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March 2013 Vol. XXIII, No. 2, $7.00

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March 2013, Vol. XXIII, No. 2

Bulletin Board Brain changes linger following concussion … New study focuses on field hockey eyewear … Relief from shoulder impingement … NSCA Coaches of the Year.

Comeback Athlete Morgan Burris 7 Muleshoe (Texas) High School Product News Concussion Prevention/Treatment Products 46 47 Antimicrobial Products 47 Aquatic Exercise 50 More Products

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On the cover: Keith Power (far right), author of our cover story about the University of California’s new High Performance initiative, poses with other key athletic department leaders. Story begins on page 32. Photo by Rod Searcey

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Optimum Performance

Able to Overcome

Paralympic powerlifters have the same goals as their Olympic counterparts, but there are some definite variations to their training. A veteran coach explains the nuances of working with these athletes. By Dr. Kyle Pierce Treating the Athlete

the Front Lines 19 On Athletic trainers need all the help they can get in the fight

against concussions. Fortunately, there are many innovative products that can help them with the job. By Kristin Maki Nutrition

27 School lunches aren’t usually a hot topic of conversation among What’s for Lunch?

strength coaches and athletic trainers, but the Healthy, HungerFree Kids Act has changed that. By Kim Tirapelle Leadership

32 In an effort to take its athletic program to a higher level, Team Approach

the University of California has implemented a unique new philosophy focused on collaboration, using best practices, and maximizing efficiencies. By Keith Power Sport Specific

Strength 39 Soccer An overhauled strength and conditioning program put together by two coaches new to campus has helped reinvigorate the Pepperdine University women’s soccer team. By Matt Young & Jamie Faro

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

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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 of Sports Medicine and Business Operations, Xcelerate Physical Therapy 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

March 2013 Vol. XXIII, No. 2 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 Director David Dubin 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© 2013 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

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Brain Changes Linger Following Concussion Are high school and youth athletes returning to play too soon after suffering a concussion? Data from recent research suggests that the answer is yes. A study published in the Dec. 12 issue of The Journal of Neuroscience found that structural changes in a child’s brain persist for months following a concussion, even after symptoms have subsided. Researchers from the University of New Mexico performed diffusion tensor imaging (DTI) on the brains of 15 children between the ages of 10 and 17 who had recently (less than three weeks earlier) suffered a concussion, along with 15 non-concussed counterparts. Comparing test scores between the children in the two groups, researchers noted discrepancies in white matter—the long fibers that carry information from one area of the brain to another. Approximately four months later, a subset of the concussed children returned for follow-up visits. At this time, none of the subjects reported symptoms, but DTI found that changes in white matter that were noted at the first visit persisted. “These findings may have important implications about when it is truly safe for a child to resume physical activities that may produce a second concussion, potentially further injuring an already vulnerable brain,” Andrew Mayer, PhD, one of the study authors and Research Associate Professor at UNM’s The MIND Research Network, told the Society for Neuroscience. Similar studies have been carried out with adult subjects, but this is the first to involve the scholastic population. Researchers noted that when comparing this study’s brain images to concussed adults’ brain images, the changes in white matter were more severe. “The magnitude of the white matter changes in children with mild traumatic brain injury was larger than what has been previously been reported for adult patients with mild traumatic brain injury,” Mayer said. “This suggests that developmental differences in the brain or the muscularskeletal system may render pediatric patients more susceptible to injury.” To view the abstract of the study, “Diffusion Abnormalities in Pediatric Mild Traumatic Brain Injury,” go to: www.jneurosci.org and search the study title.

Protective Eyewear Preventing Injuries The NFHS rule requiring protective eyewear for high school field hockey players, which took effect before the 2011-12 school year, has been receiving mixed reactions. A chief complaint among detractors is that the added equipment gives athletes a false sense of security and causes them to 4

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play more aggressively, making the game more dangerous instead of safer. But a recent review of regional and national injury databases found that what is commonly referred to as the “gladiator effect” doesn’t hold water in this case. Published in Pediatrics in December, the study analyzed data from the 2009 and 2010 field hockey seasons in states that already required protective eyewear and states that did not. Researchers found no statistical difference in concussion rates among players in either group of states, indicating that wearing protective eyewear did not result in more aggressive play and therefore more injuries. In states without the protective eyewear requirement, players suffered significantly more eye, face, and head injuries, suggesting that the eyewear helps prevent injuries. Researchers analyzed data from 180 high school teams, each with an average of 20 players. In states that required protective eyewear, teams had an average of one eye, face, or head injury per 106 practices and games. In states without eyewear requirements, the rate was one injury per 72 practices and games. Players in states without the protective eyewear requirement were 5.33 times more likely to suffer an eye injury than those in states where eyewear was a requirement. Also in states without the requirement, a larger percentage of injuries required more than 10 days to return to play—32 vs. 17 percent. Although there continues to be individuals who don’t like the addition of eyewear to the game, the study’s results should help strengthen the new rule. “Whenever new pieces of protective equipment have been introduced to a sport, there’s always a group of people saying, ‘You’re going to ruin the culture of the sport,’” Dawn Comstock, PhD, one of the study authors and a principal investigator at the Center for Injury Research and Policy at The Research Institute at Nationwide Children’s Hospital told the Kennebec Journal. “The introduction of the football helmet ... the face mask ... the introduction of ice hockey helmets ... Every sport resists change when there’s an introduction of protective equipment. It’s nothing new. [But] if you look at every sport, it has evolved over time, including field hockey.” “We encourage players to adopt protective eyewear early, at a young age, regardless of the contact/collision sport they play,” Peter Kriz, MD, another study author and Assistant Professor at Brown University, told Reuters Health. “Wearing this gear will become second nature, and they will transition easier to other sports requiring facial protection.” The abstract of the study, “Effectiveness of Protective Eyewear in Reducing Eye Injuries Among High School Field Hockey Players,” can be found by searching the study title at: http://pediatrics.aappublications.org. TR AINING-CONDITIONING.COM

Bulletin

Board Reducing Shoulder Impingement The key to resolving pain and restoring function in athletes who play overhead sports and have mild impingement symptoms may be as simple as a six-week program consisting of just four exercises. Those are the findings outlined in a study completed by researchers from Ghent University Hospital in Belgium. The research appeared in the July issue of The American Journal of Sports Medicine. The study recruited 47 athletes who were experiencing mild impingement symptoms and participated in volleyball, swimming, or tennis—all sports that require repetitive, powerful overhead arm movements. The mean age of the participants, which included 22 women and 25 men, was 24.6 years old. Forty of the participants followed through on completing the six-week training program on their own. It consisted of four exercises focusing on scapular muscle balance: Prone extension, forward flexion in a side lying position, external rotation in a side lying position, and prone horizontal abduction with external rotation. Researchers measured several parameters before and after completion of the program. They included: • Pain and functionality via the Shoulder Pain and Disability Index (SPADI) questionnaire

• Maximum voluntary isometric contraction via electromyography • Muscle activation levels, muscle ratio data, and muscle onset timing in the upper trapezius, middle trapezius, lower trapezius, and seratus anterior during arm elevation in the scapular plane. Following completion of the six-week program, particiParticipants reported decreased pain and increased functionality with dramatically improved Shoulder Pain and Disability Index scores. There was also an increase in maximum voluntary isometric contraction in the trapezius muscles. pants reported decreased pain and increased functionality with dramatically improved SPADI scores (the average decreased from 29.86 to 17.03). There was also an increase in maximum voluntary isometric contraction in the trapezius muscles and decreased activation levels during arm elevation. “The results of this study are very promising since limiting shoulder symptoms in active overhead athletes suffer-

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Board ing from persistent mild symptoms might serve as an injury prevention measure, limiting continued low-grade shoulder pain, fear avoidance, and ultimately surgical management requirement,” the researchers concluded. To view the abstract of the study, “Scapular Muscle Rehabilitation Exercises in Overhead Athletes With Impingement Symptoms: Effect of a 6-Week Training Program on Muscle Recruitment and Functional Outcome,” go to: http://ajs.sagepub.com and search the study title.

NSCA Awards Coaches At the NSCA’s Coaches Conference in January, Andrea Hudy, MA, CSCS, USAW, LMT, Associate Director of Strength and Conditioning at the University of Kansas, was named the 2013 College Strength Coach of the Year. Tony McClure, CSCS*D, Assistant Performance Training Coach at New Mexico State University, was named the 2013 Assistant Strength Coach of the Year. The winners earned their awards for exhibiting excellence in dedication to the strength and conditioning profession. Hudy, who is responsible for training the men’s and

women’s basketball teams at Kansas, is one of few female head strength coaches at the NCAA Division I level and the only female strength coach working with a D-I men’s basketball team. Hudy wrote about training the Jayhawks for us in an article titled “A Higher Level,” which appeared in the May/June 2012 issue of T&C. Hudy also shared her expertise in our annual strength coach roundtable, “Strong Foundation,” which ran in the November 2010 issue. McClure has been working with teams at New Mexico State since 1999, specializing in speed and agility training. He currently works with the volleyball, softball, men’s and women’s tennis, men’s and women’s golf, equestrian, and women’s swimming and diving teams. The volleyball squad most recently won the 2012 Western Athletic Conference Tournament and advanced to the NCAA Division I Tournament, while the men’s golf team has won six conference championships and the women’s golf team has won five conference championships during McClure’s time at the school. To read “A Higher Level” or “Strong Foundation,” search the title of the article on the T&C Web site at: www.Training-Conditioning.com.

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ComebackAthlete

Morgan Burris Muleshoe (Texas) High School By R.J. Anderson

Morgan Burris is not your typical high school senior. Nor is she a typical Comeback Athlete candidate.

Once a promising basketball player and track and field athlete, Burris was knocked out of athletics three years ago by a debilitating case of severe acute asthma. For most young athletes, this would represent a devastating turn of events, but for Burris the situation opened up a new door. Burris’s story began during the 2009-10 school year when she was a freshman at Muleshoe (Texas) High School playing basketball and throwing the shot put and discus for the track team. Though she was known as a tough-minded competitor, her asthma often left her breathless and weak, and frequently sent her to the emergency room. Burris first began experiencing problems in fifth grade when a bout of breathing difficulty put her in the hospital. At the time, her doctors didn’t think her case was anything out of the ordinary and sent her home with a simple diagnosis— she had asthma. But as she moved on to junior high and later high school, Burris’s symptoms worsened. “We started doing a lot more running in junior high and it was really hard on me,” says Burris. “I was always complaining about my chest hurting and I could barely run during Phys. Ed. class. I had to have my inhaler close by all the time.” Muleshoe Athletic Trainer Joshua Woolbright, ATC, got to know Burris well since she was making thrice-weekly trips to the athletic training room to treat her asthma with a nebulizer, which transforms asthma medicine into an inhalable mist. “The school bought the device for Morgan and another student who also had it pretty bad,” says Woolbright. “Morgan’s asthma symptoms would act up on an almost daily basis and I would have to call her mother to come pick her up from school.” As a freshman, Burris’s condition was so bad that when she played basketball, she could only stay on the floor for a couple of minutes at a time before needing to sub out. And when the track team did conditioning workouts, Woolbright would go to the track to keep an eye on her. “I said that I was there to watch everybody, but I was really there to monitor Morgan and make sure she was safe,” he says. “That’s also when I started attending track meets for the first time in my career.” As the year progressed, so did Burris’s asthma-induced challenges. “It would happen so fast—I would be okay one minute, then 30 seconds later I would have to go to the hospital,” she says. “My body hurt and I would get so tired so R.J. Anderson is an Assistant Editor at Training & Conditioning. He can be reached at: rja@MomentumMedia.com. TR AINING-CONDITIONING.COM

After being forced to give up athletics due to an asthma condition, high school student Morgan Burris discovered her school’s student athletic training program. quickly. I was always mad at myself because I knew I could play, I just couldn’t breathe.” Knowing Burris’s struggles would likely continue and recognizing her intelligence, work ethic, and love of athletics, Woolbright had a hunch that the student athletic training program might be a great fit for her. He planted a seed that spring. “I just shared with her how I got involved in the profession, which isn’t that different from most athletic trainers,” he says. “I got hurt playing sports and I didn’t want to not be around my friends and other athletes.” That summer, Burris thought long and hard about her situation. When the 2010-11 school year arrived, she enrolled in Woolbright’s sports medicine class to see what athletic training was all about. “I didn’t have any clue what an athletic trainer did,” she says. “In that class, Mr. Woolbright talked about everything he does to help athletes and it really clicked with me that it was something I should probably be doing.” Armed with a new sense of purpose, Burris joined the student athletic training program. And she made the gutwrenching decision to say goodbye to her athletic career. “It was tough, but I finally decided that athletics was just too hard on my body,” Burris says. “I was really sad about quitting because I felt like I was letting down my teammates and all of the people that had supported me.” During her first year as an athletic training student, Burris followed the program’s educational progression, which begins with hydrating athletes on the field, shadowing the athletic T&C MARCH 2013

ComebackAthlete Morgan Burris Muleshoe (Texas) High School Condition: Severe acute asthma Result: Ended her high school basketball and track and field career and became an athletic training student. Plans to study athletic training in college. Quote from Muleshoe Athletic Trainer Joshua Woolbright: “She is always by my side and is a leader and mentor for the younger students in the program. In four or five years, I definitely see her in the medical profession and as an athletic trainer if she chooses that route.” trainer or an older athletic training student, and learning the basics—like how to tape. “I teach our athletic training students the fundamentals of taping, then they practice on themselves until they’ve got it down,” says Woolbright, who started the student

athletic training program in 2007. “Once I see they’ve really improved, I have them tape another athletic training student, who wears the tape job around to make sure it’s comfortable and stays tight. Then they report back to me about how it felt. “Once a student is able to tape another student with proficiency, they tape me,” he adds. “If I find that their tape job is supportive and comfortable, they’re allowed to begin taping athletes under my supervision, beginning with freshmen and working up to j.v. and eventually varsity athletes by the time they are a senior. Now, Morgan is a very skilled taper. The two of us are able to tape 67 ankles in about 55 minutes.” After spending her sophomore year working on skills and honing her newfound craft, Burris was ready for a larger role both on and off the field as a junior. Within the student athletic training program, she stepped into more of a leadership role and began mentoring younger students. And she faced her first major injury situation during Muleshoe’s first home football game of the 2011 season. Burris was standing on the sidelines helping Woolbright provide athletic training coverage when an opposing player went down with a compound ankle dislocation. In the blink of an eye, Woolbright and Burris were at the athlete’s side. “While I was taking care of the player’s leg, Morgan was talking to him, making sure he stayed calm,” says Woolbright. “When I was helping load the player into an ambulance, Morgan took the initiative to clear our equipment off the field. She also remembered to bring me the release pump for the air

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ComebackAthlete splint, which I had forgotten on the field. Amidst all the chaos that surrounds a major injury, she was able to keep a cool head. It was quite impressive to see a 16-year-old girl conduct herself the way she did.” For Burris, being on the field helping the injured player was the experience of a lifetime. It also revealed to her that she was on the right path. “When I was out on the field with the player, I was totally focused on the moment at hand,” she says. “When I got back on the sideline, I really felt the adrenaline rush and even though I didn’t like that the player got hurt, it was very rewarding being able to help him by using my skills and knowledge. Not many people get to experience that feeling. It really opened my eyes to how exhilarating athletic training can be. I was hooked.” Despite the contentment she had discovered through her athletic training pursuits, Burris still struggled with asthma every day. After visiting one specialist after another and being hospitalized on multiple occasions (she even had surgery to remove a fungus in her sinus cavities), she finally had a breakthrough in November of 2011 when doctors discovered that Burris’s asthma is allergy-induced. “Basically, my body creates a chemical reaction within itself and I’m allergic to that reaction,” she says. “I get a shot every month to ‘put the asthma to sleep,’ as the doctors describe it. When the 30 days is almost up, I start coughing more and feel my symptoms increase until I get another shot.” Throughout the rest of her junior year, Burris’s asthma kept

improving and so did her sports medicine acumen. Bitten by the athletic training bug, Burris began seeking out ways to continue her education beyond Muleshoe. In addition to obtaining CPR and First Aid certifications, which are requirements for all athletic training students in Texas, Burris attended various clinics and an athletic training summer camp co-hosted by Texas Christian University and Southern Methodist University. “She and three other athletic training students attended,” says Woolbright. “It’s about 400 miles away from our town and they raised all of the money to attend by themselves by

“One day I asked her if she ever thought about playing again, but Morgan told me she has no regrets. She says this is who she is and that she has found her niche.” selling T-shirts and soliciting family members for donations.” The beginning of the 2012-13 school year marked the start of Burris’s third year as an athletic training student. As the program’s lone senior, she is its unquestioned leader. “She is the only upperclassmen and has taken all of our freshmen and sophomores under her wing and brought them up to a level that I never could have imagined at the beginning of the year,” says Woolbright. “She also does a lot of my record keeping and helps me manage the athletic training room inventory.” Woolbright says that Burris’s professionalism carries over

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ComebackAthlete to her work with the school’s athletes. “I know she hangs out with a lot of players outside of school, but in the athletic training room she shows no favoritism and is actually tougher on a lot of them than I am,” he says. “The athletic training room is her home and she won’t tolerate anyone coming into her home and disrespecting it. She is very proud of what she does.” On the field, Burris is just as valuable. Woolbright recalls one injury-filled football practice last October when she came up especially big. A player had fractured his ulna and radius so Woolbright accompanied him to a nearby hospital. While at the hospital, Woolbright received a phone call from Burris alerting him that a lineman had just injured his knee. “Twenty minutes later I returned to school and found Morgan and the player sitting calmly in the athletic training room,” says Woolbright. "The player had changed into shorts and was sitting with ice on his knee next to a timer that showed how long he had been icing. “Morgan immediately gave me a complete and thorough history of the injury,” Woolbright continues. “She said he felt a pop when the knee rotated and pivoted in a certain direction and pointed to all of the areas he was experiencing pain. It was exactly what I wanted to know. He ended up having torn his ACL, and I was able to do the complete history workup as part of my evaluation based on the information she provided.” For Burris, having an accessible mentor has made all the difference in her rapid education. “Mr. Woolbright opened so many doors for me that I never even knew existed,” she says.

“And if I have a question, I just ask him. I don’t ever hesitate and wonder if it’s a good question or not. He has made me comfortable coming to him no matter what.” There’s no question that athletic training has enriched Burris’s life and adequately filled the void left by her inability to play sports. “In the beginning, I thought maybe it would be a good fit,” she says. “It turned out to be the best decision I ever made. I wouldn’t trade my role for anything.” Still, as Burris’s asthma improved with the new treatment, Woolbright began to wonder if she’d itch for a return to athletics. “She is at the point where I really think she could participate if she wanted to,” Woolbright says. “One day I asked her if she ever thought about playing again, but Morgan told me she has no regrets. She says this is who she is and that she has found her niche.” Woolbright says overcoming the trials and tribulations of her condition has helped shape Burris into the finest athletic training student he has ever had. He also views her as a future peer. “She is my right hand,” he says. “She is always by my side and is a leader and mentor for the younger students in the program. In four or five years, I definitely see her in the medical profession and as an athletic trainer if she chooses that route.” “I put everything I have into athletic training and love doing what I do,” says Burris, who plans on studying athletic training when she attends college in the fall. “Even though I loved playing sports, I’ve found that I would rather help other athletes more than anything else.” n

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Able to Overcome Paralympic powerlifters have the same goals as their Olympic counterparts, but there are some definite variations to their training. A veteran coach explains the nuances of working with these athletes. By Dr. Kyle Pierce

Suzy Sanchez

Olympic weightlifter Kendrick Farris (left) works with disabled powerlifter Grebil Copp in the USA Weightlifting Center for High Performance and Development at LSU-Shreveport.

owerlifting is one of the fastest growing Paralympic sports over recent years, but it also has a significant history. The Summer Paralympic Games were first held in 1960, and only 18 men, all with spinal cord injuries, from 10 countries competed in Paralympic weightlifting. In the years following, more disability groups were added to the event, and the rules began to reflect those used in able-bodied powerlifting competitions. In 1992, the event name was changed to Paralympic powerlifting, and more than 100 men from 25 countries competed. Women began competing in Paralympic powerlifting in 2000, the same year that able-bodied women began competing in Olympic weightlifting. Last summer in London, there were 200 Paralympic powerlifting competitors. Currently, more than 5,000 athletes from 115 countries are ranked worldwide. I became involved with coaching disabled powerlifters after the 2008 Olympic Games when I was asked to host a clinic on disabled powerlifting as part of a ParalymKyle Pierce, EdD, CSCS, is an Associate Professor of Kinesiology and Health Science and Director of the USA Weightlifting Center for High Performance and Development at Louisiana State University-Shreveport. He trains able-bodied weightlifters and disabled powerlifters and was named the United States Olympic Committee Weightlifting Coach of the Year in 2006, 2007, and 2010. He can be reached at: kyle.pierce@lsus.edu.

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optimum performance pic academy here at the USA Weightlifting Center for High Performance and Development at Louisiana State University-Shreveport alongside C.J. Bennett, a 20-year weightlifting friend of mine. C.J. competed in able-bodied weightlifting, performing the snatch and clean and jerk, even though he has cerebral palsy. He has also coached many athletes in both weightlifting and disabled powerlifting, including several who competed at the 1988 and 1992 Paralympic Games. Since we put on the clinic, we’ve had competitive disabled powerlifters train in our center, and we’ve coached numerous lifters with Down syndrome who have gone on to compete in the Special Olympics and USA Weightlifting competitions. All of our lifters train together regardless of abilities or disabilities. They also train yearround, because we constantly have lifters competing in various competitions from the local level to the World Championships and Olympic Games at all times of year.

injury, the athlete must be able to fully grip and control the bar. Potential Paralympic athletes must be assessed by an authorized classifier. International Paralympic Committee (IPC) powerlifting classifiers are medical doctors or physiotherapists and trained sport-specifically to assess disabilities. Competitions are divided into weight classes for men and women. Amputees have weight added to their body weight to account for missing limbs. As of Jan. 1, the Paralympic powerlifting weight categories (in kilograms) are as follows: Men: 49, 54, 59, 65, 72, 80, 88, 97, 107, 107+ Women: 41, 45, 50, 55, 61, 67, 73, 79, 86, 86+ Additions to the lifters’ body weight are made for amputees as follows: • For each through-ankle amputation, add 0.5kg. in all weight categories • For each below-knee amputation, add 1 kg. up to 67 kg. body weight and 1.5 kg. for 67.01 kg. body weight and over • For each above-knee amputation, add 1.5 kg. up to 67 kg. body weight and 2

Regardless of whether we are concentrating on just the bench press for Paralympic athletes or multiple lifts for able-bodied athletes, the workouts should be based on the scientific training principles of overload, variation, and specificity. CLASSIFICATION & COMPETITION In order to compete in Paralympic powerlifting, athletes must meet a minimum disability standard. While the first Paralympic powerlifters all had spinal cord injuries, categories of minimum disability have expanded to include all of the following: • Amputees (double or single aboveknee and below-knee amputations and ankle and hip disarticulation) • Athletes with spinal cord injuries, spinal cord lesions, spina bifida, and polio • Dwarfs (maximum height is 4 feet, 9 inches or 145 centimeters, and the athlete must exhibit another disability besides being of small stature—excluding pituitary dwarfs from this category) • Les autres (literally means “the others,” athletes with motor paresis of the lower extremity) • Athletes with cerebral palsy. A Paralympic powerlifter must be able to fully extend his or her arms with no more than a 20-percent loss of extension through the elbows. To lower the risk of 14

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kg. for 67.01 kg. body weight and over • For each complete hip disarticulation, add 2.5 kg. up to 67 kg. body weight and 3 kg. for 67.01 kg. body weight and over. The bench press has always been the sole event in Paralympic weightlifting and powerlifting. In comparison, powerlifting competitions also include the squat and deadlift, while Olympic-style weightlifting consists of the snatch and the clean and jerk. When performing the bench press, Paralympic powerlifters lay on a specially designed bench that allows them to strap their legs for additional stability. Official competition bench straps, personal straps, or a combination of the two can be used. Straps are allowed anywhere on the legs from the ankles to the top of the thigh. With the exception of amputees without hips, they can’t be placed across or above the hip line or directly across the patella, unless severe contractures of the legs dictate otherwise. The International Powerlifting Federation (IPF) allows athletes to use a sup-

portive shirt (though the IPC does not). Known as a bench shirt, it is used to improve performance in the bench press, and it is usually made of stiff polyester, denim, or canvas and comes in single- or multi-ply thicknesses. There are different rules for equipment for the various powerlifting federations, but the IPF stipulates that support shirts must be made of one-ply stretch material. As a testament to how helpful bench shirts can be, it is reported that famed powerlifter Scot Mendelson’s bench press record “shirted” is 1,030 pounds and his best “un-shirted” is 715 pounds. There are special exceptions in competition for specific disability groups. An orthosis or special shoes are allowed for les autres and athletes with spinal cord injuries. For lifters with cerebral palsy, flexed legs can be supported by a wedge. Wherever possible, the athlete’s legs, feet and/or prosthesis should be extended on the bench. (Athletes with amputations can be granted special exceptions depending on the type and level of amputation. These exceptions must be formally granted and officially verified by an IPC classifier.) As the lifter prepares for the bench press, the barbell is taken from the rack with or without the help of a spotter or spotters. The lifter holds the bar at arms’ length with elbows locked until the chief referee’s audible signal. After hearing “start,” the lifter lowers the barbell to the chest and holds it motionless. In IPF competitions, the audible signal “press” is required before the athlete presses the bar back up to the start position. The athletes must keep their arms evenly extended as they press the bar back to arms’ length and lock the elbows at the top. When the barbell becomes motionless in this position, the chief referee signals “rack” and with help from the spotters, the barbell is returned to the rack. A majority decision by three referees determines a good lift. TRAINING TIME I train both able-bodied and disabled lifters, and while there are differences between the two training programs, the same basic principles can be applied. Regardless of whether we are concentrating on just the bench press for Paralympic athletes or multiple lifts for able-bodied athletes, the workouts should be based on the scientific training principles of overload, variation, and specificity. Periodization is an effective method TR AINING-CONDITIONING.COM

optimum performance of applying these principles to most sports, including powerlifting. Our macro- and mesocycles consist of four phases. Each phase has different goals and requires different degrees of variation. Phase 1, Preparation (general and special): During general preparation, our goal is to develop strength endurance. The high volume and repetitions (sets of 10) we employ in this phase are not typically performed often by powerlifters and weightlifters, but this approach is important for several reasons when compared to using lower volume and repetitions. The athlete experiences greater changes in body composition, increases in testosterone and growth hormone concentrations post-exercise, increased resting testosterone-cortisol ratio, better performance, fewer injuries in the subsequent higher-intensity training periods, and most importantly, the establishment of a physiological and structural foundation that will emphasize maximum strength and power in further training. Special preparation is also part of the basic strength phase because itâ&#x20AC;&#x2122;s when

we develop maximal strength capacity. The gains in basic strength provide an appropriate foundation for power specialization and further high-intensity work. Large muscle group exercises for

increased intensity. Lifters focus on performing their competition lifts for single repetitions. The week of a competition is a taper week, with reduced volume and intensity leading up to competition day.

Just as weightlifters perform partial movements of the snatch or clean from the hang position or blocks, disabled powerlifters can use a power rack to accomplish overloading at various points throughout the range of motion of the bench press. strength development are generally performed for five repetitions in this phase. Phase 2, Pre-Competition: The goal in this phase is developing maximal strength and power capacity. It is a high intensity, technique-oriented phase. A sharp rise in power can be expected during this phase as a result of increased strength and the reduction of fatigue in response to decreased volume. Repetitions decrease to three, and/or clusters of three singles. Phase 3, Peaking: In this phase, performance is brought to its maximum through further volume reduction and

Phase 4, Transition: During this phase, also called active rest, lifters are encouraged to participate in another sport or activity or occasionally weight train at low volume and intensity. The length of this phase depends on where the athlete is in his or her yearly plan. Implementing exercises other than the bench press is essential for Paralympic powerlifters to improve. Exercise selection is dependent on an athleteâ&#x20AC;&#x2122;s disability, but overall, there are two main areas to address: strengthening stability and creating and maintaining lordotic curve. Because the bench press is performed

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optimum performance by Paralympic powerlifters with their legs straight on the bench, stability is of utmost importance. The development of a wide, muscular upper back can provide great support. I like any kind of rowing or pull-tochest motion to develop the upper back muscles. Seated cable rows, lying (face down) dumbbell rows, and pull-downs to the chest are among the exercises that can be performed. These exercises should be especially emphasized in the preparation phase of training. The ability to create a reasonable lor-

dotic curve (arch) in the back, if the athlete is able to attain it, is important as well. Wheelchair users in particular need upper, middle, and/or lower back work as a result of their tendency to sit forward in their chairs. This forward sitting can cause a kyphotic curve (a convex curvature) that may result in a bulge at the upper back. Performing each and every lift using a lordotic curve, when it is appropriate, is highly important. The back should be in this arched position even when performing rowing/pulling exercises.

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Dwarfs can generally perform straight-leg Romanian deadlifts or back extensions to strengthen their lower backs. Other athletes might need to perform floor back extensions without weight in order to strengthen this area. Midsection or core work, such as crunches or planks, is essential. Twisting at the top of a crunch is good work for the obliques. Weight can be added behind the athlete’s head to increase resistance when performing crunches. Pelvic tilts, as with abdominal exercises, can also be performed by those who are able. Overloading partial movements of competition lifts is another training method that can be employed by disabled powerlifters. Just as weightlifters perform partial movements of the snatch or clean from the hang position or blocks, disabled powerlifters can use a power rack to accomplish overloading at various points throughout the range of motion of the bench press. Paralympic powerlifters can also benefit from eccentric or “negative” work. Some weightlifters might lower the bar from the knee to the floor on a pulling exercise or perform negative squats on occasion. Including negative training can assist in controlling the lowering and holding of the barbell during competitions. MOVING FORWARD In our training center, athletes of varied abilities, ages, and gender train together. They have mutual admiration and respect for each other. For example, when one lifter moves so a disabled athlete can lay down his crutches or transfer to the bench from a wheelchair. Even more inspiring are the moments when an athlete performs a personal record in training. For big lifts like these, the gym gets quiet except for a few shouts of encouragement—even for a young athlete performing a lift with 15 kilograms on the bar. It is also stirring when an Olympian performs a heavy clean and jerk and then goes over to spot a disabled powerlifter who aspires to compete at the same level one day. These are welcome sights to potential lifters of all abilities. There are individual differences and considerations taken with all athletes in all sports. But I like C.J. Bennett’s advice to me about training disabled athletes best: “You train people by their ability, not their disability.” n

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w w w . N E U R O I M PA C T . n e t

a d v e r to r i a l

Neuro-Impact is clinically proven to be effective in supporting brain and body recovery after contact sport activity. Manufactured by Trinity Sports Goup, Inc. (TSG), in a GMP-certified lab, Neuro-Impact does not contain any banned or dangerous substances. The Institute of Medicine posted an article in April 2011 on the potential role of nutrition in the treatment of brain injuries. An independent clinical trial (reviewed for publication) done by Dr. W. Joe Ford, BS, DC, CCSP, of Vitality Sports Medicine showed that nutrition could be used in the treatment of brain injuries. Dr. Ford is now with the Dallas Stars to provide both chiropractic care and administer Neuro-Impact. TSG has partnered with a Baylor University Research Team, led by Dr. Rodney Bowden, PhD, to conduct further studies. TSG is also awaiting grant approval from the Department of Defense to study usage of Neuro-Impact in the military. Neuro-Impact has the dynamic ability to minimize long-term effects sustained from contact sport activity, as well as decreased recovery time. It does this by providing the brain and body nutrients that are required to promote proper neurological function and enhance the body’s own reparative processes. Brain recovery support is long overdue. Get back on track with Neuro-Impact, a breakthrough in brain recovery support. It is essential for athletes and should be included in all recovery and return to play protocols. Neuro-Impact is provided for a wide range of athletes – from the NFL and NHL, to MMA and youth hockey.

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** Patients also showed a 16.25% improvement in reaction speed.

You wouldn’t send him back on the court if he wasn’t ready.

But how do you know he didn’t sandbag his concussion test? <

Concussion Vital Signs, an online neurocognitive concussion test, aligns to current sports concussion management guidelines. This scientifically based system contains unique features like Validity Indicators, which tell you at a glance if a student’s effort or performance on the assessment was adequate. Used as part of a medical evaluation, CVS helps facilitate confident return to play decisions while helping to protect the future of your athletes in sports, academics, and life.

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Student Athletes Circle Circle No. No. 114 114

Copyright © 2012 Pearson Education, Inc. or its affiliate(s). All rights reserved. Concussion Vital Signs is a trademark of CNS Vital Signs. Always Learning and Pearson are trademarks in the U.S. and/or other countries, of Pearson Education, Inc. or its affiliate(s). 7323 10/12

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treating the athlete

Chicago Bears quarterback Jay Cutler was one of seven NFL quarterbacks to suffer a concussion this past season.

AP PHOTOS/PAUL CONNORS

ON THE

FRONT

LINES

Athletic trainers need all the assistance they can get in the fight against concussions. Fortunately, there are many new and innovative products that can help them do just that.

TR AINING-CONDITIONING.COM

By Kristin Maki

s bodies of research on concussions continue to grow, products to help prevent, diagnose, and treat brain injuries have hit the market. In this article, we take a closer look at some of these advanced products and how they are contributing to the fight against concussions. Biodex Balance Assessment Program Objective balance and cognitive testing are important parts of concussion management, as they offer sports medicine professionals a way to evaluate and subsequently monitor an athlete’s post-injury condition. By comparing post-injury data to a baseline assessment and/or normative data, athletic trainers can track athletes’ recovery for a safe return to play. “Recent studies have demonstrated that a decreased ability to maintain balance is a hallmark sign of concussion,” says Don Gronachan, Director of Physical Medicine Sales at Biodex Medical Systems, Inc. “Research has also shown that separately, current methods of concussion assessment—a graded

Kristin Maki is an Assistant Editor at Training & Conditioning. She can be reached at: kmaki@MomentumMedia.com. T&C MARCH 2013

treating the athlete

From Training & Conditioning

In the Fight Against Concussions: Reliable Resources

1450

To help athletes fully recover from concussions, athletic trainers, coaches and athletic directors need an important ally — athletes’ parents. We’ve produced a comprehensive guide on concussions specifically created for the parents of the athletes you work with.

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symptoms checklist, neurocognitive assessment, and objective balance testing—demonstrated sensitivities of 68-, 79-, and 62-percent, respectively. When used together, greater than 90-percent sensitivity was achieved.” The Biodex Balance Assessment Program toolbox includes a software program that takes athletic trainers through baseline testing, post-injury evaluation, and rehabilitation. It includes the modified Clinical Test for Sensory Integration of Balance standardized assessment, which tracks disturbances in balance dysfunction and vestibular issues post-concussion. The Balance System SD uses a 21.5inch diameter sensor pad that athletes stand on. It looks like a scale at first glance, with several foot-placement indicator lines on its surface. The pad tilts up to 20 degrees from the horizontal. It includes adjustable handles on the side that can be raised, lowered, or swung out of the way, and a touch-screen monitor. The portable BioSway system uses a static platform and includes a foam pad to stand on for more challenging tests. Both systems provide balance testing with objective documentation, comparisons to normative data, and printed and electronic progress reports. They also offer rehabilitation and protocols to help identify and improve balance problems. Ethernet and USB ports are included for easy printing and connecting with other devices. “The NCAA, NATA, and other organizations have formulated best practices for concussion management plans,” Gronachan says. “These recommendations state that baseline assessments for each student-athlete should be recorded prior to the first practice, and the same assessment tools should be used post-injury at appropriate time intervals. Biodex provides an objective balance assessment device that not only tests for changes in balance, but also estimates the contributions of the visual, vestibular, and somatosensory systems to overall balance.” concussion vital signs Research has shown that high school and college athletes’ brains are still developing. During this time, sustaining a concussion may be one of the greatest risks they encounter on the playing field and therefore must be conscientiously managed. The Web-based concussion management platform Concussion Vital Signs aims to help.

Concussion Vital Signs is a scientifically-based information system that helps clinicians coordinate care, evaluate athletes, and make informed return to play decisions. It includes easily interpreted reports with athletes’ raw scores, percentile rankings, and “Validity Indicators” to allow users a quick view of whether a student’s effort or performance during the test was valid. “Concussion Vital Signs was designed to help clinicians and athletic trainers meet the current consensus guidelines for concussion management,” says Craig Fitzgerald, Vice President of CNS Vital Signs. “The neurocognitive tests in the assessment platform are validated across numerous peer reviewed medical publications and have been used by over 6,500 clinicians, researchers, hospitals, and academic medical centers in over 52 countries. “The Web-based platform is optimized to coordinate a continuum of care where doctors and athletic trainers can share information,” he continues. “Plus, the administrative console was designed and developed collaboratively with certified athletic trainers and other clinicians to make the evaluation and management of a school-based concussion program as efficient as possible.” Along with these features, Concussion Vital Signs has a lifespan neurocognitive normative database, which enables reliable and valid testing of athletes from ages eight to 90 years old, data collection that allows parents or guardians to enter medical history when it’s convenient, an integrated SCAT2 mobile sideline assessment tool for quick concussion screenings, and the ability to capture data with a smart phone or tablet. The Halo Recent research is showing that neck strength and flexibility is a factor in concussion prevention. But neck training hasn’t always been a simple task. The Halo, a dynamic neck strengthening rotary cable attachment, can change that. The Halo is designed to get a full contraction of the neck’s muscles by applying horizontal resistance as the head rotates through exercises. As its name suggests, the Halo is placed atop the user’s head. Made from high-grade aircraft aluminum, it has an adjustable Velcro strap for vertical fit. The device is lined with a bladder that is pumped full of air for a customized fit. And it doesn’t take up a lot of space in the weightroom. TR AINING-CONDITIONING.COM

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treating the athlete “Most weightrooms have a problem with space,” says Mike Jolly, CEO and Founder of Mission Competition Fitness, which manufactures the Halo. “Four-way neck machines have a huge footprint, so a gym won’t usually have more than one or two of them. Then coaches run into timing problems— how do you get a whole football team through a neck workout if you only have one or two pieces of equipment? “The Halo solves this problem,” he continues. “They’re inexpensive and have no footprint, so facilities can have

several. If there’s a post in the weightroom, all a coach has to do is hook up a couple of Halos to it using bungee cords. If you picture the spokes of a bicycle wheel, you could have a group of players attached to the post with bungee cords working out their necks. If you have an adjustable cable machine, the Halo works great with that.” By applying horizontal resistance on the neck muscle groupings as they contract, the Halo helps build strength and flexibility. Recent research has found that both increased neck strength and

“The Clinical Advantage”™ A MESSAGE FROM BIODEX:

It’s time to add Balance Assessment to your management of concussion.

Increase the sensitivity of your concussion evaluations by adding objective balance testing – from baseline to post-injury. In fact, research has shown that adding a balance test to a concussion assessment that includes a cognitive test and a graded symptoms checklist, increased the sensitivity of the assessment to greater than 90%. A decreased ability to maintain balance is one of the hallmark signs of concussion. This can be the result of ineffective use of one or more of their sensory systems. Difficulty in postural sway control may persist, even after signs and symptoms of concussion subside. The Biodex Balance Assessment Program is the most widely used objective, neurophysical testing tool on the market today. The objective data provides a performance baseline against which post-injury performance can be compared, equipping clinicians with an important piece of the concussion puzzle. Contact Biodex to learn why athletes, parents, coaches, trainers, physicians and therapists rely on Biodex Balance Assessment for the confidence in their return-to-play decisions, or visit Biodex Balance System SD www.biodex.com/concussion for more information.

BIODEX www.biodex.com

FN:12-364 12/12

1-800-224-6339 Int’l 631-924-9000

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flexibility will dissipate the force of head impacts. “As an athlete’s head snaps back after a hit, he can slow that down if he has a strong neck,” says Jolly. “If you can slow that blow down with a strong neck, the brain is less likely to bounce off of the skull. And if an athlete has good range of motion in the neck, there’s more time to slow the hit down in the first place, before you get the bouncing effect. In doing so, not only might a concussion be prevented, but also the sub-concussive blows that can do a lot of damage over time.” Impact Sensing Mouthguard By embedding sensors inside its Impact Sensing Mouthguard, i1 Biometrics aims to help athletic trainers determine the location and level of impact sustained by athletes. The device uses sensors placed inside a VistaMaxx plastic mouthguard, which is fully functional with a tight fit on the upper teeth and sturdier than standard ethylene vinyl acetate (EVA) boil-and-bite guards. The i1 Biometrics Impact Sensing Mouthguard does not prevent concussions. Instead, it informs athletic trainers that an athlete has experienced an impact that may have caused a concussion. Athletic trainers can then use field tests to look for any signs of a concussion and/or compare test results to baseline levels obtained before the season. The sensored mouthguard fits tightly onto the upper teeth of the athlete. Because the upper teeth are rigidly attached to the skull, the mouthguard can accurately measure skull movement and calculate the acceleration and deceleration experienced by the brain. Data is recorded and transmitted in real time to a laptop or mobile device off the field. When an impact exceeds a predetermined G-force level, an alarm goes off on the connected device to alert an athletic trainer of a sizeable impact. “In 2008, the Zurich Consensus said that hits greater than 60-G in linear force are more likely to cause concussion,” says Jesse Harper, Vice President of Sales at i1 Biometrics. “Thus, when we ship the system, that’s where the threshold is set. But the alert level is completely modifiable for each athlete. “As more research is done, or if the athletic trainer would like to be alerted to lesser hits—for example, with an athlete who’s recovering from an injury—they can adjust the threshold,” he TR AINING-CONDITIONING.COM

treating the athlete continues. “So far, everything has been geared toward linear acceleration since that’s what the research has been able to collect. But we’ve added a gyroscope to our sensors so we can measure the rotational force as well. We’re looking forward to seeing how this will help improve the research and protect athletes going into the future.” Data is also kept in a cloud storage system for later retrieval. “One of the biggest challenges for athletic trainers is that they’re very busy on the sideline,” says Harper. “They’re taping, icing, and working with their athletes, so they can’t see everything that’s happening on the field. This mouthguard allows them to capture and receive information about the magnitude and location of head impacts that occur on the field—even if no one sees them happen.” Presagia Sports’ Athlete Electronic Health Records Whether it’s dealing with medical records or assessments, paperwork is a tedious necessity for athletic trainers. By integrating medical records, treatment plans, and sideline assessment capacities, Athlete Electronic Health Records by Presagia Sports allow athletic trainers to access and update information conveniently. The Web-based system gives athletic trainers the ability to track every aspect of injuries and illnesses—from a cold all the way to a concussion diagnosis and subsequent recovery process. “Assessing athletes for concussions is an essential piece of any athletic trainer’s job,” says Mitchell Slutsken, Director of Presagia Sports. “Along with the athlete’s health risk, there’s a legal risk. If you’re at an away game and an athlete gets injured, the athletic trainer may not have all of the baseline scores handy to make an informed return to play decision. With our system, that information is accessible from a smartphone or tablet—so you can complete an electronic SCAT2 with our system and it will automatically calculate the scores—and you will be able to compare them to the athlete’s baseline right away. Not only does it allow an informed decision, but it will show that you use a consistent method across the board.” Along with this functionality, if the assessments indicate that a concussion has occurred, the system has a standardized letter to print and give to the TR AINING-CONDITIONING.COM

athlete on the spot. In it, basic information about concussions and their treatment is given. Similarly, you can send notifications to the team’s other medical personnel, alerting them about the concussion. “There are obviously certain things that need to be kept private, and the system supports HIPAA compliance,” Slutsken says. “But it enables users to share this important information with other authorized personnel so that they in turn can make better treatment and medication decisions.” This also allows updates about con-

cussions or other injuries to be shared with coaching staffs of multi-sport athletes. “The great thing about an Athlete Electronic Health Record with an integrated concussion assessment tool is that it is equally applicable for a single team, schools or universities with many sports, or even Olympic teams,” Slutsken says. “So if you have athletes competing in many places, all of their information is readily accessible, regardless of where they are. Our system is extremely scalable—from high schools all the way to Olympic teams.” n

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treating the athlete

Nutrition for the Brain Companies that manufacture supplements designed to help brain function provide updates on their products.

Klean Cognitive

Athletes need mental clarity, focus, and acuity to perform at their best. Klean Cognitive by Klean Athlete is a patented, scientifically researched combination of nutrients and antioxidants designed to support the health of an athlete’s brain. Mitochondrial function in the brain cells is damaged from free radicals and oxidative stress associated with extreme physical fitness, diet, and environmental exposures. This leads to fatigued, poor functioning brain cells and lower neurotransmission. The acetyl-l-carnitine, alpha lipoic acid, and biotin found in Klean Cognitive have been the focus of research by scientist Dr. Bruce Ames, PhD. These ingredients support the mitochondrial function and energy in all living cells. Klean Cognitive is tested and certified by the NSF Certified for Sport Program. It is a unique patented formula created to provide a safe and effective foundation to live healthy, train smart, and compete at the best possible level. Klean Athlete formulas are made by Douglas Laboratories, which is backed by more than 50 years of industry leading experience, and is a trusted manufacturer worldwide. To ensure the highest quality products and meet the most rigorous standards, Douglas Laboratories controls its own manufacturing process with outstanding quality control, from start to finish. The outcome of supplementing with Klean Cognitive is cellular energy to provide a healthy functioning brain. Klean Athlete is the natural way to peak optimal performance. *These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.

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Neuro-Impact

The three tenets outlining brain trauma are prevention, diagnosis, and treatment. We’ve seen a major advancement in literally every single area EXCEPT the one most critical to athletes: treatment. Neuro-Impact, from Trinity Sports Group, Inc. (TSG), believes athletes are grateful for all that has come from the growing awareness, but no one has yet addressed how to better help athletes through their recovery when a brain injury is sustained. Neuro-Impact is an effective and safe formula to promote normal neurologic function. It has shown great results in assisting athletes in their recovery from many of the common symptoms associated with participating in contact sports and activities. The Institute of Medicine posted an article in April 2011 on the potential role of nutrition in the treatment of brain injuries. An independent clinical trial (reviewed for publication) was done by Dr. W. Joe Ford, BS, DC, CCSP, of Vitality Sports Medicine and showed nutrition could be used in the treatment of brain injuries. Dr. Ford is now with the Dallas Stars to provide both chiropractic care and administer Neuro-Impact. TSG has partnered with a Baylor University Research Team, led by Dr. Rodney Bowden, PhD, to conduct further studies, and awaits grant approval from the Department of Defense to study usage of NeuroImpact in the military. Brain recovery support is long overdue. Neuro-Impact is not a cure by any means, but could be a breakthrough in brain recovery, and should be included in all recovery and return to play protocols.

Brain Armor

By Erin Cernkovich Barrett, PhD Manager, Nutrition Science & Advocacy at DSM Nutritional Products DHA and EPA are long-chain polyunsaturated fatty acids (LCPUFAs) that are important for competitive athletes. In addition to supporting a healthy heart, DHA has also been shown to reduce inflammation, muscle damage, and muscle soreness induced by exercise. DHA is the primary structural LCPUFA in the brain and a nutrient critical for brain development and cognitive functions throughout life. As such, DHA is being evaluated as a therapy for concussions. In animal studies, DHA supplementation before or after a head injury was shown to protect the brain from the injury by reducing axonal damage, inflammation, and cell death, and limiting injury-induced brain dysfunction. The brains of supplemented animals look similar to the brains of uninjured animals. Human studies investigating DHA as a therapy for concussion are currently underway. The limited availability of DHA in foods customarily consumed in the U.S. and other countries with “Western” diets has resulted in an obvious shortfall in DHA intake. A DHA dietary supplement and foods fortified with DHA represent viable options to increase DHA intake. life’sDHA, from algae, an ingredient made by DSM Nutritional Products, is a vegetarian source of DHA. It is produced in an FDA- and NSF-inspected facility to ensure the highest quality. Currently, life’sDHA is found in over 550 foods and beverages, including Horizon Organic Milk and Minute Maid Pomegranate juice. Supplements around the world, including Brain Armor, also made by DSM Nutritional Products, are powered by life’sDHA.

TR AINING-CONDITIONING.COM

Hard Hits:

Detecting Head Impacts One Hit at a Time Head impacts are one of the top issues in sports today–from high school and college levels all the way up to the professionals, head impacts are everywhere in the news.

With headlines like these, it’s easy to see why everyone knows it’s a big deal: “House passes requirement on athlete concussion policy” “Ex-NFL players feel concussions’ long lasting damages” “Pro Athletes, Experts Warn of Concussion Dangers” “New Laws on Concussions Protect Student Athletes”

To top it off, the facts regarding head impacts from the CDC are scary. Some of them include figures such as the following: n 3.8 Million sports brain injuries occur each year n 300,000 sports brain injuries will result in a loss of consciousness n More than 250,000 concussions occur in high school football each year n 80 percent of sports brain injuries go unrecognized and undetected

head impacts. This system uses a mouthguard that wirelessly sends head impact information to the sideline, where trained medical personnel can make a better, more informed decision about the athlete. Previously, there was no way for the medical personnel to quantify and qualify the impacts an athlete receives in practice or in games. The Impact Intelligence System, which was developed by i1 Biometrics, is changing the way athletic trainers and other sports medical personnel treat their athletes. At the Impact Intelligence System’s core is the state-of-the-art intelligent mouthguard that accurately measures the linear and rotational accelerations of head impacts during sports. The mouthguard is groundbreaking in its ability to gather and disseminate impact information from inside the athlete’s head–and in the context of an individual athlete’s history of exposure and injury. The data collected on the field is transmitted in real-time to the sideline. The system makes monitoring easy as it sends notifications and alerts to its authorized athletic trainers, team medical personnel, and/or coaches via mobile devices about impacts to players’ heads. Lastly, the system serves as a complete solution beyond its real-time monitoring and reporting by providing a suite of tools supporting athlete assessment in bench versus play decisions, recovery, and safe return to play protocols.

www.i1biometrics.com info@i1biometrics.com

But, there is good news that not everyone knows about—there is a new technology system that can be used on the field of play to accurately detect

Embedded accelerometers and gyroscopes in the innovative i1 Biometrics Impact Sensing Mouthguard accurately measure the impacts and accelerations experienced by the brain.

Data is transmitted in real time via a wireless protocol to a laptop at the sideline. The laptop transmits the data wirelessly to a secure internet database.

The system sends notifications and alerts to athletic trainers, medical personnel and/or coaches via mobile devices or computers about impacts to players’ heads.

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The system also provides a suite of tools supporting athlete assessment in bench vs. play decisions, recovery and safe return-to-play protocols.

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NUTRITION

What’s for Lunch? S School lunches aren’t usually a hot topic of conversation among strength coaches and athletic trainers, but the Healthy, Hunger-Free Kids Act has changed that. By Kim Tirapelle

ISTOCK.COM

ince the implementation this fall of the Healthy, Hunger-Free Kids Act, an increasing number of high school athletes—as well as their coaches and parents—have been calling foul. Many athletes argue that the new nutritional standards, which limit high school lunches to 850 total calories, do not provide enough energy to sustain them throughout the school day, let alone meet their elevated needs for practice or competition. However, the United States is facing an unprecedented level of childhood obesity. According to the National Health and Nutrition Examination Survey of 2007-2008, 17 percent of children between ages two and 19 are obese. The Healthy, Hunger-Free Kids Act was created to help combat this epidemic, not to under-fuel student-athletes. We need to address the childhood obesity epidemic Kim Tirapelle, MS, RD, CSSD, is a Registered Dietitian for TERRIO Physical Therapy & Fitness in Fresno, Calif., where she provides individualized sports nutrition counseling to recreational, high school, collegiate, and professional athletes. She is also the Sports Dietitian at Fresno State University and can be reached at: kimtirapelle@gmail.com.

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NUTRITION

CASE STUDIES To give you an idea of what athletes’ lunches (and possible supplementation) should look like, here are a couple of hypothetical scenarios. The lunches detailed below are from the Clovis (Calif.) Unified High School lunch menu.

Matt is a junior lineman weighing 200 pounds. His season just finished and off-season training has begun. He is hoping to continue playing in college and wants to attract the attention of scouts, so he would like to put on some weight and increase his size before his senior year. A typical school lunch at Clovis might include: • Orange chicken and rice bowl (445 calories) • A banana (90 calories) • Baby carrots (20 calories) • Eight ounces of 1% milk (130 calories). Based on his weight training program and goal to increase muscle mass, Matt should be consuming approximately 4,500 calories per day. In order to round out his lunch, I would suggest he supplement it with two granola bars (200 calories) and one ounce of nuts such as almonds (160 calories), bringing his total lunch calories to 1,045.

Kylie is a 110-pound female cross country runner who follows a lacto-ovo vegetarian diet (she consumes dairy and egg products, but no meat or fish). The cross country season is nearing its end and she is looking to maintain performance as regionals loom ahead. A typical school lunch at Clovis might include: • Chili (meat or vegetarian) with a two-ounce dinner roll (313 calories) • A cup of steamed green beans (80 calories) • A cup of steamed corn (134 calories) • Eight ounces of apple juice (120 calories) • Two fruit cups (80 calories). Kylie should be consuming about 2,400 calories per day. Because she follows a vegetarian-based diet, her protein needs are 10 percent higher than non-vegetarian athletes, and her iron needs are almost two times as high. She must also eat a variety of food sources to meet her nutrient needs for vitamin B12, calcium, vitamin D, riboflavin, and zinc. Therefore, she could have the school lunch and add some additional items from home like six ounces of reduced-fat Greek yogurt (170 calories) with one ounce of walnuts (185 calories) to increase her protein, healthy fat, calcium, vitamin D, and iron intake.

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through appropriately portioned school lunches, yet provide ample nutrition to our student-athletes who require more energy to meet their performance goals. For our athletes, this requires a detailed evaluation of their eating habits and a commitment to become better planners when it comes to their nutrition. A NEW MENU The new regulations focus on increasing fruit, vegetable, low-fat dairy, and whole grain consumption, while limiting saturated fats, trans fats, and sodium. Here is a summary of the new guidelines and some recent adjustments: • The five components of a school meal are meat/meat alternative, grains, fruits, vegetables, and milk. • School lunches now have calorie restrictions. Elementary school lunches contain 550 to 650 calories, middle school lunches contain 600 to 700 calories, and high school lunches run between 750 and 850 calories. These parameters were established based upon the government’s daily calorie goals for each age group and aim to provide at least one-third of a student’s daily calorie needs. • Schools are required to serve both fruits and vegetables every day. • Students must have one fruit or vegetable on their tray and can ask for seconds of fruits and vegetables. • By 2014, all grains offered must be whole grain. • By 2014, the maximum amount of sodium allowed in a high school lunch will be 740 milligrams. • Flavored milks must be fat free and plain milk must be low fat. Although many student-athletes have complained about the reduced portion sizes and overall calories, I think the Healthy, Hunger-Free Kids Act can be a positive for them as it provides increased access to fresh, nutrient-rich foods. Before the new regulations, many athletes over-consumed foods that were high in fat and processed carbohydrates and lacked nutrients, which left them feeling artificially full. The quantity of calories may have been higher, but the quality of those calories was lacking. In addition, the higher fat content of a large lunch can contribute to gastrointestinal upset and feeling fatigued or weak in afternoon workouts or competition. Heavier lunches can have a negaTR AINING-CONDITIONING.COM

NUTRITION tive impact on an athlete’s performance without them even realizing it, while lighter lunches paired with a pre-workout snack have the potential to improve performance. I advocate using the new regulations as an opportunity for high school athletes to learn how to fuel themselves as active individuals. Even for an athlete with a daily energy requirement of 4,000 to 5,000 calories, an 850calorie lunch would be adequate as long as they follow a consistent fueling pattern throughout the rest of the day. As a sports dietitian who works with athletes of all ages, I help elite high school athletes develop individualized performance nutrition programs. Our plans always incorporate at least three full meals paired with two to three snacks, pre- and postworkout foods, and hydration. This fueling strategy optimizes muscle glycogen stores and hydration status and provides adequate carbohydrates, protein, fat, vitamins, and minerals throughout the day to meet growth and recovery needs. MOST IMPORTANT MEAL Developing a sound sports nutrition plan that meets the needs of a growing high school athlete starts before the first bell rings. Because many athletes stay up late studying after a long day of school and practice, getting in a few more minutes of shuteye can be a high priority, but eating a nutrient-rich breakfast is equally important. For athletes, starting the day with a whole grain carbohydrate source and lean protein source is crucial for kickstarting metabolism and beginning to meet energy needs for the day. Whole grain carbohydrates provide fiber, which help increase satiety, and include higher levels of vitamins and minerals such as iron and thiamine. Including a protein source will result in a more even blood sugar response and provide consistent fuel to an athlete’s muscles and brain throughout the day. Protein sources are also rich in performance-enhancing vitamins and minerals such as iron, vitamin B12, folic acid, zinc, calcium, and vitamin D. Here are some ideas for grab-and-go breakfasts that include whole grain carbohydrate and lean protein sources: • Greek yogurt topped with low-fat TR AINING-CONDITIONING.COM

granola or dry cereal, paired with eight ounces of orange juice • Two to three whole grain frozen waffles topped with peanut butter and a banana, paired with eight ounces of low-fat milk • Two hardboiled eggs and two slices of whole wheat toast with jelly, paired with eight ounces of low-fat milk • A bowl of oatmeal or cereal topped with low-fat milk and berries • One scrambled egg with black beans and shredded cheese wrapped in a whole wheat tortilla, paired with fresh

fruit and eight ounces of low-fat milk • A whole grain bagel with cream cheese or peanut butter, paired with fresh berries and eight ounces of low-fat chocolate milk • A smoothie combining fruit, lowfat Greek yogurt, and fruit juice with two slices of whole wheat toast topped with peanut butter. SNACK TIME By the time an athlete gets to first period, lunch is anywhere from three to six hours away. Unfortunately, due to lack

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NUTRITION of planning, many student-athletes rely too heavily on their school lunches to provide the majority of their energy intake during school hours. Instead, all high school athletes—regardless of sport, gender, size, or calorie needs— should be fueling and hydrating every two to four hours throughout the school day to provide consistent nutrient blasts to muscle tissue. To do so,

pre-workout snacks should be paired with liquids such as water, low-fat plain milk or flavored milk, 100-percent fruit juice, or a sports drink for hydration purposes. Quick and easy ideas include: • Two granola bars or cereal bars • Low-fat yogurt with fresh fruit • Trail mix or low-fat granola with dried fruit

Although many student-athletes have complained about the reduced portion sizes and overall calories, I think the Healthy, Hunger-Free Kids Act can be a positive for them as it provides increased access to fresh, nutrient-rich foods. mid-morning and mid-afternoon and/ or pre-practice snacks are a must. Student-athletes have time to grab books from their lockers between classes, so they should be able to grab a snack from their backpack at the same time. Or, if need be, they can work with teachers to find appropriate class times to eat a quick snack that will help them meet their elevated energy needs. Mid-morning snacks should combine carbohydrates with protein or healthy fat sources. This helps to keep energy intake consistent between meals and will also prevent an athlete from feeling excessively hungry by lunchtime. Snacks that meet these requirements and can be packed in a backpack include granola bars with protein, fresh fruit, trail mix with nuts and dried fruit, peanut butter and jelly sandwiches, and shelf stable meal replacement shakes. The mid-afternoon and/or pre-workout snack should be high in carbohydrates, moderate in protein, and low in fat and fiber. These guidelines ensure that the energy the athlete consumes pre-workout will be available to their muscles quickly. Carbohydrates help top off muscle glycogen stores. Protein sources provide amino acids to the muscles that will be available in time for recovery after exercise. And high fiber foods such as raw vegetables, high fiber whole grain muffins, cereals, and breads, and high fat food sources like oils, sauces, cheeses, and high fat meats should be limited as they delay gastric emptying and therefore slow the availability of energy to the muscles, causing gastrointestinal upset. The following mid-afternoon and/or 30

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• A low-fat pudding cup with wafer cookies or graham crackers • Two oatmeal cookies • A bagel with low-fat cream cheese. A LITTLE EXTRA High school athletes should supplement their 850-calorie lunch based on calorie levels required. The Healthy, Hunger-Free Kids Act allows students to request seconds of low-fat milk, fruit, and vegetables. Most high schools also have additional a la carte items for purchase. In the Clovis (Calif.) Unified School District, for example, 7th through 12th

snacks, graham crackers, animal crackers, dry cereal, cheese and crackers, peanut butter and crackers, nuts, and seeds are also healthy choices. FINANCIALLY SPEAKING Providing snacks throughout the day is the responsibility of the student-athlete, and some athletes’ families may not be able to afford them. But there are some financially friendly avenues that athletes can explore. For example, the booster club may be an option. A team or the team’s coach can ask its booster club to purchase pre-practice snacks or recovery snacks for the team. Fresh fruit or fruit cups, granola bars, bagels, nuts, yogurt cups, pudding cups, pretzels, sports drinks, and low-fat chocolate milk can all be purchased in bulk by a booster club. If the team has some parents who like to be involved in projects, they might be willing to make peanut butter and jelly sandwiches or small deli meat sandwiches once a week. Putting them in the athletic training room and/or locker room would encourage athletes to grab a bite on the way to practice. Local restaurants, food service companies, and farmers markets might be willing to partner with your school or team and exchange pre-practice or pre-

The mid-afternoon and/or pre-workout snack should be high in carbohydrates, moderate in protein, and low in fat and fiber. These guidelines ensure that the energy the athlete consumes pre-workout will be available to their muscles quickly. graders can purchase a la carte items like a chicken sandwich, bean and cheese burrito, chicken wrap, chicken or steak tornados, baked chips, lowfat ice cream sandwiches, and low-fat chocolate chip cookies. These entree items can add up to 400 calories each to an athlete’s lunch and the snacks up to 250 calories each. Many schools also have student stores that sell food. Student-athletes should look for options that provide complex carbohydrates with protein and healthy fat sources. Some good choices include beef jerky, cereal bars, Chex mix, corn nuts, granola bars, peanuts, popcorn, pretzels, and trail mix. If the school has a vending machine, baked chips, dried fruit, fruit

game food donations for free publicity. This could include signage at athletic events, an ad in a game program, or mention of them as a team sponsor during media broadcasts. Finally, some sports drink or protein drink manufacturers may be able to donate their products to nonprofit entities such as school teams. Explore and take advantage of all of these options. The Healthy, Hunger-Free Kids Act doesn’t have to be a challenge for athletes. In fact, the fresh and healthy foods that it provides are a positive. Supplementing with proper fuel before and after lunch can make or break an athlete’s nutrition, but it’s up to them to do a little planning and take the right route. n TR AINING-CONDITIONING.COM

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ROD SEARCEY

Author Keith Power (far right) poses with (from left to right) Head Athletic Trainer Ryan Cobb, Head Strength and Conditioning Coach Mike Blasquez, and Athletic Director Sandy Barbour in Calâ&#x20AC;&#x2122;s Simpson Center for Student-Athlete High Performance.

LEADERSHIP

TEAM APPROACH In an effort to take its athletic program to a higher level, the University of California has implemented a unique new philosophy focused on collaboration, using best practices, and maximizing efficiencies. By Keith Power

ometimes, small observations evolve into really big ideas. During her career as an athletic administrator, Sandy Barbour had always been bemused at how little strength and conditioning coaches and athletic trainers communicated and collaborated with each other. Since becoming Athletic Director at the University of California in 2004, that observation has evolved into a unique philosophy on how to achieve top performance using a model of practice quite unlike other collegiate athletic departments. Called Cal High Performance, this philosophy challenges conventional ways of thinking about and delivering services to student-athletes. It demands collaboration among all staff, strives to maximize efficiency, and challenges everyone to be innovative. It is an initiative Cal has invested in to build a competitive advantage and ensure a world class student-athlete experience. The Cal High Performance philosophy has been seven years in the making and almost all of the pieces are now in place with the opening of the Simpson Center for Student-Athlete High Performance in 2011. At the same time, it is TR AINING-CONDITIONING.COM

a dynamic process that we continue to improve on every day. A DIFFERENT MINDSET Cal has had its share of athletic success and academic achievement. It has produced professional athletes like Jason Kidd, Kevin Johnson, Aaron Rodgers, and Marshawn Lynch and standout Olympians like Natalie Coughlin, Nathan Adrian, and Alex Morgan. In its ranks are a dozen coaches who have been chosen to work with Olympic and national teams. Cal is also ranked as one of the top 20 academic universities in the world. Upon arriving at Cal, Barbour wanted to take the athletic program to an even higher level. She asked fundamental questions about how strength and conditioning coaches and athletic trainers could better work together. This evolved into discussions about sports

performance, and then how all support services and coaches could collaborate more effectively. Without the deep pockets that some NCAA Division I athletic programs have, Barbour needed to be creative in implementing a new philosophy. She looked to best practices in sport worldwide and thought about what would fit the culture at Cal. Cal High Performance is the philosophy that now guides our athletic department. At its core, it is about aiming to be world class in all that we do at every level of support. Along with having high expectations for our athletes, we have high expectations for our leadership team, marketing department, business and finance office, custodians, and interns— everyone in athletics has to be invested. Just as important, it’s about all staff members communicating and collaborating. We strive to share information

Keith Power is the High Performance Director of the Intercollegiate Athletics Department at the University of California, coordinating the areas of sports medicine, strength and conditioning, sports science, and coaching development. A former international track and field athlete and bobsledder, he has coached Olympians, consulted for globally renowned business organizations, and published articles in academic journals and presented at conferences in the area of performance psychology. He can be reached at: keithpower@berkeley.edu. T&C MARCH 2013

LEADERSHIP at every turn so our athletes receive the exact support they need at the time they need it. Our academic counselors pass on observations to strength coaches, who collaborate with athletic trainers, who talk to coaches, and so on. Everyone works hard to be on the same page. In 2009, I was asked to direct this new initiative, which was a huge honor and privilege. The position is actually fairly commonplace in Olympic sports across the globe and many professional sports outside of the U.S., although I believe I am the only High Performance Director (HPD) in collegiate sport in the U.S. My job as HPD requires expertise in three key areas. The first is organizational development—the ability to help

cation tool when talking to our staff members about our new philosophy. The pie consists of five key performance factors that most directly impact athlete performance: Skills: sport specific skills and academic skills Fitness: sport or position specific fitness requirements and wellness Mental toughness: resilience, coachability, focus, and confidence Lifestyle management: organizational skills, study habits, and developing life skills Culture: the student-athlete, team, and departmental environment. There are several things to note about these performance factors. First, each

“Being able to get together and talk is important because I might hear something from an academic advisor at the meeting that relates to performance ... Maybe the athlete is in the middle of doing applications for graduate school.” the department be excellent in planning, organization, and leadership/management, as well as develop a high performance culture. To this end, I also serve as one of seven people on Cal’s Leadership Team. The second is expertise in coaching, including coach education and coaching science. Third, I oversee strength and conditioning, sports science, and sports medicine. Day to day, I serve and integrate 29 sports, 850 athletes, 80 coaches, and 40 support staff members (strength and conditioning, sports medicine, and sports science) in the pursuit of providing a great experience for our athletes. I’d say that my role is akin to that of the conductor of an orchestra. All parts of the orchestra sound good on their own, but having the conductor bring them together produces music that sounds truly great. Similarly, coaches, athletic trainers, strength and conditioning coaches, and sports scientists can all perform well independently, but getting them to perform together like an orchestra can produce enhanced performance. PIES & PLANS Before I describe how we’ve implemented Cal High Performance, let’s go back a step. To get everyone on the same page, it was important to develop a model of what high performance entails. We developed the Cal High Performance Pie to use as a communi3 4

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area impacts the others. For example, mental toughness has a huge impact on the ability of the athlete to maximize skill development and fitness, and to study effectively. Second, all five factors are important. Teams that have great physical talent but a rotten culture often underachieve. No amount of time dedicated to skill development and fitness will ever make up for not fixing the culture. Third, the level of importance athletes place on each factor may vary. For example, in a sport like golf, the time allotted to mental toughness training will likely be greater than the time allotted to strength and conditioning. Likewise, a freshman entering the tough academic atmosphere at Cal may need to focus on lifestyle management while the senior with professional aspirations is focusing on sports skills and mental toughness. Each athlete’s Performance Pie is unique, and we strive to develop performance plans for that individual accordingly. That’s something I’ve really emphasized to our coaching and support staff. How can we maximally individualize the performance plans of our athletes using the resources of their sport? Consequently, a central goal of Cal High Performance is to work with coaches to implement and support customized performance plans for each sport as well as each individual ath-

lete. Head coaches direct their teams based not only on their coaching philosophies, but also through a customized plan developed through very specific, evidence-based information. DELIVERING HIGH PERFORMANCE So how do we implement our High Performance philosophy on a daily basis? The delivery mechanism is based upon being excellent in four key areas throughout the entire department: communication, information, collaboration, and innovation. The expectation is that each department has specific goals and strategies for how it will excel in each area. Communication: In an intercollegiate athletics environment, over 90 percent of every individual’s time is dedicated to some form of communication. It comes as no surprise then that poor communication can easily obstruct performance, whereas great communication creates and sustains high performance. It never ceases to amaze me how important communication is in any organization and yet how little emphasis is put on doing it well! Two ways that we are striving to be world class at communication are through High Performance Team Meetings (HPTMs) and annual High Performance Plans for each sport. The HPTMs involve a weekly or twice monthly meeting of all staff on a particular team who directly impact studentathlete performance. The goal is to keep the year-long plan on track and maximize communication with all of those who are part of the program, including the coaching staff, athletic trainers, strength and conditioning coaches, sports scientists, nutritionist, operations staff, and academic advisors. Our Head Men’s Water Polo Coach, Kirk Everist, likes to assemble his group at least every two weeks. “We manage a lot of kids and some of them might communicate more openly with different staff members,” he says. “Being able to get together and talk is important because I might hear something from an academic advisor at the meeting that relates to performance in the pool, such as an athlete’s workflow or stress level. “Maybe the athlete is in the middle of doing application for graduate school and I didn’t know,” he continues. “Or maybe I knew it but wasn’t really paying attention.” The annual High Performance Plan dictates that we vigorously review each sport team and its coaching staff. PerTR AINING-CONDITIONING.COM

LEADERSHIP formance reviews aren’t always popular with coaches. They want to coach and recruit, which is only natural, and sometimes taking the time to build in better efficiencies can appear a chore rather than a benefit. But having each sport program go through a review process to understand where strengths lie and improvements are needed is critical to high performance. In the reviews, head coaches sit down with me, Barbour, and their sport supervisor at the end of each season for an analysis of the program, their own performance, and the performance of their assistants. Very importantly it is a 360-degree process, which allows head coaches to give feedback about how the department can better support them. From the review, we develop an annual High Performance Plan. This involves me working with the coach to understand the performance needs of the program, including recruitment periods, fitness testing, sports science needs, periodization, and more, and building a blueprint accordingly. “I think all of us tend to plan for the & conditioning 2013.pdf 1 2/22/2013 year, but training sometimes you get caught up

putting out fires,” says Everist. “Keith gives us the framework for an overall season plan that, as a coach, you are going to make work for you specifically. I think the overall structure of it is really good. It was something I hadn’t seen.” Information: Another critical part of Cal High Performance is for administrators, support staff, and coaches to base decision-making around asking the question, “What’s the evidence and what’s the best practice?” When analyzing and diagnosing performance challenges, we do not base our solutions on gut feeling and experience alone, but rather on evidence. The more data driven we become, the better the quality of the decision. Why guess when you can know? To these ends, we are committed to Evidence Based, Best Practice (EBBP). EBBP is in direct contrast to using information based upon rules of thumb or tradition. By using the best and most reliable information possible to inform our decisions, we will ultimately arrive at better outcomes. When I first arrived here at Cal, I challenged my staff to look at ways we could get better by using data. “Keith 2:57:33 PM sat us down and said, ‘Let’s create

structure and integration,’” says Head Strength and Conditioning Coach Mike Blasquez, CSCS, ATC. “Part of this was to implement a much more sport specific and scientific approach to how we are measuring and monitoring fitness. We have also developed a great tracking system that allows us to run reports and continually direct progress for coaches on a day-to-day basis.” Here are some of the specific technologies and data we have implemented: • Medical screening to assess potential muscular-skeletal weaknesses • Best practice fitness testing and monitoring protocols specific to each sport • “Cloud based” performance logs where student-athletes can report sleep, academic load, stress, and perceived training loads • Heart rate recovery tests (HRRT) and IGA (Immoglobuin) “real time” collection to monitor training responses and adjust training loads • Game film and video analysis • EEG (electroencephalogram)-based biofeedback evaluation and training to establish and develop areas of mental skills development

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T&C MARCH 2013

LEADERSHIP • Staff and coach education support based around the latest sports performance research • Kiosks in weightrooms, which electronically track and monitor every lift made by every athlete • Nutritional data to enhance athlete performance • The development of a sports IT platform for every program in which there is a one-stop shop for data analysis and monitoring of all aspects of student-athlete performance.

Our sports medicine team also took a hard look at how it ran itself, recognizing that it needed to implement EBBP in every area of its work. This meant continually asking itself the question, What works and what doesn’t? It also meant delving into the basics of the profession. How can we do it here? How do we cover sports? Do we need to have experienced athletic trainers on the road all the time, or are their services better used on campus? “Where Keith really started to fill

in the blanks was not only with evidenced-based practice, but best practices from around the world,” says Head Athletic Trainer Ryan Cobb, MS, ATC. “College athletics tends to look inward. Keith brings to the table a very broad perspective of what works around the world.” Collaboration: Prior to coming to Cal, I spent a fair share of time involved in collegiate programs where I found support staff often worked in silos and felt disenfranchised from their

FACILITY WISE A final piece of our HP Initiative was the opening of the Simpson Center. This performance facility enables us to fully put our philosophy of communication, information, collaboration, and innovation into place. Here are some of the highlights: HP Zone: At the core of the Simpson Center is the High Performance Zone, which includes an 18,700 square-foot multipurpose area that spans two stories and stretches the length of a football field, allowing up to 100 athletes to work out at one time. The expansive free weight area includes six training pods, each with four inclusive training stations. Each station is designed to accommodate every aspect of a workout in one location. This allows athletes to complete a training session without the need to move or wait for equipment. The HP Zone also includes a series of selectorized exercise machines, a full complement of cardio machines, and rehabilitation spaces with state-of-the-art AlterG treadmills. The center has a 15 x 30-yard block of artificial turf, which provides functional space for a multitude of previously unavailable training, including fitness assessments, warmups, medicine ball work, sled pulling, speedagility-quickness training, sprint mechanics, plyometrics, reconditioning, and rehabilitation. Supporting the high performance goal of being information and data driven, pillar-mounted, touch screen monitors provide athletes and staff with access to electronic training journals on demand. Real-time tracking of sets, reps, and weight integrate with ongoing assessments and performance plans to individualize training. Rehab: To reduce time demands for athletes, we took great care in designing our rehab spaces. At the end of our workout space, we built a therapy room beside the locker facilities so that our athletes can quickly negotiate training, therapy, and locker room facilities before and after training and competition. Treatment in these spaces

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includes preventative care, massage and chiropractic care, examination, and manual and physical therapy. A rehabilitation area outside each room provides open space for extended movement therapy and reconditioning. We also have extensive therapy pools, including three Polar Plunge pools, a warm water pool, state-of-the-art therapy pool, an underwater treadmill, and adjustable flooring and underwater video analysis for medical rehabilitation. In tandem with evidence-based research for up-to-date practices, athletes and staff use this pool technology to monitor recovery to a degree previously unseen in intercollegiate sport. Operations Center: This is a cluster of offices for department leaders in the areas of athletic training, physical therapy, strength and conditioning, performance psychology, physician care, sports physiology and biochemistry, and high performance. The offices open directly to the HP Zone’s training floor and offer immediate access to ongoing training, assessment, and rehabilitation. Bringing our core leadership together reinforces an open, collaborative environment. As coaches, athletes, and support staff train, the HP Zone becomes an open forum for learning, observation, and integration across disciplines. Training Table: A restaurant-quality food service and dining area, the Training Table includes a full-service kitchen and 3,000 square-foot eating area. A unique nutrition monitoring system that will generate data to help prepare food for individualized training and recovery is in development. This includes a check out system that automatically calculates and transmits nutrients from food choices into an electronic training journal. Additionally, we source only high quality fresh foods that are wholesome, and when possible, organic, local, and fair trade certified. Together, the sports dietitian and executive chef collaborate to create menus of high quality, performance based foods and fluids for our athletes.

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LEADERSHIP coaches. There has always been a huge emphasis on team in U.S. sports when it comes to the performers, but somehow being a team with your support staff isn’t often a priority. I cannot emphasize enough the power of collaboration and integration in athletics. The five key factors of student-athlete performance— skills, fitness, mental toughness, lifestyle management, and culture—do not exist in a vacuum. My job is to ensure we integrate these factors for each team and individual. The aim is for coaches and support staff to continually assess and monitor athletes’ performance needs, then work jointly to improve strengths and address areas needing improvement. How well we work together can make the difference between a good and great performance and a good and great studentathlete experience. One example of the collaboration process is with our women’s soccer team. Working with Head Coach Neil McGuire, we identified three critical areas—performance monitoring, performance analysis, and sports psychology—as being good investments for helping his program perform more consistently on a national level. These areas were developed in an integrated, collaborative manner, and not in isolation of each other to produce enhanced outcomes. “Performance monitoring allowed us to have a better sense of how our athletes were recovering from their training and games,” says McGuire. “We used an Interdisciplinary Performance Log, which provided information on training load, critical training variables, and noteworthy lifestyle factors, including academic stressors, to assist in monitoring the health and performance of each player. We also used the HRRT and IGA saliva testing to understand each athlete’s fatigue level and then determine the intensity of their training for the week to make sure they would have fresh legs for games.” The logs, HRRT, and IGA salivary monitoring are collected by a sports science intern and monitored and analyzed by our sports physiology expert, Joe Dunbar. Dunbar then communicates the information to the soccer coaching staff, strength and conditioning coach, athletic trainer, nutritionist, and me. Individual and team training adjustments are made as a result. In addition, to improve analysis of team performance, McGuire has worked with Professor Mike Hughes, PhD, an advisor to Cal and one of the world’s top experts in the area, over the past two years. “Performance analysis through video has became increasingly more specific with a deeper understanding of the layers you can explore,” says McGuire. “We also used video to educate the players, which allowed for significant improvement in team cohesion, ultimately leading to a better understanding of individual and collective roles by position.” The women’s soccer team has enhanced its mental game in several ways. As well as being the HPD, I am also an AASPaccredited Sport Psychologist and work with several of our programs, including women’s soccer. “Our use of sports psychology over the past couple of years has very simply created a more mentally strong and mature team,” says McGuire. “Giving our players an understanding of how to manage stress, create positive self-talk, and use imagery as a means to better prepare for games gave us an edge. It also showed up in our training—players took a much more disciplined approach to their development.” Innovation: Cal is known globally for its research innovaTR AINING-CONDITIONING.COM

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LEADERSHIP tions, changing the world, and producing thoughtful leaders, and we strive for this in our athletic department, too. Innovation can happen in two different ways. One is a novel idea or approach. The second is being creative with the resources you have. One coach who exemplifies the first approach is Teri McKeever, our Head Women’s Swim Coach, who served as the Team USA women’s coach at last year’s London Olympics. She is recognized as an influential innovator in the sport because of her unique train-

ing methods and for turning unnoticed or burned-out swimmers into champions. In the early 2000s she questioned the conventional wisdom of high yardage and almost exclusive pool work in collegiate swimming. She cut yardage, built in significant rest during the week, and put a big emphasis on other training modes like Pilates, circuit training, dry land drills, and weight training—with great success. “As the head coach of the program,” says McKeever, “I am constantly managing my athletes by asking myself

1-800-4-SAMSON WWW.SAMSONEQUIMENT.COM Circle No. 124 38

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questions. ‘What do they really need in this workout? What do they have on their plates with school? Are they rested enough to be engaged mentally but at the same time being challenged constantly?’ For me, the answer to each of those questions results in daily progress and a high performance culture.” On the sports medicine front, Cal is one of the first athletic departments in the country to make diagnostic musculoskeletal ultrasound available to athletes in the athletic training room, and even on the sidelines. Musculoskeletal ultrasound makes use of sound waves to image muscles, tendons, and ligaments without radiation and with greater resolution than MRI. In addition to accurate and immediate diagnoses, ultrasound also allows our sports medicine providers and specialists to make safer return to play decisions and offer cutting edge treatment options. THE CHALLENGE OF CHANGE There has been an enormous amount of change in Cal athletics over the past seven years, and it has not always been smooth sailing. Changing the behavior of stakeholders has been challenging. It would be disingenuous of me to claim otherwise. The key has been to not force change on anyone, but rather to collaborate and discuss ideas. Cal High Performance is not a top-down philosophy. That never works if you want to achieve sustained high performance. Working with our 24 head coaches and 70 assistant coaches is a huge part of what I do on a daily basis and is both an exciting and very challenging part of the job. It is challenging because in many respects we are putting a man on the moon. No one has done what Cal is doing in college sport. It is exciting because we are seeing results. Over the past five years we have been in or around the top 10 of NACDA Directors’ Cup standings, placing third two years ago, and have won more than 20 NCAA individual or team championships. It would be erroneous to attribute this to Cal High Performance alone, as many of our programs have been successful for many years. However, every day, we see how improving communication, collaboration, information, and innovation pushes our student-athletes forward. As in business, a world class system and process combined with world class people will produce world class results. n TR AINING-CONDITIONING.COM

sport specific

Soccer Strength An overhauled strength and conditioning program put together by two coaches new to campus has helped reinvigorate the Pepperdine University women’s soccer team.

By Matt Young & Jamie Faro

hile outsiders may assume life here in Malibu, famous for its cool ocean breeze and surfing sights, is slow and relaxing, that’s only because they have not been on campus to see a Pepperdine Universit y women’s soccer team training session. The energy-packed strength and conditioning workouts reflect a culture of focus, energy, and intensity from driven athletes whose goal is to not only win conference championships, but be successful on the national level. The players chase these goals in every training session— with impressive results. The 2011 season was a huge success for the Waves as they went 15-14, winning the West Coast Conference title and earning a berth in the NCAA Division I tournament. The team was ranked as high as third in Division I (a school record) and ended the year ranked 10th—the second best end of season ranking for the Waves since the inception of the program in 1993. The team continued its success this past season, ranking in the top 20 for

Lynn Williams was a key player in the squad’s return to the NCAA Division I Tournament in 2011—its first trip since 2005.

Pepperdine Athletics/Stephen Wandzura

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Matt Young, MEd, CSCS, is the Director of Strength and Conditioning at Pepperdine University. He can be reached at: matt.young@pepperdine.edu. Jamie Faro, MS, CSCS, is the Assistant Strength and Conditioning Coach at Pepperdine. She can be reached at: jamie.faro@pepperdine.edu. T&C MARCH 2013

sport specific much of the season and returning to the NCAA tournament. Several key changes occurred at Pepperdine leading up to this recent success. A new Athletic Performance Center opened in the fall in 2009, which coincided with the formation of a strength and conditioning department and hiring of the school’s first Director of Strength and Conditioning, Matt Young, MEd, CSCS. Assistant Strength and Conditioning Coach Jamie Faro, MS, CSCS, was hired the following fall. Soon after, they started working with the women’s soccer team and completely overhauled its training regimen. TEAM CULTURE When the players began working with us in the spring of 2011, we felt it was critical to instill a defined team culture around strength and conditioning. Without one, workouts would lose purpose and the outcome would be poor. After discussing team goals with the coaching staff, we defined our philosophy and team culture with three words: Focus, energy, and intensity. If we could get the players to bring these principles into each and every session, they would create an environment that demands

The team’s focus begins from the start of every session with the warmup. We prefer warmups that are run off commands from the strength and conditioning coach, which gets the athletes focused on the task at hand. Otherwise, the warmup can easily turn into a social gathering where teammates discuss their personal lives instead of concentrating on the assigned movement. An offcommand warmup places the focus on completing the movements correctly in a systematic fashion. Rather than calling out the movement and having athletes complete it for a set number of yards, we break each dynamic warmup movement into several commands. For example, during the warmup we perform an exercise called “handwalk to downward dog.” We give the athletes several commands throughout the exercise that allow us to control the amount of time they spend in each position. The athletes begin the exercise standing and upon the command “down” they reach down to touch the ground. Upon the command “out” they walk their hands out to a plank position while pushing their legs back to stretch their hamstrings. “Back”

The players needed to grasp that their energy level could influence a teammate to get in another round on a conditioning test, squeeze out another rep in the rack, finish the squat hold, and more ... Many had not experienced teammates pushing and challenging each other before. relentless pursuit of excellence in the weightroom and on the field. Here’s a deeper look at how each of these concepts manifests itself during a workout. Focus: Part of our coaching style is to have the athletes learn a movement by focusing on the details. Once they can execute the movement flawlessly, they won’t need to be reminded every rep to have better posture, finish with the hips, or hit the correct depth. Players who “get” the movements quickly can also help any struggling teammates. Rather than strength coaches being the only ones correcting technical miscues, in our team environment the athletes are held accountable for their teammates’ actions as well as their own. Everyone is focused on the same thing. 40

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tells them to raise their hips in the air as they go into a downward dog position. From that position, “peddle” allows them to move and bend their knees back and forth to stretch their calves and Achilles’. And “up” tells them to walk their feet to their hands and stand back up in the starting position so they are ready for the next rep. After each movement ends and the athlete returns to the start position, they are required to count out loud which rep they just finished. The idea is for the players to move in unison. This type of warmup makes for a great start to a workout because it takes a lot of focus to stay in sync with each other. It’s worked so well at getting everyone tuned in that the team has even decided to use an off-

command warmup before games. This initial focus then carries over to our training sessions. Athletes are dialed in after the warmup, ready to watch any demos, listen to the concepts and coaching cues, and understand the sets and reps that will be completed. For new movements, we complete demos and teaching sets together as a team before the team breaks up into partners for their working sets. We demand that the players focus on details during their workouts, much like their coaches do during practices and games. Therefore, we restart a set if athletes are not following directions or partners fail to provide correct technical feedback to each other. Energy: Once the culture of focus is established, it is coupled with energy. Focus comes first because energy without focus can spell disaster, especially when quickly and aggressively moving weights. In contrast, energy with focus creates an atmosphere of development. Weights are still moved quickly and aggressively, but with sound technique so improvements come faster and injury potential is lower. The players also needed to grasp that their energy level could influence a teammate to get in another round on a conditioning test, squeeze out another rep in the rack, finish the squat hold, and more. This was a learning process for the players, since many had not experienced teammates pushing and challenging each other during strength and conditioning sessions before. When we first started working with the team, we brought sessions to a dead stop whenever the energy level dipped too low, addressing the entire squad at once. We told them we would not allow sessions to be quiet and reserved. We often had them look over to the banner listing the team’s WCC conference championships and NCAA tournament appearances and made reference to the blank spots for the past few years. We talked about their energy being a product of their determination and drive to put “2011” up on that banner. If discussions weren’t effective, extra reps or sets were added to workouts. When this happened, the energy level went up dramatically. Seeing a teammate struggle across the weightTR AINING-CONDITIONING.COM

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• Firstbeat SPORTS software • Firstbeat team receiver with tripod • Firstbeat heart rate belts • Printed technical manual • Tutorial videos and installation packet on a memory stick • Team duffle and mesh heart rate belt holders PRICE: Team Packs starting at $4,100 Firstbeat team receiver Real time monitoring of 80 athletes / 150-meter range Firstbeat Dongle Real time monitoring of 10 athletes / 20-meter range Firstbeat boDYgUarD For accurate and comfortable daily stress and overnight HRV recording Other compatible devices Garmin: FR610, FR910, FR310XT Suunto: t6d, Memory belt, team pod Polar: RS800cx, CS600, S810, team system2 (exports) For more information contact: John LaLLy john.lally@firstbeat.com (310) 259-2277 FIRstbEat tEChnoLogIEs Ltd. Yliopistonkatu 28 A FI-40100 Finland www.firstbeat.fi/sports twitter: @Firstbeatinfo

sport specific room or field triggered an automatic response of encouragement from a player because there was pressure to succeed. Intensity: There is a level of intensity that is only felt when focus and energy come together. Once the team bought into those ideas, intensity became second nature. Sessions were loud, encouraging, and competitive. The culture was complete and the team was primed for success. When intensity is consistently raised in training sessions, it can change an entire season, and the players figured that out very quickly. OFF-SEASON PROGRAMMING The team’s off-season is just 13 weeks long, including spring break at week seven. We have to work within the time constraints and account for an intense spring ball slate of six games during weeks six through 10 when designing the team’s off-season program. Overall, we were tasked with packaging a standard periodized program of speed, agility, and strength/pow-

er training within the new culture of focus, intensity, and energy. We scheduled 30 lifting sessions and 20 movement/conditioning days in the off-season program, which was broken down into three phases. Phase I consisted of three weeks of general prep work, which included three days of strength work and two days of speed/agility/conditioning each week. The goals were to familiarize the athletes with the structure of the program, introduce them to a new battery of fitness tests, and increase their mental toughness and focus. Every training session was held on the field until all the players reached an acceptable level of physical and mental toughness. We kept exercise selection simple and used basic teaching progressions to provide the athletes with the foundation they needed prior to entering the weightroom. The players completed a lot of body weight exercises, including squats, lunges, pushups, and planks, progressing from a hold in a static position to a dynamic movement version. Before any external load

(medicine ball, weighted vest, etc.) was added, athletes were required to master the movement at the prescribed set/rep progression. Much of this early training was done in partner format where one athlete worked while the other provided feedback. This made each athlete accountable for her own actions as well as her partner’s and did not allow either to lose focus throughout the session. If a player couldn’t master a movement, the whole team would rally around her and give her their focus and energy to get her through the set or rep. The struggling player was motivated to give everything she could. Our final day of this phase revealed the strength of our players as individuals and concluded with our strength as a team. The team did repeated sets of walking lunge holds, with a few players repeating sets due to failed prior ones. The team finished together with one of the hardest and longest sets, resulting in the loudest and most intense session that spring. Conditioning sessions included one change of direction/technique day and

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sport specific one strictly fitness day per week. Conditioning sessions were typically completed following team practices and were extensive. Change of direction days involved working in distances of five to 25 yards, and sufficient rest time between sets allowed us to give feedback and for teaching moments to occur. A major emphasis with change of direction during the first three weeks was teaching the athletes the basics on how to decelerate their bodies in a safe and efficient manner. We broke down the basics and emphasized hip height, knee angles, and weight distribution during each drill until every athlete was able to safely decelerate her body in both the frontal and sagittal planes. On fitness training days, working distances were high (400 to 1,000 yards), rest-to-work intervals were low (2:1), and the intensity of work was moderate (60 to 85 percent of max). Volume gradually built up each week, never increasing greater than 10 percent from the week prior. Phase II consisted of six weeks of hypertrophy/strength work, with three days lifting in the weightroom and two days spent doing speed/agility/conditioning. This phase was split into two three-week cycles with one off-week between the cycles while players were on spring break. Our goals in Phase II were to build on the foundation we set in Phase I and bring the intensity to an even higher level. This would require increased focus due to the added stimulation of the weightroom, along with performing more advanced movements. Once in the weightroom, the players began working on progressions for the major lifting movements of the off-season, which included the hang clean, push press, front squat, singleleg squat, Romanian deadlift, step-up, bench press, bent-over row, military press, and pull-down. We kept movement selection very basic and limited so we could take the time to break down each one completely, even if that meant only training two movements per session. For example, progressions for the hang clean included roughly six sessions of a static pull from technique boxes, followed by a squatting progression. The team did not move into TR AINING-CONDITIONING.COM

receiving the bar until several weeks into the phase. This was part of maintaining the culture of focus and learning the movements in detail. This phase also included an emphasis on plyometrics. There were two reasons we waited until the fourth week of training to begin teaching plyometrics. The first was safety. The athletes needed Phase I to prepare their bodies to handle the stress

of jumping movements, and teaching progressions were made easier by the emphasis on deceleration mechanics in the first three weeks. The second was transferability—teaching the broad jump and vertical jump in the same phase as the hang clean allowed the athletes to relate the movements because of the hip extension necessary in all of them. When teaching plyometrics, we

TEST TIME The Man-U test is a series of 100-yard “sprints” with built-in recovery “jogs.” Reps one through 10 require a 100-yard sprint within 25 seconds, and a recovery jog back to the start within 35 seconds. Each rep after 10 requires the sprint to be finished one second faster than the previous sprint, and the recovery jog back to the start gets one second more than the last jog. Max pace is reached on the 20th rep, when an athlete gets only 15 seconds to sprint down, and 45 seconds to jog back. This pace is held until the athlete misses the cut-off time at either end of the field. Here is how points are accumulated: Rep

Sprint (seconds)

Recovery (seconds)

Point value

1-10 25

11 24

12 23

13 22

14 21

15 20

16 19

17 18

18 17

19 16

20 15

21 15

22 15

23 15

24 15

25 15

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sport specific placed an emphasis on decelerating the body and proper landing mechanics in all double-leg movements before progressing to any type of repeat jumping or single-leg take-offs or landings. Once the players mastered these movements, the bulk of plyometric work was focused on single-leg progressions. After the athletes were through the first three-week cycle of Phase II, they were put to the test—literally—through the Man-U and 300-

yard shuttle run tests. We administer the 300-yard shuttle run test by having athletes run 25 yards out and 25 yards back, six times. For explanation of the Man-U test, see “Test Time” on page 42. The team performed miserably on both initial conditioning tests. The team average for the shuttle run was 65.8 seconds, much slower than our goal of 62 seconds. And the team averaged only 15.8 points on the Man-U test when we hoped to see 19.5 points.

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“Tactical errors” during testing led to this failure. The team went out too hard and too fast on the Man-U, leading to a very early drop-off in reps. The shuttle reps showed the reverse. The team paced itself on its first rep, leading to a huge drop-off in times between rep one and rep two. We needed to instill a discipline in the players that would translate to lasting performance in testing, 90-minute games, and eventually double overtime conference and national tournament games. After these unacceptable results, both tests were repeated weekly for the remainder of Phase II. Over the

There were two reasons we waited until the fourth week of training to begin teaching plyometrics. The first was safety ... The second was transferability— teaching the broad jump and vertical jump in the same phase as the hang clean allowed the athletes to relate the movements. second three-week cycle, we were pleased to see huge improvements in the team averages, even though the players still needed to get better. The average shuttle run time decreased by 1.9 seconds, and the average Man-U score increased to 19 points. Keeping in line with the culture of focus on their own actions and the actions of their teammates, we kept the emphasis on the team averages and not individual times. If one person could not perform to the proper level, the entire team suffered. This heightened encouragement between athletes and made each athlete accountable for her performance that day, knowing that if she did not step up, she was letting down 18 other teammates and making them work extra for her shortcomings. Change of direction work continued on the field twice a week, and we began teaching proper acceleration meTR AINING-CONDITIONING.COM

sport specific chanics. Since the average sprint in soccer is only 15 to 20 yards, perfect form was emphasized in the “drive phase” of the sprint. This required teaching the athletes proper body positioning for the first 10 yards of their sprint, and allowing them to “feel” the 45- to 55-degree angle between their body and the ground. We used a series of wall drills, partner lean holds, lean fall runs, and other various acceleration drills to help them grasp these concepts. Once the team mastered linear acceleration, we progressed by having the athletes start from various positions and perform different movement patterns, including crossover steps, drop steps, backpedals, lateral runs, and angled shuffles. And after these were mastered, we progressed the drills again by adding external load via a 30-pound sled. Phase III consisted of continued strength/power work in the weightroom, a greater emphasis on acceleration/agility work, and continued effort with the goal to be match-ready each weekend. Following spring ball and entering the final week of training, end-of-semester testing was done in order to set team and individual goals for preseason training in August. Normally, we are not huge proponents of having specific “testing” days for our athletes, preferring to integrate testing and evaluation into the workouts themselves. However, in this case, we felt it was necessary for the team to see the fruits of their labor over the past 13 weeks. The following improvements were observed between week one and week 13 of the off-season program: • Broad jump: 2.23 inch increase • Vertical jump: 1.73 inch increase • Left-leg lateral jump: 3.08 inch increase • Right-leg lateral jump: 3.23 inch increase. SUMMER PLANS At the end of the semester, all athletes were sent home with three fourweek workouts that included strength, speed, and agility/conditioning components. Athletes playing in summer leagues with intense practice and/ or game schedules received modified workouts based on their team schedules and amount of playing time. In-

coming athletes also received three four-week workouts designed to prepare them for preseason fitness testing and the strength work performed during preseason and the competitive season. The message given at the end of the team’s off-season training was the need to keep raising the bar and bringing focus, energy, and intensity to their own individual workouts. We urged them to return to campus prepared to maintain a high level of

training and chase their goals of a conference championship and NCAA tournament appearance. The record-breaking 2011 season and subsequent successful 2012 campaign proved the value of our new team culture and revamped training program. It also helped the strength and conditioning department make a strong first impression on the team’s coaching staff and athletes, which are both enjoying the results of their hard work. n

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Inside Information

The Impact Intelligence System, developed by i1 Biometrics, is changing the way athletic trainers and other sports medical personnel treat their athletes. At the system’s core is a state-of-the-art intelligent mouthguard that accurately measures the linear and rotational accelerations of head impacts during sports activities. The mouthguard is groundbreaking in its ability to gather and disseminate impact information from inside the athlete’s head-and in the context of an individual athlete’s history of exposure and injury.

i1 Biometrics • 203-423-0458 www.i1biometrics.com

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Brain Armor is formulated for athletes to help support brain and cardiovascular health by delivering 1,050 milligrams of DHA per serving. Brain Armor was developed by DSM Nutritional Products, a leading innovator in the development of algalbased DHA omega-3 products that promote health and wellness through every stage of life. DSM Nutritional Products • 888-OK-BRAIN www.brain-armor.com Circle No. 527

Recovery Support

Neuro-Impact by Trinity Sports Group, Inc. is an effective and safe nutritional formula for brain and body recovery. It has shown great results in assisting athletes in their recovery from many of the common symptoms associated with participating in contact sports and activities. The results include, but are not limited to, promoting normal neurologic function. The brain is too valuable to ignore any longer, and recovery support is long overdue. Make Neuro-Impact part of your recovery protocol. Neuro-Impact • 972-867-7600 www.neuroimpact.ne Circle No. 528

Stay in the Zone

Klean Cognitive™ supports brain health so your mind performs as well as your body. When athletes talk about being in the zone, they’re usually not talking about heart rate—but about mental focus, clarity, and acuity. Klean Cognitive helps with this since, in addition to the patented combination of Acetyl-L-Carnitine and Lipoic Acid found in the Klean Antioxidant™ supplement, Klean Cognitive contains a synergistic Fruit Blend, Alpha-GPC, and a powerful dose of Lutein. And all Klean Athlete products are NSF Certified for Sport. Klean Athlete • 855-255-5326 www.kleanathlete.com Circle No. 529 TR AINING-CONDITIONING.COM

Antimicrobial Products Go Beyond Cleaning

Athletix Products™ Equipment Cleaner Wipes are non-alcohol based, easy to use, effective, and safe for vinyl, leather, chrome, foam grips, rubber, painted surfaces, metal, and electronic displays. Athletix Equipment Cleaning Wipes go beyond just cleaning—they also neutralize odors that tend to build up on soft surfaces. In addition, utilizing nanopolymer technology, they lay down a protective barrier against odor penetration. Athletix Products by Contec, Inc. • 864-503-8333 www.athletixproducts.com Circle No. 503

Stands Up to Tough Use

This stunning all stainless steel stand is one of 2XL’s newest solutions for dispensing GymWipes and CareWipes towelettes. A custom design that is 36” tall x12” diameter and weighing in at 30 pounds, this unit is built for any fitness facility’s demanding environment. The stand holds the bucket securely while the rubber grommeted dispensing hole makes it easy for clients to grab a towelette. The bucket is completely hidden and is easily refilled or replaced by removing the top.

GymWipes • 888-977-3726 www.2xlcorp.com

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Full-Spectrum Protection

The GymWipes product line offers full-spectrum protection with its cost-effective solutions, to safely clean and sanitize all fitness equipment surfaces. These wipes are bactericidal, virucidal, and fungicidal. Plus, the company’s EPA-registered disinfecting/sanitizing formulas protect against more than 50 dangerous pathogens. Safe and effective, this line doesn’t contain harmful ingredients such as alcohol, phenol, and bleach—and is tested and approved by leading manufacturers. The wipes come in 700-1200 counts, with attractive dispensers and stands available. GymWipes • 888-977-3726 www.gymwipes.com

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Kills Harmful Bacteria

Hibiclens® is a liquid antimicrobial skin soap that bonds to the skin and provides up to six hours of continuous killing action. Hibiclens is proven to kill many harmful bacteria (including MRSA), viruses, and fungi. Washing with Hibiclens before contact with contaminated skin and surfaces will almost eliminate the risk of transfer. Hibistat® wipes do not require water and offer the same continuous killing action (up to six hours) found in Hibiclens. Molnlycke Health Care • 800-843-8497 www.hibiclens.com

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Aquatic Exercise Radically Functional

Splash of Resistance

The Aqua Versa-Tube® provides a solution for performing resistance exercises in the water. It includes two contoured plastic handles, which are vented for comfort. Latex tubing is powder-free and treated to resist the damaging effects of chlorine. Available in six levels and in 48- or 60-inch lengths, there is a solution for everyone. Prices start at $13.95.

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

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Enhances Recovery

Encourage active recovery with the use of the HydroWorx ThermalPlunge and PolarPlunge pools. Utilization of these innovative hot and cold pools can be a catalyst in regeneration. “The contrasting use is very time-efficient, taking less than 10 minutes to fully complete a 2:1 or 1:1 cycle of hot:cold immersion with massage. With contrasting, the CNS/ANS is recovering faster and more completely, and the athletes come to the next session with higher functioning levels of neuromuscular firing.” - Lance Walker, Director of Performance at Michael Johnson Performance. HydroWorx International, Inc. • 800-753-9633 www.hydroworx.com Circle No. 533 TR AINING-CONDITIONING.COM

The HydroWorx 2000 Series is a radically functional aquatic therapy and performance pool. This state-of-the-art aquatic therapy equipment boasts a host of high-performance features that represent the cooperative efforts of visionaries, engineers, and clinicians. The moveable floor, 8’x12’ underwater treadmill, resistance jet technology, and computer and camera systems satisfy the varied demands of traditional sports medicine, as well as those of dominant, world-class athletes. The pool and underwater treadmill size allow you to create group-training sessions with four people at a time. HydroWorx International, Inc. • 800-753-9633 www.hydroworx.com Circle No. 534

Form and Function

SwimEx hot and cold plunge tanks offer impeccable form and function, with rugged fiberglass construction, easy-to-clean gelcoat surfacing, and unmatched beauty to match your facility. With no grout lines to clean, your tanks will look as good as their performance, year after year. And if you’re cramped for space, SwimEx plunge tanks can be sectionalized for tight installations. Visit online and see why SwimEx plunge tanks are the best choice for you and your athletes. SwimEx, Inc. • 800-877-7946 www.swimex.com

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Catalog Showcase OPTP

Ari-Med Pharmaceuticals

800-367-7393 optp.com

800-527-4923 ari-med.com

A little bigger and a little better, OPTP’s improved and expanded Volume 29 Catalog for fitness and health care professionals delivers an innovative and quality-driven product line of physical therapy, fitness, and wellness products developed by renowned experts. The new catalog features many new arrivals, including the Rotational Trainer™, Sport Cord, and “Why Do I Hurt?” For more information, call or visit OPTP online.

Power Systems

Made in the USA, with unsurpassed quality and patented safety features— these are the hallmarks of NZ Manufacturing’s TurfCordz®, StrechCordz®, and MediCordz® product lines. Whether your resistance needs are in sports training, swim training or rehabilitation, all of the products featured in the catalog are engineered to meet the most rigorous demands of team, clinical, and personal use. The various resistance levels and accessories available ensure a rewarding workout tailored to individual needs. Visit NZ Manufacturing online to find out more.

Founded in 1986, awardwinning equipment provider Power Systems continues to make a real difference in its 27th year as an industry standard for exceptional service and quality. Power Systems’ new 2013 catalogs are now available. The Sports Training edition contains 73 pages of top-quality training products. The Fitness Training edition contains 106 pages of traditional and innovative equipment solutions. Call or go online to request your copy today.

877-777-9081 studyatapu.com/sports

American Public University offers more than 170 undergraduate and graduate degree and certificate programs designed for sports and health science professionals, coaches, athletic directors, and working adults like you—completely online. APU has been nationally recognized by the Sloan Consortium for effective practice in online education. Classes start monthly with 8- and 16-week courses. For more information, visit APU online. Circle No. 509 T&C MARCH 2013

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Dome Industries, Inc.

800-321-6975 powersystems.com

800-752-4944 selfgrip.com

SelfGrip® helps athletes perform at their best by providing firm compression and maximum support to ligaments, tendons, and muscles. It comes in five colors and four convenient sizes. The exclusive properties of SelfGrip® allow it to maintain a firm grip, even under water. Plus, SelfGrip is so tough it is the official athletic tape of USA Triathlon.

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American Public University

Medically designed, athlete-proven Medi-Dyne products are easy-to-use tools that really work to relieve tight muscles, stretch important muscle groups, and prevent pain and injury. With patented stretching, strengthening, foot, knee, and blister products, the Medi-Dyne family of brands—including Cho-Pat®, Tuli’s®, ProStretch®, StretchRite®, CoreStretch®, Skin-on-Skin®, and RangeRoller® —are known for both their effectiveness and ease of use. Medi-Dyne is dedicated to providing innovations in pain relief and prevention.

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NZ Manufacturing, LLC 800-886-6621 nzmfg.com

800-810-1740 medi-dyne.com

Since 1987, Ari-Med has marketed Flexall® pain relieving gels to rehab and sports medicine professionals worldwide. Flexall gels have proven to be effective, versatile supplements to any therapy protocol— including ultrasound—by delivering fast, lasting relief from painful muscles and joints. The unique, mentholated aloe vera formulas are enriched with natural oils and Vitamin E to moisturize and soften skin. Flexall gels absorb quickly, are greaseless, non-staining, and available in professional sizes.

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Medi-Dyne Healthcare Products, Ltd.

Samson Equipment 800-472-6766 samsonequipment.com

PRO Orthopedic Devices, Inc. 800-523-5611 proorthopedic.com

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

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Offering more than 20 patented products, PRO Orthopedic is constantly upgrading designs and materials to provide the best support possible. The four-way stretch properties of the material, combined with therapeutic heat retention quality, make neoprene effective in controlling edema. Compression alone cannot produce the same results, and all PRO neoprene products are latex-free. Call or go online for more information.

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Testimonial

Quick and Convenient Cleaning

Help Your AtHletes to success From the publishers of Training & Conditioning

Athlete’s Guide To Nutrition topIcs coVereD INcluDe: zx the amount and kinds of calories athletes need zx How to make sure athletes are properly hydrated zx "When" athletes eat is as important as "what" they eat

$ 95

zx recovery nutrition Athletix Disinfectant Wipes are a quick and convenient way for your athletes and trainers to disinfect surfaces in your fitness facility. Premoistened and ready to use, these durable, disposable wipes are packaged in a portable dispenser bucket. EPA-registered in all 50 U.S. states, including California, Athletix Disinfectant Wipes kill antibioticresistant bacteria MRSA and CAMRSA—and are effective against many common bacteria such as Staphylococcus aureus (Staph), Salmonella, Streptococcus pyogenes (Strep), and Esherichia coli (E. coli). Most effective when used on hard nonporous surfaces, Athletix Disinfectant Wipes are ideal for disinfecting athletic and gym equipment, cycling equipment, weights, yoga mats, fitness balls, benches, lockers, and more. These orthophenylphenol-free wipes contain no ammonia, bleach, or alcohol and are safe for most surfaces found in fitness facilities and gyms— including acrylic, chrome, rubber, vinyl, ceramic tile, and fiberglass.

zx A close look at nutritional supplements

Greater discounts available for orders of 20 or more. call 877-422-5548, ext. 11 to receive more info. note:We can customize the cover and content of the guide for your team or athletic department. ORDER FORM

PLEASE PRINT INFO.

MAG, Inc. • 20 Eastlake Rd. Ithaca, NY 14850

Code TC23.02

Name: Street Address: City: State: Zip: Daytime Phone:

(To be used if there’s a problem with your order)

Email address: PAYMENT METHOD

SHIPPING PRICES

q U.S. check made payable to MAG, Inc. enclosed (sorry, only US orders)

q VISA

q MasterCard

0-$49.99 50-$99.99 $ 100-$149.99 $ 150-and up $

q Discover

q AmerEx

Credit card #: ________/________/________/________

= $7.00 = $9.00 = $10.00 = $12.00

Expiration date: _____/_____ 3 or 4 digit code: _______ Cardholder Name PRINTED: Cardholder Signature: ITEM TITLE Athlete’s Guide To Nutrition

Athletix Products by Contec, Inc. 864-503-8333 www.athletixproducts.com

PRICE $7.95

Fax this order to 607-257-7328 or Mail this order to MAG, Inc., 20 Eastlake Rd., Ithaca, NY 14850

QUANTITY

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Subtotal $ + Shipping $ NY residents add sales tax $ = TOTAL $

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More Products Transmit Data Wirelessly

Sticks to Itself, Not You

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

Dome Industries, Inc. • 800-432-4352 www.selfgrip.com

Along with the recent launch of its revolutionary new PSM Training ECHO system, Zephyr Technology also introduced its new, high-tech Compression Shirt. The shirt holds a sensor called the Zephyr BioModule™ firmly in the athlete’s sternum area, allowing the sensor to accurately read and wirelessly transmit a wide range of physiological status data live to a coach’s laptop or tablet. The Compression Shirt also logs the data for analysis later. Circle No. 516

PRO Exercise Trunks provide beneficial heat retention during weight training and conditioning programs for the lower back muscles, hamstrings, groin, hips, quadriceps, and waist. The trunks’ higher waist offers low-back support. The original 800 Exercise Trunks feature 1/8-inch neoprene. The 850 trunks have the same design but are constructed of a thinner 1/16-inch neoprene for slightly less heat retention, but maintain uniform compression. Both trunks are available in black N2 material only. PRO Orthopedic Devices, Inc. • 800-523-5611 www.proorthopedic.com Circle No. 517

Get it fast. Hausmann offers the quick-ship PROTEAM Two-Seat Taping Station (Model A9520346-24). It’s 6’ long x 3’ high x 3’ deep, and oak laminate is the stock finish. This unit is equipped with a hamper in the middle-storage module, and you can choose from nine Pro-Form vinyl colors. It’s available for shipment five working days after receipt of your order. Circle No. 530

Ultra-Concentrated

Monster Amino™ is an ultra-concentrated BCAA formula that delivers an 8:1:1 ratio of leucine to isoleucine to valine. Recent university research shows that a leucineenriched beverage consumed with exercise synergistically activates and prolongs activity of the mTOR signaling pathway, which increases muscle anabolic potential (muscle growth). The mTOR pathway is the “trigger” that signals the very genesis of muscle protein synthesis.

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The new Functional Training Rack Series from Samson Equipment is setting the world of strength and conditioning ablaze. This unique design combines a fully functional Power Rack with two adjustable cable column machines—all within a compact area. Never before has an athlete been able to perform all the core lifts a rack/platform provides with the multifaceted capability of a fully operational functional trainer. This product is extremely easy to adjust and use quickly, getting your athletes in and out of every facet of a workout much more effectively. Samson Equipment • 800-472-6766 www.samsonequipment.com

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Climb Your Way Back

Ships Quickly

CytoSport, Inc. • 888-298-6629 www.cytosport.com

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A Unique Design

Uniform Compression

PROTEAM by Hausmann • 888-428-7626 www.proteamtables.com

SelfGrip® helps active people and athletes perform at 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 under water. Recommended by doctors and trainers, SelfGrip is available in two-, three-, and fourinch widths and assorted colors.

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The SRM Rehab Model VersaClimber is a total-body, closed-chain, rehabilitation exercise machine. The SRM allows patients to progress from non- to partial- to fullweight bearing, full-body exercise. It is fully adjustable to fit the height, weight, and length of all types of athletes and patients. Rehabilitation routines have been developed to provide a continuous arm and leg action in a seated or standing position, using varying stroke lengths, rates, and resistance levels. VersaClimber/HeartRate, Inc. • 800-237-2271 www.versaclimber.com Circle No. 538

Understated Knurling

The Rogue Bar is a polished 28.5-millimeter bar with no center knurling—and both powerlifting and Olympic lifting knurling marks. This bar has the great understated knurling that has made Rogue Fitness’ bars famous. It features high-quality brass bushings for reliable spin, and will whip enough for use in Olympic Weightlifting. Rogue Fitness • 614-358-6190 www.roguefitness.com

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More Products Drops of Energy

Cytomax Energy Drops™ are a portable and chewable means to deliver a precise blend of carbohydrates and essential electrolytes. Cytomax Energy Drops™ may be used before and during training. Each portable pouch provides 10 individual chews. Cytomax Energy Drops™ are available in two great-tasting flavor options: Tropical Fruit + Pomegranate Berry (non-caffeinated), and Orange + Tangerine (50 mg of caffeine per pouch). Tropical Fruit + Pomegranate Berry is collegiate compliant.

CytoSport, Inc. • 888-298-6629 www.cytosport.com

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Virtually Immovable

The Rogue Fitness Monster Series Rigs are the ultimate gym accessory. Built with the collegiate athlete in mind, the Monster Rig is a classic example of Rogue’s “over-built” construction that will suit any affiliate or gym with its immovable capacity. The standard Monster Rig is built with 11-gauge, 3 inch x 3 inch steel tube uprights. This is a virtually immovable piece of American-made training equipment. Rogue Fitness • 614-358-6190 www.roguefitness.com

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Versatile Adjustability

The PowerMax Push/Pull Sled fulfills your needs for versatility and adjustability in speed training. This USA-made 11-gauge steel frame sled features a space-saving design that is less than seven inches high when folded. It also has replaceable/removable runners for use on a variety of surfaces, includes quick-release pins for fast set-up and breakdown, and it accommodates all sizes of athletes with adjustable width push posts (12-21” wide x 32” high) and multiple push/pull options. This versatile sled holds up to 300 pounds on a post large enough to fit four 45-pound bumper plates. Gill Athletics/PowerMax • 800-637-3090 www.gillathletics.com

The Model 7650 Portable Sideline/ Treatment Table has a 28” wide x 73” long PVC-free urethane upholstery top with push-button height adjustment from 24 to 32 inches. The lightweight aluminum frame weighs only 30 pounds, and the product includes an adjustable face cradle with an ultra-soft face cushion, carrying bag with shoulder sling, and removable two-inch Turf Pad for outdoor use (set of four). Comes in 751 Black as a standard color, with 752 Blue available for special order.

TR AINING-CONDITIONING.COM

The National Strength and Conditioning Association (NSCA) is a trusted authority on strength and conditioning, bridging the gap between science and application for more than 35 years. The NSCA’s annual National Conference, the premier strength and conditioning event of the year, is back in Las Vegas. Experience everything the conference has to offer— from sessions by top educators, researchers, trainers and coaches to Special Interest Group meetings, networking events and more. NSCA • 800-815-6826 www.nsca.com

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Optimize Performance

Firstbeat SPORTS is a software tool for professional sports and teams that aim high. Firstbeat SPORTS is for monitoring athletes’ training load and recovery. The advanced heart rate variabilitybased analysis detects early signs of overtraining, providing coaches a practical tool to avoid injuries and optimize each athlete’s performance. Firstbeat Technologies Ltd. • 310-259-2277 www.firstbeat.com

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Good Vibrations

Exervibe is a whole-body vibration stepper that provides athletic enhancement when used in either the static (standing) or dynamic (stepping) position. Vibration stimulation is applied simultaneously to the feet, hands, arms, and core. The Exervibe has a step range from one to 18 inches, an adjustable seat, and a control module with four settings. It is an extremely versatile device that efficiently and effectively implements the benefits of vibration. VersaClimber/HeartRate, Inc. • 800-237-2271 www.versaclimber.com Circle No. 539

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Lightweight and Portable

PROTEAM by Hausmann • 888-428-7626 www.proteamtables.com

A Trusted Authority

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Keeps An Eye on Results

The Polar FT80 heart rate monitor offers a functional way to monitor your training results. Its key features include strength training guidance, a fitness test, OwnRelax ® values, OwnIndex ® cardiovascular fitness measurements, and OwnCal® energy expenditure assessments. Its basic features include the time of day, a backlight, and a stopwatch. The Polar Service Center Division of Creative Health Products is one of the most experienced authorized service centers for Polar products. For more information or a printable return form, visit www.polarservicecenter.com. Creative Health Products, Inc. • 800-742-4478 www.chponline.com Circle No. 541 T&C MARCH 2013