Training & Conditioning 23.7 by Momentummedia

Going Vegan n Electronic Interactions n USCâ&#x20AC;&#x2122;s Volleyball Program

October 2013 Vol. XXIII, No. 7, $7.00

Down the Meridian A look at using sports acupuncture

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October 2013, Vol. XXIII, No. 7

contents

Bulletin Board 6 How migraines affect concussion recovery … New research on treating exercise-induced asthma … A look at blood pressure increases in freshman football players. Comeback Athlete 11 Amira Idris University of Delaware

Sponsored Pages 35 Hi-Trainer Product News 55 Pain Management 57 Topicals 58 Sports Massage 60 Hot & Cold

More Products

64 Advertisers Directory CEU Quiz 51 For NATA and NSCA Members

Next Stop: Web Site

On the cover: Philadelphia Phillies relief pitcher Jonathan Papelbon has used sports acupuncture to treat neck stiffness. Our cover story examines blending traditional sports medicine treatments with acupuncture, starting on page 36. Photo by APImages/Matt Slocum

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Optimum Performance

Altitude Adjustment

Much has been written about the benefits of the live-high, train-low principle. The U.S. Air Force Academy is putting the idea into practice with a special training program. By Dr. Michael Zupan Leadership

23 From texting to social media, information can be exchanged Connecting Safely

today in the blink of an eye. That’s why every athletic trainer needs a well-thought-out plan for electronic communication. By James Malseed Nutrition

29 What happens when you take meat, eggs, and dairy out of an Veggies Galore

athlete’s diet? Going vegan is possible for high performance, but only with a clear understanding of the hurdles. By Susan Kundrat Treating the Athlete

36 As more athletes seek alternatives to Western medicine, a Down the Meridian

new discipline called sports acupuncture has emerged. Our author combines his background in athletic training with this Eastern form of treatment. By George Leung Sport Specific

Their Game 45 Raising A simple, yet adaptable, off-season training program helps

University of Southern California volleyball players get ready to attack the competition. By Brent Metz T&C OCTOBER 2013

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 Conway (S.C.) High School Christine Bonci, MS, LAT, ATC Associate Athletics Director Sports Medicine/Athletic Training University of Texas

Timothy Morgan, DC, CCSP Professor of Exercise and Health Sciences University of Massachusetts

Cynthia “Sam” Booth, PhD, ATC Visiting Assistant Professor SUNY Brockport

Jenny Moshak, MS, ATC, CSCS Assistant AD for Sports Medicine University of Tennessee

Debra Brooks, CNMT, LMT, PhD CEO, Iowa NeuroMuscular Therapy Center

Steve Myrland, CSCS Owner, Manager Myrland Sports Training, LLC Director of Coaching, Train-To-Play

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) Brian Goodstein, MS, ATC, CSCS, Head Athletic Trainer, DC United Gary Gray, PT President, CEO Functional Design Systems

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Tim McClellan, MS, CSCS Owner and Strength and Conditioning Coach StrengthAndPeace.com

Leslie Bonci, MPH, RD, CSSD, LDN Director of Sports Medicine Nutrition Center for Sports Medicine University of Pittsburgh Medical Center

Cindy Chang, MD President, American Medical Society for Sports Medicine

October 2013 Vol. XXIII, No. 7

Allan Johnson, MS, MSCC, CSCS Sports Performance Director Velocity Sports Performance

Tim Neal, MS, ATC Assistant Director of Athletics for Sports Medicine Syracuse University

Publisher Mark Goldberg Editorial Staff Eleanor Frankel, Director Patrick Pizzuti, Managing Editor R.J. Anderson, Patrick Bohn, Mary Kate Murphy, Dennis Read Circulation Director Robin Flower Art Direction Message Brand Advertising Production Staff Maria Bise, Director Neal Betts, Trish Landsparger Business Manager Pennie Small

Mike Nitka, MS, CSCS Director of Human Performance Muskego (Wis.) High School

Special Projects Natalie Couch Dave Wohlhueter

Bruno Pauletto, MS, CSCS President, Power Systems, Inc.

Administrative Assistant Sharon Barbell

Stephen M. Perle, DC, MS Professor of Clinical Sciences University of Bridgeport College of Chiropractic

Marketing Director Sheryl Shaffer

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 Fred Tedeschi, ATC Head Athletic Trainer, Chicago Bulls Terence Todd, PhD Lecturer, Kinesiology and Health Education University of Texas

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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GATORADE SPORTS SCIENCE INSTITUTE PROTEIN’S IMPORTANCE IN ATHLETES’ FUNCTIONAL RECOVERY Chris Mohr, Ph.D., R.D. Consulting Sports Nutritionist, Cincinnati Bengals Co-Founder, Mohr Results, Inc.

PROTEIN FOR RECOVERY It is widely accepted that athletes need carbohydrates to fuel their bodies and aid their recovery. Protein plays just as much of a role in recovery, but the importance is not as well understood. Of course, protein is considered a key nutrient for everyone, particularly all athletes, across all sports. Anecdotally, aerobic athletes often forgo protein intake and focus only on carbohydrates. On the flip side, anaerobic athletes focus more on protein than carbohydrates. Protein is important for all athletes, though, for optimal recovery and repair.

RECOVERY AND REPAIR Arguably, the most important message about protein is about timing of intake, rather than needing to eat more (though many athletes do need to eat more). There is no storage depot for protein in the body like there is for carbohydrates (stored as glycogen) and fat (stored as fat). Therefore, the breakdown of protein into amino acids -- the beneficial components of the protein itself -- should be adequate to continually fuel the flux and needs of the body. When you consider the average protein intake, most people take in around 10-15% of their protein in the morning, 10-15% in the afternoon and the remainder (70%) at dinner. This is shown on the right side of the below graph. The optimal timing, however, would be like the graph on the left, with grams of protein spread equally throughout all meals during the day. Of course, this is just an example and not a suggestion for everyone to only eat three meals per day and take in just 90 grams of protein.

the fuel in a car, you can only fill up your gas tank so much before it spills over. The same would be true for protein, where the “excess” amino acids would simply spill over and not be used as efficiently for muscle repair and recovery. Remember, protein is not stored. So the excess taken in will simply be excreted. Therefore, focusing on timing of intake is crucial to maximize use and benefit for repair and recovery.

PROTEIN QUANTITY Taking this one step further from just the timing of intake, there are data suggesting the quantity of protein intake also matters. More specifically, around 25-30 grams of protein post workout is optimal for the anabolic response needed for muscle recovery and growth, eaten (or drank) within 30 minutes after the end of your workout. Below are a few examples of high quality protein options for this post workout “window.” Any of these can work, depending on availability and preference.

QUALITY POST WORKOUT PROTEIN OPTIONS

PROTEIN QUANTITY

1 cup Cottage cheese and fruit

~28 grams

Protein smoothie

~20 grams

Gatorade Protein Recover Shake

20 grams

6-oz flavored Greek yogurt

~18 grams

15 0 Breakfast Lunch Dinner

Breakfast Lunch Dinner

Athletes could certainly benefit from eating even more frequently than in the above example, focusing on timing that protein specifically around their workouts. The problem with this typical intake is that, again, protein is not stored. If you compare this to

SUMMARY Quality protein is essential for muscle repair and recovery. In addition to focusing on protein quality it is also important to focus on the frequency of that intake. More specifically, it’s also important to aim for 25-30 grams of protein immediately after a workout to repair those broken down muscles and prime them for the next workout.

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Board

Migraines & Recovery

Mussels to Help Muscles

Athletes typically experience headaches after sustaining a concussion, with some suffering migraines. Two separate studies published in the July issue of the American Journal of Sports Medicine suggest that migraines experienced within a week of a concussion could indicate a longer recovery time. In one study, researchers at the University of Pittsburgh evaluated 138 concussed high school football players. Fifty-six experienced migraines, 63 had non-migraine headaches, and 19 had neither. The athletes were put through neurocognitive tests and symptoms were recorded in two time periods: days one through seven and days eight through 14. The athletes with migraines had the most symptoms at the end of the 14-day period, as well as the worst visual memory and reaction time scores. They also had the lowest verbal memory scores in the eight to 14-day span. Those who experienced migraines were 2.6 times more likely to have a protracted recovery (greater than 21 days) than those who were experiencing non-migraine headaches only. “Clinicians should identify the specific type of headache a patient has following a concussion to inform better management and treatment of the injury,” Anthony Kontos, PhD, Assistant Director of Research for the Concussion Program at the University of Pittsburgh Medical Center and one of the study’s authors, told Reuters Health. “Clinicians should also consider the patient’s migraine history as well, as this may be another risk factor that could affect recovery time.” In a similar study, researchers at the University of North Carolina evaluated 296 student-athletes with sports-related concussions of which 52 had migraines, 176 experienced non-migraine headaches, and 68 had neither within one day of their injury. Balance, cognition, and concussion-related symptoms were measured when the injury occurred and at days one, two, three, five, seven, and 90. The athletes experiencing migraines reported higher symptom severity and decreased functioning than the other two groups at the time of injury and through day seven. These findings suggest that patients who suffer migraines within a day of receiving a concussion are more likely to have greater short-term limitations and extended recovery times.

Could an effective treatment for exercise-induce asthma really come from something called a green-lipped mussel? According to researchers at Indiana University, that is precisely the case. In a study appearing in the August issue of the journal Respiratory Medicine, scientists found that a unique omega-3 supplement derived from the New Zealand greenlipped mussel “significantly improved lung function and reduced airway inflammation in asthmatics who experience exercise-induced bronchoconstriction.” Lyprinol/Omega XL is a dietary supplement whose key ingredient is PCSO-524, an extract of stabilized lipids in New Zealand green-lipped mussels, as well as olive oil and vitamin E. In a randomized, double-blind, placebo-controlled crossover trial, Lyprinol/Omega XL provided 59 percent improvement in lung function after an airway challenge and facilitated a reduction in airway inflammation, asthma symptoms, and the need for emergency medication. “Not only does it reduce [exercise-induced asthma] symptoms, which will make you feel better, but it potentially could improve athletic performance,” the study’s lead author, Timothy Mickleborough, PhD, Professor in the Indiana School of Public Health-Bloomington, said in a news release. “Any time you can reduce medication is good.” Prior to the exercise-induced asthma study, PCSO-524 had proven effective in treating osteoarthritis, rheumatoid arthritis, and inflammatory bowel disease. Ahead, Mickleborough said he plans to expand his research to examine the impact of PCSO-524 on delayed onset muscle soreness and delayed onset muscle damage. He added that he is also evaluating whether PCSO-524 can improve lung function and relieve airway inflammation in elite athletes who do not have asthma or exercise-induced asthma.

To view the abstracts of both studies, go to ajs.sagepub. com and search “Posttraumatic Migraine as a Predictor of Recovery and Cognitive Impairment After SportRelated Concussion” and “Recovery of Posttraumatic Migraine Characteristics in Patients After Mild Traumatic Brain Injury.”

The blood pressure of football players typically increases during their first year of participation at the collegiate level, according to a study published in the July 30 issue of the journal Circulation. Linemen were the most likely to experience the rise, and they also ran the highest risk of concentric left ventricular hypertrophy, which the research correlated with changes in systolic blood pressure.

T&C OCTOBER 2013

To view an abstract of the study, “Marine lipid fraction PCSO-524 (lyprinol/omega XL) of the New Zealand green lipped mussel attenuates hyperpnea-induced bronchoconstriction in asthma,” go to: www.resmedjournal.com and type “PCSO-524” into the search window.

Football Players See Increase in BP

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Bulletin

Board Researchers examined six years of incoming freshman players at Harvard University and found their average blood pressure went from 116 over 64 before the season to 125 over 66 after it ended. While 63 percent of the players studied had normal blood pressures going into their rookie campaign, a statistically significant number met the Joint National Commission criteria for prehypertension (47 percent) or stage I hypertension (14 percent) in postseason tests. “What our data shows is that—as with concussion— hypertension and high BP should be another part of routine screening for young, healthy people,” Aaron L. Baggish, MD, Associate Director of the Cardiovascular Performance Program at Massachusetts General Hospital and the study’s corresponding author, told Cardiology Today. “We have spent a lot of effort talking about screening athletes before they play, but we pay comparatively less attention to screening once that decision is made.” Postseason testing of linemen revealed that 58 percent were prehypertensive and 25 percent met the criteria for stage I hypertension. Baggish told HealthDay News that the linemen were more likely than other players to gain weight during their first season, which may account for some of the BP changes. He also said that the heavy weightlifting commonly done by linemen has been known to trigger short-term spikes in blood pressure, but stress-

es that no link between such activity and chronically high blood pressure has been established. However, linemen did experience a marked increase in LV hypertrophy. “Our analyses suggest that the concentric LV hypertrophy in this population is caused in part by increases in resting BP, not simply by the transient isometric stress that occurs during training and competition,” Baggish and colleagues wrote in the study report. The researchers used male rowers as a control group and saw no increase in their blood pressure at the end of their seasons. This “indicates that the BP increase and the development of hypertension are not a uniform response to all forms of vigorous exercise training,” they wrote. “The findings are not cause for alarm as much as they are for piqued interest,” Baggish told Cardiology Today. “Football players are a new population that we know is at risk for high BP. If [a player] is a lineman, has gained weight, or has a family history of hypertension, check his BP before, during, and after the season.” The full text of the study can be found by typing “Blood Pressure and Left Ventricular Hypertrophy During American-Style Football Participation” in the search window at: circ.ahajournals.org.

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Sports Health representative Christine Carlton presents a plaque and gift certificate to Bob Marley, MA, ATC, LAT, CSCS, the 2013 winner of the Most Valuable Athletic Trainer Award. Marley works as Senior Outreach Athletic Trainer in the Department of Orthopaedic Surgery at the University of Texas Health Science Center at Houston.

A Call for Nominations Training & Conditioning and Sports Health announce the 2nd annual:

Most Valuable Athletic Trainer Award To honor: High school athletic trainers who have become MVPs in their athletic departments by going above and beyond their job duties to deliver the best sports medicine care to their athletes. Why: Because high school athletic trainers are the unsung heroes of interscholastic sports and many work countless hours to help young people become the best they can be. We would like to honor those who put their heart and soul into helping studentathletes on a daily basis. Criteria: To be considered, an athletic trainer must work with high school athletes (in either a school or clinic setting) and have the following qualities: • Have earned the respect of coaches they work with and student-athletes they care for • Go beyond their job description to support student-athletes • Put in extra effort to make the athletic training program the best it can be • Serves the local or larger community through community service Nominations: Please provide us with a 400-800 word description of how the nominee fits the above criteria. Any supporting materials are welcome. Full contact information (e-mail and phone number) for both the nominee and the person nominating must be provided. Winner: Will be featured in the April 2014 issue of T&C and honored at the NATA Convention. He or she will also receive a plaque and product-related prizes. Deadline: December 31, 2013 Questions: Please feel free to contact us with any questions: Eleanor Frankel 607-257-6970, ext. 18 ef@MomentumMedia.com Send to: Most Valuable Athletic Trainer Award Training & Conditioning Momentum Media Sports Publishing 20 Eastlake Rd., Ithaca, NY 14850 or MVatc@MomentumMedia.com

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ComebackAthlete

Amira Idris University of Delaware By R.J. Anderson

Idris’s injury troubles can be traced back to February 2012, when the then-freshman rolled her left ankle during a practice. It marked the first time in her career she had been dealt an injury blow of any kind. Although she was initially diagnosed with a sprain, her pain persisted and an MRI revealed a slight tear in her ATFL. The first treatment option she was given was surgery, which would rule her out for the rest of the indoor and outdoor seasons. The second option was rehab, which offered the possibility that she could continue competing. Idris chose the latter and began working with the Blue Hens’ athletic training department. By strengthening the muscles around her compromised ligament, Idris was able to complete a stellar freshman season in which she finished fourth in the triple jump at the Colonial Athletic Association (CAA) Championships, leaping a school-record 40 feet, 4.25 inches. The team’s most accomplished jumper, Idris returned for her sophomore year with high expectations. But this past February, in the midst of the indoor season, Idris had a major setback. Going through triple jumping drills during practice, she again rolled her left ankle. “It was an injury to her calcaneofibular ligament, which brought back her symptoms,” says Shawn Hanlon, ATC, a Graduate Assistant Athletic Trainer at Delaware, who had just begun a rotation working with the Blue Hens track and field team at the time of the injury. “It was a re-sprain resulting in gross laxity. This time the pain was worse.” An MRI showed that the tendon had additional tearing, and again the option of surgery was broached. “She was TR AINING-CONDITIONING.COM

Mark Campbell, UD Athletics Media Relations

When University of Delaware track and field athlete Amira Idris reflects on her very successful 2013 outdoor campaign, she feels both surprised and grateful. After spending the entire season competing with a ruptured anterior talofibular ligament (ATFL), Idris surprised everyone, including herself, by capturing a conference championship and shattering her own school record in the triple jump. Much of her gratitude for this improbable success is reserved for Delaware’s athletic training staff, which helped her manage an injury that would eventually require surgery.

Thanks to a specialized ankle strengthening and stability program, Idris was able to compete despite a ruptured ATFL, capturing first place in the triple jump at her conference meet. also told that instead of surgery, she could take the season off and rest while undergoing a comprehensive threemonth rehab so she could come back for her junior year at 100 percent,” says Hanlon. “She kicked around those options for a week, but eventually rejected both. She decided to fight through the pain and keep competing. Basically, she told me to do everything on my end to keep her healthy and she would take care of the rest.” With an eye on coming back for the end of the indoor season, Idris worked with Hanlon for a month to strengthR.J. Anderson is an Assistant Editor at Training & Conditioning. He can be reached at: rja@MomentumMedia.com. T&C OCTOBER 2013

ComebackAthlete en the muscles around her ankle and build up her lower body stability. “Shawn was confident that he could help me improve and he was very easy to communicate with,” says Idris. “I trusted him immediately. Once I started his workouts, my leg began feeling stronger and I had better balance.” Hanlon’s initial work for Idris included basic four-way Theraband ankle exercises and manual isometric work. “Manual strengthening allowed me to see where she was

“The triple jump is a whole body movement ... We wanted her to learn how to align her hip and her knee so that the stress of maintaining balance was not all on her ankle.” weak and helped reveal the direction we should take,” he says. “We strapped her leg to the table and asked her to give it all she had for 15 bouts of resistive ankle range of motion against constant submaximal resistance.” Following a week and a half of strength-building sessions, Hanlon turned the focus to increasing Idris’s ankle stability. “We looked at her instability as mechanical—because the ligament was compromised, there was no static stability left,” he says. “So we developed ways to increase

her dynamic stability.” Hanlon then added ground-based functional balance movements that mimicked the demands of her main event. “The triple jump is a whole body movement, so we had to develop a strategy for her to maintain balance using her entire kinetic chain, not just her ankle,” he says. “We wanted her to learn how to align her hip and her knee so that the stress of maintaining balance was not all on her ankle.” The balance program began with exercises on a stable surface. When Idris mastered the movement, Hanlon would then introduce an unstable surface. “For example, she would stand on the ground and do a single-leg squat, picking up an object and putting it back down for three sets of 15 repetitions,” he says. “After a few days, when she was strong enough to complete that movement with perfect form, I would have her stand single-legged at the center of a wobble board and hold her balance while someone tapped on the sides of the board to introduce instability. “Once she was able to control that, we introduced the Bosu ball,” Hanlon continues. “Amira would start with single-leg standing on the ball then progress to a running start position, pumping her arms to introduce rotary force while maintaining her balance. During every exercise, she was taught to set her hips so that her knee and her hip were aligned in correct posture, which would help her keep her balance and place less stress on the ankle.”

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ComebackAthlete

Amira Idris University of Delaware Sport: Track & Field Injuries: Ruptured anterior talofibular ligament Result: Prior to having surgery in the summer, managed injury on the way to a school record in the triple jump and being named co-winner of the Colonial Athletic Association Outdoor Championship’s Outstanding Field Performer award.

A few weeks into the balance program, Hanlon added a new component: landing. “Our focus was on her jumping form and we taught her to land with perfect mechanics after each foot strike,” says Hanlon. To accomplish this, Hanlon had Idris perform exercises in front of a mirror while a member of the athletic training staff gave her verbal start cues and feedback on her form. “Once she saw herself do a movement with perfect form, her neuromuscular system became trained and those ideal mechanics were second nature for her,” says Hanlon. “In every step, we had her concentrate on sticking the landing perfectly before adding repetitions and progressing to more advanced movements. “Once she was proficient at hopping forward and backward, we introduced side-to-side jumps, followed by diagonal-patterned jumps,” he continues. “She began by doing two sets of 15 for each leg and worked her way up to reps of 30 with shortened landing time.” The final phase of the four-week dynamic jumping program involved teaching Idris to land on an unstable surface. The chosen exercise would require Idris to hop onto a Bosu ball, flat side down, and land on one leg. “She wasn’t trying to do it from far away or jump high onto the ball,” says Hanlon. “It was more about landing on the ball with complete stability.” On March 2, a month into her rehab program, Idris returned to competition at the Eastern Collegiate Athletic

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ComebackAthlete Conference (ECAC) Women’s Indoor Track & Field Championships, where she placed 13th in the triple jump. “She was two feet short of her personal record, which she was happy with, especially after such a long layoff,” says Hanlon. “For the next month, as the outdoor season got underway, the coach wanted to limit the amount of pounding on Amira’s ankle, so she took a break from jumping and instead concentrated on sprinting. She joined the 4x100 team—and they did quite well. The overall plan was to keep her healthy so she could excel in the jumps at the end-ofseason meets.”

During practice, her jumping coach had her do bounding work on mattresses to minimize impact on her ankle. In the athletic training room, Hanlon continued ... “the mechanical work to make sure she was still using good landing habits.” Idris kept up with her dynamic jumping rehab, visiting the athletic training room every day before practice, which was no easy feat. “In my major, biomedical engineering, you can’t miss a lot of class,” she says. “I was very busy, running from class right to treatment and practice. It took a lot of planning, scheduling, and alarms on my phone to get me through that time.” Despite her busy workload, Idris rarely missed a day with the athletic training staff. “We worked around her schedule and she was great about coming in for early morning sessions or staying later in the evening if she had to,” says Hanlon. “She was dedicated to getting better no matter what was on her plate.” By the time the late-season meets arrived in May, Idris’s workouts and rehab had entered a maintenance phase. During practice, her jumping coach had her do bounding work on mattresses instead of the ground to minimize impact on her ankle. In the athletic training room, Hanlon continued to run Idris through the program she had begun in February. “We continued the mechanical work to make sure she was still using the good landing habits she had learned earlier,” he says. On May 3, unsure of what to expect, Idris entered the

Nominations Welcome We welcome your entries for our Comeback Athlete series. To nominate a comeback athlete, send a brief description of the athlete and his or her rehab process to ef@MomentumMedia.com. Please include your phone number and e-mail address.

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ComebackAthlete triple and long jumps at the CAA Outdoor Championships. The results were a pleasant surprise. With a jump of 41 feet, one inch in the triple jump, Idris captured first place and bested her own school record by nearly nine inches. She also finished second in the long jump. For her efforts, she was named cowinner of the meet’s Outstanding Field Performer award. It was the most gratifying moment of her career to date, she says. “After I sprained my ankle, I wasn’t hitting 40s very often and became concerned that I might never jump that far again,” Idris says. “When I jumped 41 at CAAs I was shocked, but also relieved.” For Hanlon, Idris’s performance validated all of the long hours and hard work. “It was funny thinking back two months earlier when Amira and I sat in my office discussing the possibility of her not competing that season,” he says. “And there she was breaking her school record and winning the outstanding performer award at the CAAs.” However, Idris’s performance at the CAAs belied the fact that her ankle was hurting—and everyone around her knew it. It took the combined efforts of her coaches, doctors, teammates, and Hanlon to convince Idris that it was time to consider surgery. “That conversation began the week after CAAs,” Hanlon says. “I told her, ‘It’s great that you got this far, so imagine what you could do with a fully functional ankle. Who knows how much better you could be.’” Idris wasn’t completely on board though. “I was scared,” she says. “I thought, ‘What happens if after the surgery I can’t perform like I did before?’” She eventually relented and the ATFL reconstruction was scheduled for June 4. But in the interim, she still had two more meets: the ECAC Championships and the NCAA Division I East Regionals. At the ECAC meet, Idris placed fifth in the long jump and ninth in the triple jump. She then finished a disappointing 38th in the triple jump at the NCAA Regionals, with her best TR AINING-CONDITIONING.COM

jump being just 39 feet, 1.25 inches. Her pain had been worsening during those meets and Idris says her performances further justified her decision to have surgery. With the reconstruction procedure now behind her, and a long rehab road in front of her, Idris has her sights set on returning in time for Delaware’s outdoor season in the spring of 2014. Come March, she hopes to wow the competition in the long and triple jumps and rewrite the

school record books once again. As for the rehab that will get her there, Idris says she’s confident because she knows she’ll be encountering plenty of familiar faces. “I like going to the athletic training room,” she says. “It is a vibrant place where everyone is always in a good mood. The athletic trainers and students are so good to me—they are playful, but never distracted. I’ve grown really close to everyone and it is almost like being with family.” n

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optimum performance

Ice hockey athlete Jacob Musselman sprints on a treadmill in the hyperoxic tent, which supplies extra oxygen during high-intensity workouts.

By Dr. Michael Zupan

Altitude

CAROL LAWRENCE

Adjustment

Much has been written about the benefits of the live-high, train-low principle. The U.S. Air Force Academy is putting the idea into practice with a special training program.

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here are many benefits to being a student-athlete at the United States Air Force Academy (USAFA) in Colorado Springs, Colo. One of them is living at an elevation of 7,200 feet, which allows the athletes to reap the physiological advantages of living and training at moderate altitude. Of course, you rarely get something for nothing in aerobic training. While many athletes and coaches are aware of the plusses that come from training at moderate altitude, there are also drawbacks, the most significant of which is a decrease in the maximal level of training intensity. To help our athletes reach their full potential, we needed to develop a training system that allows them to obtain the rewards of living at moderate altitude while counteracting some of the negative effects. This kind of balancing act is nothing new for strength coaches, who are used to working athletes hard but not too hard, and ensuring proper recovery while maintaining heavy workloads. However, in our case, finding the right balance for our athletes meant changing the very air they breathe. The solution we found is still a work in progress, but weâ&#x20AC;&#x2122;re excited about the results so far. For any school at an elevation of 5,000 feet or above, understanding what we are doing at the USAFA may be helpful. ALTITUDE TRAINING The performance benefits of training at moderate and high altitudes are well known in athletic circles. Training at altitude started during the lead up to the 1968 Olympic Games in Mexico City, which sits at an elevation of 7,350 feet. At that time, the thought was to train at the same altitude the competition would Michael Zupan, PhD, is an exercise/ aerospace physiologist and Director of the Human Performance Lab at the United States Air Force Academy. He has more than 27 years of expertise in training high school, collegiate, and professional athletes as well as teaching and conducting research. He can be reached at: Michael.Zupan@usafa.edu. T&C OCTOBER 2013

Â17

optimum performance be held at. However, research and experience have shown it’s more beneficial to do high-intensity training at lower altitudes while also taking advantage of the long-term physiological changes that come from living at moderate altitudes of 5,000 to 10,000 feet. The positive effects of living above 5,000 feet are varied and include increased red blood cell mass and plasma volume, which allows for greater oxygen delivery to the muscles, and increased production of erythropoietin, which stimulates the production of red blood cells. In addition, altitude training ups mitochondria and aerobic enzyme concentration, which raises aerobic metabolism during exercise. Typically, it takes about 14 to 30 days of training at moderate altitude for these changes to take hold. These benefits result from the body adjusting to the decreased amount of oxygen in the air at higher altitudes. Air is composed of a mixture of several different gases, with nitrogen and oxygen accounting for 78 percent and 21 percent, respectively. This mix remains constant regardless of elevation.

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What does change—and is relevant to training and performance—is the air pressure. As altitude increases, air pressure decreases, meaning there is less air available for athletes to breathe in, and as a result, less oxygen. To measure the amount of oxygen in the air, we look at the partial pressure of oxygen (ppO2). Partial pressure describes the density of a specific gas in a given volume of air and is determined by multiplying the percentage of a gas present by the atmospheric pressure. At sea level, the atmospheric pressure is approximately 760 millimeters of mercury (mmHg). This results in a ppO2 of 160 mmHg (760 mmHg X 0.21). At USAFA, the atmospheric pressure drops to approximately 590 mmHg, decreasing ppO2 to 124 mmHg (590 mmHg X 0.21). The reduced ppO2 means there is less oxygen available for the athlete to use, creating a drop in red blood cell oxygen saturation. A body’s average resting O2 saturation at sea level is normally 97 to 98 percent. When individuals spend time at altitudes of 5,000 to 10,000 feet, resting O2 saturation falls to 92 to 93

percent. This is important for athletes because O 2 saturation also decreases as the intensity of exercise increases, meaning the heart must pump a greater volume of blood to the muscles in order to deliver an adequate amount of oxygen to the working tissues. Although this process helps athletes build their overall endurance, it also means they are simply not able to produce the same level of force during high-intensity workouts. Since their maximum efforts are reduced, their training gains are limited compared to athletes working at lower altitudes. HYPEROXIC TRAINING Current research into altitude training suggests that athletes gain the most from a “live high, train low” model, meaning they reside at a moderate or high altitude, but perform high-intensity workouts at lower altitudes. This way they benefit from the body’s adaptations to a lower-oxygen environment while still being able to train at maximum intensity. Of course, there are several logistical hurdles to “live high, train low,”

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optimum performance

By the Numbers Below are sample treadmill workout protocols for athletes doing hyperoxic training in the Human Performance Lab. Sport

Speed (mph)

Load (lbs)

Interval Time (sec.) Recovery Time (sec.) No. of Intervals

Basketball, men’s

8-12

6-10

20-30

180-215

5-7

Basketball, women’s

8-9

3-7

20-30

150-180

4-6

Boxing

9-12 5-7

10-15

30-60

8-10

Football

12-14

30-40

3-5

15-30

Ice Hockey

9-12

4-8

10-15

60-90

7-9

Lacrosse

7-12 10-12

30-45

180-215

5-7

Soccer, men’s

10-13

8-12

15-25

150-180

4-6

Soccer, women’s

7-9

4-6

20-35

60-180

5-7

Tennis, men’s

8-11

5-12

15-40

180-215

5-8

Tennis, women’s

7-9

5-7

20-40

150-180

5-7

Wrestling

8-11 3-11

20-45

60-180

7-21

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optimum performance namely the difficulty of finding locations where athletes can quickly decrease or increase altitude, the cost of moving them from one location to another, and the time required. Instead of bringing our athletes to lower elevations for training sessions, we have addressed these problems at USAFA by recreating the conditions found at lower altitudes through hyperoxic training in our Human Performance Laboratory.

ing environment. Instead of increasing air pressure by pumping more air into a set amount of space—like an airplane does at high altitudes—the Colorado Altitude Tent raises the percentage of oxygen in the tent’s air using six air generators. The units separate the air into nitrogen and oxygen molecules, with each gas being released through different ports. We can simulate various altitudes by pumping different levels of

The resistance on the belt and the length of each interval will vary based on sport requirements. For example, a football lineman will have 30 to 40 pounds of resistance for intervals lasting three to five seconds. Hyperoxic training involves creating a training environment with increased oxygen levels. We started using hyperoxic training here in 2011 and have been very pleased with the results. In the hyperoxic environment, our athletes’ tissues can receive about the same amount of O 2 as they would when training near sea level. Athletes benefit since they are able to push muscular efforts to the max without being limited by their cardiorespiratory system. The hyperoxic environment also helps them recover faster between sets. This improved recovery time is crucial since a lot of our hyperoxic workouts utilize interval training, and it’s important that athletes recover quickly for their next set. The best part is that the athletes don’t need to spend a lot of time in a hyperoxic environment to reap the benefits. Since the biggest drawback of altitude training is a reduction in athletes’ maximum efforts, the differences in oxygen levels only hinder them during highintensity training. Most athletes at any altitude do high-intensity training only a couple of times a week because of the need to recover after such demanding sessions. By creating a hyperoxic environment for our athletes once or twice a week, they are able to match the highintensity efforts of their counterparts at lower altitudes. But they only need the hyperoxic environment for their hard days and they can do their easy and moderate days at altitude.

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MAKING IT HAPPEN Here at the USAFA Human Performance Lab, we use a Colorado Altitude Tent (CAT) to create a hyperoxic train-

oxygen and nitrogen into the CAT. By pumping more oxygen into the tent, we can increase the percentage of oxygen in the air to 26 percent, raising the ppO2 to 153.4 mmHg. This provides the athletes with the same amount of oxygen they would receive at 850 feet above sea level. For fire safety purposes, the air unit controllers will not allow the oxygen to exceed 26 percent. We also have two carbon dioxide scrubbers in the tent to limit the buildup of CO2 . This keeps the oxygen and nitrogen levels consistent as athletes expel CO2 while exercising. Our tent is a 10’x10’ enclosure that is eight feet high. It’s constructed of an aluminum frame with plastic walls and ceiling and is easy to assemble and disassemble since the walls and ceiling are delivered in panels. In it, we place two cycle ergometers (or rowing machines) and two treadmills—one motorized, one self-powered. This allows us to train up to four athletes at a time. Numerous USAFA teams utilize the hyperoxic CAT environment based on the demands of their sport and desires of their head coach. Most teams do their hyperoxic training during the offseason since the high-intensity work can leave players wiped out and unable to complete a typical in-season sport-specific practice session. Among the teams making the most use of the tent are football (although for now we focus on linemen and running backs because of the large numbers of players involved), ice hockey, basketball, track, wrestling, soccer, swimming, and tennis. We analyze the demands of each sport and develop our hyperoxic training proTR AINING-CONDITIONING.COM

optimum performance tocols to closely match those specific needs. For endurance athletes, including cross country runners and distance swimmers, we use the motorized treadmill or rowing machines to have them work at steady speed intervals with an increased recovery time. To get the athletes to push past their normal thresholds and tap into the benefits of high-intensity training, we usually set the treadmills one-half to one mile-per-hour faster than their normal running speed outside the hyperoxic tent. When using the rowing machine, we look at the distance they normally row in the ambient atmosphere and increase it by 10 to 15 percent. Athletes participating in anaerobic sports requiring short bursts of energy, such as football, tennis, and sprinters in track and swimming, have shorter intervals and complete a high number of total repetitions compared to endurance athletes. They also use greater resistance to better create an “all out” experience. Depending on the demands of their sport, they focus on the upper body or lower body. For upper body train-

ing, they use a rowing machine, and for lower body work, the self-powered treadmill, which has an internal braking system that can add up to 150 pounds of resistance to the belt, increasing the load the athlete has to run against. Using this treadmill is very similar to pulling a loaded sled, running with a parachute, or using bungee cords for resistance. The benefit of using the self-powered treadmill is that speed, time, and load (resistance) can be pre-programmed and monitored very closely during the workout. The resistance on the belt and the length of each interval will vary based on sport requirements. For example, a football lineman will have 30 to 40 pounds of resistance for intervals lasting three to five seconds. A tennis player, meanwhile, will have intervals lasting 20 to 30 seconds with five to seven pounds of resistance. By tailoring the interval-training program to mirror the demands of the athlete’s sport, we increase transfer to the playing field when competing. (See “By the Numbers” on page 19 for the loads we use for various sports.)

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A printout is given to the athletes and coaches following every workout allowing everyone to track progress. Changes to the protocols can be made as the sport coaches see fit, as long as we deem the protocol practical. Also, as the athletes improve over time, we increase running speed, load, or interval time. LOOKING AHEAD Our experiences with hyperoxic training at the USAFA have been extremely positive. It has helped our athletes grow bigger, stronger, and faster, and our coaches report improved performance on the playing field. The one major drawback with our system is the limited number of athletes we can train. Only four athletes can use the tent at one time and each workout session takes about 20 to 30 minutes. This means a team of 20 athletes requires about two hours of tent use. It would be nice to have a larger system so we could train more athletes each day. But for now, we’ll focus on what we have and keep helping our athletes make sure they benefit from living high and training low. n

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LEADERSHIP

connecting sAFELY

istock.com

From texting to social media, information can be exchanged today in the blink of an eye. That’s why every athletic trainer needs a well-thought-out plan for electronic communication.

BY JAMES MALSEED

ou’re spending a rare Friday night at home. The wrestling team is at an invitational and the boys’ and girls’ basketball teams will host a double header tomorrow. You settle in for a movie and popcorn with your family when the cell phone rings. It’s a text message from the host athletic trainer at the wrestling meet to tell you that your 103 pounder, a state runner up last year, has a possible ACL tear. The text includes the description of the injury, the name of the athlete, what first aid has been given, and the name of the physician at the meet. You don’t think twice about how this information was relayed. Maybe you should. Another scenario to think about: Your star volleyball player lands on another James Malseed, MEd, ATC, RAA, is Athletic Trainer and Chair of the Department of Health and Physical Education at Archmere Academy in Claymont, Del. He is a founding member, former president, and a Hall of Fame inductee in the Delaware Athletic Trainers Association and received a 2013 NATA Athletic Trainer Service Award. He can be reached at: jmalseed@archmereacademy.com.

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LEADERSHIP player’s foot during a practice drill and now has a softball-sized edema on the lateral side of her ankle. Teammates and athletes from other sports are taking pictures of the injury and posting them to Instagram, as well as sending them in text messages. One studentathlete takes a short video and excitedly announces she’s posting it on Vine. You may laugh and shake your head

at our school is to add a disclaimer to any of our e-mails that contain patient information. We’ve all seen examples of this on messages from physicians and other members of the health care profession. Ours includes the following: This e-mail and any files transmitted with it are confidential and intended solely for the use of the individual or entity to whom they are addressed.

Our text messages are kept general, with no identifying information allowed. For example, a text sent to the athletic trainer at an opposing school states only that one of their athletes has been hurt and an e-mail will follow. at how the world has changed. Or you may wonder if there is a problem with injury photos being quickly shared. In truth, you should do more than just wonder. We all use electronic media as part of our daily lives. It’s fast, easy, and how people communicate today. But as health care providers working in educational settings, what do we need to think about before we hit “send?” PROBLEM AREAS For most of us in athletic training, electronic media is woven into our operations. Here at the Archmere Academy in Claymont, Del., both my associate athletic trainer and myself use email and text messages as our primary method of communication with our team physicians, the athletic training students we serve as preceptors for, athletic trainers from other institutions, coaches, and parents. We also use it extensively between ourselves. However, we use these tools very carefully. We’ve put a lot of thought into how and when we will use these tools and we follow very specific rules governing their use. There are so many landmines—some very well hidden— in using electronic communication that it’s critical to understand the ramifications of what we are doing. Here are some areas to think about: Privacy Laws: Protecting the privacy of a patient is the law, which we may break when we casually relay medical information through a text or e-mail. The wrestling example above could be a HIPAA violation since medical information is provided and a FERPA issue since a student is involved. The main solution we have devised 24

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If you have received this e-mail in error please notify the system manager and sender. The evaluation of the athlete named is the opinion of the sender and may not be completely correct. This evaluation should be used to determine only if further medical evaluation and treatment should be provided. Our text messages are kept general, with no identifying information about an athlete allowed. For example, a text sent to the athletic trainer at an opposing school about an injury states only that one of their athletes has been hurt and an e-mail will follow detailing the injury.

state and federal laws. Furthermore, our school policy states that all injuries are reported to our team physicians. Athletes and parents sign a statement that they have read and understand school and state association policies, which are included in our athletic department handbook. It also is a good idea for athletic trainers to periodically read their state laws regarding patient privacy. They vary from state to state and must be thoroughly understood. Posting Photos: As relayed in the example of the volleyball athlete’s ankle sprain, it’s easy—and typical—for today’s student-athletes to take photos of anything and everything. They don’t hesitate to point their phones, capture an image, and post it for all to see. But is it okay for an athlete’s injury to become public in this way? The answer is that this is not okay, and you must take steps to prevent it. As the athletic trainer, you are the person in charge of the injured athlete and distributions of the pictures taken in your athletic training room are your responsibility. Allowing the photos could put you in violation of federal law, state law, or your state practice act. Communicating with Parents: When an athlete is injured, one of our first communications is with his or her par-

Student-athletes take photos of anything and everything. They don’t hesitate to point their phones, capture an image, and post it for all to see. But is it okay for an athlete’s injury to become public in this way? We are also helped by our state’s high school athletic association, which has a specific policy on communication among health care providers. As part of the annual physical required for all athletes, parents and athletes are asked to sign a statement that they understand the policy on the sharing of health information. This policy allows licensed health care providers associated with the school the student attends and any school where a contest takes place to communicate about an athlete regarding an injury or other healthrelated issue. The legal council for the state athletic association, who is also a member of the state attorney general’s office, has reviewed these rules and says they comply with all applicable

ents. Because news spreads quickly today, it’s imperative not to delay when informing parents of an injury. You don’t want them to hear from you 15 minutes after they already found out about their child’s injury through a friend’s text. For major injuries, we talk with the parents in person or over the phone. For other injuries, we use e-mail as our primary communication, with the disclaimer always at the bottom. The e-mail is a form letter we fill in with specifics about what the injury appears to be, what we did, what we recommend they do, and how we will follow up. We have received a lot of positive feedback about this system because it provides the parents all the informaTR AINING-CONDITIONING.COM

LEADERSHIP tion they want to know. If an athlete from a visiting school is injured at one of our home games, we notify the athletic trainer from their school via e-mail. The Delaware Athletic Trainers Association gathers email addresses of its members each fall. We are hoping that the state athletic association may soon provide us with e-mail addresses of the parents of all student-athletes in the state so we can contact parents from visiting schools directly. Oversight: If you serve as a preceptor for athletic training students from a local college, this story will hit home: One of the students tweets about an unusual injury they see. Within an hour, the tweet is re-sent to over 100 other people, including the injured athlete and members of their family. You receive phone calls from the athletic director, the athlete’s family members, and even the local press. You are in deep trouble, even if no names were mentioned. As the preceptor, you are responsible for this information becoming public. It does not matter that the name of the athlete or

the school is never disclosed—you have allowed information about one of your patients to be distributed. To make sure this does not happen, we tell athletic training students that they cannot share information about

tion about injuries, progress of injured athletes as they return to practice, game score updates, weather information, and schedule changes. This is allowable since we are all employees of the school and responsible

Because news spreads quickly today, it’s imperative not to delay when informing parents of an injury. You don’t want them to hear from you 15 minutes after they already found out about their child’s injury through a friend’s text. any of the student-athletes. If they want to use an injury from our athletic training room as a case study paper, then they must get permission of the athlete and parents using their college or university release. Sharing Information: With a 65acre campus to cover here at Archmere, keeping in touch with everyone can be a challenge. It helps a lot that we can all communicate by text message, and we frequently do. I constantly trade texts with the other athletic trainer on staff, coaches, and the athletic director. It allows for instant communica-

for the care and treatment of athletes. Even so, we have spent a lot of time developing guidelines to avoid running into any problems. The situation is more complicated when it entails sharing information among athletic trainers at different schools. It’s important to know if any state laws or association rules allow this. If not allowed by the state association or by state law in some manner, only phone calls or face-to-face contact should take place. When our teams compete out of state we depend on our coaches to notify us

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LEADERSHIP of any injuries before they return to school. Depending on the situation, we may meet the team when they arrive. In cases of the athlete being hospitalized, we notify the parents as soon as possible. A different type of sharing is when we text, e-mail, or post on Facebook a complaint or negative message. Maybe

tended for. The consequences can be career damaging. Electronic communication may feel like uncharted waters. But you can’t just casually swim through them. You need to navigate them by putting guidelines in place to protect your patients, your employer, and most of all yourself. Without the proper safeguards,

On the athletic department’s Web site, there is a link to our athletic training page, where we post a new blog monthly. Issues we’ve covered include hydration, the dangers of energy drinks, and what an athletic trainer is. we witness a display of poor sportsmanship by a coach and vent about it to friends on Facebook. Or we post to an athletic training mailing list about something unprofessional. It can even be tempting to complain to a co-worker through a text about our boss. But even when we think a message is private, it’s so easy for anything relayed over electronic communication to get in the hands of someone it’s not in-

depending on your state law, your license could be in jeopardy. GOOD PRACTICES Being careful with our use of electronic communication doesn’t mean we need to think of it as a negative. In fact, the opposite is true. There are so many ways it can be helpful in athletic training, and it should be embraced. We have tried to do this at our high

QUICK RESPONSE While electronic media can sometimes seem like a monster to tame, it can also be an angel that saves the day. We recently had a situation where an athlete at our school was diagnosed with a highly communicable disease. We received the information in the athletic training department via e-mail and quickly worked with athletic administrators to put a communication plan in place. To start, we sent text messages and e-mails to notify coaches and team physicians of the situation. Next, Web searches were done to educate ourselves more thoroughly on the signs and symptoms of the disease. We then sent another text to our team physicians outlining the procedures we were taking to disinfect the locker room and equipment that the athlete had contact with. From there, we drafted a letter to parents about the illness along with symptoms to look for in their child. We had the letter reviewed by a team physician who received it via e-mail, and then responded via text that it was good to go. At the same time, it was looked over by an athletic trainer who was away from campus. Once approved, the letter was quickly sent out via e-mail. Printed copies were later distributed to the student-athletes. Within half an hour of becoming aware of this health concern, everyone involved could take a deep breath as parents had been notified, the locker room and equipment were disinfected, and things returned to normal. The Web, text messages, and broadcast e-mail saved the day. The future isn’t coming, it’s here.

T&C OCTOBER 2013

school with great results. We find it elevates our program, aids us in communicating, and educates others. Here are some ways it has helped us: Public Relations: We have a Facebook page for the athletic training program, “Archmere Auks Athletic Training,” and use it as a way to educate our parents, athletes, and other interested individuals about prevention of injuries and current trends in the profession. We post video clips, links to Web sites, article links, and any information we think others would find helpful. To inform people about the page, mass e-mails, word of mouth, and the school newsletter are used. As a way to liven up the Facebook page, we also post game results and give “shout outs” to both individuals and teams that have received special honors and awards. We encourage individuals to comment on what we post to the page, but remove any posts that discuss individual injuries, notifying the person who left the comment as to why. On the athletic department’s Web site, there is a link to our athletic training page, where we post a new blog monthly about a topic in sports medicine. Issues we’ve covered include hydration, the dangers of energy drinks, proper weight loss, and what an athletic trainer is. There is also a page on the site that gives the background information on the athletic medicine staff. Important News: Electronic media is also fantastic for disseminating information. For example, say the state athletic association issues new guidelines for athlete physicals near the end of the academic year. We can easily let parents know through a broadcast email, mass text message, and our Web site and Facebook page. Quicker Treatment: We have found electronic media to be a great way to get athletes treated as quickly as possible. For example, an athlete trips down the steps at home and you would like to get him seen as soon as possible by your team orthopedic. He is in surgery in the morning, and has limited availability in the afternoon. A quick text can state that you need the doctor to see an athlete as soon as is convenient and possible. Remember that you will need to have the permission of the athlete and parents to discuss the problem in anything more than a general way. TR AINING-CONDITIONING.COM

LEADERSHIP Help From Others: You are rehabbing a patient post surgery and have reached a point where she is not making any progress. You have discussed the situation with the physician who performed the surgery, but this has not helped. A post on a rehabilitation blog, private state athletic training Facebook page, or a tweet, all stating the problem in a very general way such as “I have a patient who had ACL surgery and still has very limited ROM three months post surgery” will get you some new ideas and hopefully move the process forward. However, names or other identifying information should never be used. Continuing Education: For some of us, budget cuts are limiting the type and number of continuing education programs we can attend. The use of Webinars, teleconferences, and live chats via Skype, Twitter, and other methods are a great way to go. In the case of Webinars, some presenting individuals or sponsor groups offer both live and archived materials to help you obtain CEU credits. Keeping Connected: Some of the high school athletic trainers in my state are looking for ways to have monthly Web chats. The items to be discussed could be common problems of working on the secondary school level and

Everyday I read things posted by my fellow professionals that could lead to major problems for them down the road ... a loss of confidence from those we treat or even the loss of a job. trends treating certain injuries. It might also be just a nice opportunity for social interactions among fellow professionals. BOLD NEW WORLD Facebook, texting, e-mail, Twitter, and other electronic media have become an everyday fact of life for me as an athletic trainer. They have allowed me to reconnect with mentors and friends from college, meet new colleagues, learn about different ways of working with my athletes, and ultimately become a better athletic trainer. But there is a dark side to be very aware of. Everyday I read things posted by my fellow professionals that could lead to major problems for them down the road. Making light of something done or said in the athletic training room, blogging about the attitude of a coach or other department member, and sending out pictures or videos of injuries could have unintended consequences. And once something is posted, it never really goes away. Even if it’s removed later, it can be mined and cause a problem long after we have forgotten the initial post or message. These things can lead to loss of respect from those we work with, loss of confidence from those we treat, and even the loss of a job. Electronic media has its place in athletic training, but where and how it’s used is a subject that needs to be discussed with your staff, athletes, parents, athletic training students, and even your physician. Without proper knowledge and guidelines, the use of these new tools in the practice of athletic training could be a violation of your school policies, governing body regulations, or state and federal laws. n TR AINING-CONDITIONING.COM

Circle No. 120 T&C OCTOBER 2013

Circle No. 121

NUTRITION

VEGGIES GALORE What happens when you take meat, eggs, and dairy out of an athlete’s diet? Going vegan is possible for high performance, but only with a clear understanding of the hurdles.

iSTOCK.COM

By Susan Kundrat

rian Foster is a three-time Pro Bowl running back for the Houston Texans with over 5,000 career yards from scrimmage. Taj McWilliams-Franklin retired from the WNBA in 2012, capping off a 13-year professional career in which she was a six-time WNBA All-Star and won two WNBA championships. During his 2012 season with the Oakland Athletics, relief pitcher Pat Neshek had a 1.37 ERA and held opponents to a .147 batting average, both the lowest marks of his career. Three very different athletes with one thing in common: each follows a vegan diet. Foster began his plant-based meal plan in July of 2012, and it helped fuel a season in which he led the NFL in rushing attempts. McWilliams-Franklin transitioned to veganism five years ago TR AINING-CONDITIONING.COM

to further extend her career. After reading about the correlation between an animal-based diet and health problems, Neshek made the change in 2007. Vegan diets have become increasingly popular in recent years, including in the athletic community. As high school and collegiate athletes see more and more of their favorite players trading in meats and dairy for plants and grains, they may be inspired to make the transition themselves. However, doing so safely requires education, planning, and often, the input of a sports dietitian.

vegan diet after they have lived as vegetarians for a length of time. In some cases, like Foster’s, athletes consider themselves primarily vegan but occasionally eat select animal products, a diet many call “flexitarian.” When planned and implemented appropriately, a vegan meal plan can support the nutritional needs of most athletes. Overall, well-balanced vegan diets tend to be lower in saturated fat and cholesterol and higher in fiber, magnesium, potassium, vitamin C, vitamin E, folate, and a wide range of

NUTS & BOLTS A traditional vegan diet is plant-based and excludes all animal products, including meat, dairy, and eggs. Food items derived from animal sources are usually also removed, such as gelatin and honey. Most individuals adopt a

Susan Kundrat, MS, RD, CSSD, is a Clinical Assistant Professor of Kinesiology and the Nutritional Sciences Program Director at the University of Wisconsin-Milwaukee. She is also the cofounder of RK Team Nutrition and can be reached at: kundrat@uwm.edu. T&C October 2013

NUTRITION phytochemicals than diets that include animal products. However, vegans may have lower intakes of protein, vitamin B12, calcium, iron, vitamin D, and long-chain omega-3 fatty acids. Here’s a closer look at some of these key nutrients that can be deficient in vegan athletes.

day. If the athlete is vegan, a more appropriate protein recommendation is 77 to 123 grams per day, or an extra 1 to 2 cups of soy milk daily. For a 220-pound football player, protein needs are 132 to 176 grams per day. If the player is vegan, the recommendation jumps to 145 to 193 grams of protein, or an addition-

Because iron from plant-based foods is not absorbed as well as iron from animal sources, the recommended intake for vegans is 1.8 times greater. For example, an adult female vegan athlete should consume 32 mg of iron daily versus 18 mg for a non-vegetarian. Protein: Needed for maintaining and building muscle and other tissues, protein is critical for athletes. Daily needs typically range from 0.5 to 0.8 grams per pound of body weight. But vegans should consume 10 percent more than the typical recommendations, because plant-based protein sources such as soy, legumes, nuts, seeds, grains, and vegetables, are more difficult to absorb than animal sources. For example, a 140-pound runner requires 70 to 112 grams of protein per

al 1/2 cup to 1 cup of peanuts daily. Vitamin B12: Vegan diets are often low in B12, a critical vitamin naturally found in animal products. It is essential for the maintenance of optimal nerve function and healthy cells and prevention of megaloblastic anemia, which results in tired and weak bodies. Adding a B12 multivitamin or consuming ample vitamin B12-fortified foods such as soy milk, meat analogs, or sports bars, is essential to getting the recommended 2.4 mcg a day.

Top Ten Heather Fink, MS, RD, CSSD, owner of Nutrition and Wellness Solutions, LLC in Indianapolis, is an athlete who has followed a vegan diet. A gold and silver medalist in the long and short course Duathlon World Championships and competitor in the Hawai’i Ironman, she aims to consume a protein source with every meal and snack. Here is a list of Fink’s Top 10 foods she relies on most: 1. Tofu 2. Soy or almond milk 3. Nuts, seeds, and nut butters 4. Beans—kidney, navy, pinto, etc. 5. Lentils and split peas 6. All fruits, fresh and dried 7. All vegetables 8. Whole grains such as oatmeal and quinoa 9. Vegan sports bars—Lara, Clif, and Kind bars 10. Dark chocolate

T&C October 2013

Calcium: Adequate calcium intake is critical because it plays a key role in optimizing bone strength and is essential for muscle contraction. Some studies have also noted an increased risk of developing stress fractures in vegans due to the lack of this nutrient. Because plant-based diets typically don’t include dairy products, a main calcium source, vegans tend to fall below the daily recommendations of 1,000 to 1,300 mg. Structured vegan diets should contain ample sources of highly bioavailable calcium from items such as broccoli, collards, fortified fruit juices, and calcium-set tofu to boost stores. Still, a calcium supplement is often recommended to meet needs. Iron: An essential component of proteins and enzymes that maintain health, iron is also paramount in facilitating the delivery of oxygen to cells. When iron is low, fatigue, decreased performance, and lowered immunity can result. Because iron from plantbased foods is not absorbed as well as iron from animal sources, the recommended intake for vegans is 1.8 times greater. For example, an adult female vegan athlete should consume 32 mg of iron daily versus 18 mg for a nonvegetarian, and an adult male vegan athlete requires 14 mg per day rather than 8 mg. Generally, a multivitamin containing iron is added to a vegan diet. Iron stores (specifically ferritin) should be monitored periodically in vegan athletes to ensure adequate levels for optimal training and performance. They can also add fermented food products—such as miso or tempeh—sprouted grains, and legumes to their diet, as the iron in these foods is absorbed more readily. Vitamin D: This micronutrient plays a key role in bone health and immune system function. Like iron, vitamin D levels are a common concern for athletes at many levels of competition, because low levels in the body may increase the risk of developing stress fractures and other bone-related problems. In addition, inadequate vitamin D consumption is associated with a weakened immune status, which could precipitate illness in athletes. Low vitamin D intakes, low serum vitamin D levels, and reduced bone mass have been reported in some vegan groups that were not using vitamin D supplementation. Therefore, vegan athletes TR AINING-CONDITIONING.COM

NUTRITION should utilize a combination of periodic testing, supplementation, consuming vitamin D-fortified foods—such as fortified orange juice—and exposure to sunlight to meet their needs for this nutrient. Omega-3 Fatty Acids: Vegan athletes may have a difficult time obtaining the recommended 1.1 to 1.6 grams per day of omega-3 fatty acids, which are found in fatty fish and fish oils. Omega-3s are critical for overall cardiovascular health, brain health, and disease prevention, and they have the potential to decrease inflammation in athletes. However, by combining nuts, seeds (especially flax), vegetable oils, algae, and some leafy greens with fortified foods such as soy milk, rice milk, and vegan bars, omega-3 fatty acid deficiency may become less of a concern. Supplements are also commonly utilized. Besides having difficulty getting ample amounts of the necessary nutrients, vegan athletes often have to consume more food than non-vegans to meet caloric needs, maintain body weight, optimize training, and make gains in lean mass. “Since many vegan foods

are nutrient-dense but may not be calorie-dense, athletes need to make sure they are meeting their calorie needs,” says Sports Dietitian Heather Fink, MS, RD, CSSD, owner of Nutrition and Wellness Solutions, LLC in Indianapolis and an expert on vegan diets and boosting performance. “Vegan

reasons for going vegan, and knowing their motivations is essential in helping them navigate the course appropriately. For some individuals, a vegan diet is desired due to personal beliefs about animal welfare and/or environmental concerns. Many books and documen-

When an athlete is considering going vegan, finding out why he or she wants to make the move should be priority number one. Athletes may have many reasons, and knowing their motivations is essential in helping them navigate the course appropriately. athletes should plan to have food with them as much as possible and snack on high-calorie options like nuts, nut butters, seeds, dried fruit, and 100percent juices.” HOW TO RESPOND When an athlete is considering going vegan, finding out why he or she wants to make the move should be priority number one. Athletes may have many

taries have focused on the inhumane treatment of animals in the food processing industry. Much research has also been done on the carbon footprint that results from raising, producing, and transporting animal products, contributing to climate change. Some studies have estimated that eating a vegan diet contributes less than half the carbon emissions of a meat eater’s. Other athletes may be more inter-

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T&C October 2013

NUTRITION ested in the health benefits of a vegan meal plan, which has been associated with lower blood pressure, a decreased chance of developing heart disease, lower Body Mass Index, and declined overall cancer rates. A position paper from the Academy of Nutrition and Dietetics states that “appropriately planned vegetarian diets, including total vegetarian and vegan diets, are healthful, nutritionally adequate, and may provide health benefits in the prevention and treatment of certain diseases.” There is sometimes one more reason

an athlete wants to go vegan—to add more restrictions to their diet, thereby masking an eating disorder. Cutting out certain foods and slowly limiting what should and should not be eaten is a way for an individual to manage the disorder and feel “safe” with his or her diet. Recognizing this as a potential reason for a dietary change could help you notice a struggling athlete and refer him or her for proper treatment. When athletes come to you to discuss a vegan diet, ask them about their motivations, and hear them out. While

offering support, also challenge them to think through the dietary change. For example, if an athlete already has significant diet restrictions (e.g., severe food allergies or gluten intolerance), going vegan may be simply too difficult. If possible, a sports dietitian should assess the athlete’s individual needs, medical issues, and demands of their sport to help determine the appropriateness of going vegan. MAKING IT WORK Regardless of what’s behind their

Case Studies The following is a vegan meal plan that could work for both a 150-pound female soccer player and a 220-pound male football player with just a few adjustments. Breakfast: 2 slices whole grain toast + 2 T cashew butter 1 cup soy yogurt 2 cups orange juice fortified with calcium and vitamin D Multivitamin with iron = 776 calories, 25 grams protein Football player: Add 2 cups orange juice and 2 more slices of toast with cashew butter to add 620 calories and 17 grams of protein Snack: 1/3 cup raisins + 1/3 cup almonds = 425 calories, 10 grams protein Football player: Add 2 cups of 100-percent grape juice to add 275 calories Lunch: 1 cup black beans + 1 cup brown rice + 1/4 cup salsa 1 apple 2 vegan cookies + 1 cup soy milk = 871 calories, 30 grams protein Pre-workout: 1 banana + 1 T peanut butter = 200 calories, 5 grams protein Post-workout: 1 cup chocolate soy milk + 2 fig bars = 240 calories, 10 grams protein Football player: Add 1 vegan sports bar to add 370 calories and 9 grams of protein

T&C October 2013

Dinner: 1 cup tempeh sautéed with 2 cups broccoli or carrots 1 cup quinoa 1 cup strawberries 2 cups orange juice fortified with calcium = 780 calories, 34 grams protein Snack: 1 cup iron-fortified dry cereal = 150 calories, 4 grams protein Football player: Add 1 cup sunflower seed kernels to add 820 calories and 32 grams of protein

Totals: Female Soccer Player: Calories goal: 3,400 Calories actual: 3,442 Protein goal: 0.6 grams/pound = 90 grams + 10% = 99 grams Protein actual: 118 grams Male Football Player: Calories goal: 5,500 Calories actual: 5,527 Protein goal: 0.7 grams/pound = 154 grams + 10% = 169 grams Protein actual: 176 grams

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NUTRITION choice, the most important piece of advice I offer my athletes when they are moving to a vegan diet is to make “food switches” rather than simply removing foods from their diet. Athletes often know what to take out but don’t always substitute foods in to replace missing nutrients. For example, if an athlete wants to take out all meat products, he or she should find foods to swap that are nutritionally similar in terms of total calories and key nutrients provided. Sometimes a combination of foods

can do the trick. Common switches include beans and brown rice for meat or poultry, nuts and seeds for fish, soy milk for cow’s milk, and “veggie” jerky for meat jerky. Nowadays, new products on the market make it much easier to be a vegan athlete. Vegan frozen meals, freeze-dried meals, high-protein bars, meat substitutes, and sports shakes and drinks are immensely beneficial. In addition, natural food stores provide more options, and some may offer advice or cooking classes.

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T&C October 2013

I often tell our vegan athletes to “think bulk” when they cook. Many vegan main dishes like rice and beans or tempeh and veggies can be made in large quantities and refrigerated or frozen for future meals. That way, when time is short, the meals can still be heated up quickly. Another area to help vegan athletes with is team travel. Finding vegan options on the road can be a challenge. Here are some tips: • Pack some of your own foods, especially vegan protein sources. Fink, who has been a vegetarian for nearly 20 years and has followed a vegan diet for much of the past 10, often packs vegan protein bars, vegan protein powder, and nuts as her staples. Other great portable options include vegan jerky, single-serving microwaveable bean-based soups, dried soy nuts, single-serving nut butters, and portable single-serving soy milks. • Plan ahead by finding natural food markets that will be on your route. For 15 years, I served as the instore registered dietitian at a natural food store, and we often had sports teams come in for specialized vegan meals and to pick up select food items when on the road. It’s becoming more and more common for stores to have on-site nutrition experts to help you find what you need for your trip. • Search the Web ahead of time for vegan restaurants. Two helpful Web sites are the Vegetarian Resource Group (www.vrg.org) and Happy Cow (www.happycow.net). Also, consider ethnic dining options known for offering a wide range of vegan choices, such as Chinese, Thai, Indian, Korean, and Mexican fare. Finally, make sure to check in with your vegan athletes to find out how their diet is working. If they are unable to maintain weight, have a difficult time getting through workouts, are exhibiting low energy, or their performance has dropped, it’s time to take a closer look at the diet or perhaps reconsider it altogether. A vegan meal plan can be more difficult to manage, but by paying attention to key nutrients, planning, and preparing high-quality vegan foods, athletes can find success. After all, that’s certainly been the case for world-class athletes like Foster, McWilliams-Franklin, Neshek, Fink, and many others. n TR AINING-CONDITIONING.COM

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a Hitrainer prO was installed at the primary strength training and conditioning room for syracuse athletes. Members of the strength/conditioning and the athletic training departments were educated on the principles and operations behind the equipment by Brian robinson, the company’s vice president of research and development. and while the presentation was going on, staff members quickly realized how they can use the product to assist them in so many aspects of their operations.

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hree days before start of the syracuse university football season, the Orange strength conditioning and athletic training departments received a valuable tool that will not only benefit the football team, but all syracuse student-athletes.

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a HiTrainer and see it as a valuable tool in injury training and conditioning programs not only for our football team, but for all teams at Syracuse,” said Will Hicks, assistant athletics director for strength performance. “the benefits of using the Hitrainer both inseason and out-of-season are extensive.” Hicks said at the beginning, because the football team is in-season, the strengthconditioning and athletic training staffs will use Hitrainer for pre-screening and rehab with the team members. Work on the equipment can show signs for corrective measures that need to be

taken before the athlete is cleared to start practicing. Hicks also plans to have athletes use the Hitrainer to establish a baseline that will be used in watching the player’s progress if he is injured and for measuring advancements made during off-season training. “We’re honored to be working with such an elite athletics program like syracuse,” robinson said. “Will Hicks, his staff, and the athletic training department take a very global approach. everybody is involved in the steps necessary to help syracuse athletes perform at their very best. they have the insight to get the maximum benefits out of the Hitrainer.”

High Intensity Interval Training: real-time performance feedback (blue) vs personal best (red).

Down the Meridian

Jonathon Papelbom, a former patient of author George Leung, throws one down the middle for the Philadelphia Phillies earlier this season.

AP PHOTOS/MATT SLOCUM

treating the athlete

As more athletes seek alternatives to Western medicine, a new discipline called sports acupuncture has emerged. Our author combines his background in athletic training with this Eastern form of treatment. By George Leung

ike many athletic trainers, I was first drawn to the profession by a love of sports. I’ve played baseball and basketball competitively and have always led a very active lifestyle. Like many Western acupuncturists, I got involved in this profession after seeking an alternative treatment for an injury. Ten years ago, while playing in a basketball game, I twisted my low back and felt immediate pain. Within the next few days I experienced sciatica, with radiating nerve pain down my left leg. As an athletic trainer, I knew that this type of injury usually takes a long time to heal and that surgery can be necessary. When my low back and sciatic nerve pain didn’t resolve, I decided to try acupuncture treatment in an effort to avoid surgery. I visited a veteran practitioner and, to my amazement, after three or four treatments the sciatica and low back pain disappeared altogether. I was both intrigued and inspired. A friend studying acupuncture suggested that with my background as an athletic trainer and physical therapist assistant, it might be useful to learn about the different ways acupuncture has been used to treat sports injuries. After years of working as an athletic trainer in schools and clinical settings and growing frustrated with seeing the same patients return for the same problems, while being unable to provide anything other than the same protocols—I finally decided to pursue a degree in acupuncture. In the years since, I’ve treated everyone from professional athletes to Olympic hopefuls to marathon runners. More and more athletes are seeking alternative, holistic therapies to TR AINING-CONDITIONING.COM

treat their injuries in an effort to expedite recovery and enhance performance. I have found acupuncture to be a safe and effective option for a host of reasons. To start, it focuses not only on the local symptoms but on the root cause. Secondly, each treatment is individualized based on the practitioner’s style, method, and approach to treating a condition, as well as the patient’s presentation, needs, and response. In addition, you are treating the mind and body all together. Acupuncture is also a natural healing treatment involving no medication. I’ve found acupuncture treatment remarkable for both its effectiveness in resolving all kind of sports and musculoskeletal injuries and the speed at which it produces results. For many athletes, timing is vital. Returning athletes to their sport safely and quickly can be the difference between them winning a championship or sitting on the sidelines as their dreams pass them by. To this end, we as sports medicine professionals have to be able to think outside the box, and help our athletes do the same. HOW DOES IT WORK? Traditional Chinese Medicine (TCM) acupuncture treatment focuses on needling various combinations of the 360 local acupuncture points located along 14 meridian lines, or channels, on the anterior and posterior of the body. The needling stimulates the nervous system, causing chemicals to be released and an unbalanced meridian to become unblocked. This allows the local blood and energy to reach the site of the injury, which produces healing. Needling also helps the body’s affected

internal organs become balanced—resolving the underlying root problem of the injury. A fairly new discipline called sports acupuncture includes needling the motor points on an injured muscle, a treatment that causes the muscle to continually twitch (activate) and return to a normal, spasm-free state, thereby strengthening it. Another treatment involves needling the ashi points (trigger points) in TCM, which promotes localized blood flow to the injured area, eliminating pain and spasms. Also called orthopedic acupuncture or sports medicine acupuncture, sports acupuncture is used in conjunction with Western rehabilitative treatments in order to achieve the best possible outcomes. In some cases, heat modalities, electrical stimulation, cupping, or various manual techniques will be combined with acupuncture. These manual techniques can include joint mobilization, soft tissue mobilization, massage and stretching. For example, I may pair acupuncture with soft tissue manipulation to treat a specific imbalanced muscle group. In addition, I often have the athlete perform strengthening and proprioceptive therGeorge Leung, MAc, LAc, LAT, ATC, PTA, CKTP, is the practitioner and owner of East/West Sports Acupuncture & Orthopaedics in Brookline, Mass., and a former Head Athletic Trainer at Brookline, Danvers, and Lynn English high schools, all located in Massachusetts. He has treated athletes with the Boston Red Sox and New England Patriots, national- and world-level figure skaters and competitive runners, as well as youth athletes. He can be reached at: gleung@ewsportsacupuncture.com. T&C OCTOBER 2013

treating the athlete apeutic exercises. Western sports medicine tends to use a protocol treatment format focused on resolving symptoms. Sports acupuncture treats both the local symptoms and the root cause of the injury. The treatment starts with the underlying problem and works its way up to the local symptoms, as opposed to treating the symptoms first and then working on the root of the problem. The goal of any sports-injury treatment is to eliminate pain, reduce in-

The treatments employ various needling techniques using hair-thin, sterile and disposable needles applied to points identified during the intake process. Acupressure or tiny magnets can also be used. Electrical stimulation and various forms of heat are applied to promote greater blood circulation to the affected area and the needled points. This part of the treatment lasts about 30 minutes. After the needles are withdrawn, TCM and Western manual techniques

A complete sports acupuncture treatment starts with both Eastern and Western intake examinations ... A treatment plan is then mapped out according to which meridians are involved and unbalanced, as well as any range of motion restrictions or muscle strength deficiencies. flammation, increase mobility by reducing muscle tightness and spasms, and re-activate the injured, weakened muscles. Sports acupuncture is successful because it enables the practitioner to directly access the site of the injury through the use of needles. Results can include immediate reduction of pain and muscle spasms, decrease in swelling and inflammation, increase in range of motion, restoration of mobility, strengthening of weakened parts of the injured body and the immune system, and quickened healing time. There is no limit to the types of injuries that can benefit from sports acupuncture, from plantar fasciitis to hamstring strains to meniscus tears, and many others. WHAT IT LOOKS LIKE A complete sports acupuncture treatment starts with both Eastern and Western intake examinations, including a comprehensive TCM evaluation and an orthopedic assessment, which take about an hour and a half. A treatment plan is then mapped out according to which meridians are involved and unbalanced, as well as any range of motion restrictions or muscle strength deficiencies. Sports acupuncture treatments last about an hour and fifteen minutes and take place in a relaxing environment, usually on a massage table in a quiet room or with gentle music playing. Relaxing the mind helps the patient focus their energy on the recovery process. 38

T&C OCTOBER 2013

are used to increase joint mobility, correct mechanical function, improve flexibility and range of motion, and strengthen muscles. TCM manual techniques include cupping, gwa-sha, and tuina. Cupping is used to create suction by placing glass or plastic cups on specific areas of the body, with or without needles or heat. This brings the internal toxins to the skin’s

surface and creates an ecchymosis effect, which activates the inflammatory cycle and helps prevent muscle fatigue. Gwa-sha involves scrapping the skin to create redness and break up any scar tissue formation or adhesion. Tuina is a form of deep tissue massage and stretching used to enhance tissue mobility and range of motion. Western manual techniques used during treatments include joint and tissue mobilization, soft and deep tissue massage, manual stretching, and various therapeutic exercises. This active part of the treatment lasts about 30 minutes. The final part of a typical sports acupuncture treatment includes applying the Kinesio Taping Method to the affected area. The tape is worn for a few days following treatment to enhance and maintain the healing effect. CASE STUDY ONE Simon was a 23-year-old pairs figure skater with a history of chronic low back pain, or stress reaction syndrome, due to L5, S1 bulging discs and mild bilateral radiculopathy. When skating, jumping, or lifting his partner, Simon’s pain scale was 8-10, but he did not experience pain during

Author George Leung applies heat to a needled area as he treats Ross Miner, a silver medalist at the 2013 U.S. Figure Skating Championships. TR AINING-CONDITIONING.COM

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treating the athlete

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general daily activities. A TCM and orthopedic assessment on Simon determined that the gall bladder (GB) and bladder (BL) meridians were affected and that he had restrictions on both sides of the quadratus lumborum, lumbar erector spinae, and gluteus medius and minimus muscles. He also had moderate-to-severe tenderness along the quadratus lumborum muscles. The treatment goals for Simon were to resolve the inflammation, pain, and sciatica symptoms, reduce the internal swelling and muscle spasms, increase mobility, activate the weakened muscles, and calm the mind. Treatments were restricted to once a week due to physical therapy treatment he was undergoing and his ice conditioning work. Simon’s treatments began with needling points along the bladder (BL) and gall bladder (GB) meridians such as BL 23, 25, 40, 57 and 60, and GB 30 and 31. Motor points and trigger points were also needled. The quadratus lumborum muscles motor point was needled to reduce muscle tension and re-activate muscle function. Trigger points along the posterior iliac crest of the hip were needled to reduce tenderness and spasms in the gluteus medius and minimus muscles. Specific acupuncture needles were stimulated using electro-acupuncture to increase local blood circulation, decrease muscle spasms, and reduce

pain. An infra-ray dry heat lamp was placed over the low back area to relax muscles and increase local blood circulation. After the needles were withdrawn, Simon was given conventional rehabilitation, starting with deep tissue massage, manual lumbar traction, and stretching to help increase joint and muscle mobility. He was then instructed to perform home exercises to help him increase his flexibility and regain his strength and balance. The Kinesio Taping Method was applied for L5, S1 bulging discs and the lumbar erector spinae muscles to maintain the treatment results. Simon was asked to keep the Kinesio tape on for a minimum of three to four days. The tape helped the injured back muscles continue to function appropriately and prevented them from cramping up when stressed. It also continued to reduce the swelling and inflammation. Depending on his schedule and how he was feeling, Simon was advised to return once or twice a week until significant improvement or a full recovery was achieved. The results were immediate. After a course of six sports acupuncture treatments, he experienced resolved pain, increased mobility, and an increase in energy and was soon able to return to the ice rink and skate without limitations. He resumed competing in national and world competitions and he and his partner won the gold medal in TR AINING-CONDITIONING.COM

treating the athlete pairs skating at the 2013 Prudential U.S. Figure Skating Championships.

Maddy Hribar competes in a marathon after overcoming IT-band tendinitis and hip tightness.

CASE STUDY TWO Maddy, a 27-year-old competitive runner of half and full marathons, 50Ks, and 100-mile races, had a history of right distal ilio-tibial band (IT-band) tendinitis and hip tightness. She experienced right distal IT-band clicking and pain when running for longer than 15 minutes, which got worse with descending activity. Maddy was in the process of training for back-to-back full marathons but the pain was hindering her preparation. She had never tried sports acupuncture. Maddy’s TCM and orthopedic assessments determined that her stomach (ST), gall bladder (GB), and bladder (BL) meridians were affected and she tested positive for tightness in her hip flexor, IT-band, and hamstrings. She was also experiencing moderate-to-severe tenderness in the tensor fascia latae (TFL) and gluteus maximus muscles. The treatment goal for Maddy was to resolve the distal IT-band inflammation and increase mobility in the hip flex-

ors, TFL, gluteus maximus, and hamstrings. Once a week treatments for six weeks were recommended. Maddy’s sports acupuncture treatment was carried out in two parts. The first placed her in a sidelying position for 20 minutes, with the second being in a prone position for 15 minutes. In the sidelying position, TCM acupuncture points ST 31 along the stomach meridian and GB 30, 31, and 32 along the gall bladder meridian were needled. The bladder meridian points were needled in the prone position. To reduce muscle tension and re-activate the muscle, the TFL and psoas motor points were used in both positions. Electro-acupuncture was initiated on all the points to increase local blood circulation and an infra-ray dry heat lamp was placed over both the hip and the distal IT-band for 20 minutes. After all needles were withdrawn, Maddy was again treated in the prone position. This portion of the treatment focused on the gluteus maximus and the hamstrings to increase mobility. TCM acupuncture points GB 30, BL 36 and 37 were needled along the gall bladder

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treating the athlete and bladder meridian, and the motor point used was the hamstring mp x2. Electro-acupuncture with an infra-ray dry heat lamp was again used for 15 minutes. Following acupuncture, conventional and TCM manual techniques including tuina and deep tissue massage were applied to the hip and hamstrings to promote blood circulation and flexibility. The hamstrings and gluteus maximus were then stretched to increase mobility. Finally, Maddy was given the Kinesio Taping Method for patella tracking and to reduce tension on the IT-band. She was instructed to wear the tape for three to four days, including while running.

Because acupuncture is a medication-free treatment, it is free of the side effects that can be caused by medications and injections. After three treatments, the IT-band tendinitis was completely resolved and Maddy was able to run her back-toback marathons without limitations. She now regularly returns to acupuncture for maintenance work. STILL SKEPTICAL? Acupuncture has been used for over 2,500 years and its success in treating various injuries and conditions is well documented with evidence-based research. It is recognized by the National Institutes of Health and World Health Organization to be an effective treatment for a host of conditions. Acupuncture treatments themselves are very safe. The needles used are sterilized and used only once. Because it is a medication-free treatment, it is free of the side effects that can be caused by conventional medications and injections. Acupuncturists are required to complete a three-year master’s degree program at an accredited school and they must pass three national board exams to become certified and licensed. A certification in the Clean Needle Technique is also required. I encourage athletic trainers to embrace sports acupuncture as a holistic way to help their athletes. Sports acupuncture can fill in the gaps where Western medicine may fall short. n TR AINING-CONDITIONING.COM

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Raising Their Game F A simple, yet adaptable, off-season training program helps University of Southern California volleyball players get ready to attack the competition. By Brent Metz

Pierson Clair

sport specific

or 21 straight years, the University of Southern California women’s volleyball team has finished its season in the NCAA Division I playoffs. And in seven of the last 12 seasons, the Trojans have reached the final four. But the successes of November and December are actually the culmination of year-round effort by the players and coaches. One piece of the puzzle is the team’s off-season strength and conditioning program, which I develop along with several members of the volleyball staff, including Head Coach Mick Haley. The primary goal is to help the players improve how well they apply force to the ground, which enables them to jump higher. However, a lofty vertical jump is not the only factor in volleyball success, so we also work on their lateral movement. And, since volleyball requires athletes to compete in repeated short bursts, there is also a conditioning component. We have to ensure they can recover quickly between points while maintaining the stamina to sustain their power and explosiveness through a long five-set match. We use an Olympic-lift program built on a philosophy of doing explosive groundbased moves with heavy loads. We embrace the KISS principle (Keep it simple, stuBrent Metz, MEd, CSCS, SCCC, USAW, is an Assistant Strength and Conditioning Coach at the University of Southern California, where he works with the women’s and men’s volleyball teams. He has also been a strength coach at the University of Texas and Fresno State University and can be reached at: bmetz@usc.edu.

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T&C OCTOBER 2013

sport specific

Sample Workout Here is a typical off-season workout session for the University of Southern California’s women’s volleyball team. Warmup Bodyblade exercises (20 seconds each)

Arm to side

Arm overhead

Arm out front

Tubing/bands

Static holds (4 sets of 5 seconds each)

Block

“W”

External rotation

Overhead squats into snatch grip followed by Sotts presses Core Farmer’s walk (40 kg for 20 meters) Standing ab roller Agility & conditioning Wheel drill x 4 Dog drill x 4 L-drill x 4 Sprint backpedal x 4 Strength Explosive: Cleans (8 sets of two reps at 80%) Squat move: Back squats (5-6 sets of 2-3 reps at 85% of 1RM) followed by lateral jumps Push: Push presses (5 sets of 3-4 reps at 70-75% of clean max) Pull: Chin-ups (4 sets of as many reps as possible) Rotation: Cable rap Soft-tissue work Roll out using PVC pipe Partner work using forearm and elbow Golf balls Battle ropes Bars

T&C OCTOBER 2013

pid) and strive to perform a small set of exercises well rather than constantly changing lifts. The athletes are not here to become weightlifters, so the less time they have to spend learning exercises, the more time they can devote to becoming stronger and bettering their skills on the court. To show you how we accomplish this at USC, I will take you through a typical off-season workout (see “Sample Workout” at left). Along the way, I’ll explain why we’ve chosen the exercises and lifts we use, and I’ll detail the variations we make to our workouts from day to day to maximize performance gains. The Warmup Like most workouts, ours begin with a thorough warmup period. In the past, we used different warmup exercises each day so the athletes wouldn’t get bored. However, this deviated from the KISS principle, and we were changing exercises so often that athletes didn’t have a chance to improve in any of them. Now we use one warmup routine with a few variations, and the results have been fantastic. We’ve found that athletes don’t get bored when they see themselves improving. We use an active warmup that progresses from slower to faster movements. In addition to getting the athletes ready for strength and agility work, the warmup also focuses on improving their thoracic range of motion in order to enhance thoracolumbar control. We achieve this through the use of Bodyblades, shoulder bands, and core exercises. We start with the blades, which work on the sequencing of shoulder muscles through reciprocal inhibition. We perform three standard exercises with the blades. For the first, the arm is held straight out to the side with the blade vertical and vibrating front to back. The second features the arm overhead with the blade horizontal and vibrating left to right. For the third, the arm is held straight out front with the blade horizontal and vibrating up and down. The exercises are done with each arm for up to 20 seconds. Sometimes our athletes have difficulty pulsing the blade with their arm locked. When this occurs, we have them use an elbow bend to create movement. If they continue having difficulty performing the exercises properly using one arm, we allow them to use two arms until they master the blade. TR AINING-CONDITIONING.COM

sport specific Next, we move to band and tubing work. We have the athletes perform static holds against the tubing in three positions—a block, a “W,” and an external rotation. We usually have them do four sets of five-second holds. From there, the athletes stretch the tubing into a snatch grip to perform overhead squats followed by Sotts presses. We finish the warmup with core exercises. We typically use a farmer’s walk because this exercise enables athletes to brace their core in a stable position while still moving. The athletes will carry a 30 to 50 kilogram barbell, depending on their strength level, for 20 meters. We also do overhead carries with dumbbells in the 50 to 70 pound range as a variation. The core portion of the warmup concludes with the standing ab roller, where the athlete uses a barbell starting from a pushup position on the toes. This exercise is useful because it’s similar to performing a block on the court. Our athletes can typically only move the barbell out two to six inches from the starting position before they lose control, so teaching them how to manage rotation in the body while halting pelvic tilt is extremely important. We show them how by teaching them to make the bar roll away by moving their arms at the shoulder instead of dropping the hips down or forward. Once athletes feel their hips sliding forward, they shorten the distance of the rollout on the next rep. Agility & Conditioning After the warmup, we progress into the agility and conditioning portion of our workout. Throughout the off-season, we do agility drills twice a week, and slideboard and interval sprints once a week each. Any activity that requires multiple quick changes of direction can be used as an agility drill. We rely on traditional cone drills, such as the wheel drill, T-drill, L-drill, and the NBA agility drill, as well as custom movements set to mimic various volleyball movements, such as a blocking sequence or a defensive move. We also do a drill with six different colored cones set up in a diamond pattern six meters long and four meters wide. The athletes have to sprint the color pattern I call out, and we typically go six to eight colors per rep. When we first present a new agility drill to athletes, we give them only basic TR AINING-CONDITIONING.COM

directions. For example, for the wheel drill, they will be told only that their left foot goes to the outside cone and their right foot goes to the center cone. We do not explain the best way to perform the activity because we want them to try to find the quickest one on their own. Once they are comfortable with the drill and have chosen their favorite path, we show them the optimum footwork. After athletes have the preferred patterns down, we add different starting cues. For example, someone stands in front of the athlete with a ball in each

hand. Whichever hand drops the ball determines the direction in which the athlete runs. The next step is using balls that are color coded to the cones, and the color of the ball that drops determines the cone the athlete runs to. We start our agility drills this way to teach the athletes to react and make decisions quickly, like they do during games. Our sprint work is designed more for conditioning than agility. Both slideboard and interval sprints follow a decreasing-rest protocol. The goal is to develop quick-burst acceleration and

Circle No. 133 T&C OCTOBER 2013

sport specific at a 2:1 rest interval, and again add one sprint a week until they reach five. The final level is three sprints at a 1:1 rest interval that builds to five. Athletes then advance to covering two and three-quarter court lengths (approximately 80 meters) in less than 15 seconds. We then follow the same progression through 3:1, 2:1, and 1:1 rest intervals. The results of our agility program have been fantastic. We’ve noticed significant speed gains when we test 10and 20-meter sprints, and the volleyball coaches have noted the players’ faster recovery times, which make practices faster and more intense. Strength Training The heart of our off-season workout is strength building in the weightroom. The goal is to help our players build the strength to better develop the skills they will learn from their coaches. We focus on training the legs because they form the basis for most athletic movements in volleyball. Our players lift five days a week in the spring and four in the summer. Each

day, we perform an explosive move, a squat, a push, a pull, and a rotation. One thing we do a little differently than most programs is that our athletes always wear weightlifting shoes for lifting sessions. We started this practice in 2008, and it has provided a noticeable difference in stability, range, and the amount of weight our athletes can lift. Explosive: Our explosive exercises are typically cleans, snatches, or split jerks. Most of the time, we do eight to 10 sets of one or two reps, but we never exceed three reps per set because our testing has shown that bar speed starts to decrease once athletes reach the third rep. Since the focus is on power production, we stick to three reps or less at loads of at least 80 percent. Because of this emphasis on power, rest intervals are not timed for the Olympic lifts. Athletes are free to take as long as they need to recover between sets because we want their best effort each and every time they lift. Squats: Our second lifting move of the day is always a squat move. In addition to single- and double-leg squats, these include dead lifts; step-ups; sin-

the ability to maintain repeatable speed. In volleyball, athletes have a short time to rest between points. No activity lasts longer than 30 seconds, and points typically are much shorter. On the slideboard, we do no more than seven sets of sprints that last 20 seconds, with an initial rest period of 30 seconds. The rest will decrease to 10 seconds as the athletes progress. Throughout the reps, we focus on keeping the foot dorsiflexed before contact with the footplate so we get a quicker response in the opposite direction and using a wide stance so the legs have to move separately from the torso. This enables greater force creation because the feet are in a better acceleration position. We perform our sprint intervals on a basketball court, starting with four and three-quarter lengths of the court. This is basically a 150-meter shuttle, and athletes have 27 seconds to make it across the finish line. The training begins with three sprints at a 3:1 rest interval, and we add one sprint a week until the athletes reach five. We then drop back to three sprints, but this time

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sport specific gle-leg, rear-elevated squats in either a front rack, back, or overhead position; overhead squats; single-leg seated squats; split squats; single-leg dead lifts; and lateral step-ups. We choose each player’s squat movement based on her specific performance needs. If an athlete is a big-time jumper, she doesn’t need a lot of improvement on her rate of force development, but she may need more stability and strength. In a case like this, we assign her a dead lift variation. Athletes who are strong but do not have a great vertical jump do front squats or front-loaded, single-leg, rear-elevated squats because they force a forward shin angle, which helps increase the rate of force development. We follow the squat movement with some form of post-activation potentiation. Players with a good vertical leap are usually assigned a lateral jump, which forces them to maintain tightness in the torso and control the movement of their upper and lower body. Our lateral jumps typically call for an instant change of direction on contact. We like to use lateral two-footed hops where an

athlete jumps for distance off two feet back and forth, double-hop comebacks for distance and quickness, and lateral jumps over different height hurdles. Athletes who are not as strong with their vertical leap are assigned a linear jump, such as an approach jump, multiple broad jumps, or progressively

These were chosen due to their large recruitment of musculature and the coordination required to perform them successfully. Also, many volleyball movements (including serving, hitting, blocking, passing with hands, and setting) require the athlete to remain in control while their arms are overhead.

With our pull exercises, we focus on a full hang to full pull movement with the chest touching the bar. Back strength is extremely important in volleyball not just as a postural issue but because it also protects the arm in deceleration. higher box jumps. Because we’re trying to increase the athletes’ rate of force production, the exercise requires full effort from them to be successful. We typically use a 42- to 52-inch box for approach jumps. We also like to add a broad jump before the approach jump by placing a 24-inch tall foam box in front of the landing box. Presses: Most of our pressing movements are overhead, such as a standing press, push press, and split jerk.

Younger athletes are assigned standing presses because they need to develop base strength and are still learning to control their core. For older players, we rely on push presses and split jerks. When athletes are learning the movements, both legs are worked, but once they have the movements down and we start to push big loads, the same leg always goes forward. Our horizontal presses include push-ups, dumbbell floor presses, or

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T&C OCTOBER 2013

sport specific dumbbell one-arm inclines. We very rarely—maybe three or four times a year and only in the summer—do bench presses, and then only so the athletes can see their strength gains. All presses (except split jerks) are supersetted with dumbbell rows of some type, including standing, Chinese, landmine, low cable, and cable balance. We typically do four to six sets, starting at five repetitions and working up to eight before increasing the weight and dropping back down to five. Almost all of our rows require a hold in the full contraction for one

to three seconds, with a focus on keeping the shoulder back so as not to shrug. Pulls: Since we do a lot of rows with our presses, our primary pull exercises are pull-up variations. Typically, we perform chin-ups or negative chin-ups with and without weight twice a week, and traditional pull-ups and TRX inverted pull-ups once a week. In the spring, we add neutral grip pull-ups. We focus on a full hang to full pull movement with the chest touching the bar. Back strength is extremely important in volleyball not just as a postural issue

Circle No. 137

T&C OCTOBER 2013

but because it also protects the arm in deceleration. As back strength improves, hitting speed increases and the athlete’s strength in pressing exercises improves. Rotational: The last exercise is a rotational lift that varies from landmine twists in various forms of cable exercises. Regardless of the movement or the speed of rotation, the focus area is the feet. Since all rotational speed begins with foot contact, proper placement is imperative. We want to make sure feet are properly set in order to create the correct angle to apply force to the ground. During the spring, we emphasize proper rotational technique by having the athletes perform slow movements, allowing for corrections in foot, hip, elbow, and head positions. As spring progresses into summer, all cable rotations are done for speed without sacrificing form. Wrapping it Up Once the weightlifting is done, we finish the workout with 15 to 20 minutes of soft-tissue work. Initially, the players roll out using PVC pipe that hits deep into the muscle. After each individual has rolled the areas focused on in that day’s exercises, we progress to partner soft-tissue work. Players use their forearm and elbow on each other to work the same areas as before, spending one minute on each section. Then, we go back to the weightroom and perform soft-tissue work on the feet using golf balls and ropes to iron out the arch area, which tends to become knotted. During our workouts, the athletes perform a lot of overhead and Olympic lifts, which can produce tight traps that limit overhead arm action. At the end of a session, we will load up a barbell with 40 to 50 kilograms of weight and place one end of the bar on the athlete’s trap. She will then stand up so the weight is on her trap. Next, we have them perform front-arm raises. The athletes finish by using rubber bands to perform different traction-style stretches for their hips, ankles, shoulders, elbows, and knees. This typical off-season workout is just one piece of a performance-training puzzle that also includes proper periodization, attention to nutrition, and effective testing and assessment. And these all fit into a larger plan that includes skill development, mental training, and of course, talent. Only when all the pieces fit together can a team enjoy the kind of success USC volleyball has experienced. n TR AINING-CONDITIONING.COM

CEU QUIZ

T&C October 2013 Volume XXIII No. 7

uicke You c an no r&E w tak and g asi e our et yo ur CE CEU q er! U res ults a uizzes on www li C .train lick on “CEU nd credit ins ne... tantly s” at: ing-c . o nditi o

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

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

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

mail your quiz to us: Fill in the circle on the answer sheet (on page 53) that represents the best answer for each of the questions below. Include a $25 payment to MAG, Inc., and mail it to the following address: MAG, Inc., ATTN: T&C 23.7 Quiz, 20 Eastlake Road, Ithaca, NY 14850. Readers who correctly answer at least 70 percent of the questions will be notified of their earned credit by mail within 30 days.

Bulletin Board (pages 6-8)

Objective: Learn about recently published or presented research. 1. In the University of Pittsburgh study, concussed athletes experiencing migraines were how much more likely to have a protracted recovery period compared to those with non-migraine headaches? a) 1.4 times more likely b) 2.6 times more likely c) 3.1 times more likely d) 8.2 times more likely 2. In the exercise-induced asthma study, the mussel extract PCSO-524 improved lung function in patients by how many percentage points? a) 51 b) 59 c) 65 d) 69 3. The average postseason blood pressure of the freshman football players in the study was: a) 121 over 65 b) 119 over 66 c) 125 over 66 d) 130 over 67 4. What position players experienced the biggest increase in LV hypertrophy by the end of the season? a) Running backs b) Guards c) Tackles d) Linemen

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Altitude Adjustment (pages 17-21)

Objective: To understand how the United States Air Force Academy is using hyperoxic training. 5. According to the author, altitude training in sports began in the buildup to the: a) 1963 Copa America soccer tournament in La Paz, Bolivia b) 1968 Olympic Games in Mexico City, Mexico c) 1960 Denver Broncos’ season d) 1959 Inca Trail Marathon in Machu Picchu, Peru 6. A body’s average resting O2 saturation at sea level is 97 to 98 percent, whereas at 5,000 to 10,000 feet it measures: a) 74 to 75 percent b) 78 to 79 percent c) 89 to 90 percent d) 92 to 93 percent 7. When endurance athletes are being trained in the Colorado Altitude Tent (CAT), which of the following is true? a) A self-powered treadmill is used b) The distance they cover in their rowing machine workouts outside the CAT is increased by 20 percent c) Their treadmill speed is usually set at one-half to one mile-per-hour faster than their treadmill speed outside the CAT d) Steady speed intervals are used, with decreased recovery times

Connecting Safely (pages 23-27)

Objective: A look at how to use electronic communication safely and effectively.

8. In the example of the injured wrestler, which privacy act(s) does the author think the athletic trainer may have violated? a) HIPAA (Health Insurance Portability and Accountability Act) b) PIPEDA (Personal Information Protection and Electronic Documents Act) c) HIPAA and FERPA (Family Educational Rights and Privacy Act) d) PIPEDA and EPCA (Electronic Communications Privacy Act) 9. How did Archmere Academy decide to handle e-mails regarding injured athletes? a) They can only contain general information about an injury or patient b) They can contain specific information about an injury or patient if the school’s medical communications disclaimer has been included c) They can contain specific information about an injury or patient without the need for a disclaimer d) They cannot be used to relay patient information of any kind 10. If an athlete from a visiting team is injured at Archmere, his or her athletic trainer is notified via: a) text b) e-mail c) phone d) text and e-mail

T&C OCTOBER 2013

CEU QUIZ

11. When one of Archmere’s athletes is injured, how does the school notify the parents? a) For major injuries, the parents are called; for minor injuries, they are e-mailed b) For any injury, the parents are called c) For major injuries, the parents are called; for minor injuries, they are sent a text d) For any injury, the parents are called and e-mailed

Veggies Galore (pages 29-34)

Objective: Discover how to help athletes who wish to adopt a vegan diet. 12. Compared to diets that include animal products, vegan diets tend to be lower in: a) Phytochemicals b) Folate c) Vitamin B12 d) Magnesium 13. How much protein should a vegan consume compared to someone eating a diet containing animal products? a) 2 percent less b) 6 percent more c) 10 percent more c) 15 percent more

Down The Meridian (pages 36-43 ) Objective: To understand sports acupuncture and how it can be combined with traditional Western treatments.

16. According to Traditional Chinese Medicine (TCM), how many local acupuncture points are there along the body? a) 180 b) 210 c) 360 d) 420 17. Sports acupuncture features the needling of motor points on an injured muscle to: a) Reduce muscle tightness and spasms b) Cause the muscle to alternate between a twitching and spasm-free state c) Reduce localized blood flow to the injured area d) Reduce inflammation 18. What does the author pair with acupuncture to treat an imbalanced muscle? a) Joint mobilization b) Massage c) Stretching d) Soft tissue mobilization

14. Vitamin D levels in vegans should be monitored because deficiencies can increase the risk of: a) Heart-related issues b) Weakened immune system c) Anemia d) All of the above

19. The TCM manual technique gwa-sha involves: a) Scraping the skin b) Creating suction by placing glass or plastic cups on the body c) Deep tissue massage and stretching d) Electrical stimulation and various forms of heat

15. A vegan diet has been associated with: a) Lower blood pressure b) Lower Body Mass Index c) Lower overall cancer rates d) All of the above

20. About how long do sports acupuncture treatments last? a) 45 minutes b) One hour c) One hour and 15 minutes d) One and a half hours

Raising Their Game (pages 45-50)

Objective: Learn about an off-season strength and conditioning program for volleyball. 21. A goal of the off-season workout at USC is to improve the athletes’: a) Application of force to the ground b) Lateral movement c) Stamina d) All of the above 22. In the warmup to the workout, which exercise tool is used to increase the athlete’s thoracic range of motion? a) Bodyblades b) Bosu balls c) Plyo boxes d) None of the above 23. For each sprint workout on the basketball court, what rest interval is used for the first set of sprints? a) 1:1 b) 2:1 c) 3:1 d) 4:1 24. For the post-activation potentiation following squats, players with a strong vertical leap are assigned: a) Multiple broad jumps b) Approach jumps c) Double-hop comebacks d) Box jumps 25. The rotational work focuses on which area(s) of the body? a) Feet b) Hips c) Abdominal muscles d) All of the above

Quicker & Easier!

You can now take our CEU quizzes online... and get your CEU results and credit instantly. Click on “CEUs” at:

www.training-conditioning.com

T&C OCTOBER 2013

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CEU QUIZ Answer Form Instructions: Go to www.training-conditioning.com and click on “CEUs” to take the quiz online. You may also

mail your quiz to us: Fill in the circle on the answer sheet below that represents your selection of the best answer for each question. Include a $25 payment to MAG, Inc., and mail it to the following address: MAG, Inc., Attn: T&C 23.7 Quiz, 20 Eastlake Road, Ithaca, NY 14850. Readers who correctly answer at least 70 percent of the questions will receive 2.0 BOC Athletic Training and 0.2 NSCA (two hours) CEUs, and will be notified of their earned credit by mail within 30 days. Questions? Problems? E-mail: CEU@MomentumMedia.com.

A B C D

Bulletin Board

Veggies Galore

1. m 2. m 3. m 4. m Altitude Adjustment

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16. m 17. m 18. m 19. m 20. m

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21. m 22. m 23. m 24. m 25. m

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Down The Meridian

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Connecting Safely

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Raising Their Game

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T&C OCTOBER 2013

From Training & condiTioning

In the Fight Against Concussions: Reliable Resources PARENTS’ GUIDE TO SPORTS CONCUSSIONS

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. It includes:

zx Symptoms to watch for post-concussion zx What you need to know about neurocognitive testing, and Call 877.422.5548 Ext.11 for more information.

whether to seek additional testing zx Understanding return-to-play guidelines zx How to communicate and work with your athlete’s coaches and athletic trainers after the concussion zx Questions to ask your physician zx Information on choosing the right helmet

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A comprehensive guide on concussions specifically created for the parents of the athletes you work with.

CONCUSSION: AN EDUCATIONAl DVD Information on concussion and post concussion syndrome for athletic trainers, coaches, and educators.

CONCUSSION POlICy GUIDE A step-by-step approach to developing a successful and comprehensive concussion program in schools. SPORTS CONCUSSION: fROm ThE PlAyING fIElD TO ThE ClASSROOm This tip card on concussions in sports helps coaches, athletic trainers, parents and school personnel recognize and monitor early and late concussion symptoms in student-athletes.

CONCUSSION EDUCATION: IN ThE STUDENTAThlETE’S NEIGhbORhOOD This tip card provides Subtotal $ Fax this order to 607-257-7328 or + Shipping $ Mail this order to MAG, Inc., 20 Eastlake Rd., Ithaca, NY 14850 NY residents add sales tax $ = TOTAL $ Circle No. 138

checklists and practical strategies on educating everyone on the signs and symptoms of concussion in student-athletes with tips for support and accommodations.

Pain Management Combine Cold/Heat With Stim

Dynatronics introduces the revolutionary Dynatron® ThermoStim™ Probe that combines cold or heat with electrical stimulation. ThermoStim represents the future of therapeutic modalities and is the newest accessory for the Dynatron Solaris® Plus with its 7-Stim waveforms, Tri-Wave Light, plus enough power to generate eight separate treatments simultaneously and the new three-drawer Solaris Cart. Call for a demonstration. Dynatronics • 800-874-6251 www.dynatronics.com

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A Wrap for Flexed Elbows

The new Flexed Elbow Wrap offers therapy at 90- and 135-degree flexion for patients unable to straighten their elbows. The wrap fits all sizes and is universal for either arm. The Flexed Elbow Wrap features the same optimal low profile and circumferential coverage as other Game Ready products for better contact and comfort.

Game Ready • 888-426-3732 www.gameready.com

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Reduces Pain and Swelling

Veridian Healthcare offers a wealth of experience servicing the professional and consumer diagnostic markets. New, innovative sports medicine products include our exclusive 360 Gel Sleeves, 3-in-1 Gel and 2-in-1 Gel Ankle/Shoulder Wraps, and Tiny TENS wireless TENS device. The gel sleeves provide 360-degree coverage with compression that can quickly and effectively reduce swelling. The sleeves roll on for ease of use and can be positioned to optimize cold and compression. They are available in five sizes, including one for the fingers. The 3-in-1 product is one size fits all and can be used for the neck, shoulder, and hip. The 2-in-1 product is designed to be used on the ankle and elbow. The Tiny TENS is an easy-to-use, compact wireless device that is very effective in reducing pain. Veridian Healthcare • 866-799-8181 www.veridianhealthcare.com

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Breakthrough Solution

Research shows that simple, yet novel exercises using the Thera-Band® FlexBar® are effective at reducing pain associated with chronic tennis and golfer’s elbow. See the research and the exercises at Thera-BandAcademy.com. Since these research findings have been widely published, you may have athletes asking about the treatment. They’ll need your expertise—and a Thera-Band Flex Bar.

Performance Health • 800-321-2135 www.performancehealth.com TR AINING-CONDITIONING.COM

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Effective Relief

Pro-Tec’s Pre-Cut Kinesiology Tape provides effective relief for muscle tightness, knee pain, IT Band syndrome, shin splints, hamstring tears, plantar fasciitis, epicondylitis (tennis elbow), wrist pain, and most soft-tissue injuries. The tape promotes circulation, reduces muscle fatigue, and provides moderate soft-tissue management. Each package includes 20 pre-cut pieces, 10 I-cut strips, and 10 Y-cut strips as well as a manual with simple application directions for many injuries. Pro-Tec Athletics • 800-779-3372 www.pro-tecathletics.com

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Functional for Females

Pro Taco is not a brace, but instead the first functional ankle product for female athletes. The Pro Taco is designed to speed up reaction time of the muscles that protect the ankle. Topical Gear uses buttresses in the product to apply topical pressure to the neuroreceptors in the ATFL, CFL, and peroneal muscle group to enhance proprioception and reduce the stretch of the peroneal muscles. The Pro Taco is very light and easy to apply or take off. Topical Gear, LLC • 512-659-9373 www.topicalgear.com

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Strong & Flexible

SelfGrip® is the official athletic tape of USA Triathlon, providing support to some of the toughest athletes. The sport of triathlon showcases the tape’s maximum strength and flexibility as well as the exclusive ability to hold its grip under water. SelfGrip’s unique 98-percent cotton and two-percent latex woven technology allows the tape to adhere securely to itself without sticking to hair or skin. SelfGrip is hand-washable and reusable. SelfGrip Athletic Tape • 401-738-7900 www.selfgrip.com

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Find Your Calling

As the nation’s first school of acupuncture and Oriental medicine, the New England School of Acupuncture’s (NESA) tradition of excellence is without equal. Since NESA’s founding in 1975, the school has focused solely on preparing the country’s best acupuncture and Oriental medicine practitioners. NESA’s comprehensive programs in acupuncture and Chinese herbal medicine are carefully designed to develop leaders in integrative medicine. Whether you’re interested in orthopedics, elder care, pain management, or women’s health, you will find your calling at NESA. New England School of Acupuncture • 617-558-1788 http://nesa.edu Circle No. 541 T&C OCTOBER 2013

Pain Management Versatile and Powerful

Responding to Pressure

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

Topical Gear, LLC • 512-659-9373 www.topicalgear.com

Dynatron Solaris® Plus combines all the features of Solaris, delivers 7-Stim waveforms, and has enough power to generate eight separate treatments simultaneously. This includes Tri-Wave Light, which provides three wavelengths of light to create seven different treatment combinations for both pads and probe; a new fixed-frequency IFC/ Premod option; a full-color interface so easy to use that two key presses can start a treatment; and the new threedrawer Solaris Cart. Call the company for demonstrations. Circle No. 506

The BodyXcel Brace is one of the easiest back braces to apply and adjust due to its patented pulley system. This system delivers six times more support than other braces, and the instantaneous ease of adjustment adds to its practicality. Simply wrap the brace around the lower back and secure with adjustable Velcro®. When support is desired, pull the handle away from the body to activate the power pulley system. When the proper support is achieved, place handle on the Velcro® strip encircling side panels to secure. Circle No. 507

MANAGE INFLAMMATION

PolyMem is an innovative, adaptable, drug-free wound care dressing. PolyMem dressings have been shown to reduce swelling, bruising, and pain associated with both open and closed wounds. PolyMem also helps localize the inflammatory reaction to the actual zone of injury, reducing the spread of inflammation and swelling into surrounding tissues. PolyMem dressings are available in both standard and antimicrobial silver formulations and come in a wide variety of shapes and sizes.

Ferris Mfg. Corp. • 800-765-9636 www.polymem.com

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Medically designed, athlete-proven MediDyne products are easy-to-use tools that 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 includes: Cho-Pat ®, Tuli’s®, ProStretch®, StretchRite®, CoreStretch®, Skin-on-Skin®, and RangeRoller®. These products are known for both their effectiveness and ease of use. Medi-Dyne is dedicated to providing innovations in pain relief and prevention. Medi-Dyne Healthcare Products, Ltd. • 800-810-1740 www.medi-dyne.com Circle No. 509

Alternative Therapies

Dragon Rises College of Oriental Medicine uses a sophisticated system of Contemporary Chinese Diagnosis that reveals the patient’s constitution, previous illnesses, stressors, trauma, lifestyle, and emotions, allowing the patient and practitioner to begin a true healing process. “I truly believe that acupuncture and its adjunctive therapies can provide athletes and sufferers of chronic pain with a noninvasive treatment option to heal pain, improve flexibility, enhance performance, and decrease inflammation.” (Graduate Danielle Pechac, AP). Dragon Rises College of Oriental Medicine • 352-371-2833 www.dragonrises.edu Circle No. 531

Treat Multiple Athletes

Empowering Movement

PowerPlay • 918-744-1078 www.powerplay.us

DJO Global • 800-793-6065 www.djoglobal.com/donjoy

Get a jump on pain and swelling reduction with PowerPlay™. Lightweight and portable, PowerPlay delivers cold and compression anywhere your game takes you. One affordable unit lets you treat up to three athletes or sites at once, using form-fitting, re-freezable gel wraps for pain reduction. PowerPlay’s intermittent, sequential compression reduces pain and swelling while optimizing tissue healing, blood flow, oxygen delivery, and lymphatic drainage. Recover faster and boost performance with PowerPlay.

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Effective Relief

Quick & Easy Support

Cybertech Medical • 800-220-4224 www.bodyxcel.com

Published research suggests the medial to lateral quadriceps-tohamstrings co-contraction ratio is unbalanced in female athletes. The ACL Tube is a two-ounce sleeve with foam buttresses inside that apply topical pressure to the medial quadriceps and hamstring muscles. These muscles should respond to topical pressure by firing. The ACL Tube can be applied to help prevent injuries such as an ACL tear, and is very effective during rehabilitation of ACL re-constructions.

T&C OCTOBER 2013

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Even mild ligament strains can bring activity levels to a halt. Playmaker II provides the stability needed and comfort required to empower movement. DonJoy has taken the reliable Playmaker brace and enhanced it with Hi10™ (high tenacity nylon/ spandex fabric) offering an unmatched comfort and fit. The advanced spacer fabric on the front and back promotes a “cool” environment for activities at all levels. This brace continues the use of DonJoy’s proven DIII hinge bringing a custom design to manage ROM options. And molded strap tabs allow for quick and easy adjustments to deliver a secure, comfortable fit. Circle No. 542

TR AINING-CONDITIONING.COM

Topicals Added Benefit

A recent study validated adding Flexall® topical pain relieving gel into a therapeutic ultrasound protocol. A blend of 25-percent Flexall and 75-percent ultrasound gel provided results equal to 100-percent ultrasound gel, based upon intramuscular temperature rise. Subjects experienced the benefits of using Flexall without diminishing the deep-heating results of ultrasound therapy. The results confirmed what sports medicine professionals have known since 1987—Flexall makes a great ultrasound coupling gel. Professional sizes are available. Ari-Med/Diversa Products Group • 800-527-4923 www.ari-med.com Circle No. 510

Mike Lesako, Head Athletic Trainer at Washington & Jefferson College, uses RAW Heat and Ice 3 oz. rollon topical analgesics and says: “We have tried many topical agents in our athletic training room and have found RAW products to be the best. When used before practice, RAW Heat provides immediate relief of pain and stiffness over the targeted area with long-lasting results. When the RAW Ice is used after practice, muscle aches and pains are provided soothing relief. It works great and I would highly recommend RAW Heat and RAW Ice to anyone.” The Pressure Positive Company • 800-603-5107 www.pressurepositive.com Circle No. 513

Superior Technology

The new Biofreeze 360-Degree Spray delivers the number-one clinically recommended topical analgesic using superior spray technology. This spray works from any angle, making it ideal for hard-toreach areas. It even works upside down. The can’s design ensures a continuous flow of product—no pumping required—and a uniform spray pattern for better coverage. Like all Biofreeze products, this spray is free of paraben and propylene glycol. All Biofreeze spray products are also colorless and use 10-percent menthol. Performance Health • 800-321-2135 www.biofreeze.com

Immediate and Long-Lasting Results

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Relieve Aches and Soreness

Thera-Gesic is the brand of choice among athletic trainers for relief of muscle soreness, aches, and stiffness. This water-based, greaseless formula does not stain clothing or equipment, and contains one-percent menthol and 15-percent methyl salicylate. When applied evenly in a thin layer, Thera-Gesic becomes colorless and transparent. Once it penetrates the skin, the area may be washed, leaving it dry and fragrancefree without decreasing Thera-Gesic’s effectiveness.

Effective Relief

Hyland’s Muscle Therapy Gel and Hyland’s Arnica tablets provide effective relief of muscle and joint soreness, bruising, and swelling due to overexertion or injury. Containing Arnica—the number one natural remedy for swelling, bruising, and trauma—Muscle Therapy Gel provides natural, safe, and effective pain relief—and it absorbs quickly and is never greasy. This formula is FDA regulated with an unsurpassed safety profile and no contraindications or drug interactions. Treatment Options 800-234-8879 www.txoptions.com

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Mission Pharmacal Co. • 800-373-3037 www.missionpharmacal.com

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Safe, Convenient Relief

An effective topical anesthetic, Lido Gel provides a convenient and safe method for topical delivery. Lido Gel allows users to apply the anesthetic drug Lidocaine into areas of inflammation, chronic, or acute pain. Lido Gel is a non-toxic, local anesthetic that works as a gel. It has a non-staining transdermal base that is readily absorbed through tissue. This product contains four-percent Lidocaine and 0.18-percent Menthol for use in the relief of itching, pain, soreness, and discomfort.

Kustomer Kinetics, Inc. • 800-959-1145 www.kustomerkinetics.com TR AINING-CONDITIONING.COM

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Fast Relief

Flexall® topical pain relieving gels are invaluable in clinical and athletic training room settings. Increase patient compliance while augmenting ultrasound, cryotherapy, T.E.N.S., and massage therapies. Flexall® gel contains seven-percent menthol, and Maximum Strength Flexall® is 16-percent menthol. These unique aloe vera gel formulas providing fast, long-lasting relief from arthritis, backache, muscle strains and sprains, bruises, and cramps. Flexall gels penetrate skin quickly and deeply, are easy to apply, greaseless, and gentle on the skin. Professional sizes are available. Ari-Med/Diversa Products Group • 800-527-4923 www.ari-med.com

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Three in One

Arnica, MSM, and aloe—three powerful ingredients joined in one new product. Doctor Hoy’s™ Natural Arnica Boost attacks pain and inflammation at the source. Plus, it’s unscented and massage friendly. Use alone or expedite healing by combining with original Pain Relief Gel powered by Timed Release Menthol and Camphor for hours of deep relief. It gives healing a “boost.” Doctor Hoy’s Natural Pain Relief Gel • 480-357-4300 www.drhoys.com Circle No. 543 T&C OCTOBER 2013

Sports Massage Good Vibrations

Perform Better’s new VibraRoll is the only vibrating foam roller specifically designed for self-myofascial release. The vibrations allow for breaking up trigger points while improving blood circulation, range of motion, and flexibility. Its easy on-off button allows you to use this roller with or without vibrations. This durable, PVC roller with foam covering is 18 inches long, 6 inches round, and works with four D-sized batteries, which are included with each roller. The VibraRoll is only available through Perform Better. For more information, call or visit the company’s Web site.

Perform Better • (800) 556-7464 www.performbetter.com Circle No. 515

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Rehydrates Tissue

The new STAR ROLLER™ was designed by a physical therapist. Its patented lengthwise ridges alternately compress and release tense or rigid tissues as the user rolls, penetrating deeply into muscle, and creating a pressure differential that rehydrates connective tissue. It’s ideal for therapeutic self-massage, relaxation techniques, and challenging core stability. The STAR ROLLER is available in soft or firm densities. OPTP • 800-367-7393 www.optp.com

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Targeted Soft-Tissue Therapy

HawkGrips are one of the finest soft-tissue therapy instruments ever developed. The stainless steel instruments glide over the skin to detect and treat soft-tissue injuries. Choose from four different sets or purchase instruments individually. HawkGrips’s list of clients includes teams from the Olympics, NFL, MLB, NBA, NHL, MLS, NCAA, and others. HawkGrips offers simple pricing and no extra fees. We support the NATA. This product is made in the U.S.A. Contact your distributor for a free product demonstration. HawkGrips • 484-351-8050 www.hawkgrips.com

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Elevate Performance

The Thera-Band® Roller Massager+ is an innovative tool for myofascial release and deep-tissue massage. Its unique patent-pending ridged design supports both superficial and deep-tissue mobilization while providing a massagelike experience. Use of the Roller Massager+ can help increase blood flow and circulation in targeted areas, while helping to increase muscle flexibility and range of motion. The Thera-Band Roller Massager+ is available in a standard and portable version with retractable handles. Performance Health • 800-321-2135 www.thera-band.com

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Whole-Body Benefits

The TRS Activ8r™ soft-tissue release system is designed to prevent nagging injuries, maximize performance, and rehabilitate from injury or daily stress. The contoured figure-eight profile and silicone construction help it sink deep into tight tissues for an efficient myofascial release. The Activ8r is perfect for clinic, gym or home exercise programs. It’s compact, freezable, dishwasher-safe, benefits the entire body, and includes an instructional poster. OPTP • 800-367-7393 www.optp.com

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Hit the Target

Perform Better introduces itsnew Firm Massage Balls. These Firm Massage Balls are perfect for targeted massage to specific body regions. The small size of each ball helps release tension in hard-to-reach places and is used to relieve trigger points and help alleviate pain. These Firm Massage Balls are lightweight and durable and will keep their shape during and after use. They are odorless and water resistant and are available in both 3-inch and 5-inch diameters. For more information on the new Firm Massage Balls, call the company or visit the Perform Better’s Web site. Perform Better • (800) 556-7464 www.performbetter.com

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Case Study

Increase Flexibility Without Inhibiting Performance

ecline in muscle strength has long been associated with static stretching, which is often used for increasing flexibility and range of motion (ROM) prior to activity. This association discourages some athletes from stretching immediately before an event, potentially increasing their risk of injury. Even though myofascial rolling has become popular because of its purported benefits in recovery after exercise, there was very little research on the effectiveness of the technique as part of a warmup. Two recent studies out of Memorial University of Newfoundland support the effectiveness of myofascial rolling. The studies concluded that as little as two minutes of myofascial rolling with foam rollers and a mere five seconds of rolling with a roller massager significantly increased ROM without any significant detrimental effect on muscle strength. The first study, completed in late 2012, demonstrated the efficacy of myofascial rolling using foam rollers. The second study, completed in June 2013, showed its effectiveness utilizing the Thera-Band® Roller Massager+. Although used for many years in physical therapy, myofascial rolling using foam rollers has recently surged in popularity in fitness. The rolling pressure applied along a muscle is thought to compress the tissue and increase flexibility of the muscle and fascia, possibly “breaking up” fibrous adhesions between layers of fascia. While myofascial release is usually performed by a therapist on a patient, self-myofascial release is typically completed using tools such as Thera-Band® foam rollers and the Thera-Band Roller Massager+. The foam roller study found a significant increase (10 to 20 degrees) in knee ROM after rolling the quadriceps for two minutes. In addition, the participants did not experience a decrease in knee strength or muscle activation with the increased ROM, which is often seen immediately after static stretching. This study was published in The Journal of Strength and Conditioning Research.

By Dr. David Behm and Dr. Duane Button

In the second study, the research team wanted to determine if similar results were possible using the Thera-Band Roller Massager+. All study participants were measured for hamstring flexibility (using the sit-and-reach test), maximal strength, and muscle activation before and after the intervention. The results indicated a significant increase (4.3 percent) in hamstring flexibility after only five seconds of rolling. After 10 seconds, there was a 6.6 percent increase in flexibility. There was no advantage to performing multiple sets of rolling. As expected, there were no changes in hamstring muscle performance after the rolling intervention. We are very pleased that the second study further substantiated the benefits of myofascial rolling and demonstrated the effectiveness of the Thera-Band Roller Massager+, an inexpensive and readily accessible tool. With just seconds of use, the Roller Massager+ provided statistically significant increases in ROM without any significant effect on muscle strength. This should prove to be beneficial as part of an immediate warm-up prior to an athletic event. Watch the Thera-Band Roller Massager+ research video at www.therabandacademy.com/BehmVideo. David Behm, PhD, the Associate Dean for Graduate Studies and Research at Memorial University of Newfoundland, has an extensive research portfolio with more than 125 articles published in peer-reviewed scientific journals. He integrates his theoretical work with his background as a competitive athlete and coach in a variety of sports. Duane Button, PhD, CSEP-CEP, an Assistant Professor at Memorial University of Newfoundland, has written 25 peerreviewed publications in the exercise neuroscience field. He has extensive experience in personal training and fitness testing. He is a course facilitator for the Canadian Society for Exercise Physiology’s Certified Exercise Physiologist and Certified Personal Trainer certification programs. 800-321-2135

www.performancehealth.com

Reference: Macdonald G, Penney M, Mullaley M, Cuconato A, Drake C, Behm DG, Button DC. An Acute Bout of Self Myofascial Release Increases Range of Motion Without a Subsequent Decrease in Muscle Activation or Force. J Strength Cond Res. 2012 May 10. Epub ahead of print. Reference: Sullivan KM, Silvey DBJ, Button DC, Behm, DG. Roller-massager application to the hamstrings increases sit-and-reach range of motion within five to ten seconds without performance impairments. Int J Sports Phys Ther. 2013. 8(3):228-236. TR AINING-CONDITIONING.COM

T&C OCTOBER 2013

Hot & Cold Accelerate Healing

Game Ready ® is a best-in-class sports medicine device to help athletes have a speedy recovery from injury or orthopedic surgery. The system uses ACCEL™ technology to set a new standard in recovery, combining active compression and cold therapies, that gives healthcare providers the power to accelerate the body’s natural repair mechanisms. Game Ready can be found in the athletic training rooms of virtually every professional sports team in the U.S. Game Ready • 888-426-3732 www.gameready.com

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Icing Made Easy

Millions of individuals and athletes suffer from painful feet, arches, or tendons as a result of foot ailments such as plantar fasciitis or heel spurs, as well as inflammation following training, work, or exercise. The patented Icy Feet™ is the easy-to-use, no-mess way to apply an even icing to the bottom of the feet. An engineered insole with a recessed heel cup and elevated arch provides continuous contact with the sole of the foot where relief is needed most. Enthusiastically recommended by podiatrists and running stores nationwide. The Pressure Positive Company • (800) 603-5107 www.pressurepositive.com Circle No. 523

Durable & Adjustable

These ice wraps are the perfect method for applying cold therapy to most minor injuries. Made with quality neoprene for durability, these wraps are perfect for treatment of pulls and strains. They are quick and easy to use, allowing for adjustable compression to keep ice packs in place. Available for the Shoulder (#439), Knee (#103) or Back (#208), these wraps are only available in black.

PRO Orthopedic Devices, Inc. • 800-523-5611 www.proorthopedic.com Circle No. 521

Simple Solution

Ice bath therapy can be a very effective modality. Unfortunately, this therapy regimen can elicit complaints of extreme discomfort in personal areas. The easy solution to this problem is the PRO #805 Ice Bath Therapy Briefs. Constructed of 1/8-inch black neoprene with hook and loop fasteners on each side for easy application, this product is available in sizes medium, large, x-large, and xx-large. PRO Orthopedic Devices, Inc. • 800-523-5611 www.proorthopedic.com Circle No. 524

Portable Treatment

The Ice-Up Portable Ice Massager is a breakthrough product in the world of ice treatment for soft-tissue injuries. The Ice-Up comes within a portable, insulated carry cooler, which keeps the stick frozen up to 12 hours. Plus, the leak-proof design keeps you dry during travel so you can take it anywhere for an immediate postactivity ice massage.

Pro-Tec Athletics • 800-779-3372 www.pro-tecathletics.com

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Total Control

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

Therapy On the Go

PowerPlay is a portable cold and compression therapy system for joint relief and muscle recovery. At approximately one pound, PowerPlay goes wherever your game takes you. One affordable unit lets you treat up to three athletes or sites at once, and delivers cold through form-fitting, re-freezable gel wraps. PowerPlay’s intermittent, sequential compression reduces swelling while optimizing tissue healing, blood flow, delivery of oxygen, and lymphatic drainage. Recover faster and boost performance with PowerPlay.

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PowerPlay • 918-744-1078 www.powerplay.us

T&C OCTOBER 2013

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Penetrating Relief

Pro-Tec Athletics’ Hot/Cold Therapy Wrap provides penetrating cold and/or heat for therapeutic relief. It is form-fitting and remains flexible during application. The three-inch wide dual strapping system effectively compresses the entire target area evenly and the advanced gel technology pack remains flexible during application and retains cold or heat longer. Pro-Tec Athletics • 800-779-3372 www.injurybegone.com

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TR AINING-CONDITIONING.COM

Case Study

Meeting the Demands of Today’s Athletes: Introducing the Stabilizing Speed Pro

he American Journal of Sports Medicine published the results of a study on the effect of ankle braces on injury rates in high school football players. The study was performed at the University of Wisconsin, Madison by Timothy A. McGuine, PhD, ATC; Scott Hetzel, MS; John Wilson, MD, MS; and Alison Brooks, MD, MPH. This study of over 2,000 high school football players proved that wearing the DJO Stabilizing Ankle Brace reduces the incidence of acute ankle injury by 61 percent. The study concluded that, “Wearing the brace did not increase the incidence or severity of acute knee injuries or other lower extremity injuries.” Bracing also offers a low-cost alternative to athletic tape. (Source: McGuine T.A., Brooks A. AM J Sports Med.2011 “The Effect of Lace-up Ankle Braces on Injury Rates in High School Football Players”). As stated in the National Athletic Trainers’ Association Position Statement: Conservative Management and Prevention of Ankle Sprains in Athletes, an estimated 28,000 ankle injuries occur in the United States each day; 10 million a year. A study presented by the Orthopaedic Department of the University of Basel in Switzerland found that 40% of those who suffer ankle injuries will develop chronic ankle instability; 80% will develop ankle arthritis at some point in their life.

TR AINING-CONDITIONING.COM

The results of the University of Wisconsin study, and the alarming rate of ankle injury occurrence, are primary reasons why DJO introduced in September a new model to its Stabilizing Pro Ankle Brace product line: the Stabilizing Speed Pro. The Stabilizing Speed Pro is designed to meet the needs of demanding athletes. The speed-lacing system makes applying the brace exceptionally fast and easy. Playing sports often demands a sense of “urgency,” and the Stabilizing Speed Pro was created with this in mind. The Stabilizing Speed Pro also features a new contoured design made with rugged ballistic nylon which delivers comfort, performance and durability; non-stretch figure-8 straps which lock calcaneus providing ideal inversion/eversion control; reinforced eyelets and a 3” circumferential elastic strap, which provides tibia/fibula compression and stability; and removable articulated stays that offer additional support and stability without compromising comfort. The Stabilizing Pro Ankle Braces give athletic trainers conﬁdence that the vulnerable ankles of their athletes are protected. Visit djoglobal.com/donjoy for more information or call 800-336-6569.

T&C OCTOBER 2013

More Products Fuel They Need

Give it everything you’ve got. Gatorade is dedicated to providing high school athletes with the fuel they need to achieve their best during practice and competition. That’s why Gatorade offers G Series performance packages to high school coaches and athletic trainers at a significant discount. To get the most out of every play and every player, visit the Web site to learn more and place your order.

Gatorade • 800-88-GATOR www.gatorade.com/coaches

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Add a bit of cardio to your strength workout while releasing stress or excess energy with the Mega Slam Ball. This no-bounce, no-roll ball is specifically designed for high-impact throwing and slamming to the ground, and is a must for any crosstraining regimen. Use in place of a standard medicine ball to perform traditional core exercises or pass back and forth between partners. The rugged, textured surface provides superior grip, handling, and long life. It is available in sizes from 10 to 50 pounds, and in five-pound increments. Power Systems • 800-321-6975 www.powersystems.com

Top Industry Professionals

A Smart Rebounder

NSCA • 800-815-6826 www.nsca.com

Powering Athletics • 866-672-1700 www.poweringathletics.com

The National Strength and Conditioning Association (NSCA) is an international educational association. The NSCA develops the most advanced information regarding strength training and conditioning practices, injury prevention, and research findings. Unlike any other organization, the NSCA brings together a diverse group of professionals from personal trainers, strength coaches, researchers, and educators. These individuals are all in pursuit of achieving a common goal—improving athletic performance and fitness. Circle No. 526

ATP Extreme is a revolutionary performanceenhancing supplement. The main active ingredient is a patented form of ATP (adenosine triphosphate). The benefits to athletes are increased endurance, increased power, reduced lactic acid, increased training capacity and reduced recovery time. Free of added stimulants and banned substances, it’s safe and legal to use in any sport. Look for a special offer on the company’s Facebook page at www.facebook.com/atpextreme ATP Nutritionals, LLC • 949-734-1244 www.atpextreme.com

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The PlayBack-Pro Extreme is more than just a rebounder, it is a complete plyometric system that makes every move count. You can do more in less space. The only rebounder that offers a PlyoPlate, it also includes upper extremity cords, lower extremity cords, weight horn, wheel kit, gel-filled medicine balls, and a two-tier standalone ball rack. Offering more than just med ball rebounding, it’s a complete functional training system that accommodates lifts, balance exercises, jumps, step-ups, squats, lunges, and bounding. Circle No. 534

Oxygenate Then Dominate

Supplement with ATP

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There is nothing more important to athletic performance than oxygen. Oxygen Factor is 95 percent pure portable oxygen. It allows athletes to infuse their bodies with supplemental oxygen on demand and immediately affects power, endurance, and recovery. It’s legal for use in any sport, and each canister contains multiple uses. See the company’s special offer on its Facebook page at www.facebook. com/oxygenfactor Oxygen Factor • 952-460-0926 www.oxygenfactor.com

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Elite Equipment

The PowerPlyos is four machines in one that combines jump boxes (three sizes), “V” angle jump box, side angle jump box, and vertical leaper in a single footprint. Use it to develop explosive lateral power, first step, strength, and speed. The PowerPlyos accommodates single leg strength, lateral movement, resisted vertical power and rotary power, and converts into any shape in less than a minute.

The PowerMax “Athlete Engineering”™ Weight Equipment line is 100-percent U.S. made by one of the most experienced athletic companies in the industry and features materials that will exceed your expectations. This product’s welds are by the only welders in the athletic equipment industry certified by the American Welding Society’s standards. PowerMax has had powder-coated athletic equipment for more than 20 years. You want to be focused on building excellence, and PowerMax wants to partner with you. Contact your local dealer today for a quote.

PoweringAthletics • 866-672-1700 www.poweringathletics.com

PowerMax • 800-637-3090 www.gillathletics.com

Four-In-One

Superior Handling

T&C OCTOBER 2013

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