Training & Conditioning 22.7 by Momentummedia

October 2012 Vol. XXII, No. 7, $7.00

Revisiting Functional Training Detox Diets

Collaborating on Coverage New ideas in sports medicine partnerships

Circle No. 100

October 2012, Vol. XXII, No. 7

contents

35 4

Bulletin Board Nitrate helps build muscles … Ankle strength can predict risk for sprain … Track and field injuries increase … At what age should hockey players learn to bodycheck?

Comeback Athlete Lakeisha Crouch 9 Xavier University

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Product News Topicals Pain Management Hot & Cold Sports Massage More Products

Optimum Performance

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Functional training is accepted worldwide, but it’s not always implemented correctly. The master of the idea explains how it can take your athletes to the next level. By Vern Gambetta Leadership

on Coverage 20 Collaborating As hospitals expand their athletic training staffs, many are looking to partner with high schools to provide athletic team coverage. Here’s a look at two successful and innovative models. By Mike Phelps & Michael Stevenson Nutrition

Is Hot 27 Detox Some celebrities swear by cleanses or detox diets, but are they a good idea for athletes? By Marie Spano

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On the cover: The Huntsville (Ala.) Hospital SportsCenter staff, which has developed partnerships with 18 area high schools, is featured in our cover story, starting on page 20. Photo by Tina Wright Photography.

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Treating the Athlete

35 When an athlete has minor pain, topical analgesics can be a Topical Solutions

great solution. But how do you sort out the different choices and options? By Dr. Brent Mangus & Dr. Dustin Mangus Sport Specific

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be incredibly strong, flexible, and explosive. At the University of Oregon, the squad’s strength coach has developed a unique program to keep them flying high. By Geoff Ginther T&C OCTOber 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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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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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

October 2012 Vol. XXII, No. 7 Publisher Mark Goldberg Editorial Staff Eleanor Frankel, Director Abigail Funk, Managing Editor R.J. Anderson, Patrick Bohn, Kristin Maki, Mary Kate Murphy, Dennis Read Circulation Staff David Dubin, Director Erin Stewart 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. Unsolicited materials will not be returned unless accompanied by a self-addressed, stamped envelope. Periodicals postage paid at Ithaca, N.Y. and additional mailing offices. POSTMASTER: Send address changes to Training & Conditioning, P.O. Box 4806, Ithaca, NY 14852-4806. Printed in the U.S.A.

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Bulletin

Board Nitrate for Increased Muscle Power? Spinach, beetroot, and other leafy green vegetables like lettuce and chard are not just full of vitamins. They are also rich in nitrate, which, according to a study published in the August issue of The Journal of Physiology, may help boost muscle strength. Researchers from the Karolinska Institute in Sweden divided mice into two groups. One received nitrate in its drinking water for a week while the other did not. The scientists discovered that the mice given the nitrate had stronger leg and foot muscles when the seven days were up. They believe the strength came from higher concentrations of the nitrate proteins CASQ1 and DHPR, which are involved in the homeostasis of calcium, an important factor in muscle contraction. The amount of nitrate given to the mice was equivalent to what a human would get from eating 200 to 300 grams of spinach or two to three beetroots per day. “From a nutritional perspective our study is interesting because the amount of nitrate that affected muscle strength in mice was relatively low,” lead researcher Andres Hernandez, PhD, said in a press release. “Translated to humans it means that we can obtain the equivalent volume by eating more of a vegetarian diet, as nitrate is found naturally in several leafy vegetables.” To view the abstract of the study, “Dietary nitrate increases tetanic and contractile force in mouse fast-twitch muscle,” go to: www.ncbi.com.nlm.gov/pubmed and search the study title.

Identifying Risk Factors for Ankle Sprains While ankle sprains are a common and often nagging injury for soccer players, very little soccer-specific research exists to explain why certain players experience them while others don’t. But a study published in the American Journal of Sports Medicine may have pinpointed a cause: unequal ankle strength. Researchers from the University of Athens tested the ankle strength and stability of 100 soccer players from four Greek professional teams prior to the start of the season. Specifically, they looked at potential risk factors for non-contact ankle sprains, including somatometric asymmetries, previous injuries, lateral dominance traits, and ankle joint asymmetries in isokinetic muscle strength, flexibility, proprioception, and stability. After 4

T&C OCTOber 2012

the tests, the players were monitored over the 10-month season. During that time, 17 players suffered at least one noncontact ankle sprain. When researchers looked back at their preseason test results, they discovered that athletes who had one ankle significantly stronger than the other were nine times more likely to suffer a sprain than players with similar ankle strengths. As a result, researchers recommend that athletes’ ankles be evaluated in the preseason, noting that doing so may “improve prevention strategies for this type of injury in soccer.” To view the abstract of the study, “Intrinsic risk factors of noncontact ankle sprains in soccer: a prospective study on 100 professional players,” go to: www.ncbi.com.nlm.gov/ pubmed and search the study title.

Track and Field Injuries On the Rise A recent study shows a drastic rise in the number of injuries affecting young athletes competing in track and field. An article published in the May issue of The Physician and Sportsmedicine showed a 36 percent increase in youth track and field injuries that required a trip to the emergency room between 1991 and 2008. Researchers from the Center for Injury Research and Policy of The Research Institute at Nationwide Children’s Hospital in Cincinnati used data from the United States Consumer Product Safety Commission, and studied the records of children between 10 and 18 years old. The most common injuries were sprains and strains, which comprised 52 percent of reported injuries, followed by fractures and dislocations at 17 percent. The ankle and knee were the two most commonly injured body parts at 21 and 16 percent, respectively, Researchers found certain injuries were more prevalent in some events than others. Cross country running led to the most lower-leg injuries, while sprinting was four times more likely to cause a pelvis injury and three times more likely to cause an injury to the upper leg. Hurdling triggered the most upper extremity injuries. Additionally, the data varied by age group, with high school students more likely to suffer lower leg injuries, and elementary school students more likely to have an upper extremity issue. “Participation in track is a great way to encourage children and adolescents to remain physically active,” Lara McKenzie, PhD, Principal Investigator at the Center for Injury Research and Policy and senior author of the TR AINING-CONDITIONING.COM

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Bulletin

Board study, told Science Daily. “However, the increase in injuries corresponding with the increased participation in this activity suggests we need to do a better job of preventing track-related injuries among our young athletes.” The full text of the study, “Track-related injuries in children and adolescents treated in US emergency departments from 1991 through 2008,” can be found by going to: www.physsportsmed.org and searching the study title.

Teaching Checking Earlier Not the Answer A series of high profile injuries caused by bodychecking in ice hockey, including two instances where players were paralyzed, have attracted an unflattering spotlight on the safety of the sport. Some believe that safety lies in teaching players how to check properly earlier in their careers. However, a study published in the June issue of the Clinical Journal of Sport Medicine casts doubt on that theory. Researchers from the University of Alberta studied emergency room records of nearly 8,000 players ages 9

to 15 who played at three different levels of youth hockey. Records from those athletes who played from 1997 to 2002, before a rule change that lowered the age at which players were taught to check, were compared to those of young athletes who played after the rule change. Researchers found an overall reduced injury rate in the age group affected by the rule change, but no significant differences in the number of fractures, head injuries, or neck injuries. There was also no significant change in injuries experienced at older ages by players who were exposed to checking at a younger age. Donald Voaklander, Director of the Alberta Centre for Injury Control and Research, told Science Daily that the results show there is little benefit to having players check at a younger age. “It really does not have much merit,” he said. “Exposing 11- and 12-year-olds to bodychecking is not helping matters, so there is no point in continuing it.” The abstract of the study, “Hockey-related emergency department visits after a change in minor hockey age groups,” can be found by going to: www.ncbi.com.nlm.gov/pubmed and searching the study title.

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ComebackAthlete

Lakeisha Crouch Xavier University By Patrick Bohn

When Xavier University women’s basketball forward Lakeisha Crouch tore her left ACL in an October 2009 scrimmage before her senior year of high school, she knew she was going to miss her final high school season—a tough blow for any athlete. What she didn’t realize, however, was that the injury would be the first in a series of setbacks spanning two and a half years and half a dozen surgeries. In fact, after undergoing surgery that November and progressing through a standard rehabilitation, Crouch was cleared to return in June 2010. But when she arrived on Xavier’s campus for summer workouts a month later, the team’s orthopedic surgeon noticed some anterior translation in her knee during a Lachman’s test, which put her at a higher risk for re-injury. So Assistant Athletic Trainer Katie Svihlik, ATC, put Crouch on an aggressive rehab plan in hopes of getting her ready for the season. “The rehab plan ran about six weeks,” Svihlik says. “One of the first things she did was work on a Cybex machine so we could compare the strength in her left leg to her right. She had a pretty significant deficit in her left leg, so our biggest goal was to build strength on that side.” One of the exercises Crouch used to strengthen her glutes was the clam shell. She would lay on her right side with her knees bent and a resistance band around them and lift her left leg in order to fire her gluteus medius. She also worked on hip strength by doing hip abduction and four-way hip extensions with an ankle weight. “For hip extensions, our standard for athletes recovering from an ACL tear is to have them start with no weight, then progress up to 10 pounds one pound at a time,” Svihlik says. “If they can do a specific weight easily, we add one pound the next day. Once they feel a bit of a burn when exercising, they stay at that weight for a week. When they can do eight sets of 10 in each direction, we know we can safely progress them again. Lakeisha moved through that process pretty quickly.” To help Crouch’s quad muscles build more strength, Svihlik had her do a lot of straight leg raises using e-stim. Crouch also worked her quads by doing wall sits and incline squats. “Lakeisha was seeing me for an hour a day four to five days a week over the summer,” Svihlik says. “She worked her butt off from the minute she got here, and that was great to see.” Crouch admits that while the rehab itself wasn’t challengTR AINING-CONDITIONING.COM

After six surgeries that spanned two years, Crouch returned to the court last December. She finished her first season playing for Xavier as the team’s second leading rebounder. ing, that first summer was a difficult one. “I was making the transition to college, which was hard in itself,” she says. “Between therapy, study table, and class, I felt like I didn’t have time to myself. There were days when it was tough getting up in the morning, but I had to keep focused on my goal of playing basketball again.” It looked like Crouch would reach that goal soon, as her rehab progressed well and she was cleared for full participation in August 2010. But during an open gym session in September, Crouch felt her left knee bothering her. Although she managed to finish the pick-up game, the next day, her knee was swollen and it was difficult to walk. Still, when she visited Svihlik, Crouch figured it wasn’t anything serious. “I thought my knee just wasn’t used to the amount of work I’d put it through,” she says. “I figured that once I got back into the rhythm of playing every day, I’d adjust.” Unfortunately, Svihlik had a much different diagnosis for Crouch. She had torn her ACL a second time, and would Patrick Bohn is an Assistant Editor at Training & Conditioning. He can be reached at: pb@MomentumMedia.com. T&C OCTOBER 2012

ComebackAthlete miss her entire freshman season. Seeing Crouch suffer a second injury so soon after overcoming her first had Svihlik concerned. “At first, I was worried about Lakeisha mentally, because some athletes don’t handle things like that well,” she says. “But she’s tough, and she told me almost immediately that she would make it back.” Crouch underwent a second surgery in September 2010, and was told everything went well. But as Svihlik

eased Crouch into her rehab by giving her range of motion exercises, stretching her quad and hamstring, and having her do quad sets, she noticed that the swelling in Crouch’s knee wasn’t dissipating. “It had been about three weeks since the surgery, and the thought was that she was just a sweller, so the doctors decided to drain her knee of fluid,” Svihlik says. “But when they did that, they discovered a staph infection.” A coagulase negative staph infec-

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tion, to be exact. The infection is challenging in that it doesn’t present with any of the normal symptoms like fever, redness around the incision site, or warm skin upon touch. Svihlik says that while the diagnosis caught her by surprise, she also learned from it. “A lot of what athletic trainers do is based on the relationships we’ve developed with the athletes,” she says. “We know how their bodies respond after spending time with them in the athletic training room, but at that point, I didn’t know Lakeisha as well as I would know a student-athlete who had been on campus for a year or two. It really illustrated to me the importance of heightening my awareness about making sure dressings are always clean and dry post-op.” Crouch would need to be administered IV antibiotics through a peripherally inserted central catheter (PICC) line for the next month. Normally, the procedure of flushing the line and administering the antibiotics can be done by the patient themselves, but the location of the PICC line in Crouch’s arm made her nervous about doing it on her own, so Svihlik stepped up and did it for her. “I had never even heard of a PICC line before, let alone actually administered antibiotics through one,” Svihlik says. “So I didn’t know how to do it at first. But a nurse showed me the procedure, and I picked it up quickly. It was great to learn something new, even though it wasn’t something I ever thought I’d do. “Some of the girls on the team call me mom,” Svihlik continues. “As an athletic trainer, you are that mom away from home sometimes. You need to do whatever you can to help your players get healthy.” After a month of antibiotics, Crouch started her rehab again from square one. She began with towel slides to increase flexion in her knee, as well as active assisted range of motion exercises where she would sit off the edge of a table with her right leg under her left and go down into flexion and back into extension. Crouch also did “millions” of straight leg raises, as well as more e-stim for her quad. TR AINING-CONDITIONING.COM

ComebackAthlete After about 12 weeks, Svihlik was ready to ramp up the intensity of the workouts and add exercises like lunges, but doctors discovered more translation in Crouch’s knee, and reopened the surgical site so they could clean it out again. It was then they discovered the graft that had been in her knee was nearly gone, possibly eaten away by lingering infection. So in late December, another PICC line was inserted to try and clear out the infection before a second graft could be put in. “That was the one time I saw Lakeisha break down,” Svihlik says. “We were in my office, and she was crying. I felt devastated for her. She had worked hard and not complained at all up to this point, and she just kept getting hit. But after a few minutes, she regrouped and said, ‘I’m going to get through this.’” Crouch’s next surgery was scheduled for February 2011, and the hope was that with the infection cleared out, this one would repair her ACL. The multiple ACL tears had also resulted in some rotary instability in Crouch’s knee, so work would be done on her MCL and LCL in order to assist in the stabilization. But when the surgeon opened up her knee, he discovered that the bone tunnels had dilated, which meant a graft wasn’t likely to heal properly. So instead of the intended procedure, he performed a bone graft, mixing cancellous chips with DBX Demineralized Bone Matrix putty and placing the mixture in the tunnels. Crouch would then need a three-month healing period before the ligament repair surgery could take place. “At that point,

I just buried myself in my schoolwork,” Crouch says. “I still wanted to play basketball eventually, but I knew that even if I couldn’t, I was going to make sure I got a great education.” “That was a difficult time,” says Svihlik. “You always try to remain positive, but when a surgery involves bone grafting, it’s a lot harder to come back from it. I had her ride an exer-

After nearly three years of rehab and a career’s worth of setbacks, Crouch stepped onto the court for the first time in her collegiate career. Against the University of North Carolina-Wilmington, she tallied six points and eight rebounds, despite her nerves. cise bike with her teammates just to get out of the athletic training room and feel like part of the team, but that’s all we could do.” In May of 2011, Crouch underwent her sixth surgery and had a cadaver graft put in her knee. Because her mother couldn’t make the trip up from Tennessee again—she had come up for the surgery in February—Svihlik observed the procedure both as a measure of support and a learning experience. “In school, you don’t get a chance to see anatomical structures in that kind of setting,” she says. “It was an invaluable experience for me, especially because the surgeon did open

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ComebackAthlete reconstruction on the inside and outside of her knee and that’s not very common. Being able to see what was going on and that everything went well was a great experience.” The procedure went smoothly and three days later Svihlik and Crouch were ready to get back to work. Because the reconstruction had also involved the LCL and MCL, something Svihlik didn’t have as much experience with, a physical therapist worked with the pair once a week. “That was very helpful,” Svihlik says. “She knew the exact protocol for rehabbing an injury like this, and if I had any questions or concerns, I could call or e-mail her and she would get back to me with an answer quickly.” For the first two months, Crouch was in a brace with a footplate and non-weight bearing. Her rehab started with mostly range of motion exercises, as well as hip extension and flexion. She also did more straight leg raises, quad sets, and estim. By the fifth week, Crouch was doing seated heel raises, and added hip abduction work the following week. By week nine, Crouch had progressed to limited weightbearing on her left leg, so Svihlik prescribed weight shifting and single-leg balance exercises. “The balance exercises were the toughest for me,” Crouch says. “I had surgery on my left ankle in high school, so I was nervous about how I would do. But it worked out well.” At this point, with her knee more stable and some quad tone back, the goal shifted to gaining strength. Crouch started doing leg presses and toe extensions, and progressed to knee extensions with a weight on her ankle. She also performed wall slides with a Swiss ball behind her back for support and squatted to about 75 degrees. By late August 2011, Crouch was back on the Cybex machine, doing quad and hamstring strengthening exercises. Two weeks later, when Svihlik tested her on the Cybex, her left quad was at 69 percent the strength of her right, and her left hamstring was at 86 percent. The numbers were good enough that Svihlik had Crouch start light jogging. Five months after the surgery, Crouch was cleared to practice jump shots—with no other players near her—and Svihlik started believing Crouch might return to play a bit ahead of schedule. “Everything was going smoothly,” Svihlik says. “When we progressed to cone jumps and line jumps and Lakeisha was pain free, I almost wanted to knock on wood.” This was a key moment for Crouch as well. “It felt great doing some of these basketball drills again, because I felt like the journey was almost over,” she says. “I just kept pushing forward, hoping I could help the team out later in the year.” By November, Crouch had started sprinting on a treadmill and running backwards. As her left leg strength continued to increase, she added full court lay-ups and post moves—again with no teammates around—and the Xavier coaching staff began to work with her in preparation for her debut. In December, Crouch’s left quad was as strong as her right, and her left hamstring tested even stronger that the right. The light at the end of a long tunnel was finally shining. On December 29, 2011, after nearly three years of rehab and a career’s worth of setbacks, Crouch stepped onto the court for the first time in her collegiate career. Against the Univer12

T&C OCTOBER 2012

Lakeisha Crouch Xavier University Sport: Basketball Injury: Torn ACL, staph infection Result: After missing two-plus seasons due to knee problems, Crouch returned to play in December 2011 and averaged 5.8 points and 6.4 rebounds a game for the Musketeers.

sity of North Carolina-Wilmington, she tallied six points and eight rebounds, despite her nerves. “My palms were sweaty, and I didn’t talk much,” she says. “I was so nervous about what might happen. It took me a few games to feel comfortable on the floor.” Crouch improved as the season continued and finished the year as the Musketeers’ second leading rebounder, with 6.4 per game. And she has bigger goals for this season. “I want to be the Atlantic 10 Player of the Year and help my team win the conference title,” she says. “I’m feeling more comfortable in my role and knowing what I need to do to help the team succeed.” For her part, Svihlik was overjoyed to see Crouch on the floor. “To see someone who worked that hard make it back after so long, I almost wanted to run on the court and take pictures,” she says. “I felt like a proud parent.” n Did one of your athletes have an interesting, unique, or inspiring comeback from injury or illness? Nominate them for our Comeback Athlete feature by sending an e-mail to: Comeback@MomentumMedia.com. TR AINING-CONDITIONING.COM

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W W W. E L I T E S E A T. C O M Circle No. 109

Master of W

By Vern Gambetta

Movement

Functional training is accepted worldwide, but it’s not always implemented correctly. The master of the idea explains how it can take your athletes to the next level.

T&C OCTOBER 2012

hen I started formulating my idea of functional training, it was because I was uncomfortable with the way we were training our athletes. There was a lack of purpose to the training we were doing—it was an end unto itself rather than a means to an end. It seemed we were chasing artificial numbers and taking a reductionist view of the body by breaking it into independent parts and isolating Vern Gambetta, MA, is President of Gambetta Sports Training Systems in Sarasota, Fla., and a longtime contributor to Training & Conditioning. He is the author of Following the Functional Path and his daily thoughts on training can be viewed on his blog at: www. functionalpathtraining.typepad.com. TR AINING-CONDITIONING.COM

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Optimum performance muscles. My intuition, instincts, and study led me to find a better way to increase athletic performance. The result was functional training. I think it is now time to revisit the concept so we can better employ it. Where did it come from? How has it

The result is a highly adaptable athlete who can perform without limitations in a competitive environment. Contrast this philosophy to a one-sided training philosophy that results in onesided athletes who are inconsistent in performance and prone to injury.

The problem was a general failure to recognize that in order for the body to execute movement—whether that movement is a sustained endurance activity, explosive bursts, or a fine motor skill—all parts and systems need to work together in harmony. evolved? Where is it today and where is it going tomorrow? I originally conceived functional training as a multilateral training approach that integrates various modalities such as medicine balls, stretch cords, dumbbells, body weight, and more to produce significant adaptation in specific performance parameters. It trains all systems of the body while recognizing and respecting the wisdom of the body.

Functional training is really just a label for this concept. As with any concept, it is subject to various interpretations and evolutionary paths. Unfortunately, functional training as it has been adapted by the fitness industry has been compromised. We need to rewind and examine the roots of functional training in order to better understand it. We are at a crossroads in terms of the future of functional training as it is ap-

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Following The Functional Path By Vern Gambetta

plied to improved sport performance. So we need to look back over the past 20 years and carefully assess how the concepts have been applied, as well as what worked and what did not work. It is more than being sport specific, it is using modes and methods of training that are appropriate for the sport and individual. It is more than exercise, it is how exercises are combined to achieve the desired results. A LOOK BACK The concept of functional training came together for me in the late 1980s. As strength coaches, we were trapped in a mechanical approach that separated the body into distinct parts and systems. We were creating robots that performed well in a sterile training environment but had difficulty transferring that training to sport. The result was an athlete fully adapted to only one component of training. Thriving in the performance arena demands the opposite: A versatile and highly adaptable athlete whose training is not biased, but instead reflects the demands of the sport and the needs

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111005 A collection of Gambetta’s blog posts from the past five years, the book includes insights, thought-provoking questions, and new ideas in an easy-to-read format. A pioneer of functional sports training, Gambetta will inspire you to review and upgrade your coaching methods.

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Optimum performance of the individual athlete. The problem was a general failure to recognize that in order for the body to execute movement—whether that movement is a sustained endurance activity, explosive bursts, or a fine motor skill—all parts and systems need to work together in harmony. Movement is a symphony, not a solo. You can’t do a “cardio” workout, just like you can’t do a “neural” workout. Every workout has cardiovascular and neural components because all systems of the body are involved at all times. Demand on a particular system can change with the type and intensity of activity, but all are utilized to some extent. To continue with the symphony metaphor, think of when a section of the orchestra is highlighted while the other parts of the orchestra are still playing in the background. We can’t lose sight of the whole in our desire to train the parts. Functional training gives the body credit for its inherent wisdom and ability to learn to link, sync, connect, and coordinate, resulting in the beautiful movement symphony we call sports performance.

At the time of this revelation, I had been coaching close to 20 years and exposed to many different ideas and methods of training, some of which worked and some of which failed. But the conventional wisdom of the time was causing us to stagnate. There had

tation, and practical experience both as a coach and athlete. I leaned heavily on the work of Gene Logan and Wayne McKinney and their classic text Kinesiology, Margaret Knott and Dorothy Voss and their work on proprioceptive neuromuscular facilitation

There has been some confusion about what functional training really is ... For example, functional training incorporates a lot of different exercises into workouts. Some have turned this idea into a weird amalgamation of crazy exercises without any logical progression or justification. to be more than mindlessly running straight ahead, more than excessive emphasis on heavy lifting, more than fancy machines that isolated body parts, and more than static stretching. In summary, I was at a stage in my career where I thought there had to be a better way. This better way was an eclectic approach that combined my interpretation of sport science research, study of methods and concepts of rehabili-

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(PNF), and John Jesse and his approach to performance training and injury prevention. It was a move away from a reductionist and segmented view of the body to a holistic, more synergistic approach. In many ways, functional training taps into tried and true concepts and methods that were once the norm before falling out of favor for various reasons. The saying that everything old is new again could not be truer.

Optimum performance DISPELLING MYTHS Over the years that functional training has become a household term in many weightrooms, there has been some confusion about what it really is. Often, a coach takes a small piece of the method and concentrates solely on that part of the concept.

a bunch of different exercises haphazardly thrown together. It is a systematic, sequential, and progressive approach to training for the rigors of competition. You could call it “variety with a purpose.” The key to a good, sound functional training program is progression. You

There are no limits beyond your imagination and creativity as a coach, teacher, or rehab specialist. Look for possibilities, not limitations and dysfunctions. Give the body credit for its wisdom and then coach, teach, and rehab accordingly. For example, functional training incorporates a lot of different exercises into workouts. Some have turned this idea into a weird amalgamation of crazy exercises without any logical progression or justification. But functional training is not just

must carefully assess where the athlete is and carve out a step-by-step progression to help them achieve specific realistic training objectives. You have to know where they have been and where you want to take them. This begins with doing a sport de-

GUIDING PRINCIPLES Over the years, I have developed basic principles to guide functional movement training. Use these as your guide and you will have consistent results with your athletes. • Train movements, not muscles • Dynamic postural alignment and dynamic balance are the foundation for all training • Train fundamental movement skills before sport specific skills • Train core strength before extremity strength • Train bodyweight before external resistance • Train joint integrity before joint mobility • Train strength before strength endurance, power before power endurance, and speed before speed endurance • Train to build work capacity appropriate for the sport or event • Train sport appropriate: You are what you train to be.

T&C OCTOBER 2012

mands analysis profile, a sport injury profile, comprehensive testing, and an individual athlete profile. Then you need to fill the gaps with a logical functional progression that will move forward only when the previous step has been mastered. Another aspect of functional training some coaches don’t understand is that it’s not about measurable strength. How much an athlete can lift or how many foot-pounds of force they can produce are meaningless numbers. Instead, quality of movement, rhythm, synchronization, and connections are what is important. The goal of functional training is always the ability to apply the strength that is developed to sport performance—can the athlete produce and reduce the force necessary? Force production is all about acceleration, but the key to movement efficiency and staying injury-free is often the ability to decelerate and stabilize to position the body to perform a desired movement. A good functional training program will work on the interplay between force production, force reduction, and stabilization. The end result is functional strength. Finally, functional strength is not about training individual muscles or muscle groups separately. Conventional academic preparation still focuses on studying individual muscles based on classical anatomy. Unfortunately, this is where confusion about functional movement often begins. The anatomical position provides us with a way to arrange all of the individual muscles for ease of study and observation. But athletes do not function in the static anatomical position. It is important to understand that the brain does not recognize individual muscles. Rather, the brain recognizes patterns of movement in response to sensory input. TRAINING MOVEMENTS Because the foundational principle of functional training is to train movements, not muscles, let’s take a closer look at this concept. All movements are functional, just to different degrees. This can be illustrated by thinking of a one-to-10 scale with 10 being the most functional. Here are the basic criteria I use to determine placement of movements on the functional continuum: TR AINING-CONDITIONING.COM

Optimum performance Plane(s) of movement: If the movement involves multiple planes of motion as opposed to movement in one plane, then it is more functional and higher on the continuum. Joint involvement: If the movement involves multiple joints as opposed to isolation on one joint, then it is more functional and higher on the continuum. Speed of movement: If the speed and tempo of movement is as fast as can be in a controlled manner, then it is more functional and higher on the continuum. Proprioceptive demand: If the movement requires high proprioceptive demand, then it is more functional and higher on the continuum of function. Mindfulness: If the movement demands attention and concentration, as opposed to putting the mind on autopilot, then it is more functional and higher on the continuum. Carefully examine the athletic movements you are trying to enhance. What are the forces involved? What is the dominant plane of motion? It is imperative to understand the movements and then design the training program accordingly. Take the single-leg squat, for example. In order to progress in the movement, I would have an athlete begin performing the squat with their arms out so they can use them for balance, then progress to putting their hands on their hips for less balance assistance. The third step would be to have them put their arms overhead for even less help, and finally to have them hold a medicine ball overhead so they have zero balance assistance. At all four steps in this progression, I would have the athlete do three sets of six on each leg, squatting at 120 degrees and progressing to 90 degrees. The athlete would not move on to the next step in the progression without mastering the previous one. Regardless of the sport, performance is a multidimensional activity. It takes place in a dynamic environment that forces movement to occur in all planes of motion using multiple joint movements to produce the desired movement mechanics. Therefore it is important that training involves the whole kinetic chain—toenails to fingernails—to reduce and produce force. This process ensures optimal neuromuscular control and efficiency of movement.

The body is incredibly smart. It is highly adaptable and self-organizing, which gives it an amazing ability to adapt to radical environmental extremes and all the stressors that can be placed upon it. Look around and see movement with different eyes. There are no limits beyond your imagination and creativity as a coach, teacher, or rehab specialist. Look for possibilities, not limitations and dysfunctions. Give the body credit for its wisdom and then coach, teach, and rehab accordingly. Enjoy the process and

marvel at the discoveries. Understanding and applying a functional approach to training is a challenging process. It is often contrary to conventional wisdom as represented in mainstream sport science research. But that should not limit us. We need to use conventional wisdom as a staring point and move forward to think and act outside the box. Trust your instincts and allow your creativity to be expressed through movement. Follow the functional path to improved performance. n

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T&C OCTOBER 2012

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LEADERSHIP

Collaborating on Coverage As hospitals expand their athletic training staffs, many are looking to partner with high schools to provide athletic team coverage. Here’s a look at two successful and innovative models.

One of our authors, Michael Stevenson (second row, second from right), poses here with the rest of the Huntsville (Ala.) Hospital SportsCenter staff. The SportsCenter has been cultivating relationships with area schools since 1999.

TR AINING-CONDITIONING.COM

One trend that continues to gain steam at the high school level is school districts outsourcing athletic training coverage rather than hiring an in-house staff. It can be a money-saver for districts in tight financial spots, and hospitals and clinics get to give part- and full-time jobs to their athletic trainers who want to work in schools. But many of these partnerships involve more than just game coverage. In Indiana, one such arrangement recently expanded to include not only offering the services of athletic trainers to schools in the district, but also those of team physicians and strength and conditioning coaches. Another partnership in Alabama has grown to include a Friday night injury clinic during the football season and an athlete of the year scholarship program. Let’s take a closer look at these two interesting models.

T&C OCTober 2012

LEADERSHIP

Growing Fast By Mike Phelps

he Metropolitan S chool District of L aw r e n c e Township and Community Health Network (CHN), a health system comprising more than 100 care sites in Indianapolis, have only been building their relationship since last spring, but it’s

expanded drastically already. In April of 2011, CHN launched a health and wellness center for school district employees and their children. A few months later, CHN hired Lawrence Township’s school nurses and took over in-school nursing care. And this fall, the partnership is expanding so that CHN will provide not only athletic trainers, but also team physicians and strength and conditioning coaches at high schools and middle schools in the district. For Nichole Wilson, DPT, ATC, Director of Rehab

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and Sports Medicine at CHN, including physician and strength and conditioning services along with athletic training was a no-brainer. “They are all part of the sports medicine team,” Wilson says. “The team physician is the leader of a sports medicine program and if you don’t have one, you really don’t have much of a program. They are the go-to person for medical policies and set the direction for the entire program. The athletic trainers work under their guidance. Even though the athletic trainers are at the schools daily, it’s important to have a team physician who can direct care when things get tricky.

Lawrence Township is able to receive athletic training coverage from six CHN athletic trainers for less money than if it were to hire six athletic trainers directly. In addition, there are numerous specialty care sites, including physical therapy clinics, that Lawrence Township student-athletes have access to on a feefor-services basis. “Strength coaches are a major benefit to an athletic program that wants its teams to excel,” she continues. “Not all of our schools have strength coaches, but those that do have someone there every day who can safely direct studentathletes in the weightroom.” CHN athletic trainers cover home practices and events for all sports, plus away games for football. Team physicians, meanwhile, cover football games, perform weekly injury checks, and attend games for other sports on an asneeded basis. Finally, the strength and conditioning coaches are on campus during the school day to teach weightlifting classes, then provide direction to coaches in the evening regarding the development of their teams. Mike Phelps is a former Assistant Editor at Training & Conditioning.

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LEADERSHIP The sports medicine teams—particularly athletic trainers and strength and conditioning coaches—spend the majority of their time at their respective schools. The physicians do the most traveling back and forth because they also see patients at their own offices during the day or are performing surgery. Wilson believes that for this sort of arrangement to work, it’s important that the athletic trainers and strength coaches are on campus every day. “Sports medicine is really a relationship business,” she says. “It’s critical that the athletic trainer and strength coach spend as much time at the school as possible. Even though they’re employed by CHN, they are very much a part of the school and its athletic department. They need to be there to get to know the administrators and coaches and develop trust with the athletes and their parents. “The athletic trainers and strength coaches generally only come back to the CHN facilities for meetings, in-services, orientations, and things like that,” Wilson continues. “I’m often trying to find ways to make sure they still have enough

connections within our own network because they’re always at their school.” Wilson believes that partnerships like the one between CHN and Lawrence Township will become more commonplace in the future because

sician or insurance. We have programs in place to accommodate everyone and get them all directed to the right place.” Athletic trainers, team physicians, and strength coaches employed by CHN also have a wealth of resources

“If an athlete sustains a concussion and during the day is suffering from headaches at class, we already have an open line of communication to the nurses there who can assist the student right away.” school systems are seeing the benefits that a large network of health services can provide. Lawrence Township is able to receive athletic training coverage from six CHN athletic trainers for less money than if it were to hire six athletic trainers directly. In addition, there are numerous specialty care sites, including physical therapy clinics, that Lawrence Township student-athletes have access to on a feefor-services basis. “We have more than 600 primary care physicians,” Wilson says. “A lot of these athletes may not have a primary care phy-

at their disposal. Without the partnership, some resources might have been difficult to gain access to or not available at all. “For example, if an athlete is having trouble sleeping, we have an entire sleep center—in fact, we have several— they can call,” Wilson says. “If others are struggling with nutrition, we have an entire health promotions department they can get resources from. Our nutritionists will go to the school and give a presentation or other things like that to assist students and parents.” And because CHN is also responsible

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T&C OCTober 2012

LEADERSHIP for nursing services in Lawrence Township schools, communication between all healthcare providers in a respective building is seamless. “For example, if an athlete sustains a concussion, the athletic trainer might see the athlete after school,” Wilson says. “But during the day, if that student is suffering from headaches at class, we already have an open line of communication to the nurses there who can assist the student right away. “In order to do a better job and be a good organization that is truly accountable for the population we’re giving care to, it’s just easier to facilitate better outcomes when all the healthcare providers are on the same page,” she continues. “This partnership is a unique opportunity to provide care in an innovative way and impact the lives and health of those in our community.”

Test of Time By Michael Stevenson

hen partnerships multiply, you k now they’re working well. That’s the case here in Huntsville, Ala., where the Huntsville Hospital SportsCenter (HHSC) provides athletic training services to 18 high schools and seven middle schools in the area—not to mention a host of universities, professional teams, and club organizations— with a staff of almost 30 athletic trainers. To give you an idea of our growth, the HHSC started providing coverage to just four high schools with two athletic trainers in 1999. HHSC is a sports medicine outreach program and a division of not-for-profit Huntsville Hospital—the second largest hospital in the state and sixth largest publicly owned health system in the nation. HHSC operates under the direction of sports medicine physicians at The Orthopaedic Center (TOC), which Huntsville Hospital has partnered with in order to have medical oversight of the HHSC. Michael Stevenson, ATC, is Program Manager of the Hunstville (Ala.) Hospital SportsCenter. He can be reached at: michael.stevenson@hhsys.org.

T&C OCTOber 2012

Author Michael Stevenson works with a fellow SportsCenter athletic trainer. HHSC athletic trainers are stationed at their assigned schools for the entire athletic period after school every day and cover all home practices and games. They travel with teams as much as possible, and when a school requests treatment and evaluation time before the school day begins, the athletic trainers meet those requests. All in all, the HHSC athletic trainers work afternoons and evenings and some weekends with the scholastic athletes, and they spend a lot of their weekends covering the club organizations the HHSC also partner with. Our schools do a great job of helping our athletic trainers integrate themselves into the athletic department. For example, coaches often purchase team clothing for the athletic trainer and include them in staff outings. They help the athletic trainer feel as if they are truly part of the school. By the same token, we encourage our athletic trainers to take ownership of their school and show school spirit. Our schools’ teams are competitive across a number of classifications and sports in the state, with numerous teams competing for a state championship every season. A little friendly rivalry among athletic trainers who work at competing schools is fun and inclusive.

In addition to great athletic training coverage, there are several advantages for the schools and school systems that use the HHSC. First, school administrators have peace of mind knowing their athletes have a certified, licensed athletic trainer present on campus to help ensure safe participation. We have also worked with the administrators and coaches at some of our schools to help shape emergency action plans, heat guidelines, and concussion recommendations. The partnership helps lower athletic training coverage costs because the schools we partner with get athletic training coverage for free—they don’t pay athletic trainer salaries or give them any benefits. And by allowing Huntsville Hospital to have such a large presence in the community, we are able to show our dedication to providing a safe, healthy environment in which the young athletes in our area compete. Should an athlete sustain an injury that needs more specialized or longer-term treatment, the athlete and his or her parents can choose to employ Huntsville Hospital’s services. Doing so means that the healthcare of the athlete never leaves the hospital’s health system. This is a great advantage because it means increased communication among doctors, athletic trainers, TR AINING-CONDITIONING.COM

LEADERSHIP physical therapists, and others about the athlete and their progress in returning to action. Our schools also have access to the entire sports medicine team, which, in addition to athletic trainers, includes sports medicine physicians, physical therapists, exercise physiologists, and registered dietitians. Not all of these services are free to our schools like the athletic training coverage is, but financial assistance is available. The comprehensive sports medicine services the hospital is able to provide makes the HHSC an invaluable service to the schools and organizations we serve. Finally, over the years, we have offered our schools several unique “bonuses.” Since 2002, the walk-in Friday Night Injury Clinic has been in operation during the football season and allows an injured athlete to be seen quickly by an athletic trainer and/or physician. We use Huntsville Hospital’s pediatric emergency room, which has 16 beds, and staff it with one athletic trainer and one sports medicine physician every Friday night from 8 to 11 p.m. In the event of an injury, the Friday Night Injury Clinic is a convenient way for athletes to have their medical needs addressed that night. Every athlete and parent knows that injuries are part of playing sports, and a lot of them have experienced the emergency room. The clinic offers a quicker, easier, and less hectic option. Another fantastic program that helps serve the needs of all student-athletes is the Athlete of the Year scholarship program. In conjunction with the TOC, and D1 Sports Training, a sports performance facility, HHSC recognizes area high school seniors for outstanding athletic, academic, and community accomplishments throughout the school year. Anyone can nominate a student-athlete for our Athlete of the Week award throughout the year, then from this group of nearly 40 athletes, one male and one female are recognized as the Athletes of the Year and awarded a $1,000 college scholarship. The scholarship is presented at the annual Athlete of the Year banquet at the end of the school year, which is humbling to attend. We see how committed our student-athletes are to helping their communities, providing volunteer services, and setting higher standards in the classroom. n TR AINING-CONDITIONING.COM

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NUTRITION

Some celebrities swear by cleanses or detox diets, but are they a good idea for athletes? By Marie Spano

une into celebrity gossip shows or turn the pages of popular magazines and you’ll stumble across amazing stories touting the life-changing benefits of detox diets and juice cleanses. The stories claim that after a few days of cleansing, harmful toxins will leave your body—along with unwanted pounds of fat—and you’ll feel more energetic and better than ever. But are these cleansing diets a good choice for athletes? They too have seen the stories and endorsements from famous singers and actors, and may be tempted to give the diets a try. What a lot of people don’t know, athletes included, is that cleanses are controversial. They lack credible scientific evidence that prove they work Marie Spano, MS, RD, CSSD, CSCS, is the Owner of Spano Sports Nutrition. She is also a sports nutrition consultant for Competitive Edge Sports and the sports nutritionist for the Atlanta Hawks and the Atlanta Braves’ minor league organization. She can be reached through her Web site at: www.mariespano.com. T&C october 2012

NUTRITION and are safe. The majority of the diets are also very restrictive and therefore fall short on necessary calories and several key nutrients, which can contribute to fatigue and decreased performance—major concerns for athletes. For some, the restrictions associated with a cleansing cycle can even perpetuate disordered eating. DEFINING CLEANSES Cleanses are based on the premise that humans are exposed to environmental toxins, pesticides, allergens, waste, and inflammatory substances through the foods they eat on a daily basis. These toxins build up in our bodies over time, sticking to the intestinal walls where they accumulate. This leaves us bloated, fatigued, with sore joints and muscles, and overweight. Strict adherence to a cleansing regimen supposedly eliminates toxins from the body, cleanses organs, purifies cells and tissues, eliminates built up waste products, and decreases inflammation. Purported results include weight loss, improved energy levels, clearer thinking, and decreased risk of diseases such

as rheumatoid arthritis, cardiovascular disease, and cancer. And though there isn’t a scientific way to prove it, a lot of people say they simply feel great after doing a cleanse. There are Web sites on which marathon runners, cyclists, and endurance athletes claim that a cleanse helped them stay on top of their training, improve performance, and just feel better. Each cleanse is unique, though many share similarities. For example, most cut out alcohol, caffeine, tobacco, highly processed and refined foods, and foods grown with the use of pesticides or herbicides. Most also include a specific regimen for taking supplements or detoxifying drinks that may consist of ingredients such as laxatives, herbal diuretics, maple syrup, and/or lemon juice. The biggest variable from one cleanse to the next is the length of time that it is followed. Some can be completed in 24 hours, while others may take more than a month. Here is a closer look at some popular cleanses: The Master Cleanse: Also known as the lemonade diet, Stanley Burroughs

created the Master Cleanse in 1941. However, it wasn’t widely popular until Beyonce Knowles said she used it to lose weight for her role in the movie Dreamgirls. In his book, Burroughs suggests that doing the Master Cleanse will melt fat away at a rate of about two pounds per day without any harmful side effects and should be done three to four times per year. This strict diet calls for eliminating all whole foods and instead consuming a mixture of water, fresh squeezed lemon juice, cayenne pepper, and maple syrup up to six times a day for a minimum of 10 days and “up to 40 days and beyond.” In addition, a laxative herbal tea is recommended to help eliminate the waste that has loosened from the various cells and organs in the body. Burroughs’s book says that fresh squeezed lemon juice is considered the richest source of vitamins and minerals known to man and is a loosening and cleansing agent that also balances the body’s pH system, strengthens and energizes the heart, and stimulates and builds the kidneys and adrenal glands. Maple syrup is used because it suppos-

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NUTRITION edly contains a large variety of vitamins and minerals and is considered a “balanced form” of positive and negative sugar. Proponents of the diet also say that the combination of lemon juice, maple syrup, and cayenne contains all of the nutrients the human body needs—a complete balance of minerals and vitamins—which means the dieter will not suffer hunger pangs. Many also believe that cayenne pepper speeds up the body’s metabolism. Burroughs believed that flesh foods such as poultry, fish, red meat, and venison are “extremely toxic.” Eliminating them supposedly wards off every type of disease, including mucus diseases such as a cold, flu, asthma, hay fever, allergies, and sinus troubles. He also says that the Master Cleanse flushes out the kidneys and digestive system, purifies glands and cells, eliminates unusable waste and hardened material, and relieves pressure and irritation in the nerves, arteries, and blood vessels. The Raw Food Diet: There are several variations of this cleanse, but it generally includes eating only foods that are not cooked, processed, irradiated, genetically engineered, or sprayed with pesticides or herbicides. Raw food devotees claim that most healthy food is raw and cooking it decreases its nu-

There are several variations of the Raw Food Diet, but it generally includes eating only foods that are not cooked, processed, irradiated, genetically engineered, or sprayed with pesticides or herbicides. Devotees claim that cooking food decreases its nutrient value. trient value and destroys the enzymes needed to help digest it and absorb its nutrients. Some raw food cleanses allow a small amount of cooked food (one meal a day, for example) or permit cooking as long as the temperature of the food stays below 118 degrees Fahrenheit. Even with these allowances, raw food diets are typically comprised of fruit, vegetables, raw nuts, raw seeds, sprouted seeds and grains, dried fruit and fresh fruit juices, herbs, and spices. The health benefits listed for raw food cleanses include decreased digestive distress, clearer skin, improved energy levels, weight loss, and a decreased risk of disease as a result of improved digestion and better absorption of nutrients. A raw food cleanse may last just one day, but some people have made it a permanent way of eating. The BluePrintCleanse (BPC): Proponents of the BPC say it helps people “give their insides a rest” without going on an extreme cleanse. It supposedly helps the body rid itself of impurities, regain an alkaline balance, and normalize digestion and metabolism. There are several variations of the BPC, though all require skipping out on solid foods and instead consuming the company’s line of enzyme-rich, raw, fresh-pressed, USDA-certified organic juices made from ingredients such as kale, cashew nuts, apples, and pineapples. The cleanse calls for six juices per day (which amounts to 900 to 1,100 total calories) for three to 10 days, depending on which plan the dieter chooses. TR AINING-CONDITIONING.COM

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NUTRITION The creator of the BPC says that each juice has unique benefits. The citrus in its spicy lemonade acts as a cleaner and natural expectorant. Green vegetable tonics are considered healers. And chlorophyll-packed green juice helps lower acidity and balance pH. Like the Master Cleanse, cayenne pepper is found in another BPC juice, which is said to boost metabolism and get the blood pumping. The Cooler Cleanse: Co-founded by actress Salma Hayek, the Cooler Cleanse is a three- to five-day raw juice diet similar to the BPC. When doing the Cooler Cleanse, dieters cut out all meals, alcohol, and caffeine. In

derstand a lot of that lost weight is water weight and not fat. Quick weight loss from a low-calorie diet also often results in rapid re-gain (and then some) when the dieter resumes their normal eating patterns. When it comes to protein, the science-based recommendation for the amount needed to maximally stimulate muscle protein synthesis is 20 to 30 grams per meal (depending on the type of protein consumed and a person’s age). But the juices in the BPC only contain seven grams of protein or less per serving. The Master Cleanse and Cooler Cleanse are also nearly de-

tine) can sometimes be uplifting. We should also keep in mind that by cutting out entire food groups, a person is bound to cut out foods they have a negative reaction to, whether it is a food sensitivity, intolerance, or allergy. Someone may feel better short term, but not in the long run when they resume their regular diet. This also does not mean that cleanses are an ideal way to pinpoint an adverse food reaction. Instead, athletes should work with a registered dietitian or physician if they think they have a food sensitivity or intolerance. A physician who specializes in allergies can give an

Though magazine cover stories are enticing, there is no research-based evidence that proves cleanses actually work. In fact, “detoxing” is done naturally by the body’s organs, and they shouldn’t need any help from a cleanse. their place, six of the company’s freshpressed juices are consumed at evenly spaced intervals throughout the day. Dieters are also encouraged to drink plenty of water. In addition, the cleanse recommends helping the body eliminate waste by doing any one of the following: Drinking two tablespoons of extra virgin olive oil before bed, taking a magnesium supplement, or using castor oil tablets or tea as a laxative. Supporters of the cleanse say it gently and safely sheds excess waste and clears imbalances, yielding increased energy levels. THE SCIENCE Though magazine cover stories are enticing, there is no research-based evidence that proves cleanses actually work. In fact, “detoxing” is done naturally by the body’s organs, and they shouldn’t need any help from a cleanse. For example, the respiratory system—including the hairs in your nose and mucus in your lungs—filters out harmful substances such as dust and bacteria. The kidneys filter about two quarts of waste per day, which is disposed of in our urine. And the liver metabolizes drugs and filters blood before it circulates to the rest of our body. In addition to overlooking the work our organs already do, most cleanses are very low in calories and protein. For someone looking to drop a few pounds, a low-calorie cleanse will certainly help them do that. But it’s important to un30

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void of protein. Raw food diets may contain some protein, but careful planning is required. Additionally, the protein sources in cleanses are almost always plantbased, and therefore lacking in essential amino acids needed for muscle building and repair. Some supporters of cleanses say that our bodies can make all of the amino acids we need, but science tells us that the body cannot make essential amino acids (hence the word “essential”). Raw food cleanses are great for the amount of vegetables and fruit consumed by the dieter, but uncooked isn’t always best. Some antioxidants become more bioavailable to the body after cooking. For example, cooking tomatoes (any form, including ketchup) increases the bioavailability of the antioxidant lycopene. Another problem with cleanses is their use of laxatives to help the body eliminate stool. Many proponents of the diets believe that constipation or stool that lingers increases the body’s absorption of toxins found in stool, though the Mayo Clinic has dispelled this myth. Athletes should be especially careful about using any sort of laxative because of their dehydrating properties. Finally, in addition to weight loss claims, cleanses are marketed as energy enhancers that will fuel a happier disposition. However, these feelings can also be chalked up to a renewed sense of control over food intake. A new eating regimen (or really any change in rou-

athlete blood tests or prick tests to determine if they are allergic to any foods. A registered dietitian can help athletes pinpoint a food intolerance through a test or elimination diet and also assist with navigating food choices if an allergy is present. Despite the drawbacks associated with cleansing, there are a few potential benefits. For example, juice cleanses and raw food cleanses are produce-rich, which give the average athlete more servings of produce—and therefore more antioxidants and nutrients—than they typically consume. Any cleanse that cuts out cooked food also temporarily cuts out the consumption of potentially carcinogenic compounds (such as heterocyclic amines, acrylamides, and lipid polymerization products) created during the cooking process. CLEANSING FOR ATHLETES For people who aren’t very physically active, a cleanse isn’t likely to do harm. But for athletes, things are quite different. Most importantly, athletes need calories to be able to perform and cleanses drastically reduce calorie intake. Athletes not only need more calories than the average person, they need them on a constant basis when training every day. Athletes also need to be more fully hydrated than the average person. They need specific ratios of protein, carbs, and fat, and their day-to-day schedules are unique, which can make a cleanse TR AINING-CONDITIONING.COM

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NUTRITION difficult to follow. The marketing of cleanses is aimed at the general population, not those who are training hard for several hours a day. There is also the myth that a cleanse will help improve performance. “There is little to no scientific evidence that says to recommend using cleanses for enhancing athletic performance,” says Kelly Rossi, MS, RD, CSSD, Assis-

aches, and dizziness, another drawback of cleanses is that they are low in several vitamins and minerals. For example, vitamin B12, vitamin D, calcium, iron, zinc, and omega-3 fatty acids are all important for performance and are almost nonexistent in most cleanses. B12 or iron deficits can lead to anemia (independent of one another),

Despite the drawbacks associated with cleansing, there are a few potential benefits. For example, juice cleanses and raw food cleanses are produce-rich, which give the average athlete more servings of produce than they typically consume. tant Director of Sports Nutrition at the University of Virginia. “It would be especially risky attempting a cleanse during an athlete’s competitive season. Doing so could negatively impact their performance by decreasing glycogen stores to sub-optimal levels and affecting blood glucose levels.” In addition to low blood glucose levels, which can cause fatigue, head-

causing fatigue and a lack of motivation. Over time, vitamin D deficiency can lead to weak bones and bone pain. Some studies suggest that vitamin D has an important role in building muscle strength as well. Low calcium levels can result in weak, porous bones, setting the stage for fractures and eventually osteoporosis. Zinc deficiency, though rare,

can impair wound healing and lead to a weakened immune system. And though omega-3 fatty acid deficiency is rare in Westernized populations, this fatty acid may be especially important for athletes, potentially helping fight excess inflammation. Short term cleanses may not impact nutrient levels significantly unless an athlete is already low or deficient. Long-term cleanses, however, can greatly impact vitamin and mineral levels. For an athlete, shortchanging their body on calories and protein for a few days in the off-season may not be terribly harmful, but it isn’t necessarily helpful. The lack of protein in cleanses is especially concerning because it can affect retention of lean body mass. Muscle tissue eventually breaks down due to low protein intake. Inadequate protein intake can also cause athletes to feel excessively sore after workouts. Laxative use is another potential problem with cleanses (though not all recommend using a laxative). In addition to the dehydration that is a byproduct of taking a laxative, other

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NUTRITION potential negative side effects include bloating, cramping, and diarrhea— major issues for athletes in training. Laxatives should not be used for longer than one week unless prescribed by a physician. Overuse can lead to dependence to produce a bowel movement. And severe overuse can lead to nerve, muscle, and tissue damage in the intestines and bowel. Some cleanses recommend herbal blends as laxatives, but they can be unsafe, lead to a positive drug test, or interfere with a prescribed medication or medical condition. Finally, the strict guidelines, limited food choices, and lack of calories called for in various cleanses can perpetuate disordered eating behavior in an athlete who has a history of this behavior or cause an athlete with an eating disorder to relapse. When the scale drops or they feel lighter, an athlete may be tempted to follow a cleanse for an extended period of time or incorporate aspects of the cleanse into their daily life when it is unsafe. EDUCATION IS KEY When an athlete tells you they are thinking about trying a cleanse, first and foremost, educate them. Explain that cleanses are not supported by scientific evidence and can hamper performance by increasing fatigue and contributing to the breakdown of muscle. Athletes need to also understand that certain recommended ingredients can lead to a positive drug test. Educate them about the positive aspects of cleansing, like the elimination of junk food and alcohol, and suggest that they incorporate these elements— at least temporarily—into a diet that is rich in fresh fruits and vegetables, lean protein, and plain whole grains. By encouraging the consumption of grains and good sources of lean protein in addition to the typical fruit and vegetable (or fruit and vegetable juice) recommendations of cleanses, the athlete is more likely to meet their calorie needs while also feeling like they are getting some of the promised benefits of cleansing. If athletes insist on a true cleanse, help them find one that isn’t extremely restrictive and only lasts for a short amount of time. For example, a few of the versions of the raw food cleanse are fairly reasonable. And some cleanses can be done in as little as one to three days. TR AINING-CONDITIONING.COM

Encourage athletes to time the cleanse so that they do it right after their season is over when they are taking a break from training. Calorie demands are high and performance is on the line during the preseason and in-season, so these are not appropriate times for athletes to experiment with a cleanse. Finally, if you have a sports dietitian or campus health center dietitian, encourage the athlete to see them for more information about cleanses and to help determine if any issues they may think are food-related

are due to food intolerances, allergies, or sensitivities. For most people, a balanced diet is best, and that is especially true for athletes. Unfortunately, detox diets and juice cleanses have been glorified as suitable substitutes for sensible food choices. However, there are some positive parts to cleanses, and athletes can work with a dietitian to figure out how to incorporate those areas into their everyday diet without losing important nutrients, vitamins, protein, and the calories they need. n

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Topical Solutions When an athlete has minor pain, topical analgesics can be a great solution. But how do you sort out the different choices and options? By Dr. Brent Mangus & Dr. Dustin Mangus

he use of topical analgesics has become increasingly common in athletics during recent years. This is primarily due to the easy accessibility of these compounds as most can be bought over the counter (OTC). Many people also feel more comfortable using topical analgesics when compared to systemic medications, which may include more adverse side effects. But the full effects of OTC topical analgesics depends on the type of injury, the athleteâ&#x20AC;&#x2122;s innate healing process and underlying pathology, and guidelines from the person supervising the application and use of the medication. On this last point, it is important to note that there may not be anyone supervising use. Many athletes decide to administer on their own without consulting an ath-

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Brent Mangus, EdD, ATC Ret., is Dean of the College of Education and Human Services at Texas A&M UniversityCommerce. He is also the co-author of Concepts in Athletic Training and Pharmacology Applications in Athletic Training and can be reached at: Brent. Mangus@tamuc.edu. His son Dustin Mangus, MD, is a Fellow in cardiothoracic anesthesiology at Loma Linda (Calif.) University Medical Center. T&C OCTOber 2012

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TREATING THE ATHLETE letic trainer or physician, and this can be a problem. Athletes need to understand that these medications are not magic elixirs that will cure whatever ails them. Each type has a specific purpose and the solution to another athlete’s injury may not be the right one for theirs. Athletes should be reminded that contrary to popular belief and practice, they should not be indiscriminately applying

portant that athletic trainers have a basic understanding of the different products on the market so that they can make sure their athletes use them wisely and effectively. HOW ANALGESICS WORK OTC topical analgesics come in many different formulations, but they can be divided into two basic groups: salicylates and counterirritants. Salicylates

Many counterirritants produce a sensation of temperature alteration in local tissues, making them feel hot or cold. These temperature signals distract the central nervous system by overriding other pain signals and creating a blocking mechanism. a topical analgesic anytime they have some soreness after practice or a game. Instead, OTC topical analgesics should be used by athletes for temporary pain relief from musculoskeletal strains or sprains. Since many different variables exist that can enhance or reduce the effectiveness of these medications, it is im-

are generally found in cream form or as ready-to-apply patches. Counterirritants are sold as creams, patches, wraps, gels, sprays, and balms. Prescription-strength topical analgesics are also available. In certain cases, an athlete’s physician might find it appropriate to prescribe one of these stron-

• Eﬀectively reduces joint and muscle pain, bruising and swelling from injury or overexertion

ger pain relievers for severe discomfort. Salicylates are chemical compounds known to have analgesic properties. When included in a topical compound and rubbed on the skin, salicylates can provide localized pain relief. This is accomplished primarily by inhibiting the enzyme cyclooxygenase from producing prostaglandins and thromboxane, which act as messengers in the inflammatory process. In other words, salicylates help decrease inflammation. Counterirritants, on the other hand, essentially create an abnormal sensation at the skin level that overrides pain impulses. Many counterirritants produce a sensation of temperature alteration in local tissues, making them feel hot or cold. These temperature signals distract the central nervous system by overriding other pain signals and creating a blocking mechanism. This is referred to as “excessive traffic confusion” in the central nervous system. Think of it by picturing a number of freeways merging into one. All the vehicles want to get to the same place, but the smaller vehicles are typically able to pass the larger trucks, merge, and get to

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TREATING THE ATHLETE their final destination much sooner. This is similar to the way the central nervous system processes the variety of messages it constantly receives from receptors throughout the body. The temperature signal from the counterirritant overrides the pain signal from the injury. INGREDIENTS LIST There are many active ingredients listed on topical analgesic packages, which can be overwhelming or confusing for athletes. The following is a rundown of those they are most likely to see: Methyl salicylate, also known as oil of wintergreen, is a close relative to the frequently administered oral form of salicylic acid, commonly referred to as aspirin, and helps to treat joint and/ or muscle pain. Once absorbed into the body, methyl salicylate is converted into other active salicylate compounds, including salicylic acid. It is reported to be able to penetrate the skin without the need of a carrier to get the drug into the body. However, the exact mechanism of direct tissue penetration is currently unknown. Methyl salicylates should not be used

on multiple joints at one time as this increases the amount absorbed into the bloodstream and can result in toxicity. Use of this product should be limited to five consecutive days to limit absorption. Trolamine salicylate is another topically administered salicylate marketed as a product that penetrates the skin to provide an analgesic effect, much like methyl salicylate. Manufacturers say that it is good for temporary relief of

suggest that capsaicin essentially defunctionalizes nociceptive fibers through a variety of biochemical pathways. It has been reported that repeated application of capsaicin or application in high concentrations can cause desensitization and lead to long lasting sensory deficits. Applying a product containing capsaicin over multiple areas of the body for more than seven days can lead to the inhibition of sensory messages.

When recommending the use of topical analgesics, keep in mind that these products are not always well understood by athletes. But when implemented correctly and at the right times, they can be helpful for pain management. muscle soreness and recommend it for use after practice or a game. Capsaicin is an extract from hot chili peppers and is marketed as both an analgesic and anti-inflammatory topical application. It targets the nerve endings just under the surface of the skin, stimulating them to send messages to the central nervous system that there is a slight burning sensation on the skin. Current studies

If this practice is continued excessively, long term sensory deficits may arise. Menthol is mainly derived from the mint plants (peppermint, wild mint, corn mint), but it is also produced synthetically. It produces a counterirritant effect by eliciting a cooling sensation through the inhibition of calcium currents in the neuronal membranes. It should be noted that there is no ac-

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TREATING THE ATHLETE tual drop in skin temperature upon application. Rather, it activates specific receptors in the skin, which imitate a cooling sensation. Camphor comes from the wood of the camphor laurel tree and is often included with menthol in OTC topical analgesics. Camphor appears to work as an analgesic through desensitizing local pain receptors. An athletic trainer may suggest that athletes alternate between camphor and capsaicin products to determine which is more effective for their specific injury. Iron particles have a counterirritant effect and can often be found in heat patches. When exposed to air, iron undergoes a chemical reaction that, when applied to the skin, creates a feeling of heat radiating to the area covered by the patch. The iron particles in these patches generally dissipate or become inactive after a few hours and the heating effect is dramatically reduced over time. However, if an athlete has sensitive skin or an allergic reaction to a heat patch, it is possible to cause damage to the skin. Prescription medications come in

cream form or ready-to-apply patches, but can only be prescribed by a physician who will monitor an athlete’s use. Included in this category are salicylates, local anesthetics, and non-steroidal anti-inflammatory drugs (NSAIDs), which have been shown to be effective in multiple reviews. Commonly prescribed NSAIDs include topical diclofenac, ibuprofen, ketoprofen, and piroxicam. APPLICATIONS Though OTC topical analgesics are often used by older adults for single-joint osteoarthritis pain, athletes most commonly use them for handling the pain associated with a soft tissue injury like a sprain or strain. Strains often benefit from controlled tissue movement during the healing process, which can be painful. A topical analgesic can help dull that pain as the tissue remodels, and allow the athlete more movement so they can heal properly. OTC topical analgesics are intended for use by athletes experiencing mild pain for up to seven days. If lengthier application is warranted, use should be prescribed and monitored by a physician.

Topical analgesics may be most helpful if applied when the injury is close to being fully healed. Once the athlete is within five days of a return to competition, the combination of the massaging action from applying a topical analgesic cream, gel, or balm may be helpful. If done correctly, massaging can increase blood flow to the injured area and assist with the proper alignment of collagen fibers that have been laid down in the healing process. WORDS OF CAUTION Athletes should be constantly reminded that a topical analgesic shouldn’t be used in order to allow them to return to play before an injury is healed. It should only be used to help them manage pain during the healing process, if warranted. Some athletes may want to use topical analgesics before competition to produce a “warming” sensation in their muscles, creating a pseudo feeling that their muscles are ready to work. This can be dangerous for athletes, especially those who play sports that require explosive bursts or ballistic movements by the muscles. Mentally,

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TREATING THE ATHLETE

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the athlete may believe their muscles are warmed up and they are ready to compete when they’re feeling a masked effect from the counterirritant. For example, soccer players often rub a counterirritant onto their inner thighs to warm up tight groin muscles as a part of their pregame routine. But these only provide the feeling of heat and do little to warm the muscle tissue. Few players who have experienced groin pulls during a match ever reported a reduction in pain from the use of counterirritants. Most, if not all of the soccer players using these products to relieve tightness in their groin muscles, indicated the use was more helpful for “mental” pain relief than the actual relief of muscle tightness. Football players have also been known to apply a counterirritant before practice to help the muscles feel warm and stay warm throughout the practice. Some apply so much of the product that there is a visible layer on the skin before they wrap the area with elastic wrap. There are many anecdotal reports of damage to the skin—sometimes severe—when this much product is applied, covered, then left on the skin for hours. A heating device should never be used in conjunction with a topical analgesic either. If one were to malfunction or be left on the skin too long, severe damage could result to the skin since the appropriate pain messages may not be relayed to the brain. Finally, the warnings on the packaging ring true. Topical treatments should not be used if the skin is not healthy. Any damage to the skin can allow a foreign substance to enter the body, and toxicity can result. And if any blistering or abnormal reaction to application occurs, the athlete should immediately stop use and consult a physician before further action is taken or another topical treatment is initiated. When recommending the use of topical analgesics, keep in mind that these products are not always well understood by athletes. But when implemented correctly and at the right times, they can be helpful for pain management. As an athletic trainer, you can help athletes use them the right way, and for the right reasons. n

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sport specific

Flying

High

photos by Eric Evans

The new sport of acrobatics and tumbling requires athletes to be incredibly strong, flexible, and explosive. At the University of Oregon, the squad’s strength coach has developed a unique program to keep them flying high.

By Geoff Ginther

t is always an interesting challenge and valuable learning experience to figure out how to train and condition athletes in a new sport. When the acrobatics and tumbling team was formed here at the University of Oregon almost three years ago, that’s exactly what I was faced with. Overall, acrobatics and tumbling is best described as gymnastics mixed with the athletic aspects of competitive cheer. Anywhere from one to 24 female athletes are on the floor performing acrobatics, building pyramids, and throwing each other into the air, where they flip and twist before being caught. It is fast moving and very athletic. Geoff Ginther, MS, CSCS, is an Assistant Strength and Conditioning Coach at the University of Oregon, where he has worked for 24 years. He is responsible for training the acrobatics and tumbling and women’s lacrosse teams and assists with football. He can be reached at: gginther@uoregon.edu.

The Ducks have won both of the national championships that have been held for collegiate acrobatics and tumbling.

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sport specific Having worked with 15 different sports in 30 years as a strength and conditioning coach, and having done some gymnastics and dance in high school and college myself, I had a good understanding of certain parts of this new sport. But while I was familiar with some of the acrobatic and tumbling gymnastic elements, the competitive cheer influences were new to me. To start the learning process, I constantly observed the sport so I could fully understand the physiological requirements and figure out which movements were most common. I needed answers to a lot of questions: What areas of the body need to be developed in order to hold and throw teammates overhead? What tests can we come up with to assess strengths and weaknesses of our athletes specific to the sport?

women with 28 eligible to compete in any one meet. The season begins in late winter and culminates with the national championship in late spring. There are two positions in the sport: bases and flyers. Bases push their teammates overhead and catch them, while flyers are balanced overhead and thrown in the air. Competitions are structured similar to gymnastics meets and are held on a non-spring mat of two-inch thick foam that is 42 feet long and 54 feet wide, placed on an arena floor. Most regular season meets comprise of two to three teams and take 90 to 105 minutes. They consist of six events: compulsories, acro, pyramid building, toss, tumbling, and a team routine. Judges award scores based on pre-established standards.

Injury prevention is a primary concern in acrobatics and tumbling. The first year the team started training was our worst in terms of injuries suffered ... Since that first injuryplagued year, however, there has been considerable improvement in the athletes’ strength and conditioning levels.

Can the flyers get stronger and more flexible without adding bodyweight? Two years after the sport’s debut, it’s safe to say that our team is very talented and on its way to becoming a perennial powerhouse. Oregon has won the national championship both of the years that one has been held and currently sits at the top of next season’s rankings. The athletes work hard for that success, which is especially evident in the weightroom and at our conditioning sessions.

CMY

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A CLOSER LOOK While acrobatics and tumbling vies for official NCAA status (for more on this process, see “Emerging Sport Status” on page 48), the National Collegiate Acrobatics & Tumbling Association (NCATA) is the governing body of the sport. The NCATA is backed by USA Gymnastics, which certifies the coaches and sanctions the meets, including the national tournament. Oregon is one of eight schools that currently make up the NCATA. Though most were previously competitive cheer teams, acrobatics and tumbling squads are completely separate from any sideline cheerleading groups. A team usually consists of about 35

Compulsories: The compulsory event is made up of four heats: acro, pyramid, toss, and tumbling. There are established baseline skills for each heat that college-level athletes are expected to complete with a high level of proficiency. In the acro heat, eight athletes make up two groups that perform a synchronized sequence. In the pyramid heat, 15 athletes perform a standard pyramid build. In the toss heat, 10 athletes make up two groups that perform a standard synchronized toss. And in the final heat, eight athletes perform four different synchronized tumbling skills. Acro: There are three heats in the acro event, with two to four athletes competing in each. The skills are a series of acrobatic lifts that can’t last longer than 45 seconds. The first heat must have a flipping element of at least 360 degrees and can contain no more than five elements. The second heat must contain two twisting skills of more than 90 degrees and can contain no more than six elements. And the third heat must include five release skills and can contain only seven elements. Pyramid building: The pyramid event is also made up of three heats. TR AINING-CONDITIONING.COM

sport specific Up to 24 athletes can compete in each heat. The athletes have 30 seconds to build a standard pyramid with dynamic entry and dismount skills. Heat one requires a flipping skill, heat two a twisting skill, and heat three a release skill. Toss: The three heats in the toss event have been compared to diving because so much body control and awareness is required on the part of the flyer. Four athletes toss a fifth athlete (the flyer) into the air, where she twists and flips before being caught by the bases. The first heat requires the flyer to perform a skill in the air in a laid out flipping body position. The second heat requires two groups to perform a synchronized toss. And the third heat is open where the group can perform the toss of their choice. Tumbling: There are six heats in the tumbling event. Three are group heats and three are individual. The first is a quad heat where four athletes perform a synchronized tumbling pass. The second is a trio heat where three athletes do the same. Two athletes perform in the third heat. The final three

are performed by one athlete. All three must include a pass and other specific requirements. Team routine: The final event brings all of the skills performed in the first five heats together into a dynamic group routine set to music that is two-and-a-

The most commonly injured lower body parts are the ankles (evenly split between impact and overuse injuries), shins, and knees. The most commonly injured upper body parts are the head (our athletes suffer an average of seven concussions per year), hands (thumb

Bases need to develop overhead stability. We work on this by having them push and hold various objects overhead, including dumbbells, large sections of PVC pipe loaded with sand, weighted sandbags, and four- to five-foot long logs. half minutes long. It is much like a floor routine in artistic gymnastics mixed with an acrobatic gymnastics routine— all synchronized with 24 athletes. SAFETY FIRST As in any sport that requires elements of power, strength, and balance, injury prevention is a primary concern in acrobatics and tumbling. The first year the team started training was our worst in terms of injuries suffered. We had the most total injuries and the most severe, including three that resulted in knee surgeries.

and wrist), and shoulders. Concussions continue to be a problem in acrobatics and tumbling—not so much from flyers being dropped, but more often from head-to-head contact when a base catches a flyer or takes an elbow to the head. Since that first injury-plagued year, however, there has been considerable improvement in the athletes’ strength and conditioning levels. Instituting regular strength training, conditioning, and testing has helped our athletes become better able to handle some of the

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photos by Angela Ucci

sport specific

Figure Two: Two athletes perform partner-resisted sprints.

Figure One: A base trains for overhead stability with a four-foot log. high-impact movements of the sport. Other elements of our program that focus on injury prevention include: • Consistent total body warmups that are more dynamic than static • Post-practice cool-downs that include

partner-assisted proprioceptive neuromuscular facilitation (PNF) • Recovery methods such as ice baths, static stretching, rest, and proper nutrition. Injury prevention also improved when we stopped doing explosive weight training on days when practice focused on tumbling, which is high impact. The athletes also started to take one full day off in the middle of the week. And we had them practice improved landing and catching skills on the mat and in the weightroom, which lessens impact on their ankles, shins, and knees.

STRENGTH REQUIREMENTS The main needs of all acrobatics and tumbling athletes are upper body strength, power and explosiveness, flexibility, and core strength. Here is how we work on each of them: Upper body strength: When I started working with the team, the athletes were underdeveloped in this area. It was evident from early on that most had little weight lifting experience, if any at all So we started by working mostly on muscular endurance training (performing few sets, with light to medium weight, and at higher rep-

EXERCISES BY POSITION Below is a list of some of the most important and unique exercises done by each position. Bases:

Flyers:

Clean pull to power clean

Step-up

Push press to push jerk Dumbbell single-arm snatch to power snatch

Single-leg V-up, bridge, plank, and variety of physio ball exercises

Explosive step-up with squat jump

Dumbbell shoulder raise (front and lateral)

Front squat to squat

Good morning and reverse back extension

Overhead lunge to lunge

Upright row and triceps extension

Overhead stability and balance (logs, dumbbells, chains, loaded PVC pipes)

Balance stretches (double- and single-leg) on Bosu ball

Overhead toss (med balls, sandbags, logs)

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TR AINING-CONDITIONING.COM

sport specific etitions). We also used teaching progressions of multi-joint exercises (pull, push, and squat movements), and made sure to do lots of opposing muscle exercises (push-pull and flex-extend). Both the base and flyer positions require the ability to do tumbling activities, which utilize mainly the shoulder and back muscles. We place equal emphasis on the three upper body areas of pushing, pulling, and stability. For pushing, we train the shoulders with an overhead lifting progression using dumbbells, the push press, and push jerk. For pulling, we use pull-ups, lat pull-downs, upright rows, clean pulls, bent-over rows, and low cable rows. Bases, in addition to overall upper body strength, need to develop over-

Tumbling from opposing corners of a competitionsize mat covers only about 20 yards, so acceleration as quickly as possible (top speed in four to six seconds) is important. Our athletes perform resisted and assisted running exercises for this purpose. Speed and acceleration mechanics and methods such as proper starts and running form are trained as well. head stability. We work on this by having them push and hold various objects overhead, including dumbbells, large sections of PVC pipe loaded with sand, weighted sandbags, and four- to five-foot long logs (see Figure One on page 46). These exercise challenges have the added bonus of mimicking a base’s common sport specific motions and developing deep joint strength and flexibility. Power and explosiveness: We have the acrobatics and tumbling athletes do Olympic lifts to develop explosiveness for a number of reasons. The pulling motion in cleans and snatches develops good hip extension power for our bases. This movement is also very similar TR AINING-CONDITIONING.COM

to the beginning phase of tossing. Push presses and push jerks develop the overhead pushing power needed in acrobatics. And for bases, the eccentric loading on the way down from these lifts is similar to catching a flyer. We make sure to concentrate on good posture and have the athletes drop their hips instead of using their low backs to catch the weight. Flexibility: Flipping and twisting at high speeds places high impact demands on the hips, knees, and ankle joints, which makes flexibility and mo-

bility in these areas paramount. The athletes consistently perform two sessions per day that include dynamic stretches (circular movements to loosen joints, ligaments, and tendons) and static stretches (for shoulder, low back, leg, and hip muscles). We also increase flexibility by doing post-practice partner-assisted PNF stretching. Core strength: In order to train the core, which encompasses the hips, low back, abdominals, and glutes, the athletes perform exercises in all potential movement patterns, including flexion,

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sport specific

CONDITIONING REQUIREMENTS While the acrobatic portion of this sport requires strength, power, balance, and flexibility, the tumbling portion emphasizes speed and higher impact training. Conditioning includes a base level of cardiovascular fitness, acceleration and speed development, and foot quickness and agility. We base our conditioning methods on the movement patterns of the sport, which for acrobatics and tumbling are mostly forward accelerations and upward and downward motions. Cardiovascular fitness and speed endurance: It is important to develop these areas in the preseason. This is when the squad does multiple reps (up to 24) of uphill sprints, short stair sprints, towing and dragging sleds, multiple sprints of 10 to 30 yards, and fartlek training. Twice a week during the season, we do cardiovascular training for fitness and speed endurance that lasts 15 to 20 minutes. Acceleration and speed development: Tumbling from opposing corners of a competition-size mat covers only about 20 yards, so acceleration as quickly as possible (top speed in four to six seconds) is important. Our athletes perform resisted and assisted running exercises for this purpose (see Figure Two on page 46). Speed and acceleration mechanics and methods such as proper starts and running form are trained as well.

Angela Ucci

extension, rotation, and changing levels. We use medicine balls, physio balls, and plank exercises. Learning how to control the hips and activate the muscles of the glutes and abdominals is important for developing overall core strength.

Figure Three: An athlete runs through a ladder drill.

EMERGING SPORT STATUS Acrobatics and tumbling is in the pipeline to become an NCAA emerging sport. NCAA guidelines for emerging sports require 20 active collegiate varsity or club teams, and 10 schools must sign letters saying their athletic department sponsors or commits to sponsor it. Presently, there are seven other universities in addition to the University of Oregon that offer it at the varsity level. If acrobatics and tumbling is approved by the NCAA Committee for Women’s Sports, each NCAA division would vote on whether to adopt it as an emerging sport. Once 40 NCAA schools sponsor the sport, it is then eligible to become a full championship sport. Four women’s sports—ice hockey, rowing, water polo, and bowling—have progressed from emerging to championship status since the process was established in 1996. The future of acrobatics and tumbling is promising. The sport has low expenses, high interest and participation among young athletes, and spectators love it—Oregon has drawn 2,000 fans at several home meets.

For more information on acrobatics and tumbling, including videos of events, go to: www.thencata.org.

T&C OCTOber 2012

Eric Evans

These athletes want the sport to be nationally recognized and respected. The support it has received thus far is a great start. Hopefully, in the very near future, acrobatics and tumbling will be accepted by the NCAA as a new and exciting sport to be enjoyed by participants and spectators across the nation.

TR AINING-CONDITIONING.COM

sport specific

Foot quickness and agility: The athletes do ladder (see Figure Three at right) and stair drills and jump and plyometric training. But because of the number of passes athletes make across the mat during a typical tumbling practice (20 to 30 in a two-hour session), we tend to do this training only during the preseason. Cone hops in three directions and a box jump progression are usually the employed methods. DUCKS PROGRAMMING Our acrobatics and tumbling athletes do strength and conditioning training year-round. Preseason training starts prior to the start of school in late September. We begin by testing flexibility, core strength, lower body power and speed, upper body muscular endurance, and cardiovascular fitness to determine individual strengths and weaknesses. The first preseason phase is nine weeks long, and concludes in late November when we perform a second round of tests to measure strength and power. We do this with a one-rep max power clean, push jerk, squat, and bench press. After the holiday break in December, we conduct a second short preseason phase in January. Then, the in-season phase runs from early February all the way through to the national championship tournament in late April. The team then completes a short postseason phase early-May to midJune before they go home for the summer. And finally, the off-season phase runs from late June to mid-September. The fitness running test is a two-mile track run with a goal time of 16 minutes. The flexibility test includes the sit-and-reach, back bend, leg splits, and prone shoulder elevation. The core strength test includes the V-up hold, weighted plank hold, and two-minute sit-up test. Lower body and speed tests include the vertical jump and 20-yard sprint. And the upper body and muscular endurance tests include pull-ups, dips, and a one-minute pushup test. We test twice a year. In September, it’s to see if the athletes stayed in shape over the summer. In November, it’s to evaluate our preseason training phase, which includes the longest and most demanding workouts of the year. During the preseason, postseason, and off-season, the athletes complete three workouts per week. Each workout takes 75 to 90 minutes, including the warmup, lifting portion, and conditioning session. In-season, we do two 60-minute workouts per week, also including warmup, lifting, and conditioning. In-season strength and conditioning workouts are always done before practices, which we believe is a benefit to the athletes because lifting encourages proper posture and warms up the muscles and joints for the dynamic movements completed in practice. The team’s athletic trainer, coaches, and myself have also noticed that lifting and conditioning before practice stimulates and enhances the athletes’ performance at practice. (See “Exercises By Position” on page 46 for more details on our workouts.) The Oregon acrobatics and tumbling squad’s two national tournament wins showed what can happen when athletes train consistently in an intelligent and enthusiastic manner. And as long as the athletes continue their hard work, the Ducks will continue to be successful as acrobatics and tumbling takes off. n TR AINING-CONDITIONING.COM

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Pain Management Promotes Flexibility

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

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SelfGrip® helps active people and athletes perform their best by providing firm compression and maximum support to ligaments, tendons, and muscles. The unique cotton/latex woven process allows SelfGrip to stick to itself without pins or clips—without sticking to hair or skin. SelfGrip is reusable, tears easily, wicks away moisture and perspiration, and even maintains grip underwater. Recommended by doctors and trainers, SelfGrip is available in two-, three-, and four-inch widths and assorted colors. Dome Industries, Inc. • 800-432-4352 www.selfgrip.com

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Advanced Self-Therapy for arms

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The new Tola™ Neuromuscular Release System from OPTP enables users to apply deep, precise pressure to hard-to-reach soft tissues. Designed by a physical therapist with over 20 years of manual therapy experience, the Tola System features three “points” with different contours that can be used seated, standing, or lying down to target trigger points for pain relief or facilitate neuromuscular release prior to stretching. A 50-page Tola System manual guides users through proper positioning and therapeutic examples.

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Armaid is the world’s only self-therapy tool for forearms, wrist, hand, and elbow problems. This product has an incredibly efficient leverage design, combined with the most effective manual therapy techniques— trigger point, active release, and crossfiber friction. Four different attachments give the user capability to relieve tendonitis, tendonosis, deQuervains, repetitive strain, and lymphedema. Plus, concise, easy to understand videos come with Armaid to show the athlete all they need to know to help themselves. Armaid • 800-488-5505 www.armaid.com

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Rugged, Reliable, Innovative

The AlterG Anti-Gravity Treadmill® enables athletes to train longer, run faster, gain additional strength, and enhance cardiovascular performance while minimizing impact and stress on their joints. Using Differential Air Pressure technology, the AlterG provides up to 80-percent body-weight support, in accurate one percent increments. At a reduced body weight, athletes can train through injuries, add miles without the added stress, and return to walking and running sooner post-surgery.

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.

AlterG • 510-270-5900 www.alter-g.com

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

Minimizes Impact on Joints

Elite Knee Care

The Y Roller™ has a dual or single ridge option that offers a targeted aggressive massage, while providing the ability to roll in between ridges for a less aggressive, moderate massage. Made from Elastomer—high-density, durable foam—the Y Roller is an excellent tool to promote flexibility and myofascial release. It is 6” x 15.5” and helps users with deep tissue massage to reduce muscle fatigue and tightness, promote flexibility, and enhance performance.

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Pain Management Easy Use, Effective Treatments This summer marked the release of the Dynatron Solaris® Plus. Combining all the features of Solaris, plus enough power to generate eight separate treatments simultaneously, the Dynatron Solaris® Plus offers many options. This product features Tri-Wave Light Therapy, which provides three wavelengths that can blend into seven combinations for both pad and probe; a new fixed frequency IFC/Premod option; a full-color user interface, which is so easy that two key presses can start a treatment; and the new three-drawer Solaris Cart. Contact Dynatronics for a free demonstration.

Dynatronics • 801-568-7000 www.dynatronics.com

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Wireless Medical Data

Zephyr’s BioModule™ is the “brains” behind its PSM Training ECHO system—a small, circular sensor that wirelessly transmits a wide range of medical-grade physiological data and will warn you when an athlete is in danger of heat stress, dehydration, exhaustion, and more. 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. Zephyr Technology • 443-569-3603 www.zephyr-technology.com

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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

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Works Quickly and Easily

FAST Tools are soft-tissue mobilization tools that can take myofascial manipulation and mobilization to the next level in your practice. The design of the tools enables you, the practitioner, to work over all surfaces of the body quickly and easily. FAST Tools have been able to reduce scar tissue problems from old injuries/surgeries, and achieve greater results with pain control and joint and muscle flexibility than many thought were attainable.

Pivotal Health Solutions, Inc. • 800-627-2387 www.pivotalhealthsolutions.com TR AINING-CONDITIONING.COM

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Maximize Muscle Performance The Pro-Tec Travel Size Roller Massager with Trigger Point Release Grips is the newest addition to Pro-Tec Athletics’ full line of sports medicine products. Use it to reduce muscle tightness, soreness, and pain. With its raised Vynafoam™ sections that “sink” into soft tissue to roll out tightness and rounded grip ends to provide precision trigger point release, the Pro-Tec Travel Size Roller gives users deep tissue stimulation to maximize muscle performance and expedite recovery. Plus, it is only 17.5 inches—small enough to fit inside most carry-on bags. Pro-Tec Athletics • 800-779-3372 www.injurybegone.com

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Great Elastic Response

Virtually identical to latex bands, REP Bands® resistive exercise bands offer greater elastic response, higher resiliency, and faster recovery. Patented REP Bands are the only resistive exercise bands manufactured exclusively in the United States. For more information about these exercise bands, visit Magister Corp. online. Magister Corporation • 800-396-3130 www.magistercorp.com

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Quality plus Affordable

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

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A Versatile Unit

Rich-Mar offers up to seven modalities in one unit, including exclusive hands-free ultrasound and a Therapy Hammer with two- and fivecentimeter 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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Intense Myofascial Release

OPTP has introduced a new RumbleRoller™. Not for lightweights, the RumbleRoller Extra Firm is 36 percent firmer than the original RumbleRoller. This product is designed with experienced users in mind, but since it’s antimicrobial, it can be used by multiple athletes. The RumbleRoller Extra Firm is a favorite among runners, triathletes, and anyone seeking intense myofascial release. For more information, contact OPTP. OPTP • 800-367-7393 www.optp.com

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Hot & Cold/ Sports Massage Total Control

The medium-sized thermophore is 14” x 14” and has professionalquality intense moist heat that can be used for therapy any time of the day or night. Moisture helps the intense heat penetrate even more deeply, allowing it to relieve pain, relax muscle spasms, and increase rejuvenating circulation. Two switch options put the user in total control of the heat level, minute by minute. Relax as the system cycles through a 20-minute optimal moist heat therapy session. Creative Health Products • 800-742-4478 www.chponline.com

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Helps Alleviate Discomfort

Ice bath therapy can be a very effective modality for athletic trainers. Unfortunately, this therapy regimen can elicit complaints of extreme discomfort in personal areas. PRO 805 Ice Bath Therapy Briefs are an easy solution to this problem. Constructed of 1/8-inch neoprene with hook and loop fasteners on each side for easy application. The Ice Bath Therapy Briefs come in black, and are sized in medium, large, x-large, and xx-large.

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Many Treatment Options

Why settle for just cold and compression when you can have four modalities generating up to seven different treatment options without the mess of melting ice? Treatment options include cold, heat, compression, cold/ compression, heat/compression, cold/ stim, and heat/stim. In addition, the innovative ThermoStim Probe combines cold or heat with electrical stimulation to treat a wide variety of conditions in localized areas.

Dynatronics • 801-568-7000 www.dynatronics.com

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Safe and Cost Effective

Apollo has created a powerful cold laser therapy product. With over 20 years of collaborative research and data, Apollo provides safe and cost-effective Class Four Laser products at a Class Three price. With Apollo, power is inversely proportionate to the treatment time—this means that more powerful lasers require less treatment time. Apollo provides you with one of the safest and most effective laser products you can buy.

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No Ice Needed

ThermaZone™ is a powerful, compact, thermo-electric painrelieving device providing heating and cooling therapy without the use of ice. Features include a broad temperature range (38-125 degrees Fahrenheit), five timer options, and the exclusive Motion Advantage relief pads that deliver a constant temperature for as long as you need it. Maintenance-free, ThermaZone allows athletic trainers complete control of treatment duration and temperatures for maximum results. Innovative Medical Equipment, LLC • 877-646-1222 www.therma-zone.com Circle No. 522

Speeds Recovery

“As a life-long cyclist and expertcategory mountain bike racer, I spend hundreds of hours riding and training every year. I am always looking for ways to speed up recovery and relieve pain and soreness by natural methods. Pressure Positive’s massage tools have become a valuable part of my daily routine. One of my favorites is the Original Backnobber II, which is perfect for targeting all of my sore spots. Thanks, Pressure Positive.” -Cyclist Mike Ging, Phoenixville, PA The Pressure Positive Company • 800-603-5107 www.pressurepositive.com Circle No. 523

Adjustable Compression

PRO ice wraps are the perfect method for applying cold therapy to most minor injuries. Made with quality neoprene for durability, these wraps are perfect for the treatment of pulls and strains. Wraps are quick and easy to use, allowing for adjustable compression to keep ice packs in place. PRO ice wraps are black, and are available for the shoulder (#439), knee (#103), or back (#208). PRO Orthopedic Devices, Inc. • 800-523-5611 www.proorthopedic.com Circle No. 524

Superior Hot & Cold Retention

Built to last and easy to maintain, SwimEx plunge tanks are made from superior fiberglass composite. The proven design formula sandwiches a balsa wood core between layers of fiberglass, resin, and gelcoat for superior heat and cold retention and unmatched beauty. Standard plunge tanks are white with waterline color tiles to match your team colors. Sectional designs and custom appearance options are also available. SwimEx Inc. • 800-877-7946 www.swimex.com

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Case Study

Athletic Training Tools Bring Athletes to New Levels

new instrument-assisted soft tissue massage tool is now available to athletic trainers. Take your athletes to the next level with this device. FAST Tools are a set of two metalinjected plastic tools that offer a superior feel of the tissue adhesions. The built-in handle allows a better grip, and doesn’t get slippery with additional lotions, emollients, or creams. The FAST Tools package includes the larger F1 tools for work on large areas of treatment, such as the hip, back, or shoulder; and a smaller F2 tool for more intricate areas of the body. The pacakage also includes an instruction manual and a durable case with custom-cut foam for travel.

patterns can help athletes reduce their risk of injury and improve functional performance.

FAST Tools can be utilized for sprains, strains, contusion injuries, muscle aches, shortened and tight muscles, and post surgical scarring. FAST Tools can also be used for muscle and joint pain associated with overuse, chronic stiffness, and old injury scar tissue.

Many athletes leave high school and college athletics with injuries, and joint wear and tear that plagues them for life. With FAST Tools and FAST Technique we can help you improve your athletes function both on and off the court, as well as improve their chances of long-term health after organized sports.

Myofascial adhesions can develop with many types of injuries and in any sport. Compensation for pain, or shortened and tight tissue can lead to altered joint mechanics and functional movement leading to an increased risk of injury. However, introducing muscle and fascial lengthening, and improving movement

FAST Tools are available through Pivotal Health Solutions. Training, implementation support, and informational webinars are also available to therapists and trainers to better help them treat their athletes and improve healing and flexibility.

Pivotal Health Solutions, Inc. • 800-627-2387 • www.pivotalhealthsolutions.com

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