. Just like calcium is needed for strong bones, DHA is needed for strong brains. Brain Armor, which is NSF-certified for sport, is derived from a vegetarian, sustainable source of DHA that contains no ocean-borne contaminants. Brain Armor is produced by Martek Biosciences, a leading innovator of algal-based DHA omega-3 products.

The Perform Better 2011 catalog, The Guide to Functional Training, is now available. This 76-page publication is neatly divided into 18 separate categories for easy reference. There are separate categories for Balance & Stabilization, Bands and Tubing Training, Weight Training, Speed & Agility Training, Flexibility & Recovery, and more.

The focus is to supply the fitness trainer, coach, and athletic director with the highest-quality equipment to meet functional training needs.

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800-747-4457 www.HumanKinetics.com

888-625-7246 (OKBRAIN) www.Brain-Armor.com

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OPTP

Pro-Tec Athletics

Cho-Pat

OPTP has released its Volume 25 product catalog. With an improved design, updated images, and index for your convenience, it just might be the best one yet. The company has added so many new health and fitness products, the catalog has grown to more than 110 pages.

To request a copy of Volume 25, call or go online today.

Pro-Tec Athletics is a leading sports medicine company, specializing in orthopedic supports, and hot/cold and massage therapy products. In 2011, Pro-Tec Athletics will further its reputation for innovation by introducing a Gel-Force™ Knee Sleeve, a GelForce™ Ankle Sleeve, and Pre-Cut Kinesiology Tape, while continuing to improve existing product designs. Most products and this year’s catalog include Injury Guides, which recommend stretching and strengthening exercises to expedite the recovery process.

Knees, legs, ankles, elbows, and arms take a beating. Cho-Pat’s innovative, preventive, and painreducing sports/medical devices incorporate unique design characteristics, excellent craftsmanship, and quality materials to help reduce pain and discomfort and assist in healing. Each of the company’s American-made products — including its original and best-known device, Cho-Pat’s Original Knee Strap — are easy to use, comfortable to wear, allow full mobility, and are available in sizes for more specific and effective results.

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800-367-7393 www.optp.com

800-779-3372 www.injurybegone.com

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TRX

800-878-5348 www.TRXtraining.com/teamsports

TRX® produces and sells Suspension Training® bodyweight exercise equipment and programs to coaches,athletic trainers, clubs, athletes,and the military.

Suspension Training body-weight exercise develops strength, balance, flexibility, and core stability simultaneously. It requires the use of the Suspension Trainer™, a highly portable performance training tool that leverages gravity and the user’s body weight to enable hundreds of exercises for every training goal.

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800-556-7464 www.performbetter.com

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Amerx Health Care Corp.

800-221-1601 www.cho-pat.com

New York Barbells

800-448-9599 www.amerigel.com

800-446-1833 www.newyorkbarbells.com

Amerigel® is an FDAapproved line of skin- and wound-care products containing the natural healing agent Oakin®, an oak extract. It’s a proven antimicrobial against 51 types of bacteria, including MRSA, Staph, Pseudomonas, Strep, and VRE. Oakin® also contains antifungal and anti-inflammatory properties, making it an excellent choice for quickly healing skin injuries while providing a barrier against infection.

The 35th anniversary New York Barbells catalog is now available. Since 1974, New York Barbells has been a leading supplier of sports performance, fitness, and strength equipment. The 24-page catalog displays the company’s products from flooring to the latest biometric unilateral equipment. Call or go online to find out more.

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Testimonials

CATALOG SHOWCASE

StrechCordz Help “Fast Eddie” Swim the English Channel

PRO Orthopedic Devices, Inc.

AlterG, Inc.

Offering more than 20 patented products, PRO Orthopedic is constantly upgrading designs and materials to provide the best support possible.

The four-way stretch properties of neoprene, combined with therapeutic heat retention, make neoprene effective in controlling edema. Compression alone cannot produce the same results, and all PRO neoprene products are latex-free.

Call or visit the company’s Web site for more information.

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The AlterG Anti-Gravity Treadmill features revolutionary unweighting technology that’s reinventing rehabilitation. Recover from surgery and injury faster and with less pain, and work toward regaining function like never before.

Leading hospitals and professional sports organizations use this revolutionary machine to help patients train through injury by walking on air. Go online to learn more.

800-523-5611 www.proorthopedic.com

Samson Equipment, Inc. 800-472-6766 www.samsonequipment.com

510-270-5900 www.alter-g.com

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Sanctband

605-201-2800 www.sanctband.com Low Powder

Since 1976, Samson Equipment has designed, manufactured, and sold heavy-duty, industrial-strength weightlifting equipment to all five branches of the military, top high schools, college and professional teams, health clubs, and recreational facilities all over North America, Europe, Asia, and the Caribbean. Samson’s equipment line includes a wide variety of free-weight racks and benches, as well as selectorized machines and plate-loaded equipment.

Reduced Protein

Better Value

Reduced Protein

Better Value

Longer Lasting

Sanctband’s Low Powder Reduced Protein latex resistance band and tubing are developed according to the methods used in producing powder-free latex gloves. Sanctband products are low in powder, and latex protein — found to cause most cases of latex allergy — is reduced during processing. Sanctband resistance bands are available in 3-in-1 combo dispensers, 30-piece dispensers, and 6-yard and 50-yard roll dispensers.

Low Powder

Vibrant Colors

Vibrant Colors

Please visit www.sanctband.com for more information.

Distributors:

DYNATRONICS www.dynatronics.com 800-874-6251

Longer Lasting

OPTP www.optp.com 1 (888) 819-0121

MEDLINE www.medline.com 1-800-633-5463

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Avazzia

Sprint Aquatics

800-235-2156 www.sprintaquatics.com

214-575-2820 www.avazzia.com

Sprint Aquatics has been supplying the aquatics world for more than 37 years, and its combination of quality, price, and customer service is hard to match. Whether you need goggles, swim caps, fins, storage bins that can be custom made, or other products to enhance your aquatic experience, Sprint Aquatics has what you need to succeed. Call or go online to get a product catalog or for answers to questions regarding any product.

Avazzia Pro-Sport® devices are non-invasive, non-pharmaceutical micro-current biofeedback medical devices for deep stimulation and pain therapy for the athlete as well as the professional. Devices and accessories are developed using latest technological research from NASA as well as colleges and universities.

Patented and new patents pending on devices and accessories including pulsed magnetic and light therapy accessories. Avazzia is an FDA-, European CE-, and HealthCanada-accepted company.

Prescriptions are required.

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The English Channel, an arm of the Atlantic Ocean that separates Great Britain from northern France, is known for strong tides, chilling temperatures, and heavy commercial traffic. In fact, it boasts a less than 50-percent success rate for solo swims each season.

However, the channel proved no match for “Fast Eddie” Peinado, who successfully crossed it on July 18, 2010.

And NZ Manufacturing, a leader in high-quality resistance training tools, was proud to be part of this achievement.

Peinado credits NZ Manufacturing’s StrechCordz Long Belt Slider as an integral part of his rigorous training program. The company’s best-selling in-water resistance product features a heavy two-inch waist belt connected to a 20-foot latex tube. Recently improved for increased safety and comfort, the slider is ideal for resisted swim-out and speed-assisted swim back exercises.

Used regularly, it can help acceleration, strengthen the finishes of each stroke, and improve swim times.

For more on NZ Manufacturing, call the company or go online today.

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NZ Manufacturing P.O. Box 2146 Stow, OH 44224 800-886-6621 www.nzmfg.com T&C MaRCH 2011

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Testimonials

Revolutionary Treatment

Aquatic Exercise For a Better WATER Workout

Enhance aquatic workouts with Power Systems’ Aqua Versa-Tube water-specific tubing. Powder-free tubes have specialty coating that resists the damaging effects of chlorine; plugs at each end keep water out. The product’s deluxe contoured, pliable handles provide a secure grip in the water, and its handles and tube will not absorb water. Aqua Versa-Tube is 48 inches long, and available in five resistance levels, consistent with its regular land tubing.

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

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Anyone Can Float

“Our 2009 study illustrated that a novel exercise using the Thera-Band® FlexBar ® may provide a practical and effective means of adding isolated wrist strengthening exercises to a treatment plan. Compared to patients receiving standard physical therapy treatment, those performing the FlexBar exercise along with the standard treatment had significantly greater improvements in lowering pain and gaining strength.

We stopped the study early because we saw such a vast improvement in the FlexBar group; we didn’t feel that it was ethical to keep people that weren’t getting better on the standard -treatment-only protocol.”

— Timothy Tyler, PT, MS, ATC Clinical Research Associate Nicholas Institute of Sports Medicine & Athletic Trauma, New York, NY

“The Tyler research study proves what we’ve seen in the clinic — the use of the Thera-Band® FlexBar ® in concert with a physical therapy treatment regimen for wrist extensor strengthening is effective in reducing pain and improving wrist and forearm strength. We use the FlexBar regularly in our clinic and for the treatment and training of elite level tennis players at tennis facilities around the world.”

— Todd S. Ellenbecker, DPT, MS, SCS, OCS, CSCS Clinic Director, Physiotherapy Associates Scottsdale Sports Clinic; National Director of Clinical Research, Physiotherapy Associates; Director of Sports Medicine, ATP World Tour

Hygenic/Performance Health 1245 Home Ave. Akron, OH 44310 800-321-2135 www.thera-band.com

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The AquaJogger Pro Plus belt is ideal for athletes with minimal body fat who need maximum flotation for vertical aquatic training and rehab. This belt option is 50 percent more buoyant than the Classic model. The maximum waist size is 44 inches, but longer elastic belts are available for wider waistlines if needed. This product was specifically designed for “sinker” body types.

AquaJogger • 800-922-9544 www.aquajogger.com

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Learn to Teach

“Water Fitness Lesson Plans and Choreography” helps new instructors learn the basics of class organization, and keeps veteran instructors out of the proverbial teaching rut. This reference contains 72 lesson plans for shallow and deep water—each including a warmup and cool-down, variations, choreography, and modifications. A total of 576 exercises are described and accompanied by 253 photos.

Human Kinetics • 800-747-4457 www.humankinetics.com

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The Aquatics Experts

Sprint Aquatics has been supplying the aquatics world for over 37 years.

The company’s combination of quality, price, and customer service has yet to be matched. Whether you need goggles, swim caps, fins, storage bins that can be custom-made, or other products to enhance your aquatic experience, Sprint Aquatics has what you need to succeed.

Sprint Aquatics • 800-235-2156 www.sprintaquatics.com

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Work Out More Efficiently

Similar to the Long Belt Slider, the StrechCordz Quick Connect provides a quick disconnect to speed up exit/entry time during resisted swim-out and speed-assisted swim back exercises. It features two belts with connection buckles and a safety cord tube, and is available in four resistance levels. The Quick Connect is the result of coaches and swimmers alike looking for a way to reduce transition time in the pool during practice.

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

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Smart Storage Solution

Power Systems’ three-tiered racks securely hold aquatic equipment on mesh shelves, allowing for water run-off and ventilation. The Club Rack has six mesh shelves; the compact Studio Rack has three mesh shelves and fits into smaller areas. Casters are included for easy mobility. The rack is built from two-inch hard gray PVC tubing. Club Rack dimensions: 75” long by 22” wide by 70” high; Studio Rack dimensions: 47” long by 22” wide by 70” high. Equipment is sold separately.

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

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More Products Fights Cross-Contamination

Get a leg up in the battle against crosscontamination with the Hibiclens Hands Free Dispenser. The unit holds a 32-ounce bottle of Hibiclens, and includes a foaming nozzle for more efficient and cost-effective use of the product. The dispenser is available at no charge with the purchase of Hibiclens.

Molnylcke Health Care • 800-843-8497 www.hibiclens.com

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Professional treatment

Thera-Band stability products offer outstanding solutions 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 training professionals and physical therapists the tools they need to successfully treat patients. 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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No Plumbing Required

The Coldtub cryotherapy spa offers cold water therapy, hot water therapy, and saltwater therapy—all in one. It’s completely portable, so you can provide athletes with state-of-the-art treatment and pain relief without installing new plumbing or redesigning your entire facility. Users can sit or kneel in the pool, and the purification and sanitization systems keep the water clean while the solid-state cooling system maintains the temperature you want. New deeper seating accommodates taller athletes.

Coldtub • 617-480-7683 www.coldtub.com

American Public University offers affordable online degrees to help you achieve your career goals.

Pursue an online bachelor’s degree in Sports and Health Sciences or an online master’s degree in Sports Management, and focus your studies on coaching, exercise science, presports medicine, sports administration, or other courses.

Programs are 100 percent online, and 8- and 16-week courses start monthly. Tuition starts at $250 to $300 per credit hour. Learn more today!

American Public University • 877-468-6268 www. StudyatAPU.com/sports

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Safe, Comfortable Stretching The Stretch-EZ’s cradle design encompasses the foot, allowing for a comfortable stretch to the foot, heel, Achilles tendon, hamstring, quadriceps, inner/outer thigh, and calf. Made of a comfortable poly laminate and webbing, this unique stretching aide assists in the treatment of plantar fasciitis, heel spurs, calf, thigh, hip, and lower back strains and injuries. Strap loops allow for personal control of each stretch.

OPTP • 800-367-7393 www.optp.com

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Master’s program

The entry-level Master of Science in Athletic Training at The College of St. Scholastica, in Duluth, Minn., is the only program of its kind offered between Ohio and the Dakotas. The program, which includes a 23-month residency and 70 credit hours, is looking for students for its next cohort, starting in June.

For more information, contact Department Chair Dr. Hal Strough at the email below, or email hstrough@css.edu.

The College of St. Scholastica • 218-723-6798 www.css.edu Circle No. 525

Circle No. 529

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; exercise bikes; ergometers; stopwatches; fitness books and software; step benches; heating pads; and more.

Creative Health Products, Inc. • 800-742-4478 www.chponline.com Circle No. 526 TR AINING-CONDITIONING.COM

Learn to Achieve

Road-Warrior Relief

Biofreeze® Pain Reliever, the most frequently used and among the top trainer-recommended topical pain relievers, is the perfect product for your road-warrior and travelweary athletes. For nearly 20 years, Biofreeze products have been helping people manage discomfort by assisting in pain relief, therapy, and overall comfort. Three different formulations are packaged in carry-on travel sizes: 2 oz. Biofreeze Spray; 3 oz. Biofreeze Roll-On; and the newest addition to the product line, Biofreeze Pain Relieving Wipes.

Performance Health • 800-321-2135 www.biofreeze.com

Circle No. 527 T&C MaRCH 2011

51

Directory

Advertisers Directory Circle #. Company. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page #

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

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

129. AlterG. . . . . . . . . . . . . . . . . . . . . . . . . . . 43

120. DJO/Aircast® . . . . . . . . . . . . . . . . . . . . . 26

132. Perform Better (seminars). . . . . . . . . . . . 47

110. American Public University. . . . . . . . . . . 13

100. Dynatronics . . . . . . . . . . . . . . . . . . . . . IFC

121. Power Systems. . . . . . . . . . . . . . . . . . . 29

104. Amerigel®. . . . . . . . . . . . . . . . . . . . . . . . . 6

109. GymWipes FORCE. . . . . . . . . . . . . . . . . 12

111. PRO Orthopedic Devices. . . . . . . . . . . . . 15

108. AquaJogger® . . . . . . . . . . . . . . . . . . . . . 12

103. Hibiclens® & Hibistat®. . . . . . . . . . . . . . . 5

122. Pro-Tec Athletics . . . . . . . . . . . . . . . . . . 31

105. Athletix Products by Contec . . . . . . . . . . . 8

107. Human Kinetics . . . . . . . . . . . . . . . . . . . 10

127. Samson Equipment . . . . . . . . . . . . . . . . 41

130. Avazzia. . . . . . . . . . . . . . . . . . . . . . . . . . 45

102. MilkPEP. . . . . . . . . . . . . . . . . . . . . . . . . . 3

119. Sanctband™. . . . . . . . . . . . . . . . . . . . . . 25

115. Biofreeze®/Performance Health . . . . . . . 21

131. Multi Radiance Medical . . . . . . . . . . . . . 46

113. Sprint Aquatics. . . . . . . . . . . . . . . . . . . . 20

133. Brain Armor™(Martek Biosciences). . . . IBC

134. Muscle Milk® (CytoSport). . . . . . . . . . . . BC

114. The College of St. Scholastica. . . . . . . . . 20

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

126. New York Barbells of Elmira. . . . . . . . . . 38

116. TRX® . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

117. Coldtub . . . . . . . . . . . . . . . . . . . . . . . . . 24

128. NSCA . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

124. TurfCordz™/NZ Manufacturing . . . . . . . . 35

112. Cosamin® (Nutramax Laboratories). . . . . 18

125. OPTP. . . . . . . . . . . . . . . . . . . . . . . . . . . 37

118. Vibrosphere® (Accent Ventures) . . . . . . . 24

123. Creative Health Products . . . . . . . . . . . . 35

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

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

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

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

531. AlterG . . . . . . . . . . . . . . . . . . . . . . . . . . 49

538. Dynatronics . . . . . . . . . . . . . . . . . . . . . . 47

524. Performance Health (Thera-Band®). . . . . 51

534. American Public University. . . . . . . . . . . 51

502. GymWipes FORCE. . . . . . . . . . . . . . . . . 46

517. Power Systems (Aqua Versa-Tube). . . . . 50

504. Amerx Health Care (Amerigel® Wound Dressing). 47

506. Human Kinetics (catalog). . . . . . . . . . . . 48

522. Power Systems (three-tiered racks). . . . 50

500. Amerx Health Care (Amerigel® Wound Wash). . 46

519. Human Kinetics (Water Fitness) . . . . . . . 50

515. PRO Orthopedic . . . . . . . . . . . . . . . . . . . 49

513. Amerx Health Care (catalog). . . . . . . . . . 48

533. Molnlycke (Hands Free Dispenser). . . . . 51

510. Pro-Tec Athletics . . . . . . . . . . . . . . . . . . 48

518. AquaJogger® . . . . . . . . . . . . . . . . . . . . . 50

503. Molnlycke (Hibiclens®). . . . . . . . . . . . . . 46

516. Samson Equipment . . . . . . . . . . . . . . . . 49

501. Athletix Products by Contec . . . . . . . . . . 46

537. Multi Radiance Medical . . . . . . . . . . . . . 47

532. Sanctband™. . . . . . . . . . . . . . . . . . . . . . 49

535. Avazzia, Inc. (Pro-Sport devices). . . . . . . 47

514. New York Barbells . . . . . . . . . . . . . . . . . 48

520. Sprint Aquatics. . . . . . . . . . . . . . . . . . . . 50

536. Avazzia, Inc. (catalog). . . . . . . . . . . . . . . 49

521. NZ Manufacturing. . . . . . . . . . . . . . . . . . 50

528. Sprint Aquatics (catalog). . . . . . . . . . . . . 49

507. Brain Armor™ (Martek Biosciences) . . . . 48

509. OPTP (catalog). . . . . . . . . . . . . . . . . . . . 48

525. The College of St. Scholastica. . . . . . . . . 51

511. Cho-Pat . . . . . . . . . . . . . . . . . . . . . . . . . 48

523. OPTP (Stretch-EZ). . . . . . . . . . . . . . . . . . 51

512. TRX® . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

529. Coldtub . . . . . . . . . . . . . . . . . . . . . . . . . 51

508. Perform Better . . . . . . . . . . . . . . . . . . . . 48

526. Creative Health Products . . . . . . . . . . . . 51

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

Products Directory

52

T&C MaRCH 2011

TR AINING-CONDITIONING.COM

Q

CEU QUIZ

T&C March 2011 Volume XXI, No. 2

uicke You c an no r&E w tak and g asi e our et yo ur CE CEU q er!

U uiz r e www Click on “C sults and c zes online... red EUs & .train ing-c Courses it instantly. ” at: ondi t ionin

g.co

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

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

m

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

your quiz to us: Fill in the circle on the answer form (on page 55) that represents the best answer for each of the questions below.

Include a $25 payment to MAG, Inc., and mail it to the following address: MAG, Inc., ATTN: T&C 21.2 Quiz, 31 Dutch Mill Road, Ithaca, NY 14850. Readers who correctly answer 70 percent of the questions will be notified of their earned credit by mail within 30 days.

Bulletin Board (pages 4-5)

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

1. How long were the coaching sessions the basketball players participated in three times a week as part of the jump training study? a) 15 minutes b) 20 minutes c) 30 minutes d) 45 minutes 2. Decreasing knee valgus angle when landing is thought to _____. a) Increase the risk of knee injury b) Reduce the risk of knee injury c) Strengthen the quadriceps d) Strengthen the ankle musculature 3. What was one of the reasons the Virginia High School League banned energy drinks at its member schools’ practices and games? a) They are too expensive b) With no regulatory control over the various brands, their contents and purity cannot be ensured c) Athletes who drink them have an unfair advantage over those who don’t d) They keep athletes awake at night so they weren’t getting enough sleep 4. Working for Ohio State University Sports Medicine allows athletic trainers to branch out as _____. a) Physicians b) EMTs c) Nurses d) Physician extenders

Eyes On The Prize (pages 11-15)

Objective: Learn about sports vision training and what it can do for your athletes’ performance.

5. How many extraocular muscles are there in the eye? a) Three b) Six c) Nine d) Twelve 6. When athletes are performing saccade exercises, they begin with the number charts placed _____ feet apart. a) Four b) Six c) Eight d) Ten 7. When training eye-hand speed and coordination, the speed of the exercises is increased once an athlete hits _____ percent of the targets. a) 80 b) 85 c) 90 d) 95 8. What is the name of a simple exercise athletes can perform to improve stereopsis and depth perception? a) The saccade exercise b) The Sports Vision Trainer c) The Brock string exercise d) The tachistoscope 9. Some of the athletes at the Air Force Academy are able to record the numbers they see flashing on screen for as few as _____ milliseconds. a) 100 b) 110 c) 120 d) 130

Answer sheet is on page 55...or take this quiz online and get instant results: www.training-conditioning.com click on CEUs & Courses TR AINING-CONDITIONING.COM

T&C MaRCH 2011

53

CEU QUIZ Cases Solved (pages 19-25)

Objective: See how with the right nutrition solutions, four athletes got back on top of their game.

10. The university athletic department where Sasha was an athlete had an iron protocol in place of at least _____ ng/ml for its female athletes. a) 20 b) 25 c) 30 d) 35 11. The author suggested Sasha incorporate _____ into her diet four times a week to help improve her iron intake. a) Pork b) Beef c) Leafy greens d) Seafood 12. What was the first area the author worked on with Julie? a) Establishing basic healthy eating patterns and maintaining a healthy body weight b) Eating the “scary” foods Julie normally didn’t allow herself to eat c) Gaining 10 pounds d) Admitting she had an eating disorder

Back On Track (pages 27-31)

Objective: Learn about a few common running injuries—and solutions—from the athletic trainer at the University of Oregon who works with the track and field and cross country teams.

13. When do athletes with plantar fasciitis often feel pain? a) On the bike b) In the pool c) When they first get out of bed in the morning d) When they go to bed and lay down 14. If a runner’s _____ is weak, he or she will experience above average pronation. a) Arch b) Posterior tibialis c) ACL d) Calcaneus

54

T&C MaRCH 2011

15. Achilles tendinosis is often misdiagnosed as _____. a) Plantar fasciitis b) A torn Achilles c) Arthritis d) Tendonitis 16. The first two weeks after an Achilles tendinosis diagnosis, treatment should focus on _____ around the ankle and hip joints. a) Strength b) Impact work c) Increasing range of motion d) Decreasing range of motion 17. The author suggests that when runners diagnosed with Achilles tendinosis return to running, they start with _____-minute sessions every other day. a) 20 b) 30 c) 35 d) 45

Passing It On (pages 32-37)

Objective: Learn the ins and outs of starting a sports medicine class at your high school.

18. What is one of the five tasks the NATA says athletic training student aides should never do? a) Perform evaluations b) Learn how to tape ankles during a sports medicine class c) Spend time in the athletic training room observing after school d) Ask the school athletic trainer if they can observe a team practice 19. At the author’s school, the sports medicine courses are part of the _____. a) Physical education department b) Science department c) Career and technical education program d) Health department

20. The author notes that perhaps the biggest issue when it comes to getting a sports medicine course approved is _____. a) Finding interested students b) Funding c) Creating the class curriculum d) Getting other teachers on board 21. In order to appeal to all types of learners, the author combines what learning tool with hands-on work during class? a) Reading textbook chapters out loud b) Slide show lectures c) DVDs d) PowerPoint presentations

From The Top Down (pages 39-43)

Objective: See how the Stanford University water polo team approaches its weightroom training.

22. Since water polo athletes recruit the _____ for just about everything they do in the pool, it’s one of the more problematic areas for them. a) Trunk b) Quadriceps c) Shoulders d) Biceps 23. Many water polo athletes have _____ thoracic spines. a) Hypomobile b) Straight c) Hypermobile d) Shortened 24. _____ are some of the most common deficiencies the author sees in water polo players. a) Compensatory patterns b) Overdeveloped patterns c) Upper and lower body imbalances d) Left and right side imbalances 25. What is a vital part of active isolated stretching (AIS)? a) Strength b) Breathing c) Flexibility d) Mobility

TR AINING-CONDITIONING.COM

CEU QUIZ Cases Solved (pages 19-25)

Objective: See how with the right nutrition solutions, four athletes got back on top of their game.

10. The university athletic department where Sasha was an athlete had an iron protocol in place of at least _____ ng/ml for its female athletes. a) 20 b) 25 c) 30 d) 35 11. The author suggested Sasha incorporate _____ into her diet four times a week to help improve her iron intake. a) Pork b) Beef c) Leafy greens d) Seafood 12. What was the first area the author worked on with Julie? a) Establishing basic healthy eating patterns and maintaining a healthy body weight b) Eating the “scary” foods Julie normally didn’t allow herself to eat c) Gaining 10 pounds d) Admitting she had an eating disorder

Back On Track (pages 27-31)

Objective: Learn about a few common running injuries—and solutions—from the athletic trainer at the University of Oregon who works with the track and field and cross country teams.

13. When do athletes with plantar fasciitis often feel pain? a) On the bike b) In the pool c) When they first get out of bed in the morning d) When they go to bed and lay down 14. If a runner’s _____ is weak, he or she will experience above average pronation. a) Arch b) Posterior tibialis c) ACL d) Calcaneus

54

T&C MaRCH 2011

15. Achilles tendinosis is often misdiagnosed as _____. a) Plantar fasciitis b) A torn Achilles c) Arthritis d) Tendonitis 16. The first two weeks after an Achilles tendinosis diagnosis, treatment should focus on _____ around the ankle and hip joints. a) Strength b) Impact work c) Increasing range of motion d) Decreasing range of motion 17. The author suggests that when runners diagnosed with Achilles tendinosis return to running, they start with _____-minute sessions every other day. a) 20 b) 30 c) 35 d) 45

Passing It On (pages 32-37)

Objective: Learn the ins and outs of starting a sports medicine class at your high school.

18. What is one of the five tasks the NATA says athletic training student aides should never do? a) Perform evaluations b) Learn how to tape ankles during a sports medicine class c) Spend time in the athletic training room observing after school d) Ask the school athletic trainer if they can observe a team practice 19. At the author’s school, the sports medicine courses are part of the _____. a) Physical education department b) Science department c) Career and technical education program d) Health department

20. The author notes that perhaps the biggest issue when it comes to getting a sports medicine course approved is _____. a) Finding interested students b) Funding c) Creating the class curriculum d) Getting other teachers on board 21. In order to appeal to all types of learners, the author combines what learning tool with hands-on work during class? a) Reading textbook chapters out loud b) Slide show lectures c) DVDs d) PowerPoint presentations

From The Top Down (pages 39-43)

Objective: See how the Stanford University water polo team approaches its weightroom training.

22. Since water polo athletes recruit the _____ for just about everything they do in the pool, it’s one of the more problematic areas for them. a) Trunk b) Quadriceps c) Shoulders d) Biceps 23. Many water polo athletes have _____ thoracic spines. a) Hypomobile b) Straight c) Hypermobile d) Shortened 24. _____ are some of the most common deficiencies the author sees in water polo players. a) Compensatory patterns b) Overdeveloped patterns c) Upper and lower body imbalances d) Left and right side imbalances 25. What is a vital part of active isolated stretching (AIS)? a) Strength b) Breathing c) Flexibility d) Mobility

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Your Month, Your Stories March is National Athletic Training Month, and T&C would like to honor those athletic trainers who go above and beyond to make a difference in the lives of athletes they work with and the communities they serve. And we want to hear from you!

Share your favorite athletic training stories, photos, and videos or tell us about an athletic trainer who has left a positive mark on your career by e-mailing us at: tcfeedback@momentummedia. com.

Or visit our Web site and go to our March Monthly Feature and leave feedback at the bottom of the page.

www.training-conditioning.com/features.php

Strong Values

All In a Week’s Work

While football coaches get the limelight, strength coaches need to perform their job in the trenches. In this blog, Jason Benguche, MS, CSCS, PES, Assistant Director of Player Development for Football at Georgia Tech, shares the values that guide his approach to athlete development.

Ever wonder how a strength and conditioning coach approaches inseason work with a big-time college basketball team? Rich Jacobs, MS, SCCC, CSCS, Assistant Strength & Conditioning Coach at Xavier University, gives a glimpse into his role with the school’s top-10 women’s basketball team during a very competitive week.

www.training-conditioning.com/blogs.php

www.training-conditioning.com/features.php

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FOR STRONG BRAINS

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Circle No. 133

Circle No. 134