Training & Conditioning 22.6

September 2012 Vol. XXII, No. 6, $7.00

FULL SPEED AHEAD Advances in hip surgery

Ropes in the Weightroom Protein Beverages

Circle No. 100

September 2012, Vol. XXII, No. 6

contents

35 6

Bulletin Board New concussion imaging … GPS for injury prevention … Sudden death safety law …

New altitude training research.

Q&A

8 Brad Swope

Sumner Regional Health Systems Sponsored Pages 4 Gatorade 27 Balanced Body

48 49 51 54 57

Product News Rope Training Nutrition Products Lower Body Strengthening

13

41

Optimum Performance

The Power of Ropes

Rope training is making waves in weightrooms everywhere.

Here, the Cincinnati Bengals’ strength and conditioning coach shares how he integrates the idea into the team’s programming.

By Chip Morton Treating the Athlete

Speed Ahead 22 Full The number of athletes having arthroscopic hip surgery

continues to increase. The good news is that return to play after the procedure is quick.

By Dr. Mark Lawler & Dr. Daniel Solomon Nutrition

Protein 29 Packing Regardless of which form it comes in, the various protein

Product Launch

beverages on the market can have a positive effect on athlete performance. A sports dietitian explains all.

By Susan Kundrat

56

Advertisers Directory

Leadership

61

CEU Quiz For NATA and NSCA Members

64

Next Stop: Web Site

Pilates Equipment

an ATC 35 Dial When patients call this athletic trainer, she helps get them the

appointment they need and makes sure they know how to care for their injury until they see a physician.

By Elyse Putorti Sport Specific

On the cover: Alex Rodriguez had surgery to repair a torn labrum and impingement in 2009. Our cover story about hip surgery and rehab starts on page 22.

Photo by Kathy Willens/AP Photos

TR AINING-CONDITIONING.COM

Up Performance 41 Stand At the University of Alabama, perfect posture is a focus of every

strength and conditioning workout. This year, it was part of what earned the softball program its first national championship.

By Michelle Martin Diltz T&C september 2012

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Editorial Board Marjorie Albohm, MS, LAT, ATC Director, Ossur Americas Past President, NATA

Maria Hutsick, MS, LAT, ATC, CSCS Head Athletic Trainer Medfield (Mass.) High School

Jon Almquist, ATC Athletic Training Program Administrator Fairfax County (Va.) Public Schools

Christopher Ingersoll, PhD, ATC, FACSM Director of Graduate Programs in Sports Medicine/Athletic Training University of Virginia

Jim Berry, EdD, ATC, SCAT, NREMT Head Athletic Trainer Myrtle Beach (S.C.) High School Christine Bonci, MS, LAT, ATC Associate Athletics Director Sports Medicine/Athletic Training University of Texas Leslie Bonci, MPH, RD, CSSD, LDN Director of Sports Medicine Nutrition Center for Sports Medicine University of Pittsburgh Medical Center Cynthia “Sam” Booth, PhD, ATC Visiting Assistant Professor SUNY Brockport Debra Brooks, CNMT, LMT, PhD CEO, Iowa NeuroMuscular Therapy Center

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Cindy Chang, MD President, American Medical Society for Sports Medicine Dan Cipriani, PhD, PT Associate Professor Deptartment of Physical Therapy Chapman University Gray Cook, MSPT, OCS, CSCS, RKC Clinic Director Orthopedic and Sports Physical Therapy Dunn, Cook and Associates Keith D’Amelio, ATC, PES, CSCS Nike Sparq Training

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Bernie DePalma, MEd, PT, ATC Assistant Athletic Director Head Athletic Trainer/Physical Therapist Cornell University Lori Dewald, EdD, ATC, CHES, F-AAHE School of Public Safety and Health American Public University David Ellis, RD, LMNT, CSCS Sports Alliance, Inc. Boyd Epley, MEd, CSCS Director of Coaching Performance National Strength & Conditioning Association Peter Friesen, ATC, NSCA-CPT, CSCS, CAT Head Athletic Trainer/Conditioning Coach Carolina Hurricanes Lance Fujiwara, MEd, ATC, EMT Director of Sports Medicine Virginia Military Institute

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T&C september 2012

Vern Gambetta, MA President, Gambetta Sports Training Systems P.J. Gardner, MS, ATC, CSCS, PES Athletic Trainer, Liberty High School, Colo.

Joe Gieck, EdD, ATR, PT Director of Sports Medicine Professor, Clinical Orthopaedic Surgery University of Virginia (retired)

Allan Johnson, MS, MSCC, CSCS Sports Performance Director Velocity Sports Performance Tim McClellan, MS, CSCS Strength and Conditioning Specialist Rehab Plus Sports Performance and Injury Rehabilitation Timothy Morgan, DC, CCSP Professor of Exercise and Health Sciences University of Massachusetts Jenny Moshak, MS, ATC, CSCS Assistant AD for Sports Medicine University of Tennessee Steve Myrland, CSCS Owner, Manager Myrland Sports Training, LLC Director of Coaching, Train-To-Play Tim Neal, MS, ATC Assistant Director of Athletics for Sports Medicine Syracuse University 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, Center for Medicine and Sport Ellyn Robinson, DPE, CSCS, CPT Assistant Professor of Exercise Science Bridgewater State College Kent Scriber, EdD, ATC, PT Professor/Clinical Education Coordinator Ithaca College Chip Sigmon, CSCS*D Speed and Agility Coach OrthoCarolina Sports Performance Bonnie J. Siple, EdD, ATC Assistant Professor Department of Exercise and Rehabilitative Sciences Slippery Rock University Chad Starkey, PhD, ATC, FNATA Division Coordinator, Athletic Training Program, Ohio University Ralph Stephens, LMT, NCTMB Sports Massage Therapist, Ralph Stephens Seminars Jeff Stone, MEd, LAT, ATC Head Athletic Trainer, Suffolk University

Brian Goodstein, MS, ATC, CSCS, Head Athletic Trainer, DC United

Fred Tedeschi, ATC Head Athletic Trainer, Chicago Bulls

Gary Gray, PT President, CEO Functional Design Systems

Terence Todd, PhD Lecturer, Kinesiology and Health Education University of Texas

September 2012 Vol. XXII, No. 6 Publisher Mark Goldberg Editorial Staff Eleanor Frankel, Director Abigail Funk, Managing Editor R.J. Anderson, Patrick Bohn, Kristin Maki, 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 Marketing Director Sheryl Shaffer Advertising Sales Associate Diedra Harkenrider (607) 257-6970, ext. 24 Advertising Materials Coordinator/Sales Mike Townsend (607) 257-6970, ext. 13 T&C editorial/business offices: 20 Eastlake 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., 20 Eastlake Road, 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© 2012 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.

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POSTMASTER: Send address changes to Training & Conditioning, P.O. Box 4806, Ithaca, NY 14852-4806. Printed in the U.S.A.

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GATORADE SPORTS SCIENCE INSTITUTE Julie DeMartini, MA, ATC, Vice President of Research Korey Stringer Institute | University of Connecticut

As hot-weather practices start up, coaches, athletic trainers and athletes need to understand how hydration and fueling can impact performance and safety during the hot, summer months. Heat can take a significant toll on an athlete’s body. Beat the heat this summer by paying attention to fueling and hydration when working out, training or competing along with knowing how to prevent and treat heat illness.

Exertional heat stroke (EHS) is one of the leading causes of death among high school and collegiate student athletes. Over the last 5-year reporting period (2005-2009), data from the University of North Carolina National Center for Catastrophic Injury has shown that there has been a increase in the number of heat stroke fatalities.1 The total number of EHS deaths over this period (18 deaths) was more than any other 5-year block since 1975 (and twice the 5-year average).

The majority of collegiate athlete deaths occur during conditioning sessions while the majority of high school athlete deaths occur on the football field. The crux of the problem is that current policies for decreasing the incidence of exertional heat illness are insufficient and ineffective and the potential for inappropriate care continues to be a large threat.

A proper heat acclimatization plan in secondary school athletic programs is essential to minimize the risk of EHS during the preseason practice period. Nearly all EHS cases occur during the first week of preseason practices, highlighting the importance of making changes during this time to maximize the safety of student athletes. Heat acclimatization involves gradually increasing athletes’ exposure to the duration and intensity of physical activity, the environment and protective athletic equipment. The goal of the acclimatization period is to enhance exercise heat tolerance and the ability to safely and effectively train in warm and hot conditions during the first 14 days of athletic participation (see table 1).3 Currently, seven states have officially passed a high school heat acclimatization policy, including New Jersey, Texas, Connecticut, Georgia, North Carolina, Arkansas and Arizona, while many others are actively pursuing this endeavor. In addition to adopting these heat acclimatization policies, other initiatives can be taken to minimize the occurrence of sudden death in student athletes.4 For example, institutions should implement emergency action plans (EAP’s)5 for all venues associated with athletic events. Additionally, it is recommended that all institutions employ a full time certified athletic trainer (ATC) as these medical professionals are educated and trained to prevent, recognize and treat EHS as well as other common causes of sudden death in sport.

Unfortunately, only approximately 50% of high schools employ an athletic trainer. For school lacking a certified athletic trainer, coaches should undergo mandatory education sessions focused to prevent EHS and teach how to treat an EHS if it does occur. Other recommendations include rescheduling practices to avoid the hottest time of the day, providing ample rest breaks during practices and ensuring that there are sufficient hydration options for athletes before, during and after games and practices. By implementing these policy changes and following proper prevention strategies, the occurrence of EHS and the unnecessary deaths of student athletes are likely to be reduced.

For more information on preventing EHS, visit ksi.uconn.edu

TIPS TO FUEL AND HYDRATE FOR HOT WEATHER •

Hydrate safely throughout the day with fluids that contain electrolytes.

Electrolytes help regulate the balance of fluid in your system which could help reduce the risk of dehydration. Dehydration can cause a very dangerous imbalance in your blood-sodium and fluid level that can lead to heat-related illnesses and even death.

•

Weigh yourself before and after practice to determine individual fluid loss.

Replace every pound lost with approximately 20 ounces of fluid. Drink enough fluids to replace sweat losses and stay hydrated but be careful not to overdrink, as that can be dangerous.

•

Intense heat and humidity can put more stress on your body. This can cause you to sweat more and can make your heart work harder. Change your exercise routine in these conditions by taking more frequent breaks, decreasing exercise intensity and replenishing fluids and electrolytes when you’re out on the field.

•

Sports fuels that contain carbohydrates and electrolytes can be a dual defense against dehydration and an intense workout in the heat. Electrolytes can help your body replace what’s lost in sweat and retain fluid and carbohydrate fuel will make sure your body has additional energy to keep going. Fuel your body before exercise to perform in the heat of the moment.

•

Be conscious of the steps you take after a workout to plan for your next one.

Your body is your most essential athletic gear. Prepare to perform day after day by putting the right fuels and fluids in your system after your workout ends. Your post-game plan should include protein to help rebuild muscle and fluid with electrolytes to help replace and balance your fluid-levels.

Table 1: Recommended Heat Acclimatization Policies for High School Athletics.

Days of Practice

Recommendations

Days 1-2

1. Single practice sessions only 2. Players may only wear helmets 3. Daily practice time cannot exceed 3 hours (plus one 1-hour walk through)

Days 3-5

1. Single practice sessions only 2. Players may only wear helmets and shoulder pads 3. Daily practice time cannot exceed 3 hours (plus one 1-hour walk through)

Days 6-14

1. A single practice session day must fall between two double practice session days (cannot have two consecutive days of double practice sessions) 2. Players are permitted to wear full pads/equipment 3. Daily practice time cannot exceed 5 hours (plus one 1-hour walk through)

References: 1 Mueller F and Cantu R. Twenty Sixth Annual Report of the National Center for Catastrophic Sports Injury Research: Catastrophic Football Injuries. 2009.

2 Casa DJ, Almquist J, Anderson S, et al. Inter-Association Task Force on Exertional Heat Illness consensus statement. NATA News. June 2003:24-29.

3 Casa DJ, Csillan D. Preseason Heat-Acclimatization Guidelines for Secondary School Athletes. J Athl Train. 2009;44(3):332-333.

4 Casa DJ, Guskiewicz KM, Anderson SA, et al. National Athletic Trainers’ Association Position Statement: Preventing Sudden Death in Sports. J Athl Train. 2012;47(1):96-118.

5 Anderson JC, Courson RW, Kleiner DM, McLoda TA. National Athletic Trainers’ Association Position Statement: Emergency Planning in Athletics. J Athl Train. 2002;37(1):99-104.

Circle No. 103

Bulletin

Board

A New View of Concussions When it comes to identifying concussions, diffusion tensor imaging (DTI) is making waves in the medical community. Researchers who used the new MRI technique in a recent study found that concussed individuals have unique spatial patterns of brain abnormalities that change as time goes on.

The new technique could offer help in diagnosing concussions and predicting which patients will have persistent and progressive symptoms. While previous studies have found differences between the brains of people with and without concussions, this research delves into the differences between one concussion victim and another.

The study, published in a special online edition of Brain Imaging and Behavior in June, used DTI to view the brains of 34 patients who were diagnosed with mild traumatic brain injury, as well as 30 healthy control subjects. The patients, 19 women and 15 men between ages 19 and 64, were imaged within two weeks of suffering their injury and again three and six months later. The study authors then analyzed that data using Enhanced Z-score Microstructural Assessment Pathology (EZ-MAP), a new piece of software that allows researchers to, for the first time, examine microstructural abnormalities in the brain.

The images showed areas of abnormally low fractional anisotropy (FA)—a scale used to measure whether tissue maintains its microstructural integrity—in the concussion patients, but not in the controls. Each concussion patient also displayed a unique spatial pattern of low FA that changed throughout the study. This helps prove that people respond differently to concussions.

The abstract of the study “Robust Detection of Traumatic Axonal Injury in Individual Mild Traumatic Brain Injury Patients: Intersubject Variation, Change Over Time and Bidirectional Changes in Anisotropy” can be found by searching its title at: www.springerlink.com.

GPS for Injury Prevention Many people use global positioning systems (GPS) technology to help them get from point A to point B in their car. But could it also help athletes avoid injury? Anecdotal evidence from two professional teams indicates that it may.

Craig Duncan, PhD, Head of Human Performance for Australian professional soccer team Sydney FC, believes that soft tissue injuries can be prevented if players wear GPS devices. The devices measure how much a player is working on the field by tracking his or her movements. Theoretically, if a player were overworking during practice, coaches would be aware that the athlete’s risk of injury was increasing and ­ 6

T&C september 2012

could decide to have them take a break or cut the practice short. GPS is generally preferred over pedometers because it is more accurate and real-time data can be tracked by coaches or athletic trainers on a laptop at the sideline.

FIFA, soccer’s international governing body, currently does not allow players to wear GPS during matches because the systems are not a part of the players’ basic equipment. But Duncan believes wearing the devices should be allowed.

“We have substituted players in preseason when these numbers start getting outside normal zones and also monitor loads in training to ensure injuries are prevented,” he told CNN.com. “As with any prevention initiatives it’s hard to say how much we have prevented, but I will say we have reduced injury rates at my club by over 60 percent this year due to careful monitoring. If we could use [GPS devices] in games, I do think we could prevent more, as many injuries are fatigue related.”

GPS technology is catching on in American football as well. The New York Giants used GPS devices, in addition to heart rate monitors and nutrition/hydration monitors, during off-season workouts this year. According to The New York Times, approximately 35 Giants players volunteered to wear GPS watches during workouts, which were monitored in real time on laptops.

“Currently, Coach [Tom] Coughlin comes to me and says, ‘Do you think the team looks tired?’” Ronnie Barnes, MA, ATC, the Giants’ Vice President for Medical Services, told the Times. “Or the players come to me and say, ‘Our legs are dead.’ And I’ll go up and say, ‘Coach, the guys are telling me they’re really tired.’ And usually he says to me, ‘Well, we haven’t done that much!’ But then he’ll make adaptations based on what I’ve told him. With this setup, I’ll be able to tell him, yes, they are tired.”

Protecting Athletes from Sudden Death A new bill in Pennsylvania aims to protect the state’s student-athletes who have undetected heart conditions from sudden death while playing sports. House Bill 1610, the Sudden Cardiac Arrest Prevention Act, was signed into law

by Pennsylvania Governor Tom Corbett on May 31 during a ceremony in Norristown, Pa., making Pennsylvania the first state to enact legislation to protect student-athletes from Sudden Cardiac Arrest (SCA).

The new law requires coaches, game officials, athletic trainers, and doctors to look for signs of cardiac arrest, such as fainting, difficulty breathing, dizziness, chest pain, and a racing heart rate, and remove any athletes showing those symptoms from competition immediately. To return to play, the athlete must provide a written note from a doctor, registered nurse, nurse practitioner, or cardiologist.

Coaches must also participate in annual training on the TR AINING-CONDITIONING.COM

Bulletin

Board warning signs of cardiac arrest and cannot coach their team until the training is completed.

Educational materials will be developed by the Department of Health of the Commonwealth and Department of Education to inform student-athletes, their parents, and coaches about SCA. The materials will be posted on the departments’ Web sites along with existing materials developed by organizations such as Parent Hearth Watch and Sudden Arrhythmia Death Syndromes.

The bill also outlines minimum penalties to be enforced by a school if a coach is found in violation of the terms of the new law. First-time violators are suspended from coaching any athletic activity for the remainder of the season, while a second violation will result in a suspension for the remainder of the current season plus the next season. A third violation would result in permanent suspension from coaching.

Altitude Training: When To Come Down?

Athletes at elite levels across many sports have found success with altitude training. But while most agree that the practice has its advantages, there are two opposing schools of thought on when an athlete should return from altitude to compete.

Robert Chapman, PhD, an exercise physiologist at Indiana University, and fellow IU researchers set out to see

which camp was right. It turns out that both ways of thinking may be valid.

Their study “Time-course of changes in cardiorespiratory measures post-altitude training: Implications for competitive endurance performance” was presented in May at the American College of Sports Medicine annual meeting.

Researchers worked with six elite distance runners who lived at an altitude of 2,150 meters in Flagstaff, Ariz., for 28 days. The runners trained at 1,000 meters during that time in order to do harder and faster workouts. Once the runners returned from the camp, researchers tested their heart rate, running economy, and running mechanics over the following 26-day period.

The results showed that 48 hours after returning was a good time to compete based on breathing results, while days seven and 13 showed more breathing difficulty. But the study also indicated that an athlete might perform at his or her best between days 18 and 22 because the breathing difficulty went away and the body became re-acclimated to a lower altitude.

“This research will help athletes plan for major competitions,” said lead author Abby Laymon, a graduate student at Indiana. “For example, if an athlete is training for the Olympic trials, they can count backwards and plan their workout[s] accordingly to perform their best after altitude training.” n

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Q&A Brad Swope

Sumner Regional Health Systems Brad Swope, LAT, ATC, EMT-P, Athletic Trainer at Sumner Regional Health Systems and Station Camp High School in Gallatin, Tenn., has worn many hats during his 30-plus year career—from administrator to teacher to provider of care for athletes and police officers. In addition to covering more than 400 athletes at Station Camp on a daily basis, he is an athletic trainer for USA Roller Sports and volunteer athletic trainer with the Tennessee Highway Patrol.

Swope began his career in 1984, working for his father at a family-owned sports medicine practice in Springboro, Ohio. In 1993, he moved to Tennessee and joined Baptist Sports Medicine in Nashville. He soon became Coordinator of Athletic Training Services and was responsible for supervising a staff of athletic trainers that provided coverage for area professional teams, college athletic departments, and high schools. During his tenure, he was named Clinical Athletic Trainer of the Year by the Tennessee Athletic Trainers’ Society.

In 2001, Swope became the Athletic Trainer at Volunteer State Community College, a position he held for six years while simultaneously working as the Director of Sumner Sports Medicine (a division of Sumner Regional Health Systems). At Sumner, he supervised a dozen athletic trainers who worked at high schools throughout the area.

After eight years at Sumner, Swope tried his hand as an account manager for a business consulting company, then spent two years as a high school teacher, instructing students interested in healthcare occupations. Finally, things came full circle when Swope returned to Sumner Regional —and the sidelines—last year.

When Swope isn’t providing coverage for high school athletes, roller athletes, or state troopers, he can be found officiating high school basketball games, going about his duties on the NATA Clinical and Emerging Practices Committee and as the Corporate Relations Chairman of the Tennessee Athletic Trainers’ Society, or volunteering in student ministry at his church. We caught up with Swope and talked to him about the role social media plays in his job, the key to providing coverage as the only athletic trainer at a high school, and the reason he volunteers his time with the Tennessee Highway Patrol. ­8

T&C SEPTEMBER 2012

An NATA 25-year award winner in 2004, Brad Swope cares for a diverse group, including high school and roller sport athletes and state highway patrol officers.

T&C: How do you make yourself part of a high school’s community when you’re employed by an outside group?

Swope: It’s not going to happen by just treating studentathletes in the athletic training room during the school day and on the sidelines after school. You have to make yourself available 24 hours a day, seven days a week.

We have to remember that having an injury and not being able to play sports is potentially a major crisis for a high school student-athlete. We’re used to telling injured athletes they can’t play, but they may not have heard that before. So we can’t just tell them to call us only between 8 a.m. and 9 p.m. If an athlete needs to meet me at 2 a.m. just to talk, I need to be there for them. I can count on one hand the number of times I’ve done that, but it’s critical that the athletes know I’m willing to.

Additionally, I look for other ways to provide value to the community. For example, my son plays Little League baseball, and when I can’t attend the games, my wife will sometimes call me and say, “Someone on his team just got hurt.

Can you come by and take a look at him?” And I always do.

Finally, one of the things I constantly tell young athletic trainers is to establish personal relationships with the coaches. Go see your school’s football coach during the off-season and talk about anything except football. Talk TR AINING-CONDITIONING.COM

Q&A about your families and get to know him on that level. Do the same with your administrators as well. That way they’re getting to know you in a different context.

spend time with my family for a few hours in the morning.

Tomorrow, I might get some “me time” in the afternoon. My family is very supportive, and that helps quite a bit.

How do you handle being the only athletic trainer at Station Camp?

Balancing the schedules and needs for all the different teams is very difficult. But I have figured out that there are a lot of ways I can make things run smoothly and ensure that teams don’t feel ignored. For example, if there are soccer, baseball, and softball games going on at the same time, I can situate myself in a spot where I can see both the softball and baseball fields, and be at the soccer field in two minutes.

I also make sure all the sport coaches know I’m there for them, even if I’m not providing event coverage. I don’t think any high school golf coach expects an athletic trainer at one of his matches, but I make it clear to ours that I’m always there for his athletes, whether it’s seeing them right away if they get hurt, taking a heat measurement, or including him in a text message tree about inclement weather.

You’re an active user of social media, including Facebook, Twitter, and LinkedIn. What role does technology play in the athletic training profession?

On the positive side, it’s a valuable tool for gathering and disseminating information, especially if you’re the only ath-

Is it challenging maintaining a work-life balance with that mentality?

Very much so. Sports schedules change constantly, and the athletic trainer is often the last to know if a game has been cancelled or rescheduled. I’ve learned you just have to roll with the punches or you’ll get burnt out. Today, I might

“We have to remember that having an injury and not being able to play sports is potentially a major crisis for a high school student-athlete.” letic trainer at a school. I never thought I’d get involved with Facebook or Twitter, but the schools I’ve worked at have used them to communicate with the staff and make announcements. They’re also great ways to stay in touch with former athletes and fellow professionals.

However, on the flip side, I think an over-reliance on social media and technology can be extremely detrimental.

The relationships you build talking with someone face to face are much different than the ones you establish through Facebook or even e-mail. I’m seeing this become an issue at the state association level. So many young athletic train-

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T&C SEPTEMBER 2012

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Q&A Brad Swope LAT, ATC, EMT-P Athletic Trainer at Sumner Regional Health Systems and Station Camp High School in Gallatin, Tenn.

Athletic Trainer for USA Roller Sports Volunteer Athletic Trainer with the Tennessee Highway Patrol NATA 25-year Award Winner in 2004 Named Clinical Athletic Trainer of the Year by the Tennessee Athletic Trainers’ Society in 1997

ers balk at anything they can’t do online—they don’t see the value in going to meetings and connecting with people in person.

What is the benefit of going to state and national association meetings?

A lot of inexperienced athletic trainers see the significant costs associated with travel and gravitate away from meetings, especially now that we can get CEUs without leaving our desks. But I view the costs of going to these meet-

“The relationships you build talking with someone face to face are much different than the ones you establish through Facebook or even e-mail.” ing as part of what you need to incur to gain experience.

I think of who I’ll be able to meet and what I’ll be able to learn from the exhibits, presentations, or just informal conversations.

How did you get started as a volunteer athletic trainer with the Tennessee Highway Patrol?

This actually illustrates my point about the importance of attending meetings and making connections. In 2007, I was at the NATA Meeting and one of the presentations was on athletic trainers in public safety. Nancy Burke, who is a full-time athletic trainer with the Fairfax County police department in Virginia, was discussing her role there, and I was fascinated.

After the meeting, I spoke with my hospital administrator about the idea. At the same time, a student-athlete’s father, who was the captain of the local highway patrol, mentioned that their training center could use an athletic trainer. So we set up a meeting, and it took off from there.

Currently, I work with them during their 18-week cadet school, a few hours a day, two to three times a week. It’s ­10

T&C SEPTEMBER 2012

actually very similar to working at the high school—just replace the word “athlete” with “trooper.”

I think this is an incredibly valuable thing to do for many reasons. First, it saves the state money. And instead of an injured cadet going to the doctor, we can usually handle it in-house quickly. I’m proud to provide the service. These are the people who run toward trouble instead of away from it. They take care of us, so we need to take care of them.

What has it been like working with USA Roller Sports?

It’s been fantastic. The organization is under the Olympic umbrella, and essentially, everything you’re used to seeing ice skaters do, these athletes do on roller skates. I work with the artistic skating and hardball hockey teams. I’ve been able to travel all over the world with them and it is amazing working with that level of athlete.

I’ve also been able to take some of what I’ve learned working with the skaters and use it at the high school level. I see similar injuries at both levels: the artistic skaters get a lot of overuse injuries while the hockey players get hurt after being hit with a stick or ball. I’m able to talk to my student-athletes about how I’ve handled those injuries and how the athletes were able to overcome them, and that’s been helpful.

What is the biggest issue facing high school athletic trainers?

We need to make administrators understand the challenges we face when we’re stretched too thin. They have to know that we can’t effectively care for hundreds of student-athletes at one time. Colleges have slowly started to understand this, thanks in large part to the data that illustrates how many athletic trainers you need to handle a certain number of athletes. But high schools haven’t caught on. I know lots of schools are facing budget issues, but we have to make them understand it’s not for our benefit—it’s for their kids’ benefit. n TR AINING-CONDITIONING.COM

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Optimum performance

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The Bengals use ropes to train grip strength, an important part of any player’s repertoire.

THE OF

POWER

ROPES

Rope training is making waves in weightrooms everywhere. Here, the Cincinnati Bengals’ strength and conditioning coach shares how he integrates the idea into the team’s programming.

By Chip Morton

F

or many of us, our first exposure to ropes as an exercise modality came in gym class.

Do you remember standing around while everyone took a turn climbing—some more successfully than others—a thick manila rope hanging from the gym rafters?

Climbing a rope has been, and always will be, an effective strength- and stamina-building workout. But more recently, the use of ropes for exercises beyond traditional climbing has gained attention from athletes, strength coaches, and personal trainers everywhere. For the purposes of this article, we will refer to these exercises as rope training.

Chip Morton, MA, CSCS, is the Strength and Conditioning Coach for the Cincinnati Bengals. He can be reached at: Chip.Morton@bengals.nfl.net.

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Optimum performance Integrating ropes into workouts adds versatility by allowing for a wide variety of exercises to develop strength and endurance. Athletes can loop a single rope around a pole, attach one or two ropes to an anchor point, or if available, use a machine with a rope mounted on a pulley system to perform various pulling motions from different stances. With free standing or anchored ropes, athletes can create undulating, wave-like patterns (referred to as wave training).

Ropes can also be used to build strength by substituting them in place of conventional modalities like barbells, dumbbells, and weight machines. Since we started incorporating rope training into our programming with the Cincinnati Bengals in 2007, our players have exhibited positive adaptations in their conditioning; strength and stability through the midsection, back, biceps, triceps, shoulders, and lower body; and an increase in grip strength.

From a conditioning standpoint, wave training appears to provide significant stimulus to the cardiovascular system. It Figure one: Horizontal pull to waist

Performing the pulling motion while standing integrates the whole body and places demand on the entire kinetic chain, while a seated or lying position focuses more on the upper body musculature.

Figure two: Horizontal pull facing away

Figure three: Hand-over-hand sled pull ­14

T&C SEPTEMBER 2012

allows an athlete to perform high output training in a low impact manner, which gives a strength coach an effective alternative to more traditional higher impact conditioning drills.

Next to the physical benefits accrued, one of the most appealing things about rope training is its simplicity. If a rope machine is not readily available, all that’s required is a length of rope. The most commonly used ropes are between 25 and 50 feet long with a diameter of 1.5 to 2 inches.

In our program, rope training affords us a great way to change up some of our more traditional workouts and challenge our players’ work capacity and resilience. We utilize ropes in a number of different scenarios throughout the year.

For example, with individual players who are injured and cannot perform ground-based running or agility drills, with players who desire extra work, or with groups in a circuittype setting to develop work capacity.

ROPE EXERCISES There are numerous exercises that can be done with ropes. The movement we use most often is “making waves,” but we also perform other movements such as horizontal and vertical pulling. Each exercise recruits different muscle groups and places a unique demand upon the athlete. A needs analysis will help determine which method(s) should be used.

Horizontal Pulling: Using a rope machine with adjustable resistance or by simply wrapping a heavy rope around a cylindrical pole (usually three inches in diameter—a football goal post works well), the athlete sits or stands in various positions and pulls the rope toward themselves hand-over-hand at a brisk, constant pace, usually for a predetermined work interval or number of “lengths of rope.” When using a rope machine, the rope never runs out as it is on a pulley system. If using a rope wrapped around a pole, the athlete just releases TR AINING-CONDITIONING.COM

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Figure five: Alternate waves

Figure four: Kneeling vertical pull

Post-Lift Circuit In this circuit, players work at each station for approximately five minutes. The circuit “driver” is the first exercise. When the player is done cycling at station one, everyone moves to the next station in the rotation.

Station one: Cycling On an Airdyne bike, players sprint for five seconds at 100-plus RPMs, pedal easy for 25 seconds, and repeat 10 times.

Station two: Kettlebell carries Players perform single-arm overhead kettlebell carries (also known as a waiter’s walk) for approximately 60 feet, then repeat with the other arm. This drill can be done with a partner in an alternating format to allow for rest.

Station three: Waves and holds Using a rope around a pole, players perform two sets of both two-arm waves and alternate waves for 30 seconds each. The waves are alternated with two sets each of planks and static rope holds (an isometric hold at the top of a pull-up position) for 30 seconds each.

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the end of the rope when he reaches it, picks up the other end, and resumes pulling.

This method, known as the pole system, can be performed from a number of different body positions and by pulling from different angles. Pulling hand-over-hand, an athlete can stand, kneel, sit, or lie down. Performing the pulling motion while standing integrates the whole body and places demand on the entire kinetic chain, while a seated or lying position focuses more on the upper body musculature.

Facing the pole and pulling toward the waist targets the shoulder extensors (lats), elbow flexors (biceps), and grip (see Figure one). Standing sideways to the pole while pulling trains the rotational muscles of the midsection, and facing away from the pole and pulling through the legs places emphasis on the shoulder flexors and grip (see Figure two).

For another very effective variation of horizontal pulling, ropes can be attached to weighted sleds or other heavy objects for pulling and dragging. (If we want to make some of the exercises even more challenging, we have the players wear

The athlete pulls downward to train the shoulder and elbow extensors. Or to train the shoulders and elbow flexors, the rope can be looped around a ground-level attachment and the athlete pulls upward. a weighted vest.) Loaded hand-over-hand pulling is a potent developer of upper back and grip strength, as well as endurance. Dragging a sled by walking, marching, or running in different directions targets torso stability and single-leg strength in a format that is appropriate for field and court athletes (see Figure three).

Vertical Pulling: Athletes can pull a single rope hand-overhand in a vertical motion on a machine. Most of the current models have seats, so an athlete can sit and either face the rope so that it is centered on their body or put both of their legs to one side so they are focusing more on their oblique muscles.

To make it a total body exercise, the athlete can also stand to the side of the seat.

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Optimum performance In lieu of using a machine, a single rope can be looped around an overhead bar. The athlete then pulls the rope downward to train the shoulder and elbow extensors. Or to train the shoulders and elbow flexors, the rope can be looped around a ground-level attachment and the athlete pulls upward. As with horizontal pulling, the athlete can stand, sit, or kneel (see Figure four).

Wave Training: Arguably the most well known ropes exercise is wave training, also known as velocity training. Using this method, the athlete creates rhythmic waves with one long rope (50 feet long for advanced athletes) looped around an anchor point or two shorter ropes attached to a single anchor point. In its most basic form, the athlete grips the ropes with an overhand (“pushing” emphasis) or underhand (“pulling” emphasis) grip and creates wave patterns by moving both arms together in unison or by alternating them (see Figure five).

Other forms include making waves in different planes of motion, such as diagonally across the body, clockwise or counterclockwise circular waves, and side to side. Similar to the pole system of training, the athlete can “make waves” while standing, kneeling, or sitting on a stool, box, or physio ball.

Wave training presents a unique conditioning modality where the velocity and amplitude of the waves created by the athlete determines the intensity of the exercise. Performing wave patterns with the rope(s) for a predetermined length of time or number of waves is rhythmic in nature and provides no opportunity for rest, thereby training the athlete’s body and mind to sustain effort. Wave programming can include larger amplitude waves with lower frequency for power and

Figure six: Bodyweight recline row

Circle No. 110 ­8 1

T&C SEPTEMBER 2012

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On-Field Circuit In this circuit, players work at each section for approximately six minutes. The circuit “driver” is the first exercise. When the player is done with the waves and planks station, everyone moves on to the next station in the rotation.

Station one: Waves and planks Using a rope around a pole, players perform three sets each of two-arm waves and alternate waves for 30 seconds each.

The waves are alternated with two sets of push-up extended planks (where the athlete holds at the top of a push-up position) and two sets of side planks (where the player is on the elbow for support).

Station two: Carries This station includes four sets of farmer’s walks for 40 yards and two sets of both singlehand carries and single-arm overhead kettlebell carries (waiter’s walk) for 40 yards each. A partner can be used so players get a break between exercises.

Station three: Med ball throw & chase relay With two players on each team, the race starts at one sideline. The first player throws a medicine ball and runs to it, repeating the throw and run all the way across the width of the field and back (approximately 106 yards). The ball must cross the starting sideline before the second player proceeds. We perform three “relays” using forward squat throws, reverse granny tosses, and forward scoop tosses.

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Optimum performance strength, or shorter and more frequent waves for speed. Here, the options are almost limitless.

Variations on Conventional Exercises: In addition to the aforementioned rope-specific methods of training, ropes

BENGALS PROGRAMMING In Cincinnati, we follow the principles and training ideas outlined in the “Battling Ropes” training system developed by John Brookfield. During specific phases of the training year, dif-

We have used rope training with great success in team camps with players who are limited by injury ... In this instance, having a conditioning modality that elicits a substantial training response with a reduced-impact training load is especially appropriate. can be used in the weightroom by attaching them to a rack or cage system to perform grip-enhanced variations of standard exercises like pull-ups, recline rows (see Figure six), triceps extensions, and static holds. Static holds can be used as a stand-alone exercise to train the stabilizers and grip, or performed between other exercises to make “rest” periods more profitable. For example, have your athletes hold in the contracted position of a pull-up (see Figure seven) or recline row.

ferent methods of rope training are programmed into our players’ workouts.

For example, during the week prior to starting voluntary on-field work with position coaches this past off-season, we moved a portion of our conditioning work from the field to the weightroom by having players perform a circuit that included a series of wave intervals after completing a lifting workout. Wave training with the ropes was a perfect fit for our needs during this time of year because it was lower impact, present-

Figure seven: Static pull-up hold

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Optimum performance ed a significant training stimulus, and could be performed in a limited amount of space. (See “Post-Lift Circuit” on page 16.)

The low impact but cardio intensive workout reduced the actual and perceived orthopedic load on the players’ feet, ankles, knees, hips, and low backs.

Our players really appreciate this type of consideration, as it allows them to continue the conditioning process while staying mentally and physically fresh for the skill-specific on-field work in the weeks to come.

We used another circuit with our first-year players after the conclusion of our mini camp. The goal of this particular circuit was the development of core stability, power, and endurance, all in a lower-impact setting. This threestation circuit was preceeded by mobility work and dynamic movement drills performed on the field. (See “On-field Circuit” on page 19.)

Another setting where we have used rope training with great success is in team camps with players who are limited by injury, reconditioning after an injury, or have specific goals such as weight control. In these instances, having a conditioning modality that elicits a substantial training response with a reduced-impact training load is especially appropriate because during these times, players may be completing multiple workouts in a day. For programming purposes, the strength coach can manipulate the duration of work and recovery intervals to match the energy system needs of the sport or player’s position, create an energy deficit, or train around an orthopedic limitation in the return-to-play process.

Rope training can also be incorporated into workouts to promote variety.

For example, if the workout of the day calls for a horizontal pulling movement using the upper body, the movement may be performed using a machine, dumbbells, kettlebells, or bodyweight.

If a bodyweight row is selected, we have the option to use suspension straps or ropes hanging from a rack.

And it’s a time saver, which comes in handy quite often. If we are dealing with a large number of players in a compressed time frame, this is a great option because no weight changes or recording is involved, making for quick transitions from one user to the next.

Training with ropes has been a difTR AINING-CONDITIONING.COM

ference maker in our strength and conditioning program. We have used all of the aforementioned variations to provide our players with an effective training modality that can be adjusted to our needs under a myriad of circumstances.

That is the beauty of rope training: It is adjustable, simple to use but not easy, and will improve your athletes’ mental and physical ability to sustain effort.

Any athlete playing any sport can use rope training as well—it’s not just for football players.

As is true when introducing any new

exercise, the strength and conditioning coach should seek out a reputable source of information before implementation. Get familiar with the basic teaching cues and progressions before unleashing it on your athletes. Once a baseline level of understanding and confidence with the material has been established, insert exercises into the program incrementally over time and progress them gradually in volume and intensity to facilitate positive adaptations of the muscles and movements involved. n

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Yankees player Alex Rodriguez had surgery to repair a torn labrum and impingement in 2009.

kathy willens/ap images

TREATING THE ATHLETE

full speed Ahead

The number of athletes having arthroscopic hip surgery continues to increase. The good news is that return to play after the procedure is quick.

By Dr. Mark Lawler & Dr. Daniel Solomon

C

hase Utley had arthroscopic hip surgery to repair a torn labrum in 2008.

Fellow baseball player Alex Rodriguez had the surgery done to fix a torn labrum and impingement the following year. Olympic sprinter Tyson Gay had the procedure in 2010.

And because many hip joint problems, including labrum tears and impingements, can be treated successfully with hip arthroscopy, more athletes have had it since then. While arthroscopy for the knee and shoulder have been around for many years, hip arthroscopy is still relatively new to mainstream orthopedics and not as common. But the procedure is gaining in popularity, especially among athletes, because of the fast recovery time associated with it.

Without the use of arthroscopy, the hip has to be approached through an “open” technique—similar to how a hip replacement is performed. It is significantly more invasive, patients have to stay in the hospital for several days following surgery, and the potential for blood loss and infection are greater. Hip arthroscopy is an outpatient procedure, there is minimal blood loss, and the potential for complications is far less.

Arthroscopy is performed with the use of a camera called an arthroscope. Small incisions or “portals” are utilized to insert the camera and surgical instruments into the injury site. The joint is then distended with water to expand the area and increase Mark Lawler, MD, and Daniel Solomon, MD, are orthopedic surgeons at Marin Orthopedics and Sports Medicine in Novato, Calif. They can be reached through the Marin Orthopedics Web site at: www.marinorthopedics.com.

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T&C september 2012

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TREATING THE ATHLETE visualization. As the surgeon performs the procedure, he or she views what they are doing inside the joint on a television screen in the operating room.

Hip arthroscopy is similar to those techniques used in shoulder and knee arthroscopy. However, the anatomy of the hip joint presents some unique and difficult challenges for the surgeon.

Unlike the knee, there is little room to enter with the arthroscope and maneuver within the joint space. Because the hip is a ball-and-socket joint, manipulating the arthroscope inside the joint is like trying to squeeze it in around a tennis ball sitting in a cup.

In order to increase access to the joint, a special table is used to “distract” the

femur. Contrary to popular belief, the joint is not dislocated. Newer, improved instruments are continually being developed to aid the procedure and help with anatomical challenges.

THE INJURIES Though most intra-articular hip injuries go undiagnosed for quite some

REHAB TIMETABLE Post-operative rehabilitation guidelines are as important as the surgery itself. Without proper restrictions and progression, recovery will be prolonged and less-than-optimal outcomes will result.

• Active assisted ROM work (do not push through hip flexor pain)

The goals of the patient should be clearly established ahead of time and continually reviewed (and possibly altered) throughout the rehab process.

Most patients want to return to an athletic lifestyle as soon as possible, but unrealistic goals should be identified early. Elite athletes often need to be “slowed down” as they tend to try to progress too rapidly, which can actually inhibit their progress.

• Closed chain bridging, weight shifts, and balance drills

The following is a general outline for rehabilitation following arthroscopic hip surgery. It may need to be accelerated or decelerated based on an individual basis.

Initial Phase: Days one through 10 The goals during this phase are to protect repaired tissue, diminish pain and inflammation, slowly increase range of motion (ROM), and prevent muscle atrophy. Swelling and pain are controlled with the use of ice, non-steroidal anti-inflammatory drugs (NSAIDs), and pain medicine as needed.

­24

• No hip extension in prone position • Gentle straight plane distraction techniques are okay

• Stationary bike with little to no resistance for 20 minutes at a time • Avoid hip flexor tendonitis (very common).

Intermediate Phase: Day 11 through week three The goals during this phase are to slowly regain and improve strength, restore normal joint kinematics, introduce core strength and stability, and normalize gait.

• Increase ROM with gradual sustained stretches, as pain permits (not forced) • Begin slow, progressive resistive exercises • Closed chain single-leg bridging • Open chain with slow resistance (pulley or Thera-band) in flexion, extension, adduction, abduction, and hamstring curls as tolerated

Advanced Phase: Weeks four through six The goals during this phase are to increase functional strength, core strength and stability, and endurance.

• Continue flexibility exercises • Progressively increase resistive and functional strengthening • Closed chain exercises as tolerated • Avoid hip flexor tendonitis and joint inflammation • No regular treadmill/elliptical use.

Return-to-Sport Phase: Weeks six through 12 The goals during this phase are to promote advanced strengthening and increase control and strength during sport specific activities. For most of the phase, patients should focus on restoration of muscular strength and endurance, cardiovascular endurance, and neuromuscular control. Toward the end of the phase, they should be able to return to competition.

• Elliptical trainer • Treadmill walking with progression to jogging

• Stationary bike as tolerated

• Sport specific/functional movements initiated

• Weight bearing as tolerated, with crutches as needed (for patients who had microfracture, partial weight bearing should continue for four to six weeks)

• Pool exercise (as long as incisions are healed)

• Gradual return to sport as goals are met

• AlterG machine if available

• Isometrics for quadriceps, gluteals, hamstrings, adductors, and abductors

• Avoid hip flexor tendonitis.

• Demonstration of dynamic neuromuscular control during multi-plane activities without deficits means the athlete is ready to return to play.

T&C september 2012

• Proprioceptive/balance work

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TREATING THE ATHLETE time, they are increasingly being recognized more quickly. Loose bodies, labral tears, chondral injuries, and femoroacetabular impingement (FAI) are common hip joint diagnoses treated with arthroscopy. Additionally, synovial pathology, joint infection, and extraarticular problems such as a snapping hip or bursitis can be treated with arthroscopy.

Patients usually undergo hip surgery for a tear of the cartilage or labrum.

The labrum is analogous to the meniscus in the knee. It is made of fibrocartilage and acts like a gasket, attaching to the rim of the socket and aiding in stability by acting as a fluid seal for the joint. Injury to the labrum can cause significant pain and disability while chronic tears have been linked to the development of arthritis.

Labral tears can be caused by several mechanisms. For young athletes, most tears result from an acute injury to the hip. Twisting injuries, traumatic falls, and hyperflexion/extension mechanisms are common triggers. Like all joints, as we age and have various stages of developing arthritis, more minor actions can lead to degenerative tears of the labrum.

The key to diagnosing most hip injuries is that the athlete will complain of groin pain. Labral tears can cause a sharp “pinching” type of pain that increases with flexion. Patients have also reported locking, catching, and the feeling of “giving way” or instability. The severity of these symptoms varies from disabling pain that prevents an athlete from performing to an athlete being able to compete, but with decreased performance.

FAI syndrome has been linked to many acute and chronic tears. When a patient has impingement, it means that the femoral head/neck butts up against the socket in flexion. This leads to repetitive “pinching” of the labrum between the femur and socket. The labrum is therefore thought to be more vulnerable to tearing both acutely and over time when impingement is present.

Impingement comes in two different forms. The more common variety, cam impingement, occurs when the head and neck of the femur lose their normal shape, creating a cam at the head/neck junction. This cam hits the labrum during certain hip positions such as abduction and internal rotation, creating a gradual tear. The tear TR AINING-CONDITIONING.COM

can propagate to the adjacent cartilage and create scuffing, wear, and arthritis of the hip joint.

The other form of FAI, pincer impingement, occurs when the rim of the socket extends out and down such that the femoral neck rubs up against it.

This too can create friction and a degenerative tear of the labrum. The signs and symptoms of pincer FAI are similar to cam FAI. Patients with impingement present with a variety of symptoms. The most common is pain with flexion and inter-

nal rotation of the hip. Going up stairs, getting out of a chair or low couch, getting in and out of a car, and twisting or squatting activities usually elicit pain.

Other athletes can have similar presentation, however, their pain only presents during athletic movements required in their sport. High repetitive hip flexion athletes tend to complain of pain in maximum flexion (especially if it involves rotation). Jumping athletes report pain both during takeoff and landing. And athletes who play sports

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TREATING THE ATHLETE involving intensive trunk/hip rotation say that they have pain on their “finishing” side.

DIAGNOSIS Most hip pathology can be determined by taking the patient’s history and a corresponding physical examination.

During the exam, range of motion testing of the joint with comparison to the opposite side is critical. Log roll and Figure-4 tests should also be performed and compared to the unaffected side.

Evaluation of extraarticular pathology should be undertaken as well, including a thorough evaluation of the lumbar spine and surrounding nerves. It is well known that lumbar spinal pathology can refer pain to the hip and thigh region.

long term (from the steroid), the area of pathology is confirmed and treated. If the patient doesn’t get pain relief, then the diagnosis is questioned and other areas are explored.

We prefer ultrasound or fluoroscopic -guided joint injection with local anesthetic and corticosteroid for both diagnostic and therapeutic benefits. If a patient gets good relief, but it doesn’t last beyond a few weeks or months, we choose to get an MRI of the hip joint.

MR arthrogram utilizes a pre-MRI injection of contrast material into the joint and may help discover any labral tearing that wasn’t previously detected.

SURGERY When ultrasound and/or fluoroscopicguided joint injection doesn’t provide

Sometimes it is difficult to decipher the true area of pathology. Is it hip or back? In the hip joint or outside the hip joint? This is where diagnostic/therapeutic steroid injections can provide needed clarification.

Radiographic data is also imperative to evaluate the injury. Simple or “plain” x-rays are the first step. They reveal information about the boney structures and architecture. Fractures, dislocations, arthritis, prior injuries, and FAI can all be assessed using x-ray.

Radiographs can also determine arthritis, which, if severe, would contraindicate hip arthroscopy. Additionally, radiographs can show prominence of the femoral neck described as a cam lesion or may suggest loose bodies in the joint. If further information is needed, an MRI with or without dye or contrast can be used.

Sometimes it is difficult to decipher the true area of pathology. Is it hip or back? In the hip joint or outside the hip joint? This is where diagnostic/therapeutic steroid injections can provide needed clarification.

The hip joint and spine are deep structures and difficult to localize for an injection. But using a real-time x-ray, fluoroscope, or ultrasound can increase proper placement and accuracy. This procedure involves placing a needle into the hip joint or the spine, verifying placement/location with x-ray, fluoroscope, or ultrasound, and injecting a local anesthetic and steroid.

If the patient’s pain decreases, either temporarily (from the anesthetic) or ­26

T&C september 2012

long-term relief, arthroscopic surgery is the patient’s next option. The good news is that it is usually performed on an outpatient basis, which means the patient can go home the same day of the surgery. The procedure takes anywhere from 30 minutes to two hours, depending on the complexity of the injury.

The surgery can be performed with the patient supine or lateral based on the surgeon’s preference. Either way, the set-up should allow the hip to be flexed, as this will open the peripheral compartment. Because the hip joint must be distracted, the patient is placed under general anesthesia.

At the outset, the surgeon usually makes three portals: One for the arthroscope and two “working” portals for tools. Once the damage is identified with the arthroscope, the appropriate corrective procedure is performed. The steps may include: • Debridement of a torn labrum • Repair of a torn labrum, which involves reattaching the labrum to the socket with anchors and sutures • Removal of a torn labrum • Debridement of chondral lesions • Microfracture, which involves drilling holes into exposed areas of bone to stimulate bleeding in order to fill the defect with scar cartilage • Removal of excessive bone on the

femoral neck for cam FAI or socket for pincer FAI. As with any surgical procedure, complications can occur during arthroscopic surgery. Proper visualization is the key to a successful surgery, therefore, fluoroscopic imaging is utilized to ensure proper initial placement of the arthroscope into the joint.

The surgeon must be careful when inserting tools into the joint, as the limited space increases the risk of iatrogenic damage to the cartilage surface and labrum. Specially designed arthroscopic hip instruments will enhance the surgeon’s ability to access the joint and treat pathology encountered.

The surgeon must also be aware that too much or prolonged traction can lead to nerve damage. Additionally, fluid can extravasate, especially during arthroscopy of the peripheral compartment.

REHAB & RETURN TO ACTIVITY All surgeries have general post-op principles, such as avoiding joint inflammation via early excessive flexion and abduction. Passive range of motion can be started immediately, with progression to full range of motion at two weeks. Gentle isometrics can be initiated within the first few days. And active range of motion can begin at two weeks and increase as tolerated.

Too aggressive or too much activity within the first six weeks after hip arthroscopy can lead to flares of pain, synovitis, and stiffness. We recommend crutches for a few weeks with gentle range of motion exercises, and beginning very easy exercise on a stationary bike after two weeks.

If pain-free, the patient can progress to pool exercises, stretching, and core work. Most athletes can return to play within 12 weeks of a “simple” hip arthroscopy. (See “Rehab Timetable” on page 24 for more.)

If the procedure is more complex, such as a labral repair with debridement of FAI or microfracture, the recovery will be slower. Protected weight bearing for up to six weeks post-op is necessary after microfracture. Labral repair or treatment of FAI requires protected partial weight bearing for the first two to four weeks. n To view references for this article, go to: www.Training-Conditioning.com/ references.

TR AINING-CONDITIONING.COM

Simple Yet Effective Core Exercises

by Ken endelman

Core training has become all of the rage these days with many athletic trainers. And rightfully so. The integration of a strong core and the dynamic muscle groups: the biceps, triceps, etc., helps athletes tap into their deeper layers of muscles to really maximize their power and decrease the chance of injury.

Quite simply, a strong core gives the body more stability so the outer or skeletal muscles can perform at their highest level.

There are a lot of equipment and tools that trainers can use to give their athlete a strong core. But there are many simple yet very effective exercises that don’t require anything but a mat. Here are two of them:

Repeat until a count of 100 pulses is reached. For more advanced variations, straighten the legs to the ceiling, or lower to 45 degrees.

Leg Pull Down

The Hundred Begin in plank position, with the shoulders directly over the wrists, inner thighs together, in one straight line from the top of the head to the feet. Keep the hips level throughout this exercise.

To start, lie on your back with arms reaching towards the ceiling, knees bent with feet flat on the floor about hip distance apart. Inhale to prepare.

Exhale, engage the abs, and lift the feet off the floor until your knees and hips are at a 90 degree angle.

Inhale. Exhale, raise neck and shoulders off the floor, while straightening the arms. Inhale for five counts, exhale for five counts. On each count, pulse the arms up and down, as if slapping the arms and hands into still water.

Inhale and lift the left leg towards the ceiling. Pulse twice. With each pulse, point then flex the standing foot. Exhale and lower the leg to the mat. Repeat on the other leg. Do 4 to 6 reps on each leg, alternating sides.

Want to see more? Balanced Body has a whole library of exercise podcasts designed specifically for athletic trainers.

Check them out at www.pilates.com/podcasts Ken Endelman is the Founder and CEO of Balanced Body, the worlds largest provider of Pilates equipment and education.

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NUTRITION

Packing Protein

Regardless of which form it comes in, the various protein beverages on the market can have a positive effect on athlete performance. A sports dietitian explains all.

By Susan Kundrat

S

hakes, smoothies, powders, re ady-to - d r i n k. P rotei n beverages are everywhere, and most of them are marketed to athletes.

With extensive research on protein and its role in athletic performance being conducted over the past few years,

it would make sense that athletes are more interested than ever in how supplementing their diet with protein beverages may help them gain an advantage over their opponents.

But how should an athlete decide which protein beverage is right for them? With so many brands, flavors, and types of proteins or protein combinations, the choices can be mindboggling.

LATEST RESEARCH Studies on the role protein plays in athletic performance have found that protein can boost lean muscle mass gains, enhance exercise recovery, and may even help with weight loss and

Susan Kundrat, MS, RD, CSSD, is the Program Director of the Nutritional Sciences bachelor’s program at the University of Wisconsin-Milwaukee and the former Sports Dietitian for the University of Illinois. She is also the co-founder of RK Team Nutrition and owner of Nutrition on the Move. She can be reached through the RK Team Nutrition Web site at: www.rkteamnutrition.net.

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NUTRITION maintenance. Let’s take a closer look at the research.

Lean muscle gain: Strength athletes especially are often looking to gain lean muscle for stronger, more efficient bodies. Think about football linemen.

These athletes want to be large, but it’s important that they are also strong. If offensive and defensive linemen who are the same size meet each other at the line of scrimmage, the one who has more lean muscle mass will beat the one who has more body fat.

Maximizing muscle gains requires a sound training program, ample calories (500 to 1,000 calories per day above maintenance needs), and optimal protein intake throughout the day.

Protein requirements for strength athletes range from 1.4 to two grams per kilogram of body weight per day. It can sometimes be tough for an athlete to ingest that much protein through whole foods, so protein beverages can be good supplementation.

In addition to the total intake of protein, many researchers believe that the timing of it is a key component to building lean mass. Optimizing protein intake means ingesting 20 to 30 grams at a time, every three to four hours during the day. Many protein beverages provide this amount of protein per serving and are portable, so drinking one a few times a day is a good way to ensure proper intake.

ON A BUDGET Ready-to-drink single serving beverages can start to get expensive pretty quickly. Athletic departments have a budget that allows them to buy in bulk, which helps lower costs considerably, but for athletes buying on their own, the story is quite a bit different. Take a look: • Milk: 2.5 cents per gram of protein • Chocolate milk: 3.5 cents per gram of protein • Protein powder (without a carbohydrate source to mix): 4.0 cents per gram of protein • Ready-to-drink single-serving protein beverage: 6.3 cents per gram of protein.

One solution for avoiding any issues with impermissible ingredients is for athletes to make their own protein beverages at home. The following recipes have an ideal carbohydrate-to-protein ratio, and include quality proteins and additional antioxidants for recovery purposes: Blend three-quarters of a cup of vanilla Greek yogurt with half a cup of cherry juice, half a banana, half a cup of frozen dark cherries, and ice.

Nutrition analysis: 275 calories, 55 grams carbohydrate, 15 grams protein, zero grams fat, 3.7:1 carbohydrate-to-protein ratio.

Blend one 20-gram scoop of vanilla flavored whey protein with one cup of orange juice, one cup of frozen unsweetened peaches, and ice. Nutrition analysis: 325 calories, 62 grams carbohydrate, 20 grams protein, zero grams fat, 3.1:1 carbohydrate-to-protein ratio.

Another idea is to consider chocolate milk at least some of the time.

Chocolate milk is an ideal recovery beverage because it contains a mix of high-quality proteins (whey and casein), naturally boasts a beneficial carbohydrate-to-protein ratio because of the added sugar, and is considerably less expensive than pre-packaged protein beverages. One cup of chocolate milk provides eight to nine grams of protein and 120 (skim), 150 (one percent), or 180 (two percent) calories. For non-dairy drinkers, flavored soy milk is a great option.

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Recovery enhancement: We have learned a lot about how important recovery is over the years, and nutrition plays a big role in that process. It’s important for athletes to get recovery foods on board during the 30-minute window after a workout. Protein beverages are a fast, easy way to get some of those necessary nutrients.

Several studies have found that ingesting protein and carbohydrates instead of carbohydrates alone following resistance training can help enhance recovery by better stimulating muscle protein synthesis. Anywhere between six and 30 grams of protein may provide this benefit, especially if the protein is high in quality, like whey protein.

“We utilize recovery shakes containing 20 to 27 grams of protein and a 3:1 or 2:1 ratio of carbohydrate to protein per serving,” says Jen Ketterly, MS, RD, Director of Sports Nutrition at the University of Georgia. “We make them available to athletes following strength workouts, at certain day-long competitions, or as post-game recovery fuel. Although we also utilize gels and chews, shakes are typically able to deliver more protein. And for a lot of athletes, shakes are easier to consume post-workout than a bar because they don’t have strong appetites but crave something cold.”

Weight loss and maintenance: Not all athletes are looking to lose weight, or even maintain, but for those who are, protein may help. Calorie for calorie, protein can help people feel full longer than carbohydrates and fats. A greater feeling of satiety means feeling less hungry and thereby causes a decrease in overall calorie intake and eventually body weight.

One recent study that compared a high-protein diet to high-carbohydrate and high-fat diets found that participants on the high-carb or high-fat diets both had 14-percent stronger appetites before meals than those on the high-protein plan. Research has also shown that the type of weight lost on high-protein diets versus high-carbohydrate or high-fat diets is different. Less lean mass and more body fat is lost on high-protein, calorie-restricted diets— exactly what athletes who are looking to lose or maintain weight want.

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NUTRITION options can be overwhelming. It’s also sometimes hard to understand what the different ingredients do, and safety and NCAA compliance is a concern for college athletes.

The majority of protein beverages boast a milk-based protein (most often whey) as the primary protein source.

cursors for muscle energy production, they are an important energy source for athletes.

Casein is another common protein of choice for athletes and makes up about 80 percent of milk proteins. While athletes may choose whey protein for recovery and quick response, casein can

The NCAA bylaw says that athletic departments can provide athletes with supplements (bars, beverages, gels, etc.), but they must contain no more than 30 percent of their calories from protein or artificial, non-whole food sources.

Milk-based protein powders usually provide between 15 and 30 grams of protein per serving and can be mixed with milk, juice, or water, or blended into a smoothie or shake.

The lactose level varies depending on the type and amount of the protein source. For example, whey protein isolate is the most pure and concentrated form of whey protein, and contains very little lactose, so it is the milk protein of choice for athletes who are lactose intolerant.

Whey protein is often considered the “gold standard” of proteins because of its high biological value. Overall, whey protein contains a very high dose of essential amino acids. It also has high levels of branched chain amino acids (BCAA) leucine, isoleucine, and valine.

Because BCAAs serve as direct pre-

be mixed into a drink before bed to offer a more slowly digested amino acid release over time.

Athletes who need a vegetarian or vegan protein beverage usually turn to soy protein, which is found in readyto-drink or powder form and can be added to smoothies, juice, or water.

Soy protein is a complete protein like whey, containing all of the essential amino acids needed for protein building and repair. However, it is absorbed more slowly than whey. One serving typically provides 10 to 20 grams of protein.

Rice protein and hemp protein are two more good protein options for vegetarians and vegans. Each contains 10 to 15 grams of protein per serving, usually in a ready-to-mix powdered form. As a bonus, some of these types

OLDER GENERATION A lot of protein beverages are marketed to athletes, and for good reason, but there is another population that can benefit greatly from what they have to offer: older adults. One-third of the U.S. population is now age 55 or older, and protein can be a key to optimal health for this group— especially if they are still active.

The average loss of muscle mass is approximately 0.5 percent to one percent per year, beginning at age 40. Research has pointed to a high-protein diet being a key factor in helping preserve lean mass during these years.

Sufficient protein intake helps maintain rates of protein turnover, which aids in the building and repair of tissue, as well as maintenance of muscle protein.

Taking in 25 to 30 grams of high quality protein at each meal is an important strategy for aiding in the maintenance of lean mass. Other plusses are that protein beverages are easy to digest, require no chewing, and can pack a big nutritional punch in small volumes.

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T&C september 2012

of proteins are also high in fiber and natural phytochemicals.

Along with protein, most beverages have other ingredients, too. When shopping around, athletes should check labels closely. Many protein powders also contain substances such as creatine, herbs, androgenic compounds, or additional amino acids that may or may not be permitted by the NCAA (or other governing bodies). When weighing options, I would suggest the following: • Look for protein beverages that have been certified by governing bodies, such as NSF International.

• Research products using wellrespected resources such as the National Center for Drug Free Sport, ConsumerLab.com, and the Natural Medicines Comprehensive Database to help determine the safety and efficacy of the product.

• Research the company to make sure it has a solid record of clean products and that the ingredients listed on the label are indeed the ingredients found in the product.

• Check with the manufacturer for quality assurance and safety information about the product.

• Choose a protein beverage marketed as a food with a nutrition facts label. These standards are set by the Food and Drug Administration and can be trusted.

• Check the label to be sure the ingredients are not on the NCAA’s or your respective governing body’s banned list.

For example, while protein may be added to a supplement, NCAA rules prohibit specific amino acids.

For professionals working with NCAA Division I and II athletes, it’s important that you understand the NCAA bylaw about supplements. For these schools, the bylaw says that athletic departments can provide athletes with supplements (bars, beverages, gels, etc.), but they must contain no more than 30 percent of their calories from protein or artificial, nonwhole food sources. The bylaw also disallows amino acids or amino acid chelates.

All in all, if athletes decide to purchase ready-made beverages or a powder, they should look for high-quality proteins (such as whey, soy, and casein) with few additional ingredients.

From a safety standpoint, the fewer ingredients, the better. If the athlete is trying to limit calories, unflavored TR AINING-CONDITIONING.COM

NUTRITION or unsweetened versions are best. And in addition to finding a clean product, taste is imperative for athletes. They should like the overall taste and consistency so they can use the product consistently enough to make a difference in their performance.

MIX IT UP Once an athlete has decided which protein beverage to try, how should they implement it into their diet? The answer depends on whether they are aiming to use the beverage for recovery, weight control, or lean muscle gain.

Most athletes who supplement with protein beverages drink them after workouts for recovery. An athlete’s overall recovery meal should aim for an average carbohydrate-to-protein ratio of 3:1. For example, a whey protein powder mixed with water, milk, juice, or a smoothie contains 100 calories, 20 grams of protein, and five grams of carbohydrate.

Drinking it with 16 ounces of a sports drink that contains 28 grams of carbo-

Adding a whey protein that can be mixed into a homemade smoothie is a great option. Then, the next meal can be higher in carbohydrates and moderate in protein to boost overall calories. hydrate is a great start. Along with a large banana that contains 27 grams of carbohydrate, the athlete would be right on target: 20 grams of protein and 60 grams of carbohydrate.

It is important that athletes who are supplementing with protein beverages after workouts not lose sight of the importance of the entire recovery meal.

Some may focus so much on protein that they miss the carbohydrates necessary to maximize glycogen recovery.

For example, athletes who are concerned about calories can ingest a 100calorie, 20-gram protein drink with a lower-carbohydrate fruit such as an orange. Then, within the next hour, eat a light meal such as a salad with grilled chicken, a whole grain roll, and a cup of strawberries. This way, they are still eating lean, but getting a great balance of macronutrients plus key vitamins and minerals on a lower-calorie plan.

TR AINING-CONDITIONING.COM

If an athlete is looking to lose weight or maintain, protein beverages are a great option when the athlete is feeling hungry. We know that protein helps people feel satiated longer, which means they will take in fewer overall calories.

For those trying to gain lean weight, adding a whey protein that can be mixed into a homemade smoothie with milk or juice is a great option. Then, the next meal can be higher in carbohydrates and moderate in protein to boost overall calories. An ideal meal is pasta and

meat sauce, steamed vegetables, whole grain bread, and two glasses of 100percent fruit juice. This provides more than 1,000 calories and enough protein to help maximize lean mass.

Consuming protein beverages can be an excellent way to boost overall calories for lean muscle mass gains, enhance recovery, help athletes who want to lose or maintain weight, and even provide a quick snack during the day.

As with any supplementation, the key is to continue eating a well balanced, nutrient-rich diet. n

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Circle No. 118 T&C september 2012

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Par t of you r gam e plan Circle No. 119

Dial an ATC

LEADERSHIP LEADERSHIP

When patients call this athletic trainer, she helps get them the appointment they need and makes sure they know how to care for their injury until they see a physician.

By Elyse Putorti

L

ike most athletic training students, I imagined myself working at a school or physical therapy clinic after graduation. But during my job search a very different position caught my eye. The Cayuga Center for Orthopedics and Sports Medicine, a division of Cayuga Medical Center in Ithaca, N.Y., was looking for an athletic trainer to provide care in a more behind-the-scenes role: Answering its new orthopedic service line.

The Orthopedic Patient Navigator (OPN) position called for a certified athletic trainer to help patients coordinate appropriate care with Cayuga Medical Center-affiliated sports medicine, orthopedic, physical

Elyse Putorti helped more than 800 patients get the care they needed last year.

Elyse Putorti, ATC, is the Orthopedic Patient Navigator at the Cayuga Center for Orthopedics and Sports Medicine in Ithaca, N.Y. She can be reached at: eputorti@cayugamed.org.

Dave Burbank Photography

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LEADERSHIP therapy, and physiatry offices over the phone. The OPN is also responsible for advising patients on self-care until their appointment.

There are three types of callers: Primary care offices that set up appoint-

at all. But I wanted to explore the idea more, and I was eventually offered the position. Over the past year, I’ve had the opportunity to help hundreds of patients navigate the medical system as the OPN. It’s been a really interesting

I typically get calls from patients who have had acute injuries, but when a patient has a chronic issue like tendonitis or a specific weakness that would benefit more from physical therapy, I can schedule it for them. This is where my clinical background and judgment are put to use. ments for patients needing specialized orthopedic care, patients who call after they have been discharged from the emergency room or our hospital’s urgent care facility, and self-referring patients who have seen or heard our advertisements about the service line. I help all three get the right appointment with the right provider, and if warranted, give the caller general advice on how to care for their injury until they see a doctor.

This type of job was not on my radar

way to be involved in patient care as an athletic trainer.

DEVELOPING THE OPN My position as OPN, and the orthopedic service line itself, was created by the Cayuga Center for Orthopedics and Sports Medicine as a way to ensure that our patients receive the highest quality care and customer service by assisting them through the healthcare process. The position is modeled after the Cayuga Medical Center’s oncology

AWAY FROM THE DESK One of the perks of being an Orthopedic Patient Navigator is that it is a “9 to 5” job. I arrive at and leave the office at the same time every day. There are no early morning practices or night games to cover, which has been great. But on the other hand, I do miss working with teams and getting to know a group of athletes throughout a season.

So I’ve made sure to continue practicing my hands-on skills as well. I work as a physician extender at Cayuga Medical Center’s sports medicine and athletic performance facility two half-days per week and work at our local high school on Wednesdays. (There are other athletic trainers employed by the hospital who cover the phone for me when I’m away from my desk.) And I help with football coverage in the fall and with other competitive events like a local triathlon held every summer.

I am also involved with teaching a monthly preoperative lecture for the hospital’s patients. The lecture is a chance for joint replacement patients to learn more about what to expect before, during, and after their upcoming surgery. They hear more about the surgery itself, inpatient and outpatient physical therapy, occupational therapy, nursing services, and how to obtain durable medical equipment. All of the different roles and responsibilities I’ve been able to take on outside of the service line have been great for making me still feel like part of the “traditional” athletic training world.

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nurse navigation system in which cancer patients are assisted by a navigator who works as a liaison between the patient and their caregivers/providers.

The idea for the service line came after the hospital analyzed the number of orthopedic patients seen at the hospital and urgent care centers compared to the number of patients seen at the hospital’s off-campus orthopedic care offices. The data showed that a lot of patients did not follow the recommendation that they visit an orthopedic, sports medicine, or physical therapy office after being seen in the emergency room or at the urgent care facility.

Having and advertising one central phone number for patients to call allows for improved lateral integration of care and better communication so that more patients receive the treatment they need. The hospital has the resources to provide its patients with these services, it was just a matter of better aligning all the orthopedic care services we offer and then educating patients and providers about the service line.

MASTER SCHEDULER My primary responsibility is to answer the service line from 8:30 a.m. to 5 p.m., Monday through Friday. If someone calls outside those hours they are prompted to leave a voicemail, and I return their call the following business day. Patients are guaranteed to be seen by a physician as quickly as possible after speaking with me, almost always within 48 hours.

Having a 48-hour guarantee for appointments is a key component of the service. The faster a patient can be seen, the sooner he or she can get the necessary treatment or care recommendations from our team of orthopedic specialists.

The number of calls I field per day varies based on the time of year. For example, the fall tends to be busier than the summer months. In my first year, we helped more than 800 patients secure appointments with an appropriate provider within 48 hours.

When a primary care office or selfreferring patient calls with an orthopedic injury, I ask about the injury and based on that information, schedule an appointment for the patient following a rotating schedule that includes three different orthopedic offices in town.

If it’s important that a patient see an orthopedist right away after discharge TR AINING-CONDITIONING.COM

LEADERSHIP from the emergency room or urgent care, I follow an on-call schedule.

If based on the description of the injury—and their insurance policy allows—I can also schedule the patient for physical therapy at two different office locations. I typically get calls from patients who have had acute injuries, but when a patient has a chronic issue like tendonitis or a specific weakness that would benefit more from physical therapy, I can schedule it for them. This is where my clinical background and judgment are put to use. Regardless of the injury, we don’t conclude our conversation until I have scheduled an appointment for the patient.

Callers don’t typically request a specific doctor, but if they do, I try to accommodate them. It’s part of our dialogue on the phone: “Have you seen anyone in the area before for orthopedics or would you like me to schedule you at a particular office?” If they say yes, I call that office to set something up. If not, I follow the rotating or oncall schedule. This works the other way around, too. If a patient has seen a physician in the past and does not want to

see them again, we will offer appointments at other offices.

Sometimes challenges arise when time is a factor, especially with pediatric patients. A primary care office may request a same day appointment or one before the school day begins because the patient needs clearance for a big soccer game that afternoon. Callers may also be in a crunch due to business travel schedules or vacations, so our or-

ined. Before coming into this position, I had no idea there are so many different components to each plan.

Because I talk to a lot of different people each day, my communication skills have had a workout over the past year. It is especially important to show compassion and understanding when speaking to the patients. I think the most important quality I have honed as the OPN is patience. Sometimes I have to explain

Since I can’t perform a physical exam over the phone, I try to find a balance where I can obtain enough information from the patient to provide appropriate self-care advice, but not waste my time—or theirs— with an extremely detailed history. thopedic and sports medicine offices try to be as helpful as possible.

One of the major challenges being the OPN is that few callers are knowledgeable about the medical system or fully understand their insurance policy.

I have learned more about insurance and billing than I ever could have imag-

every detail, or repeat myself multiple times because the patient is writing down everything I say. Other times there is a language barrier. (Though I haven’t had to use it yet, the hospital does have a translation service.)

One of the oddest conversations I had was with a patient who had

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LEADERSHIP to apply my knowledge and provide important patient education to different groups of people—all just via a phone conversation.

MOVING FORWARD Because the OPN position is so new, the hospital wants to continually evaluate its effectiveness. Therefore, about a week after every patient’s appointment, I call to follow up and ensure they had a pleasant experience with the service line and do not need further assistance. I ask how their appointment went and if they need help scheduling any further appointments. Before hanging up, I ask if they have any questions or concerns about their experience with the service line and their resulting visit.

Almost all the people I speak with are satisfied and the most common response is gratitude. But any negative feedback is recorded and if it is related to a specific office, I call the practice manager to address the issue raised.

I also monitor patient feedback left on our Web site survey. This is important information that paints a picture of how the service line is helping to serve patients. The 15question survey asks patients to rate the facility, physician they saw, reception staff, other staff members like nurses and athletic trainers, the scheduling process, and wait time in the office. There is also space for comments at the end of the survey.

I regularly distribute the results to the office managers so that they can see the customer satisfaction ratings and fix any issues. Every other month, we have an orthopedic service line meeting that all providers and office staff attend.

During this meeting, we review statistics from the previous two months and address any questions or concerns regarding the service line. For example, after a patient said that the x-ray room in one of our offices was very cold, the office bought extra blankets to have on hand to ensure that patients are comfortable during exams.

Finally, my own performance is evaluated by both the Director and Coordinator of the hospital’s Center for Orthopedics and Sports Medicine. I also work closely with these two individuals when preparing for our bi-monthly meetings and other events.

I get a lot of different calls from a lot of different people, but the callers who stick with me are the ones who genuinely had no idea what to expect from the service line. These callers often say, “I went to Cayuga Medical Center and they told me to call you.” They don’t fully understand what I can do for them at first, but by the end of our conversation, they have a timely appointment that fits their schedule, advice on how to manage their injury until the appointment, and a number to call back in case they have any questions. It’s a good feeling to know that I helped them manage their care.

Athletic training is a unique and growing profession.

Though this job wasn’t part of my master plan, it’s proven to be a great choice. I think that more and more athletic trainers will soon be working in different settings such as this one. n

To learn more about the orthopedic service line, visit the Cayuga Center for Orthopedics and Sports Medicine Web site at: www.everyonesanathlete.org.

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sport specific

Stand Up Performance

university of alabama athletics

The team poses with its NCAA Division I trophy after winning the title game in June.

At the University of Alabama, perfect posture is a focus of every strength and conditioning workout. This year, it was part of what earned the softball program its first national championship.

By Michelle Martin Diltz

M

ost people know University of Alabama softball for its big bats, speed on the bases, and continuous winning seasons. While our lifting program helps produce those monster hits and our conditioning program helps keep the players’ feet churning, what a lot of people don’t know is that our focus on posture is also a major contributor to the team’s success.

Softball is about power and speed through precise movements, but if the body cannot maintain good posture throughout those movements, power and speed suffer. If a batter has some

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deficiencies in her posture, she will not get full force behind her swing. If a pitcher has poor posture, her pitches will not be as strong. Gray Cook said it best in his book Athletic Body in Balance: “Most athletes work around energy leaks instead of through them.”

That message has stuck with me, as well as one from my mom, who always reminded me to stand up straight when I was growing up. At 5-foot-9, I used to slump in order to be the same height as my friends.

Then, I started noticing a trend at Alabama. Freshmen were arriving with bad posture just like I used to have. The

problem was highlighted about five years ago at an off-season training session run

by Head Coach Pat Murphy. The players lined up from freshmen to seniors to introduce themselves, and the freshmen were standing slumped over, looking scared and uncomfortable, while the Michelle Martin Diltz, SCCC, CSCS, is an Assistant Strength and Conditioning Coach at the University of Alabama.

She is responsible for training the softball, women’s basketball, and women’s golf teams, and assists with cheerleading. She can be reached at: mmartin01@ia.ua.edu.

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sport specific seniors were standing tall, looking confident and proud.

Although I had never worked directly on the older players’ posture, I realized that by focusing on coaching proper form and technique, using the right coaching cues, and even role modeling good posture myself the players had improved in this area. Since that day at camp, I have done a lot of research on the topic, and I now combine traditional strength and power exercises with Pilates and yoga philosophies to improve posture.

While the team’s focus on posture translates to great results on the field, it also gives our athletes better body awareness, confidence, and a certain swagger. It creates a “look good, feel good, play good” mentality, and our players demonstrate that when they walk into the batter’s box or pitching circle. In this article, I share some of

back is rounded or slumped, shoulder blades press out from the ribcage as if they were wings, thumbs rotate toward the posterior, pelvis is anteriorly rotated, and the pubic bone is posteriorly rotated. Athletes with KL usually have tight low backs and hip flexors and weak abdominals and gluteals. These unbalanced weak links in a softball player’s body translate to inefficiencies in movement and over time, create energy leaks or overuse injuries that can sideline or end a career.

Good posture is defined as head in neutral position, shoulder blades back and down the thorax, spine with natural curvature, palms facing the body with thumbs anteriorly rotated, pelvis in neutral, pubic bone in line with the pelvis, and knees straight ahead. Any force is distributed evenly, muscles are balanced and relaxed, movement patterns are normal, and joints are open

Bad posture can be influenced by a lot of things, including genetics, hand dominance, past and current injuries, illness, emotional stresses, sitting at a computer, texting, driving, wearing a backpack, and even playing a sport. If you think of a college athlete, almost all of these influences are present. our team’s off-season strength and conditioning program and explain how I integrate a focus on good posture into every workout.

DEFINING POSTURE Bad posture can be influenced by a lot of things, including genetics, hand dominance, past and current injuries, illness, emotional stresses, sitting at a computer, texting, driving, wearing a backpack, and even playing a sport. If you think of a college athlete, almost all of these influences are present, so it makes sense that we see a lot of players coming into the weightroom with poor posture.

In general terms, bad posture equals bad body alignment. Poor alignment means that stabilizing muscles are stretched, which weakens them while putting other muscles under heavier stress. When muscles are under heavy stress for a length of time, misuse results, and injury can occur.

The most common type of bad posture seen in athletes is kyphosislordosis (KL). KL posture is present when the head thrusts forward, upper ­42

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and loose with the core stable to allow energy (power) to flow through the body unhindered.

Posture is usually thought about just in context of the spine, but there is a lot more to it. When I talk about posture in the weightroom, I am referring to the players’ “girdle of strength,” core, hips, shoulders, and feet.

Girdle of strength: Joseph Pilates coined this term to identify the muscles making up the center of the body, including the pelvic floor, transverse abdominus, internal obliques, and multifidus. These four muscles form a natural corset that draws up and in, creating a strong center from which smooth, easy, and safe movements start.

The muscles in the girdle of strength are stabilizers, so they are the first and deepest layer of muscles that contribute to creating a tall, stable spine to support the body, transfer power, and make movements efficient. The girdle of strength’s function is to prevent or stabilize movement rather than initiate it.

Core: Though traditionally defined as the abdominals, the core actually encompasses everything located be-

tween the hips (pelvis and glutes) and the shoulder girdles. The core muscles in the hips need to be flexible and the core muscles in the trunk need to be strong. Combined, they make up the powerhouse of an elite softball player.

A strong core allows energy to flow from the center of the body out to the arms and legs.

Hips: The hip is a ball and socket joint made up of the pelvis, gluteal, hip flexor, adductor, and abductor.

Movement at this complex joint depends on the teamwork of all the surrounding muscles. For example, if a player’s girdle of strength is weak, then big mobilizers like the hip flexors and hamstrings will do much of the work, creating an imbalance.

KL posture usually creates imbalances and eventually injuries due to the pelvis being anteriorly rotated (tilted forward), which has an affect on the spine and hips. The forward tilt creates too much curvature in the spine, shortening the erector spinae and hip flexors while creating weakness in the gluteals due to tightness in the hamstrings. When stiffness or tightness is present, an athlete’s body will find a way to work around it, expending extra energy and decreasing power and speed.

Shoulders: Throwing athletes who exhibit KL posture tend to have abducted scapula, weakened lower trapezius, lengthened serratus anterior, and slumping due to tight anterior deltoids and pectorals. On the surface, a lengthened serratus anterior is an advantage for a softball player because it allows the athlete to throw further and harder. But this is only a shortterm benefit. Eventually, the internal rotation of the shoulders shortens the latissimi, pectoralis, and subscapularis, causing the muscles in the upper back (rhomboids, trapezius, infrasinatus, and teres minor) to lengthen. This creates dysfunction and weakness at the shoulder joint. If the athlete continues to work around the weakness, an injury will likely occur.

Feet: The foundation of the body, the feet are also crucial for good alignment.

Most athletes forget about the importance of their feet because they have come to rely on sneakers, cleats, and/or orthotics to stabilize them. However, when using shoes and orthotics for stabilization, the muscles, ligaments, and tendons in the feet become untrained TR AINING-CONDITIONING.COM

sport specific and unresponsive to the stresses produced by playing sports.

A player who has weak feet and limited range of motion at the ankle will see her performance suffer. This reliance also increases the chance of injury by creating an imbalanced, dysfunctional weak link. ’BAMA WORKOUTS Training proper posture is a neverending task, but it is one that can be done during any team activity. In the weightroom, I prescribe a traditional workout and focus on posture in each exercise we do.

During the off-season, the team lifts three days a week. Each lifting session is 90 minutes long and includes a warmup, quick feet drills, Olympic variations, and lower body, upper body (including shoulder prehab), and core work. Here’s a glance at the team’s lifting day workouts, including how posture is a focus in each part.

Warmup: The team lines up on the 20-yard line of the turf field three mornings a week, barefoot and ready to begin its warmup. Movements con-

sist of dynamic stretches, balance work, and glute activation. Warming up barefoot—without tape or socks—allows the muscles, ligaments, and tendons of the feet to strengthen, which promotes good alignment and force absorption up the kinetic chain from the ankle, knee, and hip.

Before each new exercise begins, the players complete a posture check: toes straight ahead, knees in line with toes and not collapsing in, girdle up and in, pubic bone titled forward, chest open with shoulder blades back and down— like putting your shoulder blades in your back pockets—and neck long with head held high.

Every movement of the warmup, from a jog to tin soldiers to leg swings, must be done with good posture by every player or the entire team starts over. Focusing on proper movement of the body from the start prepares it for the more advanced exercises that come later in the workout.

After the athletes are awake and aware of how their body is moving, they complete supersets of balance and glute activation exercises. Generally speak-

ing, softball players have “glute amnesia” due to their KL posture. Glute amnesia is a term Cook uses to explain that due to athletes’ bad posture and their reliance on big mobilizers rather than the core to stabilize, their gluteals stop working in the right pattern for movement. The glutes essentially shut down, which creates tightness and shortening in the big moblizers, putting a kink in the chain.

We use scales and excursions to increase strength of the stabilizers in the feet and lower legs, and to reiterate girdle of strength activation to promote movement and not create it. Players also complete mini-band walks forward, backward, and laterally for five to 10 yards along with variations of bird dogs, clams, or bridges—all while focusing on using the glutes to stabilize the pelvis, which allows the hamstrings and hip flexors to mobilize.

Quick feet: After the warmup is complete, the nervous system needs to be primed for the workout that will follow. During the first few weeks of the fall off-season, freshmen and players who didn’t stay on campus over the

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sport specific tact time, coordination, stamina, and posture. Jumping rope also promotes good alignment from the feet up, and it gives the athlete immediate feedback if their body is misaligned or out of sync.

Good posture is necessary for power and speed in this activity.

Olympic variations: Triple extension is key to success for athletes in all

summer put their sneakers back on for this portion of the workout so we don’t over-train their feet. Upperclassmen and those who were on campus over the summer continue barefoot. Each week, the players progress a little further into the quick feet section while barefoot in order to continue promoting good body alignment and strength

Of all the tools out there, my favorite is the jump rope. It can be used by athletes at all levels to improve ground contact time, coordination, stamina, and posture. Jumping rope also promotes good alignment from the feet up, and it gives the athlete immediate feedback if their body is misaligned. sports, and the best way to improve it is through full body Olympic movements and medicine ball throws. However, our softball players do not clean, snatch, or jerk. Instead, we train Olympic variations. Using Olympic pulls and med balls in movements similar to Olympic lifts allows the athletes to reap the benefits of power without the risk of injury.

throughout the kinetic chain.

A quick posture check to realign is completed if needed. To train quick feet, we use jump ropes, cones, ladders, hurdles, lines, and The Cube, which help improve ground contact time and multi-directional movement. Of all the tools out there, my favorite is the jump rope. It can be used by athletes at all levels to improve ground con-

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Players pull from the ground, hang, and rack, but never complete the catch portion of the lift. Posture and triple extension can be trained through the pulls without the athlete having to decelerate the bar at the shoulder, which can lead to an increased risk of shoulder injury. Prior to each pull, every player must complete a posture check which ensures their spine and core are in position to hold strong so that power can smoothly transfer from the ground up.

Med balls are also used for training power production and promoting triple extension. Granny throws, overhead backward throws, squat to presses, and many other variations are used to promote proper body alignment and posture for max power production.

Lower body: “Big butts, big power” is something you can hear our players saying around the weightroom pretty often. We squat, and we squat heavy, but not until the athlete is ready and their posture can handle the load on their back through full range of motion. Posture checks take place and are coached throughout the entire lift.

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sport specific If I see someone losing form and not working through full range of motion, then the weight is lowered to allow for proper body alignment and posture.

Single-leg squat and lunge variations are used during the other two lifting sessions of the week. They include lunges in all directions, step-ups, rear foot-elevated squats, and overhead squats. Each of these movements promotes and encourages good posture.

Unlike the squat, the single-leg exercises are more similar to sport-specific movements. Teaching the athletes how to not only stand with good posture, but also how to move multidirectionally with good posture will have more carryover onto the field.

After working the multi-joint lifts, the posterior of the body needs to be addressed. To do this, we use partner glute ham raises, leg curl variations, and Romanian deadlift variations.

Most female athletes are quad-dominant and have tight hamstrings and weak glutes, which creates imbalances in the body and increases the chance of injury all the way up the kinetic chain. Placing lateral band walks, lat-

eral squats, and lateral lunges into the workout teaches the body to maintain posture while fielding, running the bases, pitching, and hitting.

Upper body: Next, the team progresses to upper body work, which includes one chest exercise for every four (or five) back exercises. The one-to-four ratio helps create better posture and shoulder strength because it balances out the players’ actions on the field.

Fielding, running, hitting, and pitching are all anterior-strengthening movements. Therefore, in the weightroom, we work more on the posterior muscles.

I prescribe the team a heavy bench press along with many different variations of the press, including incline, speed, or dynamic presses, dumbbell work, band work, and pushups. As with all of our exercises, posture is key. When completing a bench or incline press, athletes are expected to firmly plant their feet on the ground, pull their girdle of strength up and in, open the chest and push the shoulder blades back and down to create a solid and stable base.

A lot of softball teams no longer

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include the traditional bench press in their workouts, but this lift gives the athletes confidence and the opportunity for a little intra-team competition.

If done correctly and with the oneto-four ratio at the right time of year (which for us is the off-season), the bench press can be a great exercise for softball athletes.

After a heavy bench press or variation, the players follow with one heavy back exercise plus three other posture or shoulder prehab exercises. My favorite back exercises are the single-arm dumbbell row and all-purpose band rows (single- and double-arm). Both of these exercises require good posture to resist rotation. Other exercises include pull-ups, horizontal pull-ups, Hammer rows, and lat pull-downs.

The posture and shoulder prehab exercises are completed with body weight, light bands, or light dumbbells, working between 10 and 15 reps to increase the stamina of the postural muscles. My favorites are the reverse fly, Y-T-W, bird dog, external rotation, and 90/90 band row.

Along with the prehab work that

sport specific players do in the weightroom, Softball Athletic Trainer Nick Seiler, ATC, has set up a great shoulder care program for all freshman athletes and those with previous shoulder injuries. Nick creates an environment for the athletes to achieve success by working with them one-on-one during shoulder care to make sure they demonstrate proper posture and body alignment during the movements, reinforcing the message they are hearing from me in the weightroom.

Core: We end every workout with a

core section, though a lot of core work has already taken place during the rest of the workout. The athletes complete four to five exercises such as sit-ups, Russian twists, supermans, crunches, wipers, planks, and other traditional movements. These exercises are completed in one to three sets, with 10 to 25 reps in each, depending on where we are in the off-season. On Wednesdays, the players complete a core circuit at the end of the workout that includes anti-rotation with bands, farmer holds with 25-pound plates,

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traditional core work, and back extensions.

We concentrate on posture in each of these ordinary core exercises in our own way. For example, when doing the superman, the athletes are told to pull their belly button away from the ground to pull the girdle of strength up and in.

When doing crunches, they are told to pull their belly toward the ground to create a strong, stable center.

OUTSIDE THE WEIGHTROOM Good posture can also be developed anywhere and anytime during an athlete’s day—during class, while driving, or while doing homework, for example. As the athletes grow more aware and conscious of their bodies, they will be able to practice great posture throughout the day, now realizing that what had previously felt natural may not be.

Our softball players also hear me talking about good posture to my assistants, interns, and athletic training students ... I know I’ve done my job well when I hear a sophomore telling a teammate, “Get your traps out of your ears and stand tall.”

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In addition to hearing my coaching cues throughout their workouts, our softball players also hear me talking about good posture to my assistants, interns, and athletic training students.

“Traps out of your ears” is a favorite of mine. Because the athletes hear it so much, I often see them fixing their posture themselves before I say anything.

I know I’ve done my job well when I hear a sophomore telling a teammate, “Get your traps out of your ears and stand tall!”

Coach Murphy and his staff preach the mentality that champions give “that little extra.” This could be the team’s intensity, ownership, dedication, passion, or focus. In the weightroom, I contribute to that mentality by coaching and enforcing a little extra on the players’ posture. n TR AINING-CONDITIONING.COM

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Circle No. 128

Lower-Body Strengthening Total Leg Development

The TDS Tibia Dorsi Calf Machine is great for runners, jumpers, and those interested in general leg sculpting. This product exercises the gastrocnemius and soleus, and has superior isolation of the tibia. Users can exercise each leg independently or both simultaneously. The TDS Tibia Calf Machine pivots on two industrial-grade pillow blocks. It is also commercialquality with a steel deck plate and heavy padding for comfortable use.

New York Barbells of Elmira, Inc. • 800-446-1833 www.newyorkbarbells.com Circle No. 509

Sprinting Toward Strength

The new Samson Sprinter is yet another way the company is leading the way in heavy-duty custom equipment.

This unique piece allows your athletes to perform a sprint motion while in a biomechanically sound running position. Adding resistance is made easy with the plate-loaded weight horns that are designed to prevent any plate movement. Created with comfort, durability, and adjustability in mind, the new Samson Sprinter will fit every athlete comfortably, and just like any other Samson piece, it will last a lifetime.

Samson Equipment • 800-472-6766 www.samsonequipment.com

Minimize Joint Stress

Circle No. 551

The AlterG Anti-Gravity Treadmill enables athletes to train longer, run faster, gain additional strength, and enhance cardiovascular performance— all while minimizing impact and joint stress. By using Differential Air Pressure Technology, the AlterG provides up to 80-percent bodyweight support, in accurate one percent increments.

At a reduced bodyweight, athletes can safely work on increasing endurance, overspeed train, run backwards, do interval training, practice plyometrics, and more.

AlterG, Inc. • 510-270-5900 www.alter-g.com

l®

Circle No. 511

Practical Education

New editions of two popular DVD correspondence courses—Scientific Back Training and Program Design—are now available. Presented

by Paul Chek, a world-renown corrective exercise and performance-conditioning specialist, these courses provide in-depth, practical education for strength and conditioning coaches. Program Design includes information on choosing reps, sets, loads, tempo, and rest periods. This course explores the science of designing effective programs. Scientific Back Training covers functional anatomy, assessments, and exercises for postrehab to enhancing performance.

C.H.E.K Institute • 800-552-8789 www.chekinstitute.com TR AINING-CONDITIONING.COM

Circle No. 539

Comfortable Single-Leg Exercises

Perform Better’s new Single Leg Squat Stand is perfect for working your hamstrings, glutes, quads, and low back. It allows you to perform all single-leg exercises comfortably with its tubular top and vinyl encased foam covering. Its sturdy design is made with a diamond-plated platform and it measures 18 inches high.

No more searching for a bench to do your lower-body work. For more information on Perform Better’s Single Leg Squat Stand, check out the company’s 2012 catalog.

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

Circle No. 512

Best-Selling Bungie

The Safety Super Bungie is NZ Manufacturing’s number-one TurfCordz™ resistance product. Used by professional athletes and Olympians worldwide, it helps increase speed, improve endurance, and overcome resistance. The Safety Super Bungie is made from high-strength, large-diameter bungie cord with industrial-strength steel snaps. There are three resistance levels and lengths for softball, football, track, hockey, and more. For additional information on the complete line of TurfCordz resistance tools, contact NZ Manufacturing today.

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

Circle No. 513

Indoor Cycling Options

The Power Lift ® Indoor Cycling Bike is available in both a chain- and belt-driven version. The belt-driven version allows users to pedal backwards with resistance.

Standard features for both bikes include dual-sided pedals with a clip-less system on one side and toe-cages on the other; adjustable positions for the seat height and forward/back position; and adjustable positions for the handlebar height.

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

Circle No. 540

Climb Your Way Back

The SRM Rehab Model VersaClimber is a total-body, closed-chain, rehabilitation exercise machine. The SRM allows patients to progress from non- to partial- to fullweight-bearing, full-body exercise. It is fully adjustable to fit the height, weight, and length of all types of athletes and patients.

Rehabilitation routines have been developed to provide a continuous arm and leg action in a seated or standing position, using varying stroke lengths, rates, and resistance levels.

VersaClimber/HeartRate Inc. • 800-237-2271 www.versaclimber.com Circle No. 542 T&C september 2012

51

Lower-Body Strengthening

Company News

Adjustable Weight Rack

Looking for quality weight equipment at an affordable price? Perform Better introduces its new PB Extreme Half Rack. This rack comes complete with weight storage for both Olympic and Bumper plates, safety spot arms, bar holders, hook plates with a safety lock system, a knurled P-grip pull-up bar, and band attachments. The adjustable pull-up bar allows you to make your rack 7.5 feet high, eight feet high, or 8.5 feet high. This rack is constructed of 11-gauge, 3” x 3” steel uprights, and is made in the USA. Check out Perform Better’s 2012 catalog for more information.

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

NASA Drink Additive

Circle No. 514

View Peak Power and Velocity

The Laser Rack is one of the first bar measuring units that calculates peak power and velocity using patented no-touch infrared sensing technology.

The Laser Rack allows users to view their peak power in horsepower or watts. Users’ peak velocity can be measured in either feet-per-second or meters-per-second.

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

Circle No. 541

Good Vibrations

Exervibe is a whole-body vibration stepper that provides athletic enhancement when used in either the static (standing) or dynamic (stepping) position.

Vibration stimulation is applied simultaneously to the feet, hands, arms, and core. The Exervibe has a step range from one to 18 inches, an adjustable seat, and a control module with four settings. It is an extremely versatile device that efficiently and effectively implements the benefits of vibration.

VersaClimber/HeartRate Inc. • 800-237-2271 www.versaclimber.com

Circle No. 543

Tone and Condition

The TDS Pro Sissy Squat is useful for toning, reducing, bulking, or conditioning the hams, glutes, and quadriceps. Use the TDS Pro Sissy Squat with bodyweight for toning and conditioning, or with dumbbells for bulking and building mass. This product is a commercial-quality machine, with heavy-form padding for a comfortable feel, and an adjustable front foot holder and rear pad for a precise fit. The TDS Pro Sissy Squat is white powder-coated and made of 2” x 4” steel tubing.

New York Barbells of Elmira, Inc. • 800-446-1833 www.newyorkbarbells.com

Circle No. 515

Develop Quickness

The Lateral Resistor incorporates SPRI Braided Tubing Technology, which brings the Lateral Resistor to the next level in lower-body training. The braided rope-like construction makes it one of the most durable tubing products on the market. Its large, padded cuffs make the Lateral Resistor comfortable and ideal for the development of dynamic lower-body quickness, reaction, and strength. This unit is available in five resistance levels.

SPRI Products • 800-222-7774 www.spri.com

The Right Stuff is an NASAdeveloped, zero-carb liquid electrolyte concentrate. It is excellent for use before, during, and after activities. According to numerous published studies, The Right Stuff is far more effective for: fighting symptoms of dehydration including cramps, muscle fatigue, headaches, light-headedness etc., increasing endurance by over 20 percent more than any other NASAtested formulas; improving core thermo-regulation; and protecting the body from overheating in high- exertion and high-heat settings. The Right Stuff is now available in an orange-tangerine flavor.

Technology Exclusively Licensed from NASA US Patent # 5,447,730.

Circle No. 510

A Unique Combination

The new Functional Training Rack Series from Samson Equipment features a unique design that combines a fully functional power rack with two adjustable cable column machines, all within a compact area.

Athletes can perform all the core lifts a rack/platform provides with the multifaceted capability of a fully operational functional trainer.

This product is extremely easy to adjust and use quickly, allowing your athletes in and out of every facet of a workout much more effectively.

Samson Equipment • 800-472-6766 www.samsonequipment.com

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Circle No. 550

The Right Stuff® 720-684-6584 www.therightstuff-usa.com TR AINING-CONDITIONING.COM

Testimonial

Products That Ease Athletes’ Pain

“I’ve found Pro-Tec products to be a great addition to my patient care, as they are very patientcompatible.”

—Jim Whitesel, MS, ATC, Former Seattle Seahawks Head Athletic Trainer

“I have found the Iliotibial Band Wrap to offer unmatched effectiveness in alleviating conditions of iliotibial band syndrome. We are recommending it for our patients.”

—Dr. Shintaro Ohtake, Aim Treatment Center

“Finally, because of the Shin Splints Compression Wrap, I feel no pain in my shins during strenuous activity.”

Circle No. 130

—Lisa Duke, ballerina and runner

2012: an Olympic year!

“Thanks to the Arch Pro-Tec, the plantar fasciitis in my foot has completely disappeared.”

—Christina Cambra, Ironman Austria third-place finisher

“With Ice Up, the benefits of ice massage are ready for me anytime, anywhere.”

—Scott Jurek, PT, seven-time champion, Western States Ultra 100-Mile Marathon

liFe iS SHOrT. PLAY HARD.

“I use the Pro-Tec Foam Roller and the Pro-Tec Roller Massager to help me get stretched out and to loosen up before practice. They’re great because I have them at home, so anytime I’m sore or feeling a little tight, I break out my foam roller.”

TurfCordz® resistance tools – with Safety Cord Tubing – meet the extreme demands of high-level athletic training.

Used by pro and Olympian athletes, the best-selling Safety Super Bungie and two-person Modular Speed Belt can increase speed and improve endurance.

—Roman Harper, pro football player

800-779-3372 www.injurybegone.com

Made in USA

Pro-Tec Athletics

Order today! 800.886.6621 or visit nzmfg.com Circle No. 131

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T&C september 2012

53

Pilates Increase Flexibility

The Pilates Versa-Tube® allows you to simulate reformer or Cadillac-style workouts in a matbased setting. The tube increases flexibility and postural alignment awareness, and allows you to experience a Pilates-style resistance workout without the heavy equipment. The Pilates VersaTube®) is available in four resistances. It is comprised of four equal-length resistance tubes, two of which have padded handles and the other two are outfitted with foot/ ankle cuffs—all connected to a center nylon strap. The Pilates Versa-Tube retails for $16.95 to $19.95.

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

Explore movement with 40 intermediate to advanced exercises on the OPTP PROROLLER™, the preferred foam roller choice for use with PRO-ROLLER™ Pilates Challenge, by Angela Kneale, OTR. Combine these exercises into a personalized routine while emphasizing key principles such as proper alignment, control, fluidity, concentration, and breath. Incorporating the PRO-ROLLER™ with Pilates exercise is a motivational way to deepen mind-body awareness, promote better posture and symmetry, and challenge core strength and balance.

Circle No. 520

Enhance Muscle Activation

The SpongeBall is perfect for enhancing core-muscle activation, body-rolling techniques, and postural re-setting activities. The soft, light, scented, inflatable ball adds energy and excitement to any mat-based exercise routine. The SpongeBall is approximately 9 inches in diameter, and can be cleaned with a soft cloth and warm, soapy water. A free instruction sheet for the item’s use is included in each order.

SPRI Products • 800-222-7774 www.spri.com

Perform Reformer-style movements without heavy Pilates equipment with Power Systems’ Reform Bar™.

Two 30-inch-long resistance tubes are attached to each side of the bar, so you can perform a variety of movements using the attached Velcro®-adjustable cuffs.

In four weights from extra-light to heavy, the 39-inch Reform Bar includes tubing with attached ankle cuffs and a carrying bag. The bar disassembles for easy storage. The price of the Reform Bar ranges from $37.95 to $43.95.

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T&C september 2012

Balanced Body ® • 800-PILATES www.pilates.com

Circle No. 534

Measure Major Muscle Groups

The T-17K Cable Tensiometer measures all major muscle groups in kilograms. The T-17K Cable Tensiometer comes with accessories to measure foot, ankle, thigh, wrist, and head muscle strength; this includes two chains and four coupling links. Also available is the T-17LB Cable Tensiometer, which uses pounds as a measuring unit and has a range up to 640 pounds.

Creative Health Products • 800-742-4478 www.chponline.com

Circle No. 526

Versatile Exercise Prop

This exercise wedge from OPTP can be used in a variety of ways for added comfort and to alleviate overstretching or pressure on the joints.

Use it under heels, knees, or seat bones in forward bending exercises to maintain alignment and achieve a deeper stretch. For tight or problem wrists, use the wedge for added comfort and support in otherwise uncomfortable positions. Visit OPTP online for more information.

OPTP • 800-367-7393 www.optp.com

Circle No. 519

Circle No. 517

Easy Storage

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

Pilates on a Reformer takes functional athletic training to a new level. The Allegro® 2 Reformer was designed in collaboration with fitness professionals and offers a streamlined and optimized functional training experience for athletes and instructors. The Allegro 2’s EasySet Footbar adjusts vertically by lifting up the footbar and moving it to the next position—even with the feet. The SoftTouch Rope System makes instant, onetouch, rope adjustments—even while lying on the carriage.

Circle No. 516

Personalized Routine

OPTP • 800-367-7393 www.optp.com

Functional Training

Circle No. 518

Small Enough to Store Anywhere

The Orbit ® is ideal for athletic trainers and conditioning professionanls who’d like the functional training benefits of Pilates but don’t have space for larger equipment pieces.

The Orbit is lightweight and small enough to store anywhere. Athletes can sit, lie, kneel, or stand to perform a variety of exercises designed to challenge the entire body and keep the core engaged. The Orbit can improve balance, coordination, and strength. A 35-minute workout DVD is included with the Orbit.

Balanced Body • 800-PILATES www.pilates.com

Circle No. 535

TR AINING-CONDITIONING.COM

Case Study

Performance Gains for Injured Athletes

T

raining injuries can sideline even the most dedicated athletes. However, one company that is doing its part to get them back in the game is OPTP.

Beginning in 1979, OPTP (Orthopedic Physical Therapy Products) has been a leading provider of physical therapy, fitness, and wellness products. The company continues to feature an extensive range of exclusive, innovative tools and resources developed by renowned experts, including products for myofascial release, core strengthening, stretching, rehabilitation, and training and conditioning.

Initially marketing to the rehab community, OPTP soon discovered that many of its customers and its clients’ customers were injured athletes. Desperate and frustrated by continued attempts to find relief from a host of nagging muscular ailments, these athletes—both amateur and professional—sought lasting and effective treatment for conditions that were prohibiting them from performing at their peak levels.

One such individual, Steve, was an avid football, rugby, swimming, and rock-climbing enthusiast who also engaged in an intense home-exercise program. After years of rigorous training, Steve had acquired a number of medical conditions, including a lumbar disk injury; a cervical disk injury; a torn rotator cuff; thoracic curvature; upper crossed syndrome; and most recently, a ruptured Achilles tendon.

Several attempted courses of exercise-based physical therapy had failed and Steve was faced with the possibility of ending or significantly limiting his activity level. With the help of a physical therapist, he discovered relief in the form of trigger point release and subsequent restoration of muscle balance with added strengthening and stretching.

By beginning each workout with the OPTP ProRoller (a standard density foam roller), or the RumbleRoller ® (for more intense myofascial release), Steve was able to relieve muscle

Designed by physical therapist Jonathan Reynolds, the Tola™ System uniquely enables users to apply deep, precise pressure to hard-to-reach soft tissues.

tension and make significant progress in range of motion and pain relief. After undergoing surgical repair of his Achilles tendon, he used the TOLA™ Neuromuscular Release System to apply deep pressure to the gastrocnemius and soleus muscles, and to apply deep transverse frictions to the repair.

To independently sustain gains made in the therapy sessions, Steve continues to use the TOLA System on trigger points in the gluteal, back, thigh, and shoulder muscles. He also uses the TOLA System on muscle spindles in the mid-bellies of various muscles prior to stretching, which has greatly affected the strength of his workouts.

Steve’s thoracic curvature, which originally measured at 44 degrees, improved over 30 percent in six months.

Through augmenting his physical therapy care with selfhelp products from OPTP, Steve has been able to continue with his training.

To view a full range of products, visit OPTP online.

OPTP 800-367-7393 www.optp.com

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55

Directory

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

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

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

104. AlterG. . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

117. EAS® Sports Nutrition. . . . . . . . . . . . . . . 31

124. Samson Equipment . . . . . . . . . . . . . . . . 43

105. American Public University. . . . . . . . . . . . 9

103. Gatorade . . . . . . . . . . . . . . . . . . . . . . . . . 5

106. Shamrock Farms Rockin’ Refuel. . . . . . . 11

132. Athlete’s Guide to Nutrition. . . . . . . . . . . 60

109. MilkPEP. . . . . . . . . . . . . . . . . . . . . . . . . 17

127. SPRI . . . . . . . . . . . . . . . . . . . . . . . . . . . 46

115. Balanced Body®. . . . . . . . . . . . . . . . . . . 25

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

121. Stromgren® Athletics . . . . . . . . . . . . . . . 38

116. BiPro . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

113. Muscle Ropes. . . . . . . . . . . . . . . . . . . . . 20

114. The Halo (Mission Competition) . . . . . . . 21

112. Brace International. . . . . . . . . . . . . . . . . 20

135. New York Barbells of Elmira. . . . . . . . . . 47

118. The Right Stuff®. . . . . . . . . . . . . . . . . . . 33

133. Brain Armor. . . . . . . . . . . . . . . . . . . . . IBC

120. OPTP. . . . . . . . . . . . . . . . . . . . . . . . . . . 37

125. ThermaZone™ . . . . . . . . . . . . . . . . . . . . 44

130. C.H.E.K Institute. . . . . . . . . . . . . . . . . . . 53

111. Perform Better. . . . . . . . . . . . . . . . . . . . 19

131. TurfCordz™/NZ Manufacturing . . . . . . . . 53

110. CalRopes. . . . . . . . . . . . . . . . . . . . . . . . 18

107. Power Lift®. . . . . . . . . . . . . . . . . . . . . . . 12

126. VersaPulley & VersaClimber . . . . . . . . . . 45

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

122. PRO Orthopedic Devices. . . . . . . . . . . . . 39

128. Xtreme Research. . . . . . . . . . . . . . . . . . 50

119. Cramer. . . . . . . . . . . . . . . . . . . . . . . . . . 34

108. RG Medical Diagnostics. . . . . . . . . . . . . 15

102. Zephyr Technology. . . . . . . . . . . . . . . . . . 3

123. DARCO International. . . . . . . . . . . . . . . . 40

100. Rich-Mar . . . . . . . . . . . . . . . . . . . . . . . IFC

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

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

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

511. AlterG . . . . . . . . . . . . . . . . . . . . . . . . . . 51

505. EAS® Sports Nutrition (Protein Powder). . . . 49

522. Power Systems (Training Ropes). . . . . . . 48

528. American Public University . . . . . . . . . . 58

501. Gatorade (Energy Chews). . . . . . . . . . . . 49

529. PRO Orthopedic (611 Ankle Anchor). . . . 59

534. Balanced Body (Allegro® 2 Reformer). . . 54

507. Gatorade (Recovery Beverage). . . . . . . . 50

525. PRO Orthopedic (Diamondback Knee Sleeves).58

535. Balanced Body (Orbit ). . . . . . . . . . . . . 54

538. Kestrel by Nielsen-Kellerman. . . . . . . . 57

508. Pro-Tec Athletics (Roller Massager) . . . . 57

548. BiPro . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

503. MilkPEP. . . . . . . . . . . . . . . . . . . . . . . . . 49

527. Rich-Mar (EVO Therapy System). . . . . . . 59

549. BiPro (BioZzz). . . . . . . . . . . . . . . . . . . . . 50

532. Mission Competition (The Halo) . . . . . . . 59

537. Rich-Mar (seven modalities in one unit). . . 59

563. Brain Armor. . . . . . . . . . . . . . . . . . . . . . 49

553. Muscle Ropes. . . . . . . . . . . . . . . . . . . . . 48

550. Samson Equipment (Training Rack). . . . 52

552. CalRopes. . . . . . . . . . . . . . . . . . . . . . . . 48

515. New York Barbells (TDS Pro Sissy Squat). . . . 52

551. Samson Equipment (Sprinter). . . . . . . . . 51

554. CalRopes (CalChain). . . . . . . . . . . . . . . . 59

509. New York Barbells (TDS Tibia Calf Machine). . 51

500. Shamrock Farms Rockin’ Refuel. . . . . . . 49

539. C.H.E.K Institute. . . . . . . . . . . . . . . . . . . 51

521. New York Barbells (training ropes) . . . . . 48

510. SPRI Products (Lateral Resistor). . . . . . . 52

524. Cho-Pat . . . . . . . . . . . . . . . . . . . . . . . . . 58

513. NZ Manufacturing. . . . . . . . . . . . . . . . . . 51

523. SPRI Products (ropes). . . . . . . . . . . . . . . 48

531. Cramer (950 tape) . . . . . . . . . . . . . . . . . 58

519. OPTP (exercise wedge). . . . . . . . . . . . . . 54

517. SPRI Products (SpongeBall) . . . . . . . . . . 54

533. Cramer (ESS Ankle Compression Sleeve). . . . 59

520. OPTP (PRO-ROLLER ) . . . . . . . . . . . . . . 54

559. Stromgren Athletics . . . . . . . . . . . . . . . . 58

526. Creative Health Products . . . . . . . . . . . . 54

514. Perform Better (Extreme Half Rack) . . . . 52

560. Stromgren Athletics (1530 SHTP) . . . . . . 59

506. CytoSport (Cytomax Energy Drops™). . . . 50

536. Perform Better (Red Training Ropes). . . . 48

530. The Right Stuff® . . . . . . . . . . . . . . . . . . 49

502. CytoSport (Monster Amino™). . . . . . . . . . 49

512. Perform Better (Single Leg Squat Stand). . . . 51

543. VersaClimber (Exervibe). . . . . . . . . . . . . 52

545. DARCO (Body Armor Dorsal Night Splint). . . . . 58

540. Power Lift (Indoor Cycling Bike) . . . . . . 51

542. VersaClimber (SRM Rehab Model). . . . . 51

546. DARCO (Elastic Tape) . . . . . . . . . . . . . . . 58

541. Power Lift® (Laser Rack). . . . . . . . . . . . . 52

555. Zephyr Technology (Bio Module™). . . . . . 58

547. DARCO (Web™ Ankle Brace). . . . . . . . . . 57

516. Power Systems (Pilates Versa-Tube®). . . 54

556. Zephyr Technology. . . . . . . . . . . . . . . . . 59

504. EAS Sports Nutrition (Lean 15 ). . . . . . 50

518. Power Systems (Reform Bar ). . . . . . . . 54

561. Zephyr Technology (Product Launch) . . . 57

Products Directory

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T&C september 2012

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TR AINING-CONDITIONING.COM

Product Launch

Pro-Tec Roller Massager -Travel Size

Kestrel 4400 Heat Stress Tracker

Pro-Tec Athletics injurybegone.com 800-779-3372 Circle No. 508

Kestrel Weather Instruments by NK heatstress.com 800-784-4221 Circle No. 538

Unique features:

Benefits for the user:

Unique features:

Benefits for the user:

• Raised Vynafoam sections “sink” into soft tissue to roll out tightness • 17.5-inch length fits most carry-on bags • Includes instructional brochure covering 20 massage and trigger point release techniques

• Deep tissue stimulation and expedited recovery • Maximum muscle performance and flexibility • Travel size allows user to take it anywhere • Rounded grip ends provide precision trigger point release

• The Kestrel 4400 is water-less, lightweight, and easy to use • Measures Wet Bulb Globe Temperature, the recognized parameter of NATA’s Position Statement on exertional heat illnesses

• Prevents heat stress injuries in athletes with the Kestrel 4400, which is supported by the Korey Stringer Institute • Rugged, accurate, and affordable device • Bluetooth® wireless data transfer and a fiveyear warranty

Web™ Ankle Brace

PSM Training ECHO Zephyr Technology zephyranywhere.com 443-569-3603 Circle No. 561

Darco International, Inc. darcointernational.com 800-999-8866 Circle No. 547

Unique features:

Benefits for the user:

Unique features:

Benefits for the user:

• Removable medial and lateral stays are rigid enough to provide controlled restriction of inversion/eversion • Multiple strapping configurations allow direct compression where needed • Reimbursable under suggested L-code 1902

• Bungee closure provides superior compression and allows for adjustments on the run • Durable ballistic nylon shell is breathable and conforms to the foot

• Wirelessly measures transmits medical-grade data on accelerometry, heart rate, HRV, breathing rate, jump and dash, load and intensity, and core temperature— without pills or probes • Provides live readout of data and stores for later analysis with wide range of reports

• Measures up to 50 athletes simultaneously at distances up to 1000 feet • Quick and easy to use

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57

More Products Alleviate Shin Splints

Medical professionals helped design and evaluate Cho-Pat’s unique, sports/medical device that alleviates the symptoms of pain and discomfort associated with shin splints.

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

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

PRO 130 Standard and Altered Diamondback Knee Sleeves have an exclusive design that is unique enough to receive a patent, making them two of the most comfortable sleeves developed.

Geometrically opposed seams provide a bent-knee configuration while eliminating bothersome popliteal irritation. Using 1/8-inch neoprene for a comfortable, controlled tension fit makes it ideal for all-day wear. These sleeves are available in N1 or N2 material.

PRO Orthopedic Devices, Inc. • 800-523-5611 www.proorthopedic.com Circle No. 525

Complete Ankle Protection

The Stromgren Athletics model 329 brace offers complete heel-lock ankle protection without tape, yet it has outstanding compression and moisture-management features. A Spandex sock applies comfortable and even compression to the entire foot complex, yet stays cool and dry because of the fabric’s moisture-wicking properties. Permanently attached heel-lock straps help control severe eversion and inversion of the ankle complex.

This support fits both the left and right foot and is available in black or white.

Circle No. 559

Sustains Stretches

The DARCO Body Armor Dorsal Night Splint is the only night splint that engages the windlass mechanism of the foot, resulting in a sustained stretch of the Plantar Fascia, flexor tendons, and Achilles tendon. The Body Armor Dorsal Night Splint is an excellent product for runners and active athletes who experience symptoms of Plantar Fasciitis or Achilles Tendonitis. This splint comes in one size and fits all athletes.

For more information, visit DARCO online.

DARCO International • 304-522-4883 www.darcointernational.com

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DARCO Elastic Tape is a sport and therapy product used for kinesiology taping—a technique used on athletes, as well as patients in a physiotherapeutic setting. This tape is used in treatment of muscle and tendon symptoms and assists in performance by way of continuous receptor stimulation. The healing process is enhanced via improved circulation in the taped areas. The suggested retail price for DARCO Elastic Tape is $9.95 per roll.

DARCO International • 304-522-4883 www.darcointernational.com

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Patented Knee Sleeves

Stromgren Athletics • 800-527-1988 www.stromgren.com

Tape for Treatment or Performance

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Perfect for Athletic Trainers

Every roll of Cramer 100-percent cotton porous tape is like the next, which means you can count on it to unwind consistently, conform better, and adhere longer.

Cramer 950, constructed with a latex-free adhesive, is perfect for athletic trainers or athletic programs looking for a high-quality, economically priced porous tape alternative. Cramer Products has been the industry leader in sports medicine and athletic training room supplies for more than 85 years.

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

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Medical-Grade Data Without Probing

Zephyr’s BioModule™ is the “brains” behind the revolutionary PSM Training ECHO system. There are two comfortable options for mounting this small, circular sensor to the athlete—a chest strap called the Zephyr BioHarness™ or Zephyr’s new, high-tech Compression Shirt. Once mounted, the BioModule™ wirelessly transmits a wide range of medical-grade physiological data— including heart rate, HRV, breathing rate, jump and dash, even core body temperature—without pills or probes.

Zephyr Technology • 443-569-3603 www.zephyr-technology.com

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National Recognition

American Public University (APU) offers more than 100 online degree and certificate programs that are designed for sports and health sciences professionals, coaches, athletic directors, and working adults like you. APU has been nationally recognized by the Sloan Consortium for its effective practices in online education. For more information, call or go online.

American Public University • 877-777-9081 www.studyatapu.com/tc

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More Products Unrestricted Movement

The Cramer ESS Ankle Compression Sleeve’s patented articulated ankle joint allows for unrestricted movement while providing mild compression and support to the joint.

Compression provides a performanceenhancement benefit as well as mild muscular support. The unique knitted design allows for lightweight fit and exceptional stretch and comfort.

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

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A Versatile Unit

Rich-Mar offers up to seven modalities in one unit, including exclusive handsfree ultrasound and a Therapy Hammer with two- and five-centimeter applicators.

The company’s products are protected by industry-leading three-year warranties. Rich-Mar offers TENS, MENS, NMS, high-voltage, interferential, laser/ light, and ultrasound, with four channels and all of these stimulation modes: Quadpolor IFC, pre-mod IFC, Russian, high-voltage, microcurrent, and biphasic.

Rich-Mar • 423-648-7730 www.richmarweb.com

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Rugged, Reliable, Innovative

The EVO (Every Viable Option) Therapy System by Rich-Mar is one of the most innovative modality systems in the industry.

The unique, customizable, and upgradeable platform offers up to seven modalities in one unit. Systems featuring independent channels of stimulation include the Quadpolar IFC, Pre Mod IFC, Russian, Hi Volt, and the Microcurrent.

These systems also feature Rich-Mar’s patented Therapy Hammer and Hands-Free AutoSound Ultrasound Applicators, as well as optional Laser & Light Applicators.

All of these products are backed by one of the industry’s best warranties.

Rich-Mar • 423-648-7730 www.richmarweb.com

Circle No. 527

With the recent launch of its revolutionary new PSM Training ECHO system, Zephyr Technology also introduced its new, hightech Compression Shirt. The shirt holds a sensor called the Zephyr BioModule firmly in the athlete’s sternum area, allowing the sensor to accurately read and wirelessly transmit a wide range of physiological status data live to a coach’s laptop or tablet. The data is also logged for analysis later.

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Starting with the popular and very effective 610 Arizona Ankle Brace, PRO Orthopedic has taken ankle support to a new level with the PRO 611 Ankle Anchor. By combining the ankle brace with a non-elastic strapping system that anchors on the calf, PRO has created a supportive inversion resistant bracing system.

Ideal for chronic ankle conditions and high ankle sprains, the Ankle Anchor System is lightweight and machine washable. For more information, please contact PRO. PRO Orthopedic Devices, Inc. • 800-523-5611 www.proorthopedic.com Circle No. 529

Concussion Prevention

The 1530SHTP hamstring compression girdle, part of the Hammy series, is designed to provide numerous functions while on either the game or practice field. The high-compression, anti-microbial, moisture-wicking girdle provides optimal protection to the athlete’s iliac crest and tail bone. The adjustable straps are attached to the back of the girdle legs, then pulled tight to add support to the hamstring. Thin neoprene in back helps to retain body heat.

TR AINING-CONDITIONING.COM

CalRopes Fitness • 858-232-8309 www.calropes.com

Circle No. 556

Optimal Protection

Stromgren Athletics • 800-527-1988 www.stromgren.com

The CalChain, from CalRopes Fitness, is part kettlebell, part barbell, and part dumbbell—and it is revolutionizing resistance training as we know it. The instability of the CalChain activates accessory and stabilizing muscle groups to make even basic lifts extremely challenging, making the CalChain seem twice as heavy as it actually is. Visit CalRopes online to view free instructional videos and complete CalChain workouts.

Ideal for Ankle Conditions

High-Tech Made Easy

Zephyr Technology • 443-569-3603 www.zephyr-technology.com

Finally, Something Completely New

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Mission Competition Fitness Equipment created and manufactures The Halo, a dynamic rotary neck strengthening cable attachment. The Halo works the neck out by applying horizontal resistance during neck rotation. The company’s goal is to help in the prevention of concussions and neck injuries by increasing the athlete’s neck strength. Greater neck strength equals greater force dissipation upon head impact, which equals far fewer neck injuries and concussions.

Mission Competition Fitness Equipment • 310-776-0621 www.halotwister.com Circle No. 532 T&C september 2012

59

HELP FUEL YOUR ATHLETES TO SUCCESS INTRODUCING:

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Topics covered in The Athlete's Guide To Nutrition include: • The amount and kinds of calories athletes need • How to make sure athletes are properly hydrated • "When" athletes eat is as important as "what" they eat • Recovery nutrition • A close look at nutritional supplements

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Learn how proper nutrition can help your players reach their true potential through the valuable information presented in this collection edited by Susan Kundrat, Sports Dietitian for the University of Illinois.

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CEU QUIZ

T&C September 2012 Volume XXII No. 6

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

U res ults a uizzes on www li C .train lick on “CEU nd credit ins ne... tantly s” at: ing-c . o nditi o

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

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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.

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

to us: Fill in the circle on the answer sheet (on page 63) 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 22.6 Quiz, 20 Eastlake Road, Ithaca, NY 14850. Readers who correctly answer at least 70 percent of the questions will be notified of their earned credit by mail within 30 days.

Bulletin Board (pages 6-7)

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

1. What did researchers find while using diffusion tensor imaging with concussed individuals? a) All concussion patients had similar recoveries b) The concussed individuals’ brains did not vary from the non-concussed control groups’ brains c) Each concussion patient showed areas of abnormally low fractional anisotropy d) Each individual in the control group showed areas of abnormally low fractional anisotropy 2. How does anecdotal evidence suggest that using GPS technology may help prevent injury? a) It allows athletes to see if they are in an area where several injuries have occurred b) It allows athletes to see exactly where they should go on the field c) It allows coaches to see aerobic output data after the workout is completed d) It allows coaches to track an athlete’s movement in real-time 3. What does the Sudden Cardiac Arrest Prevention Act require? a) Coaches must sign a waiver saying they are aware of cardiac arrest symptoms b) Coaches must participate in annual training on warning signs of cardiac arrest c) Players must remove themselves from competition if they feel faint d) Players must participate in annual training on warning signs of cardiac arrest

TR AINING-CONDITIONING.COM

4. The study on altitude training followed elite distance runners for _____ days. a) 26 b) 21 c) 14 d) Seven

8. Variations of horizontal pulling do not include which of the following? a) Attaching weighted sleds b) Wearing weighted vests c) Performing recline rows d) Pulling hand-over-hand while sitting down

5. The study indicated that an athlete may perform their best between days _____ and _____ after returning from altitude. a) Five, Nine b) Seven, 12 c) 14, 18 d) 18, 22

9. In the post-lift circuit described, players perform two sets each of twoarm waves and alternate waves for _____ seconds each. a) 30 b) 25 c) 20 d) 15

The Power of Ropes (pages 13-21) Objective: See how rope training has been integrated into the Cincinnati Bengals’ strength and conditioning program.

6. The most commonly used ropes are between 25 and 50 feet with a diameter of ___ inches. a) 1 to 1.5 b) 1.5 to 2 c) 2 to 2.5 d) 2.5 to 3 7. The rope exercise movement the Bengals use most often is _____. a) Horizontal pulling b) Vertical pulling c) Hand-over-hand sled pulling d) Making waves

Answer sheet is on page 63...or take this quiz online and get instant results: www.training-conditioning.com click on CEUs

Full Speed Ahead (pages 22-26)

Objective: Find out why the number of athletes having arthroscopic hip surgery has continued to increase.

10. Benefits of hip arthroscopy include minimal blood loss, lessened potential for complications compared to “open” procedures, and _____. a) It is an outpatient procedure b) It has been a mainstream technique for a long time c) Hip anatomy is easy for surgeons to work around d) Manipulating the arthroscope is simple 11. The Advanced Phase of rehab spans weeks _____. a) Two to three b) Three to five c) Four to six d) Five to seven

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CEU QUIZ

12. The key to diagnosing most hip injuries is that an athlete will complain of _____. a) Muscle twinges b) Groin pain c) Lower back pain d) Feeling “off”

17. Optimizing protein intake means ingesting 20 to 30 grams every _____ hours during the day. a) One to two b) Two to three c) Three to four d) Four to five

13. When determining the hip pathology, the exam should include the Figure-4 and _____ tests. a) Log roll b) Single-leg bridging c) Hamstring curl d) Sport specific functional movement

18. A recent study showed that participants on a high-carb or highfat diet had _____ percent stronger appetites before meals than those on a high-protein plan. a) 14 b) 16 c) 18 d) 20

14. Too aggressive or too much activity within the first _____ weeks can lead to flares of pain, synovitis, and stiffness. a) 10 b) Eight c) Six d) Four 15. Most athletes can return to play within _____ weeks of a “simple” hip arthroscopy. a) 14 b) 12 c) 10 d) Eight

Packing Protein (pages 29-33)

Objective: See how protein beverages can have a positive effect on athlete performance.

16. Protein requirements for strength athletes range from _____ grams per kilogram of body weight per day. a) 0.5 to one b) 1.4 to two c) 2.1 to three d) 3.5 to four

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19. An average loss of 0.5 to one percent of muscle mass begins at age _____. a) 60 b) 50 c) 40 d) 30 20. Rice and hemp protein are good options for _____ athletes. a) Overweight b) Vegetarian and vegan c) Underweight d) Lactose-intolerant 21. An athlete’s overall recovery meal should aim for an average carbohydrateto-protein ratio of _____. a) 2:1 b) 3:1 c) 4:1 d) 5:1

Stand Up Performance (pages 41-46)

Objective: Learn about how a focus on posture helps the University of Alabama softball team perform well.

22. Symptoms of kyphosis-lordosis include having the head thrust forward, upper back rounded, shoulder blades pressing out, pelvis anteriorly rotated, pubic bone posteriorly rotated, and _____. a) Thumbs rotated anteriorly b) Thumbs rotated posteriorly c) Toes pointed inward d) Toes pointed outward 23. The girdle of strength has four components: the pelvic floor, transverse abdominus, multifidus, and _____. a) Gluteals b) Pectorals c) Internal obliques d) Deltoids 24. When working the upper body, the team performs _____ chest exercise(s) for every four or five back exercises. a) One b) Two c) Three d) Four 25. The players end every workout with a core section that includes four or five exercises, such as sit-ups, Russian twists, crunches, or _____. a) Farmer holds b) Back extensions c) Anti-rotation with bands d) Supermans

TR AINING-CONDITIONING.COM

CEU QUIZ Answer Form Instructions: Go to www.training-conditioning.com and click on “CEUs” to take the quiz online. You may also mail your quiz to us: Fill in the circle on the answer sheet below that represents your selection of the best answer for each question. Include a $25 payment to MAG, Inc., and mail it to the following address: MAG, Inc., Attn: T&C 22.6 Quiz, 20 Eastlake Road, Ithaca, NY 14850. Readers who correctly answer at least 70 percent of the questions will receive 2.0 BOC Athletic Training and 0.2 NSCA (two hours) CEUs, and will be notified of their earned credit by mail within 30 days. Questions? Problems? E-mail: CEU@MomentumMedia.com.

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