Training & Conditioning 23.9

Nutrition for Basketball n New Model in Sports Medicine n Off-Season Baseball Workouts

December 2013 Vol. XXIII, No. 9, $7.00

HEART OF THE MATTER Implementing ECG screens

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Patent Pending.

December 2013, Vol. XXIII, No. 9

contents

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27 Bulletin Board 4 Taking acetaminophen to beat the heat …

Work-life balance … New study on creatine … Research on pitching injuries.

Comeback Athlete 7 Kelsie Johns Xavier University

Sponsored Pages Hydroworx HiTrainer

16 41

42 Advertisers Directory

CEU Quiz 43 For NATA and NSCA members Product News 46 State of the Industry 49 Aquatic Therapy Pools

50 51

Product Launch More Products

On the cover: In the Bryan (Texas) School District, Athletic Trainers Jamie Woodall (left) and Josh Woodall (right) spearheaded an ECG screening program for all athletes after football player David Wilganowski (center) suffered cardiac arrest during a game two years ago. Story begins on page 18.

PHOTO BY TERRY FIELD

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37

Optimum Performance

Hitting Their Stride

At Columbia University, student-athletes are focused and finishing strong, thanks to a new performance-enhancement program emphasizing both body and mind.

By Dr. Brent Walker Treating the Athlete

of the Matter 18 Heart While debate continues on whether ECG tests should be

standard practice for athletes in the U.S., some schools have begun to implement them in the meantime. Athletic trainers in the Bryan (Texas) School District and at the University of Washington explain their screening programs.

By Josh Woodall and Jamie Woodall, and Patrick Jenkins Nutrition

27 The University of North Carolina is using a “full court press” in Fueled for Takeoff

nutrition to assist its men’s basketball players.

By Mary Ellen Bingham Leadership

31 What’s the best way to deliver athletic training coverage and Many Hands

sports medicine care in the 21st century? A large-scale model, outlined here, may provide an answer.

By Mitch Bellamy Sport Specific

37 An off-season training program centered on injury prevention Twofold Approach

and position-specific workouts has helped the University of South Carolina baseball team win two national championships in the past four years.

By Billy Anderson T&C DECEMBER 2013

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

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

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

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

Jim Berry, EdD, ATC, SCAT, NREMT Head Athletic Trainer 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 Former Associate 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

December 2013 Vol. XXIII, No. 9

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 Manager 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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Board Take Two, Stay Cool Athletes who train in hot conditions are often in search of ways to “beat the heat” and exercise longer. One new answer may be as simple as taking a few pills of acetaminophen. Researchers in England have found that the drug helps athletes improve their time to exhaustion when exercising in the heat, possibly due to its ability to lower body, core, and skin temperature.

Accepted for publication in Experimental Physiology, the study was done by researchers from the University of Kent and the University of Bedfordshire. Eleven recreationally active subjects cycled to exhaustion on an ergometer in hot conditions (86 degrees Fahrenheit and 50 percent relative humidity), once after receiving acetaminophen and once after taking a placebo.

When given acetaminophen, the subjects showed a 17 percent increase in their average time to exhaustion—from just under 19 minutes to about 23 minutes. They also had lower core (-0.15 degrees Celsius), skin (-0.47 C), and body temperatures (-0.19 C) than when they received a placebo.

The results compared favorably with those produced by pre-cooling the body. “This improvement in exercise capacity is less than that achieved with the ‘gold standard’ external pre-cooling method of cold water immersion, where improvements in the region of 37 percent have been observed,” the study’s authors wrote. “However, when compared with the more logistically practical internal pre-cooling methods such as cold drink ingestion, ice slurry ingestion, and cold air inhalation, improvement in exercise capacity is similar.”

However, the authors warned that the use of analgesics such as acetaminophen does carry some risks. “[We] do not condone the use of analgesics for ergogenic performance, as they can mask injury, cause gastrointestinal damage and, according to the present findings, may affect usual thermoregulatory working,” they wrote. “However, the quick, easy and practical administration of ACT may provide a useful and effective means of moderating [core temperature] during challenging occupational pursuits or in individuals suffering from exertional heat illness.”

The full text of the study can be found by typing its title, “Acute acetaminophen (paracetamol) ingestion improves time to exhaustion during exercise in the heat,” into the search window at: ep.physoc.org.

Balancing Act for ATCs Maintaining work-life balance can be difficult for athletic trainers. A recent study revealed common themes in how female athletic trainers at the NCAA Division I level strive to keep this balance. ­ 4

T&C DECEMBER 2013

Twenty-seven female athletic trainers took part in the study, which appears in the September/October issue of Athletic Training & Sports Health Care. All were full-time employees working between 39 and 77 hours a week, 14 were unmarried, six were married, and seven were married with children.

Nine worked primarily with women’s basketball, seven with women’s soccer, three with football, three with volleyball, and five were not assigned to a specific sport.

Researchers at the University of Connecticut collected data through online interviews featuring a series of openended questions. Four common strategies for achieving work-life balance emerged: establishing support systems at home and at work, prioritizing family time, setting boundaries between home and work, and exercise. Those who were married and/or had children found prioritization most effective, whereas single participants relied most heavily on exercise. Leaning on strong support systems was found to be the most common strategy, regardless of marital status.

Participants were also asked about their biggest challenges in finding balance. The three most-cited responses were travel and hours worked, lack of control over schedules, and communication difficulties with coaches.

Based on these findings, the study’s authors advise female athletic trainers to maintain a balance between their personal and professional lives, encouraging them to take advantage of resources such as the support of co-workers. In addition, the authors believe formal policies regarding work-life balance are needed to help Division I schools retain female athletic trainers in the future.

To view an abstract of the study, “Factors and Strategies Contributing to the Work-Life Balance of Female Athletic Trainers Employed in the NCAA Division I Setting,” visit: digitalcommons.uconn.edu/gs_theses/393/.

Later is Better for Creatine Use Creatine users may be better off taking the supplement after a workout rather than before. A recent study published in the Journal of the International Society of Sports Nutrition found that creatine had a greater effect on strength and lean body mass in bodybuilders who used it post-workout compared to a group that took it pre-workout.

Researchers from Nova Southeastern University, led by Jose Antonio, PhD, Assistant Professor of Exercise Science at the school, randomly assigned 19 bodybuilders to receive five grams of creatine monohydrate before or after their workouts for four weeks. They found the post-workout supplementation group increased their fat-free mass by an average of 2.0 kg compared to 0.9 kg in the pre-workout group. The post-workout group also averaged an increase of 7.6 kg in their one repetitive max bench press compared TR AINING-CONDITIONING.COM

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Board to a 6.6 kg average increase in the pre-workout group. Total body weight and fat mass were also measured, but no significant differences were found.

“The main findings of our creatine study indeed showed that timing can have an important effect on the adaptive response to exercise,” Antonio told NutraIngredients-USA. com. “Whether this is important over the course of taking creatine for months or years isn’t known. Nonetheless, this investigation adds to the growing body of evidence that when you eat or take supplements does critically affect lean body mass and exercise performance.”

The full text of the study, titled “The effects of pre versus post workout supplementation of creatine monohydrate on body composition and strength,” can be found at: www.jissn.com/content/10/1/36.

New Research on Pitching Risks Two recent studies, both published in Sports Health: A Multidisciplinary Approach, have shed new light on the risks of injury for baseball pitchers. The first study, conducted as a literature review looking at 10 biomechanical and five epidemiologic studies published between 1979 and 2011, found

no evidence to support the idea that throwing curveballs increases a pitcher’s risk of injury compared to throwing fastballs. While the biomechanical studies suggested increased activity of extensor and supinator muscles when curveballs were being thrown, a majority of the epidemiologic studies showed no significant association between pitching curveballs and upper extremity pain or injury.

In the second study, researchers analyzed the fastball pitching motions of 15 adolescent players throwing on flat ground as well as from a mound. The results revealed a statistically significant increase in internal rotation of the shoulder and an inward movement of the elbow in pitchers throwing from the mound, which puts increased stress on the shoulder and elbow.

According to the researchers, the findings support the practice of having pitchers throw on flat ground when they start their season or return from injury before pitching from the mound. This could help athletic trainers devise better return-to-play protocols for these pitchers.

To view the abstracts of the studies, search their titles, “The Curveball as a Risk Factor for Injury: A Systematic Review” and “A Biomechanical Comparison of Pitching From a Mound Versus Flat Ground in Adolescent Baseball Pitchers,” at: sph.sagepub.com.

Training & Conditioning and Sports Health announce the 2nd annual: 866.323.5465 | www.sportshealth.com

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 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

Deadline: December 31, 2013

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T&C DECEMBER 2013

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ComebackAthlete

Kelsie Johns Xavier University

By Mary Kate Murphy

Kelsie Johns’s summer break in 2012 started on a high note. Returning home to Wilmington, N.C., after a successful freshman year with the Xavier University swim team, during which she entered the school’s top 10 list in the 100-yard butterfly and posted top 20 times in the 100- and 200-yard breaststroke, she was looking forward to some relaxation. For Johns, that meant making up for missed time with her horse.

About a week later, she decided to go for a morning ride.

As she was ending her ride, coming to the woods in her yard, the horse got spooked. Before he could take off, Johns decided to bail.

“I’ve had to jump off horses before, but I’d never been seriously harmed by it,” she says. “When I landed this time, though, I had to hold my arms out to brace my fall, and my right arm took the brunt of the impact. When I looked down and saw the injury, my first thought was, ‘I can’t swim anymore. My life is over.’”

It was a gruesome sight. Her ulna was broken in three places, and part of it had pierced through her skin. Another piece of her ulna had fallen out through the open fracture.

She also had a dislocated radial head.

The on-call physicians in the emergency room decided to operate immediately, inserting a plate and six screws into her arm. Their post-op diagnosis backed up Johns’s original fears of never swimming competitively again.

“They told me I’d be lucky if I ever straightened my arm or turned my palm over, which would have made swimming nearly impossible,” she says. “I went through a bit of depression after that first surgery, because I didn’t think I’d ever get in the pool again.”

An additional operation six weeks later set the stage for Johns’s rehab. “The doctors had to do a bone graft with a piece of my pelvic bone to replace the missing ulna segment,” she says. “And because they wanted to make sure the bone had time to heal properly, I was ordered not to lift anything heavier than one pound for the next three months.”

Still on summer break after the surgeries, Johns started rehab at home. When she returned to college, she worked in tandem with a local hand therapist and Kelsey Pilati, MS, ATC, a Graduate Intern Athletic Trainer with Xavier at the time.

“Kelsie was referred to a hand therapy clinic that I had worked with before, so I was familiar with the physician and TR AINING-CONDITIONING.COM

After a horseback riding accident shattered her right arm, Kelsie Johns was told she might never be able to turn her palm over again. Six months later, she was back competing for Xavier. the techniques involved,” says Pilati, who is now an Assistant Athletic Trainer at Oberlin College. “Kelsie attended hand therapy once a week, and I would often go with her to get an idea of the exercises they were giving her. Then, I would adapt them so Kelsie could continue her hand therapy in the athletic training room for the rest of the week.”

In addition to continuing the work prescribed by the hand therapist, Pilati’s main focus for Johns’s rehab in the athletic training room was regaining range of motion in her forearm and elbow. Although she would not be able to return to her pre-injury range of motion, there was much work to be done.

“Shortly after we started rehab, doctors found scar tissue in Kelsie’s arm, which would prevent her from ever having full range of motion, so they put her in a brace that held her arm at a right angle,” Pilati says. “While in the brace, Kelsie had to do an exercise in which she gripped a bar and turned knobs on it. The brace turned out to be beneficial, because it prevented Kelsie from letting go when she experienced discomfort. It forced her to hold her position and complete each movement, which ultimately helped her reach her Mary Kate Murphy is an Assistant Editor at Training & Conditioning.

She can be reached at: mkmurphy@MomentumMedia.com.

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ComebackAthlete month, a disheartening blow for Johns.

“I was disappointed because the swim team had already started fall training, and I was hoping to participate,” she says. “It was frustrating going from lifting three times a week and swimming twice a day, six days a week before the injury to simply trying to straighten my arm and being excited if I had a one-degree increase in my range of motion.”

The additional month did the trick, though, and Johns was cleared to slowly start adding weights to her rehab in October. “We began with bicep curls without weight and gradu-

Kelsie Johns Xavier University Sport: Swimming Injuries: Broken ulna in three places, with one piece falling out of a compound fracture wound, dislocated radial head.

Result: Returned from two surgeries, a sixmonth rehab, and a bout with shoulder tendonitis to compete in the Atlantic 10 Conference Championships.

range-of-motion goals.”

A typical session began with heat to warm up Johns’s muscles followed by ultrasound and a massage over her scar to break up any adhesions that had developed. After that, Johns started her exercises.

“I wasn’t allowed to use weights, so I laid on the floor and Kelsey would manually straighten my arm at the elbow and bend it back up as far as it would go to try to get my thumb to touch my shoulder,” says Johns. “For another exercise, I

“It’s easy to cheat when you are doing range of motion, so I had Kelsie hold a pencil when rotating her wrist to make sure she was going all the way around.” faced a wall and tried to walk my fingers up it.”

Pilati believes being in the athletic training room helped Johns get the most out of her rehab. “It’s easy to cheat when you are doing range of motion, so I had Kelsie hold a pencil when rotating her wrist to make sure she was going all the way around,” says Pilati. “At times, I pushed on it for a few seconds, and Kelsie had to resist against me.”

In September, three months after the bone graft, Johns was eager to start ramping up her rehab with weights. However, because the graft in her ulna hadn’t healed completely, the doctors pushed her weight-bearing date back another ­8

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“I took everything day by day, and I celebrated any improvement, whether it was one degree in range of motion or one pound in strength.” ally increased to one pound, which was extremely difficult for Kelsie at first,” Pilati says. “Once that started feeling pretty easy, we upped the repetitions and slowly moved to a twopound dumbbell.”

Johns continued to make strides throughout October, and doctors cleared her to begin swimming. “It was strange to be back in the water,” she says. “In the beginning, I was only permitted to swim the equivalent of a warm-up, but it was great to feel like I was doing something again.”

The return to the pool was not a return to normalcy, however. Johns still couldn’t fully pronate or supinate her forearm, which affected her strokes. In addition, she was allowed to increase her distance no more than 10 percent each week, and doctors limited her swimming to once a day instead of twice as the team was doing.

Pilati carefully monitored Johns’s progress in the pool. “At times, she swam fine but would come into the athletic training room the next day and her entire arm would be sore,” says Pilati. “When that happened, I would hold her out of practice.

She seemed to keep taking two steps forward and one step back throughout her rehab. But we focused on the fact that she was moving forward.”

Open communication was crucial during this up-and-down period. “Kelsie knew I wasn’t holding her out to be mean, but it’s obviously disappointing for any athlete to be prevented from doing what they love,” says Pilati. “So it was important that we formed a good relationship. She was very honest about how she felt every day because she didn’t want to hinder her progress, and I was open about what I thought she should attempt.”

There was one more hurdle to get over. Because Johns hadn’t used her right shoulder for four months, its muscles were very weak. In the pool, her tendons tried to overcompensate for this frailty, causing them to become inflamed.

About a month after taking her first strokes, an official diagnosis of tendonitis in her shoulder meant Johns was out of the pool again for a week to rehab the new injury.

“We put heat on her shoulder and used ultrasound to reduce the inflammation,” says Pilati. “Then we did a lot of internal and external rotation exercises on her rotator cuff and TR AINING-CONDITIONING.COM

ComebackAthlete flexion and extension stretches on her shoulder. Even after she got back in the pool, Kelsie continued this protocol three times a week to keep her shoulder strong.”

The reward for all her hard work came when Johns got the opportunity to swim at the Atlantic 10 Conference Championships in February. She had participated in a handful of meets beforehand, and her coach entered her in several events. She came away with season-best times in the 100- and 200-yard breaststroke and the 100yard butterfly.

“Once I got back in the pool, my goal was to swim at the conference meet,” says Johns. “I didn’t really have high expectations for myself. I just wanted to go in, give it my all, and see what happened. I was thrilled by the results.”

After a fulfilling end to the 2013 season, Johns spent the summer at home training and lifting every day with swimmers from the University of North Carolina-Wilmington. Motivated by the setbacks of the previous year, she entered the fall preseason at Xavier with equal strength in both arms—and in the best shape of her life. Her aspirations for her junior season are high, and she is eager to improve on her times from her freshman year.

Throughout all the moments of frustration, Johns says she got through the difficult recovery process by trying to remain positive at all times. “I reminded myself that I was lucky to even have the chance to swim again,” she says. “I took everything day by day, and I celebrated any improvement, whether it was one degree in range of motion or one pound in strength.”

Pilati says that she was amazed by Johns’s attitude throughout the rehab and did her best to provide encouragement whenever needed. “During

Kelsie’s moments of doubt, I talked about how her situation was not permanent,” says Pilati. “She had already gone through the injury and the surgeries. Compared to that, I told her, everything else was a minor setback.

“Her positive attitude actually often lifted my spirits,” Pilati continues. “I could be having a tough day in the athletic training room, and Kelsie would come in so happy it would brighten my mood. I’d think to myself, ‘This girl

broke her arm and she can’t lift anything, but she is positive and ready to get to work. I can get through the rest of the day.’”

And as for Johns’s other extracurricular activity, after some trepidation, she got back on her horse and enjoyed riding this past summer. “It was scary at first, and I was a little uncomfortable,” she says. “But then something clicked and I started loving it again. I rode almost every day after that.” n

Nominations Welcome To nominate a comeback athlete, send a brief description of the athlete’s injury and his or her rehab process to: ef@ MomentumMedia.com. Please include your phone number and e-mail address.

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In women’s tennis, the Lions captured their first Ivy League title last spring, while the men’s cross country team has been ranked in the top 10 nationally over the past two seasons for the first time in program history.

Gene Boyars/Columbia Athletics

Paul Everett

Hitting Their Stride At Columbia University, student-athletes are focused and finishing strong, thanks to a new performance-enhancement program emphasizing both body and mind.

By Dr. Brent Walker

E

veryone in an athletic department wants to see athletes achieve success.

From the director of athletics to the strength and conditioning intern, we’re all working toward more victories, both large and small.

But sometimes we operate in silos, unable to see the big picture and develop plans that would help student-athletes reach their full potential. For example, a strength coach may focus on comparative gains to motivate two athletes with similar injuries, yet the athletic training staff has put them on completely different rehabilitation schedules. At the same time, a nutritionist may be providing a meal plan that does not mesh with the athletes’ rehabilitation goals.

Here at Columbia University, we have implemented a new program to avoid such communication breakdowns. It’s called the Championship Performance Initiative, and it incorporates a unique combination of performance-enhancing techniques used at organizations such as the IMG Academies and the Army Center for Enhanced Performance.

The aim of the program is to empower our athletes to make the most of their athletic and academic careers by connecting the valuable resources currently at their disposal and adding ones that are sometimes missing from a traditional athletic department. We’ve also put systems in place to ensure all staff members involved in student-athlete development follow the same game plan.

The impetus for the program came from our Director of Intercollegiate Athletics and Physical Education, Dr. Dianne Murphy. Along with defining its parameters, Brent Walker, PhD, is the Associate Athletics Director for Championship Performance at Columbia University. In addition to serving on the Executive Board of the Association for Applied Sport Psychology, he has worked with the U.S. Soccer Federation and provided mental training services to NFL, NBA, and MLB players. He can be reached at: bww2108@columbia.edu.

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Optimum performance she organized a major fundraising campaign to support the idea and allow us to construct the Campbell Sports Center, a 48,000 square-foot multipurpose facility, which houses a new strength and conditioning space, coaches’ of-

tive is made up of five components: mental preparation, sports nutrition, the First-Year Transition Program, the Leaders for Life Program, and the Career Development Four-Year Action Plan. Each component plays a vital role

Meeting the psychological needs of more than 700 student-athletes on 31 varsity teams is a balancing act, so I devised a five-pronged approach ... The goal is to reach every athlete, team, and coach through at least one tactic. fices, a theater-style meeting space, a hospitality suite, and a student-athlete study area and lounge.

THE PIECES The Championship Performance Initia-

in enhancing the student-athlete experience. Some were in place previously, but now they work in synergy with the efforts of our sport coaches, strength coaches, athletic trainers, and other staff members.

AXING ANXIETY One huge way mental preparation can help athletes is through teaching them to conquer performance anxiety. I once worked with a runner who got so nervous during races that she was unable to perform anywhere near her training capabilities.

Our initial discussions revealed that she would start to doubt herself and panic when she sensed the pack making a move late in the race. At that point, she would fall back and run a much slower pace.

We turned that point in the race into a cue and changed her thinking about it. First, heart rate biofeedback was used, which provides immediate feedback when negative or stressful thoughts are experienced.

She learned to understand when anxiety was beginning and then used focused breathing to calm herself physically and mentally.

Next, she played a jet ski video game in which her performance was judged by her ability to remain calm. If she wasn’t calm, the jet ski would slow down and fail to clear ramps, dark clouds and fog would roll in, and she would fall behind in the race.

To help her overcome the poor performance spot in the jet ski race, she returned to her calmness training and eventually started to get through the race with less and less “bad weather.” We replicated the training with EEG biofeedback, teaching her to maintain her attention with a clear mind.

We then transferred the mental training to her running by instructing her to visualize the race up to the point where she started to worry about being passed by other runners. When she first visualized this, a negative response could be seen in her heart-rate patterns. At that point, she was instructed to return to a calm mental state. Through this continued process, she was able to transcend the negative feelings and stress surrounding the scenario and perform to her full potential.

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Mental preparation: Many of the greatest barriers to maximizing athletic potential are psychological in nature, yet most athletes lack the formal training to overcome them. To help our athletes reach their potential, we use confidence building, goal-setting, attention control, visualization, and stress-management techniques.

Nutrition: Sports nutrition is a critical part of any athlete’s success. Columbia offers student-athletes and coaches access to a registered dietician for services such as group nutrition consultations, diet assessment and analysis, menu planning, eating on the road, and supplement information and education. Student-athletes can also schedule individual sessions with the dietician to cover topics such as eating for injury prevention, nutrition and hydration for performance enhancement, and the difficulties of maintaining a healthy diet in one of the most expensive cities in America.

First-Year Transition Program: This initiative was created to help new Columbia student-athletes acclimate to the fast pace of New York City and their academic, athletic, and life commitments. The program is required for all first-year athletes, and it includes a series of semester-long, interactive workshops that focus on academic and social development, including topics such as academic integrity, drugs and alcohol, and diversity and inclusion.

Leaders for Life Program: This is a year-long program for studentathlete upperclassmen designed to identify and cultivate leaders in Columbia athletics, the university community, and beyond. Leaders identified from the university’s athletic teams are invited to participate in small-group learning, self-assessments, and peerto-peer and peer-to-coach interactions.

It gives our leading student-athletes a forum to identify and manage specific team needs and gain a deeper understanding of the skill sets needed to become effective leaders.

Career Development Four-Year Action Plan: Ivy League student-athletes value their educational experience and the career possibilities created by their high-caliber undergraduate environment. The Career Development Four-Year Action Plan is a progressive, year-long program that involves a series of business etiquette, interviewing, and networking activities.

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Optimum performance The plan is aimed at helping top-level student-athletes establish skills that will prove valuable when they’re striving to achieve their career goals.

Athletes learn about the Championship Performance Initiative in a variety of ways. For starters, coaches have been an invaluable referral source. The program has become part of their recruiting vernacular, so many studentathletes are already familiar with the program when they arrive on campus. In addition, coaches often refer a student-athlete for mental training or a nutritional consult when they notice it is needed.

However, the best referral source for the Championship Performance Initiative has been the student-athletes themselves. When they experience success with the program, they share their stories with teammates and contribute to effective grassroots recruitment.

WINNING MENTALITY While the Championship Performance Initiative is designed to leverage the benefits of all five of its components,

mental preparation has received the greatest attention. Mental preparation can lift student-athletes on the brink of success to the next level and help underachieving teams develop legitimate expectations of success. Part of my role in directing the Initiative is

sessions, workshops, team meetings, coaches’ meetings, and self-guided resources to efficiently serve their needs.

The goal is to reach every athlete, team, and coach through at least one tactic.

Individual Sessions: In most situa-

Individual sessions range from 45-minute conversations to short discussions on the sideline. The most common reasons athletes seek out sessions are confidence issues, performance anxiety, and motivational difficulties. to also manage mental preparation.

I teach athletes skills that empower them to develop a championship mindset and remain focused and emotionally in control during stressful competitive situations.

However, meeting the psychological needs of more than 700 studentathletes on 31 varsity teams is a balancing act, so I devised a five-pronged approach comprised of individual

tions, the best way I can positively impact a student-athlete’s performance is by meeting with them one-on-one.

These individual sessions range from traditional 45-minute conversations in my office to short discussions on the sideline during a team practice. The most common reasons athletes seek out individual sessions are confidence issues, performance anxiety, and motivational difficulties.

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T&C DECEMBER 2013

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Optimum performance Confidence issues can impact anyone and are often tied to flawed definitions of success and failure. To help athletes gain confidence, I teach them to restructure their thinking to focus

cially common in physically demanding, repetitive endurance sports like rowing, cross country, and swimming. For example, when the weather is bad at the beginning of the spring

To make mental training accessible to our studentathletes on their own time, I created a resource center that includes iPad stations, EEG and heart rate biofeedback equipment, a vision board, and an egg chair. on factors that are within their control, such as their attitude, effort, preparation, and response to adversity.

Performance anxiety can be tied to a lack of confidence. Treating it involves a combination of cognitive restructuring—turning the mind from worrisome to positive thoughts—and relaxation training in the form of breathing exercises, progressive relaxation aimed at the muscles, or biofeedback.

Motivational difficulties are espe-

semester, our crew team might practice on ergometers for weeks at a time without ever seeing the water.

Staying motivated when competitive action is a long way off is a difficult challenge for even the most driven athletes and I provide strategies to overcome this.

Workshops: Each semester I present a series of workshops for our student-athletes on topics such as mental toughness, focus, managing competitive pressure, and confidence build-

IN ACTION How does the Championship Performance Initiative work on a day-to-day basis? One of its most powerful aspects is the way in which different disciplines work together to support our student-athletes. For example, when an athlete suffers a season-ending injury, there is communication and overlap among many people.

As part of the rehab process, the team’s athletic trainer may refer the athlete to the nutritionist to discuss whether any dietary changes are necessary to facilitate recovery. Our dietitian may prescribe a diet higher in protein but lower in calories as the athlete adjusts to the rehab program.

The athletic trainer may also direct the athlete to me for mental training so I can help create recovery goals and offer psychological support. This can help greatly in figuring out the best path for the particular athlete.

For instance, if an athlete feels it will be very difficult to be around the team when she can’t compete, she may choose to rehab in the athletic training room exclusively and spend the semester focusing on her studies. Another athlete may rehab best by remaining actively engaged with the team on a daily basis, doing rehab work on the practice field and traveling to away competitions.

In each case, we work as a team to help the athletes find the right solution. Through regular discussions between myself and the athletic trainers, coaches, and nutritionist, we devise a strategy that will put the athlete in the best position to fully recover, both physically and psychologically.

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T&C DECEMBER 2013

ing. These workshops allow me to supply a baseline level of information to our entire student-athlete population. They include a number of interactive exercises to help the athletes identify their mental strengths and weaknesses, and they allow athletes to explore mental training without the fear of being stigmatized.

Team Meetings: Usually requested by coaches, team meetings cover topics ranging from assessing the current team climate and developing camaraderie to exploring topics such as resiliency, communication, leadership, and focus. Meetings that focus on a specific mental issue are similar to my mental training workshops, only with a contextualized focus on the specific needs of the team.

Coaches’ Meetings: I meet with the coaches following a team meeting to discuss ways in which they can help reinforce mental training. For instance, if a team lacks confidence, I might recommend the coach limit showing video of a successful upcoming opponent or address specific ways to contain their strengths. In other cases, a coach and I might discuss a pre-game message aimed at inspiring a team without putting additional pressure on the players.

Since mental skills require regular, deliberate practice—just like physical skills—I spend time helping coaches incorporate mental preparation into their practices. For example, we might use mental-skills training to improve basketball players’ free-throw shooting. After helping the players develop and hone their free throw routines, we might incorporate a follow-up practice into an intra-squad scrimmage.

If a player fails to follow his routine during the game, play is momentarily stopped and the mistake is brought to his attention.

Many coaches want to focus on adversity training, which can take many forms. One is to manufacture games where athletes have to succeed without using their strengths. For instance, coaches might implement a rule where a right-footed soccer player can only score using her left foot. Or an offensive unit has to face a defensive unit with extra players. We might ask an official to make a series of poor calls during an intra-squad scrimmage. Although the student-athletes tend not to enjoy adversity training initially, TR AINING-CONDITIONING.COM

Optimum performance they quickly learn the point of the exercises and understand the importance of effectively coping with the challenges of their sport.

Self-Guided Resources: To make mental training accessible to our student-athletes on their own time, I created a performance and stressmanagement resource center that includes iPad stations, EEG and heart rate biofeedback equipment, a vision board, and an egg chair.

Each iPad station features audio visualization and relaxation programs as well as EEG and heart rate biofeedback activities that can help athletes manage stress and improve focus during competition. Using the instant feedback viewable on the iPad, student-athletes can practice controlling their heart rate and concentration levels through different relaxation and focusing exercises.

Our vision board is a state-of-theart interactive system designed to promote and enhance visual function, hand-eye coordination, and neuromotor abilities, which then improves an athlete’s reaction times and deci-

sion-making skills. The board also provides an excellent opportunity for adversity training because an athlete is highly unlikely to master all the programs.

formance Initiative is only in its second year, I’m excited about the direction it’s heading. One of the biggest challenges ahead is meeting the needs of interested student-athletes

Each iPad station features audio visualization and relaxation programs ... Using the instant feedback viewable on the iPad, student-athletes can practice controlling their heart rate and concentration levels.

Shaped like a pod and designed to reduce distractions, the egg chair uses noise-cancelling foam to create an excellent environment for relaxation and visualization exercises. The chair is connected to a computer with audio files and computer software similar to the iPad stations. It can be used as a stress-management tool to temporarily block out the mental clutter of a busy day, or as a performance enhancement device where an athlete can train attention skills without any outside distractions.

Although the Championship Per-

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across the department—requests for services during September and October of 2013 were more than double those in the same two months of 2012. To help, we hope to add at least one intern within the next year, and our five-year plan includes hiring a second expert in mental preparation. Ideally, the Championship Performance Initiative will establish Columbia as a dominant athletic force and show other athletic departments how to provide unified support to their student-athletes, pushing everyone to higher levels of success. n

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The Power of Aquatic Therapy H

uman beings have been harnessing the power of water since ancient times.

Now, earth’s most abundant natural resource is powering a rehabilitation and conditioning movement that’s caught the attention of the entire sporting world—from journalists and sports medicine professionals, to coaches and athletes at the highest levels.

Recently, Adrian Peterson, Robert Griffin III, Jamal Charles and A.J. Green have been added to the growing list of world-class athletes who have used water therapy pools to help them come back from career-threatening injuries faster than was previously thought possible.

Here’s a look at one of their incredible journeys: Adrian Peterson: The traditional mindset had been that elite athletes in a position such as NFL running back have very little chance of getting back to their best—let alone improving— following a serious operation such as ACL reconstructive surgery. During the 2012-13 season, Peterson shattered that mindset when he rushed for 2,097 yards—330 yards better than his previous season high—en route to being named the league’s MVP. Peterson’s remarkable recovery has even prompted many to seriously consider the question: Can a top athlete return from a career-threatening injury a more potent force than they were before the injury?

When planning Peterson’s rehab, Vikings’ Head Athletic Trainer, Eric Sugarman, was intent on utilizing many advanced technologies along with the therapeutic properties of water, to accelerate the athlete’s recovery.

“The water therapy [Peterson] did in the HydroWorx pool was extremely beneficial because it allowed us to begin his aquatic rehab only two and a half weeks after his surgery,” says Sugarman. “We eventually were able to have him workout on the underwater treadmill and against powerful

TOP PHOTO: World class track athlete Michael Johnson utilizing aquatic therapy at Michael Johnson’s Performance Center in McKinney, TX; BOTTOM PHOTO: The HydroWorx 2000 series pool at the University of Kentucky.

resistance jets for eight intense weeks at only 20% of his body weight. By the time we were able to transfer him to land-based therapy, he was able to jog straight ahead effortlessly and was remarkably ready for drills involving cutting and sprinting.”

Aquatic therapy was an early key driver of Peterson’s recovery along with true determination. When training in the water, hydrostatic pressure, water temperature, and resistance combine to enhance cardiovascular stamina, muscle strength, and flexibility, reduce swelling, and drive early range of motion gains during rehab. Gait training in a lowimpact environment—the pool can eliminate 20% to 100% of a person’s bodyweight—and allow for earlier replication of proper ambulatory biomechanics and reduces the accumulated damage of land exercise.

Athletes move in all directions and their therapy should reflect that. In the pool you can cross all planes of motion with your therapy exercises, unlike other anti-gravity devices that remove your body weight but only allow you to exercise in the sagittal plane.

Lance Walker, Director of Performance at Michael Johnson’s Performance Center, says, “HydroWorx underwater treadmill training doesn’t speed up Mother Nature; rather, it allows the physical

therapist or ATC to optimize the healing process while simultaneously driving advanced movement retraining, soft-tissue integrity movements, and inter-treatment recovery timeframes…” ultimately returning the athlete to full function sooner.”

Dr. Steve F. Crouse at Texas A&M University has been researching water treadmill and jet exercise for over six years, and has found that underwater treadmill training is indeed an effective strength and conditioning tool. His research team’s findings show the training builds lean muscle mass, reduces muscle soreness, and improves strength in the body’s key areas better than land treadmill exercise.

Many factors contribute to the timeline for an athlete’s return from injury and water therapy can play a large role in getting the athlete active sooner. With its versatility and effectiveness, advanced aquatic therapy with technology such as underwater treadmills, resistance jets and hydromassage is becoming a common choice for the rehabilitation and conditioning needs of the athletic world. n To see profiles of Aquatic Therapy Pools, go to page 49.

Think Beyond Traditional Rehab Timeframes Help your athletes recover faster and stronger with hydrotherapy.

Athletic Trainers worldwide rely on HydroWorx products to: Decrease recovery time Closely mimic land running for non-weight bearing athletes Build lean muscle mass and increase leg strength Safely offer active recovery and performance training “The strategic use of HydroWorx has, in some cases, allowed us to rewrite exercise progressions for athletes returning from injuries.�

Lance Walker, CSCS, PT, Director of Performance, Michael Johnson Performance

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In the Bryan (Texas) Independent School District, Athletic Trainers Jamie Woodall (left) and Josh Woodall (right) found a way to offer free ECG screens to all athletes last spring following an on-field cardiac arrest by former football player David Wilganowski (center).

Terry Field

treating the athlete

Heart of the Matter

Although the NATA’s latest guidelines do not call for ECG screenings on athletes prior to participation, some schools have begun to implement them anyway.

In this two-part article, athletic trainers at the high school and university levels explain why and how.

By Josh Woodall and Jamie Woodall

T

he evening of Sept. 2, 2011, started like any other fall Friday night here at Rudder High School in Bryan, Texas. The football squad was in the thick of a home game against a rival team and the stands were full of fans. But that normalcy would not last.

At the end of a routine play, one of our defensive linemen, David Wilganowski, laid motionless on the field. His collapse was much different than typical reactions to an orthopedic injury. He simply became limp, falling to the grass field without making any effort to brace himself. David had not even been hit during this play. In fact, he was having a stellar game.

Watching the action in my role as Head Athletic Trainer at Rudder, I rushed on the field with Assistant Athletic Trainer Phillip Lozano, MS, ATC, LAT, and we promptly determined that David was experiencing cardiac arrest. Along with two team physicians, we administered CPR and applied the AED. Bryan Fire Department EMTs and paramedics, who are routinely on standby during football games, responded quickly and continued advanced care.

After several cycles of CPR, two shocks from the AED, and the joint efforts of athletic trainers, team physicians, EMTs, and paramedics, David regained a pulse.

He was immediately transported to St. Joseph Regional Health Center before being transferred by air to Texas Children’s Hospital in Houston. He would undergo many tests and procedures, including one that implanted a defibrillator into his chest, before making a full recovery—with one exception. He never played football again.

For the athletic training staff in the Bryan Independent School District (ISD), which includes Rudder and Bryan High Schools, the incident was not something to quickly move on from. While we were proud that our emergency action plan worked so well, we could not stop asking ourselves how this type of incident could be prevented in the future.

One of the first things we did after David’s cardiac arrest was to examine his preparticipation physical forms. He had no family history of cardiac conditions and no

Josh Woodall, MEd, ATC, LAT, is Head Athletic Trainer at Bryan High School and Jamie Woodall, ATC, LAT, is Head Athletic Trainer at Rudder High School. Both schools are part of the Bryan (Texas) Independent School District and recently won NATA Safe Sports School awards. The authors, who are married to each other, can be reached at: josh.woodall@bryanisd.org and jamie.woodall@bryanisd.org.

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T&C DECEMBER 2013

­19

treating the athlete abnormalities were found during any of his examinations. That raised a question: “If there was nothing we missed from our traditional screening process, what could we have done differently?”

To answer this, we started by taking a few steps back. We knew that some high school and college athletic departments had begun offering cardiac screenings to their athletes, but we had questions about them, from what types of tests are best to cost and effectiveness. We began our search for answers by forming Bryan ISD’s Athletic Health Care Team (AHCT).

This team included all school athletic trainers, team physicians, local EMS personnel, school nurses, a nutrition consultant, and district administrators. The goal of the group was to improve student-athlete health and safety by facilitating communication between school medical personnel and

fers to student-athletes, which are conducted on a Saturday toward the end of the spring semester. We determined the screenings would be made available to all students, not just student-athletes, including those in our middle schools.

However, the target audience would be student-athletes. We also discussed whether to make ECG screenings mandatory, ultimately deciding not to.

Our next step was educating studentathletes and their families on why they should participate. With so many requirements already in place by governing bodies, we wondered if families would see these heart screenings as just another hurdle to participation. To make our case, the Bryan ISD AHCT organized a town hall meeting to discuss student-athlete health care.

The overriding topic of the meeting was sudden death in student-athletes, with a focus on cardiac arrest. We talk-

Initially our concern was cost—surely the expense of transporting equipment and trained staff to conduct these screenings would be significant. However, we were pleased to find out the price tag is only 15 dollars per test. Space was not a problem either, with only one classroom needed. physicians, which would help us make the best decisions about sports medicine policies.

One of the first objectives of the AHCT was to discuss offering heart screenings to Bryan ISD student-athletes. Kory Gill, DO, one of our team physicians, suggested we make ECG screenings available, arguing that it is a cost efficient, non-invasive test, which takes only a few seconds to perform and has a low rate of false positives.

From there, we discovered the Cypress ECG Project, a Texas-based company that will come to a school and perform the tests.

Initially our concern with this was cost—surely the expense of transporting equipment and trained staff to conduct these screenings would be significant. However, we were pleased to find out the price tag is only 15 dollars per test. Space was not a problem either, as Cypress only needed one classroom to perform the exams.

The AHCT also decided that the most effective way to offer ECG screenings would be to incorporate them into the preparticipation physicals Bryan ISD of­20

T&C DECEMBER 2013

ed about the benefit of preventative screening and details of the ECG tests that would be offered. Athletic trainers, team physicians, district administrators, and the school district’s registered sports dietitian all spoke at this event.

We knew there would be questions, and that some people might be hesitant to ask theirs publicly. So we set up a system that allowed community members to text message questions to the moderator during the meeting. Common topics raised included cost, whether or not the screenings would become mandatory, who would be allowed to take the tests, and how results would be disseminated.

One of the best outcomes of the town hall meeting developed after it had officially ended. We had a surprise guest, Scott Stephens, the father of Cody Stephens, a young athlete from the Houston area who had passed away in May 2012 due to sudden cardiac arrest. Mr. Stephens approached us after the meeting, offering to help through the Cody Stephens Foundation. We then applied for and received a grant from the foundation that would fund all of the ECG

screenings performed on Bryan ISD students.

Along with the town hall meeting, we informed parents of the ECG screens in other ways. This included using local media outlets, Bryan ISD Web sites, and flyers distributed to all campuses for display around athletic facilities.

Because most of the student-athletes we work with are minors, consent forms were required prior to the ECGs being performed. Cypress ECG helped in this area, sending us an informational handout with a consent form at the bottom that the student-athlete could bring with him or her on the day of the test. Approximately two weeks prior to the screenings, this information was sent home with the student-athletes who planned to attend.

On the day designated for Bryan ISD’s annual preparticipation physicals, a team from Cypress ECG arrived on our campus with all the necessary equipment in tow. The student-athletes signed in at a table in the hallway outside the exam room, and if they had a consent form, they submitted it at this time. If not, a form was provided for parents to complete on the spot.

Students entered the exam room individually, were set up, and the ECG was administered. The wait time was only three or four minutes between exams, there was never a long line, and no concerns were voiced.

Approximately one week later, we received an e-mail from Cypress ECG containing all results, including detailed information on three individual tests that suggested a follow-up. Those three students and their parents were given a copy of their ECG, along with a brief summary and explanation of the findings. They were told that while they were welcome to follow up with a cardiologist at the Cypress group, they also could call their primary care physician to get a referral to a local cardiologist.

The test results were noted in the students’ files and further clearance was required prior to participation the following school year.

Since that tough day back in 2011, we have learned a lot about cardiac arrest in athletes. While the event was most significant for David, it was a life-changer for us, too. We are now committed to offering ECGs and are convinced they can be a very effective tool in preventing unnecessary cardiac health risks to young student-athletes.

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treating the athlete

Leading the Way

By Patrick Jenkins

W

hile it is a topic of ongoing debate, screening athletes for cardiac abnormalities is not currently endorsed by the medical community in the United States. The risks for cardiac death are low and the cost of screening is fairly high.

But that doesn’t mean you should not consider implementing cardiovascular screening for your athletes. Here at the University of Washington, we have spent the last decade debating and eventually putting into place a mandatory screening protocol for all our student-athletes. The process started with a challenge, continued with asking and answering questions, and has resulted in important findings.

Our story begins in 2004, when our Team Physician for Men’s Basketball, Jonathan Drezner, MD, pushed us to rethink the status quo. A leader in the education and prevention of sudden

compelling evidence that showed today’s baseline ECG screening does an excellent job at identifying athletes with at-risk conditions and using this tool could reduce the number of sudden cardiac deaths.

I distinctly remember when he said this: “Often, the first sign of a potentially fatal cardiac condition is sudden death.” Immediately I flashed back to 2002, when a women’s basketball athlete went into sudden cardiac arrest.

She was at home with her teammates, who fortunately knew CPR and administered it until EMS arrived. They saved her life and after the incident, she had an internal defibrillator implanted.

Had her teammates not been in the same room with her, the outcome may have been different. Despite all of our athletic department emergency action plans, AEDs, and CPR-trained health care providers, we could have lost this student-athlete because we didn’t even

At the University of Washington, we have spent the last decade debating and eventually putting into place a mandatory screening protocol for our student-athletes. The process started with a challenge, continued with asking and answering questions, and has resulted in important findings. cardiac related deaths in athletes, Dr. Drezner proposed a baseline cardiac screen for UW student-athletes.

This was initially met with resistance from fellow physicians and athletic trainers. What if we had to tell someone their athletic career was done? No one wanted the task of looking an athlete in the eye and saying they could no longer participate. We also balked at the costs and reported problems with false positives.

But Dr. Drezner did not back down.

He steadfastly presented more and more Patrick Jenkins, MA, ATC, LAT, NASMCES, has been Head Athletic Trainer at the University of Washington since 2005, after serving as Assistant Athletic Trainer at UW for four years. He can be reached at: pjenkins@uw.edu. ­22

T&C DECEMBER 2013

know she was at risk. Dr. Drezner’s arguments, taking me back to this incident, convinced me we had to strengthen our preparticipation screening procedures. Eventually, others in our sports medicine department agreed.

We began performing baseline ECG screenings during preparticipation exams (PPEs) on all student-athletes in 2009, with the primary objective of finding silent but potentially deadly cardiac disorders. These include hypertrophic cardiomyopathy (HCM), arrhythmogenic right ventricular cardiomyopathy, dilated cardiomyopathy, left ventricular non-compaction, Long QT syndrome, Wolff-Parkinson-White syndrome, and myocarditis.

MANY QUESTIONS Our sports medicine team had a long

list of questions prior to implementing a baseline ECG screening program, however. We knew the roadblocks that lay ahead—costs, follow-up testing, tough discussions—and wanted to clear them before we hooked our first athlete up to an ECG. Here are some of the questions we addressed: Should these screens be conducted annually or just during the initial PPE? We decided that for most of our athletes, one ECG was sufficient. However, men’s basketball players are screened annually as they have shown to be the highest risk group for sudden cardiac death. A recent study led by UW Team Physician Kim Harmon, MD, found the incidence of sudden cardiac death in NCAA student-athletes is 1 in 43,770, but is 1 in 3,100 for Division I men’s basketball players.

What are the costs?

How can you weigh the value of a young life compared to the expense of an ECG? You will never be able to justify costs or procedural hassles if an athlete dies under your watch. However, we still needed to get a handle on expenses in order to present our proposal to the athletic department.

Here’s how we saw it: In 2009, the NCAA Catastrophic Injury Insurance Program (CIIP) deductible was $75,000 and a potential lawsuit for the preventable death of a student-athlete had an unknown but presumably large expense. In comparison, the total cost to implement baseline ECG screens in the first year of the program was an estimated $12,000. Expenses included $5,000 for the ECG machine and $7,000 for cardiology over-reads for around 500 student-athletes. There is also a small expense for disposable pads. In future years, the total expense was estimated at $2,100 annually since there would be fewer athletes tested and the equipment would already be purchased.

With these estimated annual costs, it would take 35 years of baseline screening, or 5,357 athletes tested, to equal the deductible of one CIIP claim. With today’s $90,000 CIIP deductible, it would take approximately 43 years, or 6,428 athletes, to balance out. Just think about that for a second. Four decades of screening compared to one CIIP deductible. We asked the athletic TR AINING-CONDITIONING.COM

treating the athlete administrative team: Aren’t the ECG costs worth it from a risk management perspective?

We also made it clear to the administration that there are additional expenses associated with positive findings. Follow-up testing, which usually includes an echocardiogram or stress ECG and is not normally covered by insurance, typically costs an addi-

we arranged several training sessions with an ECG technician from the UW Medicine Regional Heart Center so we could learn lead placement, patient data entry, and data transmittal processes.

After each ECG, a printout is available immediately and read on-site by our team physician. The data are also transmitted electronically to a sports

After each ECG, a printout is available immediately and read on-site by our team physician. The data are also transmitted electronically to a sports cardiology team at a regional heart center ... where they are over-read using the Seattle Criteria, which accounts for routine ECG abnormalities. These criteria significantly reduce the number of false positives. tional $2,000, and we estimated four student-athletes might require such testing per year. The false positive rate of ECGs is three percent, which means sometimes the follow-up work would show the athlete was fine. We would have to be okay with spending a lot of money even if there was no problem.

How would findings be interpreted?

Athletes’ hearts undergo many physiologic changes related to regular training and exercise that can look like abnormalities on an ECG. These changes must be distinguished from ECG findings associated with a pathologic cardiac condition. After several meetings between our team physicians and cardiology consultants reviewing the available evidence, our medical team defined the ECG criteria that would be used to classify an ECG as “normal” (no further evaluation needed) or “abnormal” (further evaluation needed).

How would we conduct the testing?

We decided that the ECGs, which take less than five minutes per athlete to administer, would be integrated into the vitals portion of our athletes’ physicals, which they undergo prior to seeing our team physicians. The ECG is not optional and is considered an essential part of the PPE. To make the process run as efficiently as possible we have certified athletic trainers taught to set up and administer the ECG. Prior to starting testing, TR AINING-CONDITIONING.COM

cardiology team, assembled by Dr. Drezner, at the UW Medicine Regional Heart Center where they are over-read using the Seattle Criteria, which accounts for routine ECG abnormalities commonly found in athletes’ hearts.

These criteria significantly reduce the number of false positives. The overread happens within 24 to 48 hours of the initial test and results are relayed to team physicians through Dr. Drezner.

A nice feature of the electronic over-read is that the patient data and interpretation both end up in the student-athlete’s electronic medical record. This allows our team physicians access from any secure computer in the UW Medicine system.

What steps would follow a positive test?

When putting 500 athletes through ECGs, we knew there would be positive findings, both false and real, and we needed to be prepared to deal with them. Along with cost, such tests involve time and emotional energy.

We began by exploring a relationship with the UW Medicine Regional Heart Center, asking them questions about their process, availability, affordability, and willingness to expedite the relatively urgent nature of student-athlete assessment.

They were open to working with us and we reached a reasonable follow-up scheduling timeline of 24 to 48 hours.

One of the greatest challenges to the baseline ECG screening program

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Circle No. 111 T&C DECEMBER 2013

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treating the athlete is that we typically perform our PPE the day of or the day before practices begin, as most institutions do. This does not leave a lot of wiggle room to complete any follow-up testing necessary for positive ECG findings, and we all know coaches and student-ath-

athlete to practice or compete.

RESULTS Since implementing the baseline ECG screening program we have had several positive findings each year. The most common diagnosis has been Wolff-

Since implementing the baseline ECG screening program we have had several positive findings each year.

The most common diagnosis has been WolffParkinson-White syndrome ... Our toughest finding was a men’s basketball player who was found to have HCM. letes want the test scheduled yesterday!

Needless to say, a positive finding can take an otherwise healthy student athlete, excited sport coach, and nervous parent by surprise.

In the case of a positive test, we immediately call the UW Medicine Regional Heart Center and ask them to expedite the follow-up testing. We explain to the athlete and coach that finding out the reasons for the abnormal ECG is critical before allowing the

Parkinson-White syndrome, but there have been others. Our toughest finding was a men’s basketball player who had participated the previous two seasons but was found to have hypertrophic cardiomyopathy (HCM) in 2009.

The case was particularly difficult because this athlete had to sit out his freshman year due to a lower leg injury that required surgery. As a redshirt freshman, he participated without symptoms and was looking like he

1

could be a regular contributor to the team. But the ECG screening during his annual health exam between his redshirt freshman and sophomore years suggested something was not right with his heart.

A follow-up cardiac echo was ordered for further investigation, which showed an abnormality. A cardiac MRI was conducted to confirm and better characterize what appeared to be pathologic and asymmetrical hypertrophy. After reviewing the results with the sports cardiology team, it was confirmed that this athlete had HCM. Gulp. This was our first experience with the conversation we all dreaded.

In the following days, we circled the proverbial wagons and arranged a meeting with the head coach, athlete, and his mother to deliver the news.

It was important that we had already established a well thought-out policy.

With this or any other life-threatening diagnosis (where the risk cannot be adequately mitigated by medical management), the student-athlete is not permitted to participate in athletics at the University of Washington. It was

O O %

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T&C DECEMBER 2013

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treating the athlete tempting to be sympathetic with the coach, athlete, and parent and let the athlete play—after all that’s what he came to UW to do. But when presented with the potential reality of sudden death, cooler heads prevailed.

As unfortunate as situations like this

cal centers and physician offices. And there are several organizations that can help such as the Nick of Time Foundation or Parent Heart Watch.

In addition, the NCAA is currently offering institutions the chance to test athletes for free as part of a study to

The NCAA is currently offering institutions the chance to test athletes for free as part of a study on ECG screening.

We helped pilot the procedural steps and are participating in it. So far ... one in 300 athletes have been found to have a cardiac disorder associated with sudden cardiac death. may seem, we avoided a potential catastrophe for the player and his family as well as the team. The athlete demonstrated immense character and strength in handling his diagnosis.

COME ABOARD I would encourage all athletic departments to examine the idea of cardiac screenings for their athletes. Funding can be a challenge, but there are ways to negotiate deals with local medi-

understand findings, challenges, and costs of ECG screening. We helped pilot the procedural steps for the study and are participating in it. Currently 24 institutions have signed up and so far, the study has found three percent of athletes have an ECG abnormality requiring further work-up. In addition, one in 300 athletes have been found to have a cardiac disorder associated with sudden cardiac death.

Cardiac screening is now a mainstay

at the University of Washington, but it was important we figured out the logistics first. Essential components to a successful ECG screening program are that physicians and athletic trainers are in agreement to screen, interpretation standards have been agreed upon by the sports medicine and cardiology team responsible for ECG over-reads, and secondary investigations can be conducted quickly. Possibly most critical is also having a plan in place for those unfortunate—yet fortunate— findings of a heart abnormality. n

The author would like to thank Jonathan Drezner, MD, Team Physician for Men’s Basketball at the University of Washington and Immediate Past President of the American Medical Society for Sports Medicine, who assisted with this article. For information on participating in the NCAA study, Dr. Drezner can be contacted at: jdrezner@uw.edu.

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NUTRITION

By Mary Ellen Bingham

Jeffrey A. Camarati

James Michael McAdoo and his teammates benefit from strategies like individualized diet plans and social media reminders on nutrition.

Fueled for Takeoff

The University of North Carolina is using a “full court press” in nutrition to assist its men’s basketball players in rising above the competition.

TR AINING-CONDITIONING.COM

F

rom the moment his alarm clock sounds, a typical day in the life of a University of North Carolina men’s basketball player is jam-packed with activities.

After a morning of classes and possibly a session with a tutor, the afternoon may bring a team meeting, treatment for a sore ankle in the athletic training room, and a strength workout, followed by an intense practice that runs until early evening, two hours of study hall, and, hopefully, an early bedtime so he has the energy to do it all over again the next day.

And this is only a practice day! When you factor in travel to and from games around the country and some social activity—they’re in college, after all—it’s easy to see how one of the vital components of a basketball player’s success can easily fall by the wayside: proper nutrition. For players to maintain healthy eating habits during their busy seasons, top-notch nutrition education and support is essential.

With concerns like these in mind, we developed a “full-court press” here at UNC to educate all of our student-athletes on nutrition. Our program covers a range of topics—from game-day meal plans to grocery shopping—and we utilize everything from team meetings to social media to get our messages across.

Similar to the full-court press in basketball, we have found that collaboration and communication among all members of our “Performance Team”—which includes athletic trainers, strength and conditioning coaches, a sport psychologist, and sport nutritionists—is the most effective way to enhance the athletes’ experience. This ensures everyone is on the same page and dedicated to providing consistent messaging and reinforcement around nutrition strategies.

It’s a concerted effort to promote a culMary Ellen Bingham, MS, RD, CSSD, is the Head Sports Nutritionist at the University of North Carolina, where she works closely with many of the varsity sports teams, including men’s basketball.

She can be reached at: BinghamM@ email.unc.edu.

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NUTRITION

CASE STUDY A 6-foot-8 freshman men’s basketball player arrived at campus weighing 195 pounds and was cleared to gain an additional 15 to 20 pounds.

However, after several months he had achieved only minimal weight gain.

Eventually he admitted to skipping meals because he was having trouble fitting them in his schedule, which is packed from 7:00 a.m. to 10:00 p.m.

A typical entry in the player’s food record read as follows: 7:30 a.m........... 16 ounces of orange juice 11:00 a.m......... 1 protein bar, 1 apple 1:00 p.m........... 2 crispy chicken sandwiches, 20 ounces of lemonade 3:00 p.m........... 2 nutrition shakes 9:00 p.m........... 12-inch sub with grilled chicken, lettuce, pickles, and ranch dressing, Gatorade 10:30 p.m......... 2 peanut butter and jelly sandwiches, 16 ounces of milk The record reveals an inadequate intake of total calories, protein, fat, and carbohydrates, and his food choices are low in nutrient density, with few fruits and vegetables. In addition, he isn’t spacing his meals properly. For this player to meet his weight-gain goals in a healthy way that allows him to optimize his body’s ability to train and recover, his diet should focus on quality sources of protein, complex carbs, and healthy fats, and his meals should be spread consistently across the whole day.

Here’s a sample meal plan for this player, not including the water he should be drinking throughout the day: 7:15 a.m. ...........Omelet (4 eggs with ham, spinach, mushrooms, avocado, shredded cheese)

1½ cups sweet potato home fries

16 ounces low-fat milk

1 medium-sized apple 11:00 a.m..........3 ounces mixed nuts

8 ounces tart cherry juice 12:30 p.m..........Two 5-ounce grilled chicken breasts

2 cups sautéed broccoli

2 cups brown rice

8 ounces Greek yogurt

2 cups mixed fresh berries 2:15 p.m. (weightroom) ..... Sports drink

Recovery shake 3:30 p.m. (practice) ..... Sports drink 6:15 p.m............Two 5-ounce sirloin steaks

2 cups mashed potatoes

2 cups mixed vegetables sautéed with extra virgin olive oil

16 ounces low-fat chocolate milk 9:15 p.m............High-calorie nutrition shake (Greek yogurt, banana, protein powder, peanut or almond butter, milk)

Fish oil supplement (optional)

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T&C DECEMBER 2013

ture of healthy eating within the UNC men’s basketball team. Jonas Sahratian, MS, CSCS, Head Strength and Conditioning Coach for Men’s Basketball, incorporates tips about healthy eating and hydration into his daily conversations with players, and Doug Halverson, MA, ATC, CSCS, Head Athletic Trainer for Men’s Basketball, also regularly touches base with them regarding their hydration and fueling strategies. Team Physician Tom Brickner, MD, CAQSM, may prescribe micronutrient testing and provide supplementation, along with referring them to me for nutritional counseling, as needed. With this type of collaborative culture, players get the message!

GAME PLAN Our first step in developing fueling strategies is to understand our athletes’ unique requirements. Since there is no “one-size-fits-all” plan, to be effective they must be tailored to each player.

When creating individual nutrition plans, I meet with the player to assess his nutritional needs. I may have him complete food records or recall a typical day of eating and together we then set personal health and performance goals and design simple and realistic strategies to optimize his performance. For example, a player who never touched a vegetable until he arrived on campus isn’t likely to immediately start eating every vegetable in sight, so we design his plan to slowly expand his palate.

We also use the dual-energy X-ray absorptiometry test to gather the player’s bone mineral density information and body composition data. Collaborating with the strength coaches, we then set his body composition goals.

Along with developing fueling strategies, we focus on three areas: recovery nutrition, supplementation, and hydration. We use the following approaches in these areas: Recovery Nutrition: We tell players to “Honor your recovery window” after vigorous physical activity, which creates muscle breakdown. We teach our players to rebuild their muscle strength through solid recovery nutrition practices. These include getting the right amount of fluids, electrolytes, carbs, and protein within 30 minutes of finishing a workout, practice, or game.

Drinks such as low-fat chocolate milk and recovery smoothies are a good way to refuel. Proper recovery nutrition can help athletes stay healthy and strong TR AINING-CONDITIONING.COM

NUTRITION throughout the season.

Supplementation: Because of the catabolic effects of playing basketball over a long season, supplementation is crucial, not only for muscle restoration and recovery, but also to aid in the preservation of lean body mass. We provide multivitamins to each player and micronutrient supplementation when needed.

Though not provided by the school, athletes can also opt to take protein powders, amino acids, creatine, and fish oils in appropriate doses.

However, it’s important to note that before a student-athlete at UNC takes any type of nutrition supplement, they need to have it approved by the sports medicine department. The staff carefully reviews the supplement to assess its efficacy, safety, and legality for college athletes.

Hydration: To ensure adequate hydration, the American College of Sports Medicine recommends a minimum of 125 ounces of water daily for male athletes, in addition to what’s needed to replace fluid lost during physical activity (16 to 24 ounces per pound of weight lost). Our men’s basketball play-

ers are given a one-liter water bottle to carry with them throughout the day to help them consume their recommended amount of fluid.

Since basketball players vary greatly in size, shape, and body composition, they often require very distinct nutrition plans.

For example, some players have an ectomorph somatotype, meaning they aren’t predisposed to storing fat or building muscle and have long, thin muscles and limbs. They have to work harder to put on and retain lean muscle mass. Other players face the opposite challenge and have to be very diligent about keeping their body-fat percentage down.

MAKING IT HAPPEN Once the players have been taught how to optimally fuel their bodies, the real challenge is getting them to consistently stick to their nutrition plans, which is especially difficult due to their hectic schedules. To aid in this, we provide structure to their eating schedule and offer small reminders throughout the day.

First of all, we urge players to settle on a game-day nutrition strategy early in the season and stick with it until

the season is over. There should be no “NEW”-trition on game day, as we like to tell them. The stakes are too high, and any failed experiments could adversely affect their performance. Sticking to a schedule also helps players develop a routine, making it easier for them to incorporate healthy habits into their daily lives.

In an effort to maintain energy levels and achieve body composition goals, basketball players should aim to eat every few hours, spreading meals and snacks consistently over the course of the day. However, to adhere to a schedule like this, they have to be disciplined and willing to plan ahead. It can seem

The author would like to thank Jonas Sahratian, MS, CSCS, Head Strength and Conditioning Coach for Men’s Basketball, and Doug Halverson, MA, ATC, CSCS, Head Athletic Trainer for Men’s Basketball, for their contributions to this article.

Take T&C’s CEU Quizzes See pages 43-45 in Dec. T&C, or quizzes in previous issues. onlinE, click on CEU’s at www.Training-Conditioning.com Circle No. 117 TR AINING-CONDITIONING.COM

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NUTRITION

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like a daunting prospect, and this is where the full-court press is so effective. Members of the Performance Team let the players know that they’re not going it alone by constantly reinforcing and encouraging their commitment.

For example, our Staff Sports Nutritionist, Rachel Stratton, RD, CSSD, and I utilize Twitter to share helpful tips on nutrition and hydration with our players. Our UNC Sports Nutrition handle—@WeFuelTheHeels—tweets easy recipes and articles of interest. We also encourage the players to tweet us pictures of their healthy and balanced meals.

In addition, we stress the importance of eating breakfast and getting a jumpstart on the day. But we also understand that it can be hard for our players to pull themselves out of bed following a tough practice or big game the night before. If a player is struggling with this and needs additional motivation, he can hold himself accountable by texting pictures of his breakfast to Coach Sahratian.

To make sure our players eat at appropriate times, we remind them to always carry snacks with them. We provide suggestions for healthy, portable, and calorie-dense options, such as nuts, trail mix, apples with peanut butter, and nutrition bars. Nutritious shakes are also available to players as a post-workout recovery snack after strength and conditioning sessions. Players that need to gain weight are steered toward higher-calorie shakes, while those looking to lose weight are encouraged to take in lower-calorie choices.

When the squad eats together as a team, we make sure there are plenty of healthy options. A typical team breakfast will include omelets with a variety of fillings, oatmeal with toppings, grits and assorted cold cereals, fresh fruit, breakfast potatoes, Canadian bacon, and French toast. The menu for lunch or dinner is usually two or three lean protein options, cooked vegetables, tossed salad, and fresh fruit, as well as pasta, bread, potatoes, or rice. Players are taught to build a balanced plate, which includes a variety of fruit and vegetables, a lean protein source, and a starch.

For all the effort behind the full-court press, we’re careful not to sour the players on healthy eating by making the process too rigid. Occasionally, players need to buckle down and follow their nutrition plans about 95 percent of the time to achieve their training goals. Typically, though, they are taught to make healthy choices 80 to 90 percent of the time, depending on the periodization of the team’s training schedule and their progress toward their goals. We don’t want to rob them completely of their favorite foods!

With the full-court press approach, we’ve changed the way our men’s basketball players look at nutrition. Our fueling strategies give them specific information about what and when they should eat, and our focus on areas such as recovery nutrition, supplementation, and hydration makes sure nothing falls through the cracks. Even with their busy schedules, we’ve shown the players that it’s still possible to reap the rewards of a balanced fueling strategy. n

For an example of a resource the University of North Carolina gives its men’s basketball players to help them follow their nutrition plans, please look for “Tip Sheet” in the blog section of our Web site at: www.Training-Conditioning.com/blog.php.

TR AINING-CONDITIONING.COM

LEADERSHIP

Michelle Johnson, Athletic Trainer for Overton High School in Nashville, Tenn., provides one set of the many hands working at Vanderbilt Sports Medicine.

MANY HANDS

Joe Howell, Vanderbilt University Medical Center

What’s the best way to deliver athletic training coverage and sports medicine care in the 21st century? A large-scale model, outlined here, may be an answer.

By Mitch Bellamy

Every athlete should have access to an athletic trainer while participating in sport. Among sports medicine professionals, that statement is neither controversial nor debated. We all know that athletes who do not have access to athletic training services are at a greater risk for injuries and miss out on many health-related services.

The question of how to best deliver that access is not as straightforward. In a time of tight budgets, ensuring every athlete has sports medicine coverage can be difficult. There is not one perfect model or easy, inexpensive solution.

Here at Vanderbilt Sports Medicine, a division of Vanderbilt University Medical Center’s Orthopaedic InstiTR AINING-CONDITIONING.COM

tute, we’ve developed a way to provide athletic training services to a large and varied population in a somewhat nontraditional way. The model has been 20 years in the making, and it won’t work everywhere, but it has proven to have many benefits for both athletes and the athletic trainers who work with them. It may also be the wave of the future.

ics employed its own athletic trainers and utilized an outside physician group for medical consultations.

VUMC would supply a team of athletic trainers to cover all traditional services, from injury prevention to rehabilitation. The partnership would also allow athletes to receive care from faculty members in the Department of Or-

HOW IT WORKS Vanderbilt Sports Medicine began when the leadership of the Vanderbilt University Medical Center (VUMC) approached the athletic department at Vanderbilt University with a proposal to provide sports medicine coverage for its teams. Previously, University athlet-

Mitch Bellamy, MS, ATC, is the Assistant Director of Sports Medicine and Athletic Training at the Vanderbilt Orthopaedic Institute, where he has been employed since 2004. He has previously worked at Belmont University and Marshall University and can be reached at: dennis.m.bellamy@vanderbilt.edu.

T&C DECEMBER 2013

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LEADERSHIP thopaedic Surgery and Rehabilitation as well as other clinical departments at VUMC. The idea was approved and is basically the same model we still use today.

The intra-university partnership with Vanderbilt athletics proved to work well, and Vanderbilt Sports Medicine has grown in many ways since then. We began offering services to local high schools in 1995, and then added everything from youth to pro teams. When Kurt Spindler, MD, became Director of Sports Medicine in 1991, he was just the second faculty member in the division, which handled about 1,100 annual patient visits. Today, there are 14 faculty members, more than 40,000 annual visits, and $1.5 million awarded in research funding.

In addition to Vanderbilt athletics, Vanderbilt Sports Medicine now provides coverage to Belmont Univer-

are responsible for specific units: Vanderbilt athletics (Head Athletic Trainer, Assistant Manager), Belmont athletics (Head Athletic Trainer), and high school outreach (two Assistant Managers, each of whom oversees a county).

Our staff athletic trainers are assigned to one of these teams.

Each unit also has a physician leader who works with Dr. Spindler and our team of doctors. All are fellowship trained and their expertise covers several different sub-specialties, including orthopedic surgery, pediatrics, internal medicine, emergency medicine, and primary care. Staff physicians perform preparticipation physicals, hold clinics in the athletic training rooms to evaluate injured and sick athletes, cover games, and are on-call around the clock.

An important aspect of our model is the relationship between the athletic trainers and physicians. Athletic train-

The unit that covers Vanderbilt athletics functions as a traditional collegiate athletic training staff. However, they report up through ... the Vanderbilt University Medical Center instead of the University athletic department. sity athletics and 28 high schools in middle Tennessee. It is also the official sports medicine provider for the Nashville Predators (NHL) and the Nashville Sounds (Triple-A affiliate of the Milwaukee Brewers), as well as the Tennessee Secondary School Athletic Association (TSSAA).

The top of our organizational structure uses a paired leadership model consisting of myself as a director-level athletic trainer and Dr. Spindler as our Physician Medical Director, who is also the Director of the Division of Sports Medicine. We work in partnership to oversee the program, which entails making sure everything runs smoothly day to day and that we are providing top-notch services to all of our athletes and patients. Our big-picture focus is on clinical care delivery, quality assurance, and maintaining relationships with the community and coaches.

In my role, I perform administrative oversight for our athletic training services, which includes monitoring and evaluating the care we are providing, business development, strategic planning, budgeting, coverage when needed, and staffing. I also work with our leadership team of five athletic trainers who ­32

T&C DECEMBER 2013

ers do not need to go to one doctor for an orthopedic concern and then another for a general medicine issue. Instead, the team coalesces to provide care. Our staff’s love of sport and commitment to the welfare of the athlete keeps the group aligned and the program successful.

To best serve our clients, we have developed separate coverage models for each level of competition. This allows us to provide services based on what each type of team needs.

Professional Organizations: Our team of physicians is responsible for the coverage of the two professional sports teams we have agreements with. These organizations contract with us for physicians to cover their games but utilize their own staff of athletic trainers.

Collegiate: The unit that covers Vanderbilt athletics functions as a traditional collegiate athletic training staff and does not provide services outside of Vanderbilt athletics. Their athletic training rooms are located within Vanderbilt athletics facilities. However, what makes this model unique is that the athletic trainers report up through Vanderbilt Sports Medicine and Vanderbilt University Medical Center instead of the University athletic department.

(See “Ensuring Integrity,” on page 33.)

At Belmont, athletic trainers work out of traditional collegiate athletic training rooms located at the school. The group functions the same way as Vanderbilt’s does, with athletic trainers reporting to Vanderbilt Sports Medicine.

High School: For our high school clients, we provide practice and game coverage for athletes and coaches during the school year. Treatment can range from something as simple as a bandage for a cut to rehabilitation for an ACL tear. Our high school athletic trainers perform clinical duties at VUMC in the mornings and are on-site at the high schools in the afternoon.

We provide one athletic trainer per high school. Each school is then grouped with three others and assigned a lead athletic trainer who oversees all four. This system enables us to quickly manage any staffing problems or conflicts, and complicated issues are quickly brought to an experienced leader. It also identifies a clear communication path for our team. Overall, we have found the structure provides nice flexibility for our staff, while still giving the high schools consistency in their health care providers.

Community Sports: Recently, one of our largest growth areas has been athletic training services for youth sports.

With the potential for serious injuries occurring in youth sports and an increase in concussion awareness, local league administrators frequently seek to ensure their athletes have access to on-site medical care. This spurred us to create the Vanderbilt Sports Medicine Events Management Team, which is a fee-for-service model allowing local groups to obtain sports medical coverage with certified athletic trainers for any type of competition.

We currently have agreements in place with more than 35 youth organizations throughout middle Tennessee for a variety of sports including soccer, lacrosse, and football. Along with covering games, we assist in the development of site-specific emergency action plans and offer CPR/AED certification courses for coaching staffs. The Events Management Team is a way for us to serve as a community resource while also reinforcing our role as a comprehensive sports medicine provider.

We believe this outreach helped us secure our role as the sports medicine provider for the Tennessee Secondary TR AINING-CONDITIONING.COM

LEADERSHIP School Athletic Association (TSSAA).

In this relationship, Vanderbilt supplies athletic training coverage for Tennessee’s state high school championship events.

COMMUNICATION & COLLABORATION The key to covering all of the above schools and events is our team approach. This allows us to provide familiar faces to our athletes and coaches and maintain continuity of care. But it also requires that we communicate well among ourselves.

To do this, we have set up specific systems. Each team holds regular staff meetings connecting information at all levels. In addition, leaders from each group meet regularly to review, discuss, and update policies and procedures in areas such as post-concussion returnto-play and heat-related illnesses.

But some flexibility is necessary, too.

We try to create an atmosphere where we have a foundation of protocols that pertain to everyone, but also allow each team to create its own identity and culture to meet the needs of its constituents.

Having such a large staff provides synergy and leads to exciting new ideas.

Tom Bossung, MEd, ATC, Head Athletic Trainer for Vanderbilt athletics, says that the chance for dozens of athletic trainers to work for the same organization and learn from each other makes Vanderbilt Sports Medicine special.

“Even though my staff members and I work with Vanderbilt athletics, Belmont’s staff is on another campus, and the high school outreach athletic trainers focus on their schools, we can come together under the umbrella of Vanderbilt Sports Medicine,” Bossung explained in the Winter 2012 edition of Vanderbilt Orthopaedia. “This allows us to share ideas and form our own support groups. It makes us better medical professionals.”

For example, the sport of lacrosse has grown in middle Tennessee, and we have become the sports medicine provider for several high school club teams.

In the beginning, we utilized the knowledge and skills of one of our collegiate athletic trainers who had experience in lacrosse to help us review common injuries and helmet-removal techniques to ensure we were prepared.

Individuals on our staff also hold inservices for any new treatment technique, taping protocol, or evaluation TR AINING-CONDITIONING.COM

skill they have learned. This provides continuing education opportunities and opens up best practice ideas to our entire athletic training staff.

Our work has also been boosted through collaborations with the information technology and research arms of VUMC. For example, we worked with them to develop an online documentation tool accessible from a computer, tablet device, or smartphone.

Using drop-down menus, free text data fields, or dictation, an athletic trainer can record injury reports and daily notes, providing a confidential record of care. This has allowed our outreach athletic training staff to become more efficient and improved our overall documentation as a staff.

Another advantage of being employed by a medical center is the use of the electronic medical record (EMR). “Being able to utilize and access our athlete’s EMR allows us to communicate with other providers across VUMC to make better decisions in the patient’s plan of care,” says Mollie Malone, MEd, ATC, Assistant Athletic Trainer and the Assistant Manager for Vanderbilt athletics. “This minimizes repeat and un-

necessary testing.”

And athletes and/or their parents then have access to our portal, My Health at Vanderbilt. This enables a patient to communicate with their health care provider, view their medical records, and quickly see any test results.

We have also benefited by the introduction of the CoachSmart app, a joint effort between Vanderbilt Sports Medicine and Monroe Carell Jr. Children’s Hospital at Vanderbilt, which provides on-the-field information about lightning strikes in the area, as well as heat index information. The app also offers a FAQ section for coaches, athletic trainers, and parents on topics such as heat-related illnesses, proper treatment for sprains and strains, and warning signs related to concussions. Leveraging the resources of the Medical Center creates unique collaborations and deepens the professional tools available to our athletic trainers.

For Vanderbilt athletes specifically, we’ve used the many resources of a large medical center to create a Health Enhancement Committee. Members come from a variety of positions in the athletic department and on the sports

ENSURING INTEGRITY A study conducted by The Chronicle of Higher Education earlier this year found that return-to-play concussion decisions in football at many NCAA Division I schools were influenced by coaches. In a survey of 101 head athletic trainers, head football athletic trainers, and other sports medicine professionals from the NCAA’s Football Bowl Subdivision (FBS), 53 said they had felt pressure from football coaches to return a student-athlete to play faster than they thought was in his best interest medically. In addition, 42 responded they had felt pressure from football coaches to immediately return an athlete to the field after suffering a concussion.

Having an athletic department’s sports medical coverage run by a university medical center helps ensure that oversight issues do not get muddled.

At Vanderbilt University, athletic trainers report directly to the Medical Center rather than someone in the athletic department.

Lori Alexander, Associate Director of Vanderbilt Student Athletics, believes this has been an important benefit to student-athletes. “It allows us to maintain the utmost integrity of care to our student-athletes,” she says.

“The sports medicine staff and physicians make the decisions regarding when a student-athlete can return to competition based on what is best for him or her, independent from when a coach may want them to return.”

For a closer look at The Chronicle’s study and story, visit: www.training-conditioning.com/2013/09/06/whos_the_boss/index.php.

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LEADERSHIP medicine staff such as team physicians, athletic trainers, a dietitian, a sport psychologist, and athletic administrators, including the life skills coordinator. The goal of this group is to recognize any student-athlete issues that arise and address them through a multidisciplinary approach.

STAFF BENEFITS What is it like to work for such a large sports medicine group? The biggest plus is being surrounded by all the resources of a large medical center. Our athletic trainers have avenues for professional development and opportunities to be involved in many areas of medicine.

training in: • concussions • sideline emergency training • general medical conditions (e.g. asthma, anaphylaxis) • dental injuries • environmental injuries (lightning and heat related) • spine boarding and helmet removal • injury documentation • yearly team physician and sports medicine educational sessions.

Working in a world-renowned sports medicine program also pushes us to be the best health care professionals we can be. All of our physicians are involved in research and serve as faculty

Each year athletic trainers complete continuous quality improvement projects, which usually have some research component to them. This ... may change our patient care practices and gives our staff a unique opportunity to present their findings to peers and other professionals.

To start, in addition to traditional practice and game coverage, our high school outreach athletic trainers are utilized in outpatient rehabilitation and physician clinics. These opportunities allow each athletic trainer to be involved in the entire care process, not just a part of the on-field or in-arena support team.

Another benefit for our high school athletic trainers is reasonable work hours due to our team coverage approach. Having a large staff gives our athletic trainers the ability to take time off during athletic seasons. In addition, we have resources available when coverage is needed for large tournaments.

An athletic trainer assigned to the host school does not have to be on-site for the entire tournament. Instead, other staff members take shifts.

To make sure individuals don’t get lost in the crowd of our large organization, our leadership team communicates regularly with all athletic training staff members. Every athletic trainer is evaluated annually on their performance, receiving structured feedback from management, coaches, and peers.

This formal conversation provides an avenue for staff to discuss professional and developmental goals.

In addition, each member of the athletic training team completes annual competencies and quality assurance ­3 4

T&C DECEMBER 2013

members in the Vanderbilt School of Medicine, while holding leadership positions locally and nationally. Through their example, staff athletic trainers are expected to not only stay current in their field but be educators and innovators.

For example, athletic trainers are provided the opportunity to partake in a career advancement program (CAP).

Under CAP, each athletic trainer must complete additional requirements in patient care, advocacy, professional development, teaching, and research.

Athletic trainers also participate in physician conferences and medical resident lectures augmenting their knowledge base of musculoskeletal problems, treatments, and research. In addition, each year athletic trainers complete continuous quality improvement (CQI) projects, which usually have some research component to them. This evidence-based medical research may change our patient care practices and gives our staff a unique opportunity to present their findings to peers and other professional organizations.

One of our most recent outcomes from a CQI project was the development of our collegiate concussion protocol. It provides sports-specific return-to-play procedures for college athletes and was a collaboration among athletic trainers, sports medi-

cine physicians, and VUMC’s Department of Neurosciences. The creation of this protocol would not have been possible without the resources from VUMC coming together.

MEETING THE CHALLENGES Of course, any model has its drawbacks, and being part of a large organization can present challenges. Decisionmaking related to Vanderbilt athletics typically must flow through the dual channels of the VUMC and University athletics. Multiple levels of review can make for a long lead time when seeking to expand programs or pursue additional resources.

In addition, pressure points and perspectives can be very different for a hospital administrator and a university athletics director or coach. As a result, conflicts can arise over competing priorities. Our athletic trainers sometimes find themselves having to bridge the understanding gap between these different parts of the organization, while at the same time demonstrating their continuous commitment to the success of the athletic team.

Another hurdle is that funding is tied to the economics of medical care delivery. While Vanderbilt University athletics and Belmont University help fund their respective athletic training room staff, VUMC supports much of the administrative infrastructure and the high school outreach programs. Many health care entities have had to eliminate or reduce their sports medicine programs due to decreased revenue streams. Medical-related budgets are under tremendous pressure at a time when there is more and more recognition of the need for health care resources to support student-athletes at all levels.

Despite the challenges, we believe our model works well and can be a template for others affiliated with an academic medical center. It could also be implemented at smaller hospitals or through a group of practicing community physicians.

At the end of the day, though, it’s the commitment of the athletic trainer to the athletes that makes or breaks a program. Athletes can achieve higher and higher levels of performance, and do so safely, in large part because of the services of athletic trainers. Whatever organizational structure is used, it all comes back to our dedication to serving the athlete. n TR AINING-CONDITIONING.COM

Circle No. 120

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You can earn up to 16 CEUs in 2013 through T&C.

Athletic trainers can earn valuable continuing education units by

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taking the CEU Quiz in each issue of Training & Conditioning.

To take one quiz or multiple quizzes online, click on “CEUs” at:

www.training-conditioning.com Circle No. 121

SPORT SPECIFIC

Workouts for USC pitchers zero in on arm endurance, shoulder stability, single-leg balance, and torso rotation.

An off-season training program focused on injury prevention and positionspecific workouts has helped the University of South Carolina baseball team win two national championships in the past four years.

TWOFOLD APPROACH South Carolina Athletics

By Billy Anderson

T

oday’s baseball coaches know that a team can’t afford to rest on its laurels.

Here at the University of South Carolina, our program has enjoyed a great deal of success, but every year we step up our efforts in the off-season, designing and implementing more effective training programs.

Our players are typically involved in competition from February to August.

As a result, the fall is a critical time for them to build the strength, both overall and baseball-specific, that can help set them apart during the spring season.

TR AINING-CONDITIONING.COM

Our fall training begins in mid to late August and runs through November.

Though we do some strength training in the summer and winter, the fall is when it becomes a major part of the players’ routine. To maximize our time, we train through the entire period, despite a busy practice and scrimmage schedule.

The success of the baseball program is a testament to the year-round hard work and dedication of the players and coaches. During my 12 years working with the team, the Gamecocks have won two NCAA Division I national championships, reached the Col-

lege World Series six times, and claimed three Southeastern Conference titles.

The team has also set NCAA postseason records for consecutive tournament wins (22) and consecutive wins in the College World Series (12).

As the team’s strength and conditioning coach, I’m able to do my part thanks to the support I receive from the Billy Anderson, MSCC, is the Head Strength and Conditioning Coach for Olympic Sports at the University of South Carolina and the Head Strength Coach for its baseball team. He can be reached at: bdanders@mailbox.sc.edu.

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SPORT SPECIFIC sport coaching staff. I have a great relationship with them, and they have an unconditional faith in our strength and conditioning program. They strongly believe in its importance and will even end practice early sometimes rather than cut into the players’ training time.

My programs have evolved considerably over the years. I’ve come to understand that a successful baseball strength and conditioning routine must be tailored to each player’s fitness levels, physical abilities, injury history, and role on the team, and it needs to revolve around improving the strength, mobility, and flexibility of the athletes.

I believe in variety, and my exercises are drawn from a number of different disciplines, but I’ve also learned the value of simple, well-thought-out rou-

vent a recurrence, while still helping him gain strength.

For example, if a player has had back problems, we may remove full squats from his workout and replace them with squat variations such as singleleg squats and Bulgarian-split squats, lunges, or even leg presses. If an athlete has had shoulder issues, we may opt for push-up or dumbbell bench-press variations instead of bench presses because those exercises tend to put less stress on the shoulders while still building sufficient strength in the chest.

In other cases, we omit an exercise from a workout based on position. For example, we don’t include the straight bar bench in pitchers’ workouts because the player can build too much muscle mass if the exercise isn’t carefully

To avoid excess bulk in pitchers, we maintain at least a 1:2-3 ratio of push-to-pull exercises—using rowing variations, pull-downs, pull-ups, and chin-ups—and focus on keeping their backs as strong as possible. tines. I use some form of periodization throughout the year, whether it be linear, progressive, or undulating, as well as some power lifting and strongman work. I also incorporate prehab, mobility, agility, and speed routines, and a few fun bodybuilding exercises.

INJURY PREVENTION First and foremost, I subscribe to the philosophy that a good baseball strength and conditioning program is a good injury-prevention program.

There’s a great deal of research that points to overuse and long-term sportspecific training as frequent causes of injury in baseball. Many players struggle with hip, torso, shoulder, or elbow problems, which may have developed when they were in high school, or even earlier.

For that reason, we take a low-risk approach to training. We assess injury history before starting any strength work and build up carefully, staying away from exercises that could cause or re-aggravate injuries.

When a freshman baseball player arrives at South Carolina, he undergoes a very thorough exam by our doctors and athletic trainer, which includes discussions on any injuries he has suffered. If there have been prior injuries, we make sure his training protocol will help pre­38

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regulated. This can lead to restrictions in the flexibility, mobility, and range of motion—especially in the throwing arm—that are key to pitchers’ success.

Instead, we’ll use dumbbell presses or push-up variations because they’re less likely to restrict range of motion. During the fall, we’ll sometimes drop squats from a catcher’s workout depending on the number of innings he’s caught or how his legs are feeling.

We’ve also excluded certain types of weight training from our program entirely, such as Olympic lifting. While Olympic lifting is an effective way to build athletes’ explosiveness, the lifts are very technical and require proper form at all times to reduce the risk of serious injury. Since most of our players have little or no prior Olympic-lifting experience, it isn’t worth the time it would take to get them fully proficient in these lifts when there are other ways to build explosiveness.

Instead, we use box jumps, dumbbell jump squats, sprints, split squat jumps, and hurdle hops. Like Olympic lifts, these exercises all incorporate explosive movement. As a result, they can just as easily help a player achieve his training goals, but in a much safer manner.

FALL FOCUS For our fall work in the weightroom,

we split pitchers and position players apart and develop different workouts for each group. For our pitchers, we focus on arm endurance, shoulder stability, single-leg balance, and torso rotation. The training for our position players emphasizes strength in the chest, arms, and hips.

However, the two workouts have some common themes, such as building foundational strength and maintaining flexibility. Both also aim to strengthen the lower body and core. As in many sports, most power movements in baseball, regardless of player position, begin with the legs, so it’s crucial that our strength training develops the lower body. As another source of power, the core is also involved in many of the same movements, so we do med ball work with both groups to build and maintain core strength.

It’s in the approach to upper-body training that the two workouts differ significantly. To avoid excess bulk in pitchers, we maintain at least a 1:2-3 ratio of push-to-pull exercises in their routines—using rowing variations, pull-downs, pull-ups, and chin-ups— and focus on keeping their backs as strong as possible to help with shoulder function and stability. For our position players, we use a 1:2 ratio in the same push-to-pull exercises because a little extra bulk doesn’t adversely affect their performance, and the extra strength often helps.

We rarely do traditional conditioning work with our position players because our coaching staff believes the best way to get in shape for baseball is to play baseball. These players are expected to fully exert themselves during practice, hustling after fly balls and grounders, running hard on the bases, and getting on and off the field quickly between innings. If the coaches feel the team has put forth enough effort, the players don’t do any extra running afterward.

If the effort doesn’t meet the coaches’ standards, we’ll throw in a quick sprint workout at the end. We may also do some sprint work at the end of a short practice.

On the other hand, our pitchers do little in the way of conditioning work while practicing so we try to run them through two to three days of sprint and agility work per week, depending on our scrimmage schedule. The first day will feature “long” sprints of 30 to 120 yards, the second will include TR AINING-CONDITIONING.COM

SPORT SPECIFIC three to four agility exercises of four to six sets each, and if we opt for a third day we’ll focus on short sprints of five to 30 yards. We’ll also head over to the football stadium to run sprints up the stadium stairs periodically.

POSITION PLAYERs’ WORKOUT In the fall, our position players work out four days per week. Mondays and Thursdays are dedicated to lower-body workouts and Tuesdays and Fridays are devoted to the upper body, though individual workouts vary depending on a player’s injury history, physical attributes, conditioning levels, or positionspecific requirements. We use dynamic warm-ups to help prevent injury, and the sets and reps of our exercises vary depending on our practice and scrimmage schedule.

Monday is a lower-body day, with an emphasis on squats. A typical workout will start with some foam-rolling work, followed by a dynamic warm-up focusing on the hips and ankles. The squats are always the first weight exercise we do because they work the largest muscle group and we want the players to be at their best when they do them.

We generally follow the squats with an explosive exercise—usually a box jump—and superset this with some type of lunge variation (forward, reverse, or from a deficit). We also include a hamstring exercise such as an RDL or variation, as well as a leg curl with a Bulgarian split squat. We use a linear periodization method with all of our assistance exercises, usually performing three sets of anywhere from six to 12 reps.

Tuesday is an upper-body day, and the primary lift is the bench press. We also incorporate shoulder work into both our warm-up and main workout.

In addition, we work with med balls, choosing two exercises—one rotational and one overhead throw—and doing two to three sets each after our warmup and before the bench press.

We often use a band-pull series as our shoulder exercise. This is a simple routine of three light resistance-band exercises, which are most effective if done at a slow and controlled pace.

The first exercise in the band-pull series is a band pull-apart. The player begins by holding the band with his arms straight out in front. From there, he pulls the band apart until his arms are positioned directly out from his sides, TR AINING-CONDITIONING.COM

holding the position for a full second before returning to the starting position. We do two eight-rep sets of this exercise, one with palms facing up, and a second with palms down.

The second exercise is often referred to as “No Money” because of the arm positions and movements. The player starts with his upper arms hanging down next to his body, with the lower arms in front at a 90-degree angle.

Keeping the elbows at his side, he pulls the band apart, pausing for a full second when the lower arms are straight out from his sides. We do two sets of eight reps, one palms-up and another palms-down.

The last exercise is a band pull-down.

Beginning with his arms directly overhead, the player pulls the band down behind his neck just as he would do a pull-down weight exercise.

SHOULDER STRENGTH To strengthen our pitchers’ shoulders and increase their range of motion, we use YTWL exercises, so named because a person’s arms and body form each letter during different sections of the routine. We do three sets of the routine, lying face down on a bench or on a physioball, either with or without light dumbbells.

During each exercise, the arms move from the down position—hanging towards the floor—to the highest position that can be reached without changing the angle of the torso. The end position is held for three seconds, with the thumbs pointing at the ceiling. After each exercise, the arms are slowly rotated down to the starting position. To strengthen the back of the shoulders and help with stabilization, before each exercise in the routine we have the players pinch their shoulder blades together while keeping their arms straight.

Y: Raise the arms to a 45-degree angle, forming a “Y.” Keep the body and arms straight, with palms facing one another. This exercise targets the anterior deltoids.

T: Extend the arms straight out to the side, palms up, to form a “T.” This variation hits the trapezius, medial, and posterior deltoids, balancing the anterior work from the “Y” movement.

W: Bend the elbows to a 90-degree angle and perform the same arm movement as the “T.” This exercise works the posterior deltoids.

L: With elbows bent at a 90-degree angle, rotate the arms up until the forearms are perpendicular to the ground. This hits the anterior, medial, and posterior deltoids, and the traps, while moving the shoulders through their full range of motion.

L to external rotation: At the end of the “L” movement and before returning to the starting position, rotate the hands up with the palms facing the floor.

L to external rotation to press: At the end of the “L to external rotation” movement and before returning to the starting position, press the hands directly out in front as in a shoulder press.

Skiers: Pinching the shoulder blades and keeping the arms straight, move one arm forward over the head and the other toward the hips. Hold and alternate movement, doing three full reps.

Posterior Fly: Same as the “T” exercise except done with palms facing down.

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SPORT SPECIFIC Along with the band-pull series, medball throws, and bench press exercises, the players perform several other lifts focused on the shoulder. These include front lat pull-downs, Band pinch W’s, push ups with feet on the bench, DB rear delt supersets with DB external rotation, DB rows, and tricep exercise supersets coupled with bicep exercises.

Thursday is a lower-body and back day. We mainly utilize deadlifts and a variety of pulls in this routine. We also do additional upper-back work to ensure we’re keeping our upper-body push-to-pull ratio on track for the week.

The day’s workout includes a dynamic warm-up, deadlifts, DB split squat jumps, single-leg squats, three-way leg curls using a stability ball, glute-ham raises, cable low rows, TRX rows, and

pecs, and improve shoulder stability.

We use the same series that we do with the position players.

A typical Monday workout for a pitcher includes a dynamic warm-up, foam rolls, med-ball work (one rotational exercise and one overhead throw), squats, box jumps to one leg, band pinch W’s, DB RDL’s, Bulgarian split squats, Paloff press holds, face-pulls, push ups and scap push ups, three-way leg curls, and wrist curls.

Wednesday features our YTWL exercises, which strengthen the shoulders while increasing their range of motion (see “Shoulder Strength” on page 39). A sample workout on Wednesday includes a dynamic warm-up, foam rolls, mobility work, YTWL exercises, a med-ball exercise (backward overhead throw),

Tuesday is an upper-body day for position players, and the primary lift is the bench press ... In addition, we work with med balls, choosing two exercises—one rotational and one overhead throw—and doing two to three sets each. sandbag flips to work the forearms.

Friday is an upper-body day, which we try to make as much fun as possible because the workout often follows a scrimmage. We begin with the band pull-down series, but after that we sometimes allow the players to determine the exercises, with an upperclassman often choosing the day’s routine.

We call Friday our “bodybuilding” day because the workouts usually end up centering on the “mirror muscles”—biceps, triceps, pecs, and abs—that guys are often so proud of.

PITCHERs’ WORKOUT Our pitchers go through full-body workouts three days a week—Mondays, Wednesdays, and Fridays—although this may be altered once scrimmages begin. Like the position players, we put the pitchers through a dynamic warmup before each workout, along with some foam-roll exercises and mobility work. In addition, we have them do shoulder exercises at the beginning of the routine and a static stretch at the end.

Monday features band-pull exercises, which are great for pitchers because they help stretch and strengthen the arm and target the reactive muscles used in throwing. They also strengthen the scapulas and upper back, stretch the ­40

T&C DECEMBER 2013

goblet squats, seated one-arm cable rows, leg curls, skaters, single-arm pulldowns and DB bench presses, DB lateral raises, and scapular wall slides.

Friday features some shoulder prehab, which is usually a three-way routine of lateral and front raises, in addition to a rear delt exercise. A Friday workout usually features a dynamic warm-up, foam rolls, mobility work, shoulder prehab, BB reverse lunges, hurdle hops, standing single-arm cable rows, gluteham raises, band external rotations, chin-ups, DB step-ups, cable crossover rows, a plank series, and wrist curls and rotations.

The fall season includes approximately 21 scrimmages—usually on Fridays, Saturdays, Sundays, and a few Tuesdays—from mid-September to the first weekend of November. During this time, the primary goal is to have pitchers fresh and in top shape for their next outing. To avoid overuse injuries, we usually only run our pitchers through two strength workouts between appearances, and determine the routine based on number of innings pitched and pitches thrown. We’re especially careful with freshmen because they’re often unaccustomed to the heavy workload of a college pitcher. Here’s a sample workout schedule for a pitcher who’s taking the mound for consecutive Friday

scrimmages: Friday: Light conditioning of 15 minutes on the stationary bike, treadmill, or elliptical after the game.

Saturday: Light conditioning of an easy 10 to 12 minute run followed by heavy lifting focused on the lower body and core to allow the pitcher’s arm and shoulder to recover fully. We still do our shoulder prehab work to maintain stability in the shoulder.

Sunday: Off Monday: Conditioning of eight to 15 medium-paced sprints of 60 to 120 yards.

Tuesday: Usually a bullpen session day, which we follow with moderate lifting geared toward the upper body, keeping the weights a bit lighter so the pitchers can stay fresh for their next outing.

Wednesday: Conditioning work consisting of 12 to 20 reps of short sprints of five to 30 yards.

Thursday: Light conditioning and/or shoulder work.

We have to make additional variations in the workouts for relief pitchers during scrimmage season. For example, if a reliever throws 25 pitches or less on a Friday, there’s a possibility that he could be used again the next day, so we would only put him through some brief mobility work and shoulder-stability exercises after the scrimmage. If a pitcher throws 26 to 50 pitches on a Friday, it’s unlikely he’d be used the next day, but the coaches would expect him to be ready to go again on Sunday.

Therefore, his weight training on Friday night would be a little more extensive, but on Saturday we’d only have him do some light conditioning and mobility work.

I have a great situation here with the South Carolina baseball team. The sport coaches value my contribution to the program and rarely question my workouts. Plus, they take pride in running a program that challenges the athletes, both mentally and physically, without running them into the ground.

The success of the strength program comes down to the commitment of our players, and they take pride in the hard work they put in. They also hold each other accountable, and this rubs off on new players. Working hard in practice and training doesn’t guarantee success, but in combination with great players and coaches, it gives you a much better chance of coming out on top. n TR AINING-CONDITIONING.COM

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108.... Thera-Gesic® (Mission Pharmacal) . . . . . . . . . 15

109.... HydroWorx. . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

101.... TurfCordz®/NZ Manufacturing. . . . . . . . . . . . . . 2

118.... Medi-Dyne . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Products Directory Circle #. . . . . Company . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page #

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

508. . Ari-Med (Flexall®). . . . . . . . . . . . . . . . . . . . . . . . 49

524. . Mission Competition (The Iron Neck) . . . . . . . . 47

522. . California University of Pennsylvania . . . . . . . . 52

501. . New York Barbells . . . . . . . . . . . . . . . . . . . . . . 46

515. . CardeaScreen . . . . . . . . . . . . . . . . . . . . . . . . . . 51

510. . NSCA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51

525. . Catalyst CryoHelmet/All-Star (Product Launch) . . 50

521. . OPTP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

526. . Catalyst CryoHelmet/All-Star (cold therapy) . . . . 52

518. . Powering Athletics (Activity Rack). . . . . . . . . . . 50

514. . Cypress ECG Project. . . . . . . . . . . . . . . . . . . . . 52

502. . Powering Athletics (State of the Industry). . . . . 46

512. . CytoSport (Cytomax Energy Drops™) . . . . . . . . 51

520. . Pressure Positive . . . . . . . . . . . . . . . . . . . . . . . 49

513. . CytoSport (Monster Amino™). . . . . . . . . . . . . . . 52

504. . PRO Orthopedic . . . . . . . . . . . . . . . . . . . . . . . . 47

517. . DARCO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

511.. Rich-Mar (State of the Industry) . . . . . . . . . . . . 47

506. . Dynatronics (Dynatron®ThermoStim™ Probe) . . 52

519.. Rich-Mar (Product Launch). . . . . . . . . . . . . . . . 50

503. . Dynatronics (State of the Industry) . . . . . . . . . . 46

505.. Samson . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

523. . Firstbeat Technologies. . . . . . . . . . . . . . . . . . . . 52

527.. SwimEx (plunge tanks) . . . . . . . . . . . . . . . . . . . 49

516. . Football Bar. . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

528.. SwimEx (hot and cold plunge tanks). . . . . . . . . 49

500. . HiTrainer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46

507. . Thera-Gesic® (Mission Pharmacal) . . . . . . . . . . 49

529.... HydroWorx (Thermal and Polar Plunge) . . . . . 49

509. . TurfCordz®/NZ Manufacturing . . . . . . . . . . . . . 51

530.... HydroWorx (HydroWorx 2000). . . . . . . . . . . . . 49 42

T&C DECEMBER 2013

TR AINING-CONDITIONING.COM

Q

CEU QUIZ

T&C December 2013 Volume XXIII No. 9

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

ning

.com

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

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

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 45) 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 23.9 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 4-6)

Objective: To learn about recently published research in sports medicine.

1. According to the authors of the acetaminophen study, taking analgesics for performance enhancement may lead to: a) Gastrointestinal damage b) Abnormal thermoregulatory functioning c) Injury masking d) All of the above 2. Which of the following was not a common strategy used by female athletic trainers to achieve work-life balance? a) Setting boundaries between home and work b) Exercising c) Eliminating night-game coverage d) Prioritizing family time

5. Pitching from a mound versus flat ground increases stress on the: a) Back and shoulder b) Shoulder and elbow c) Wrist and elbow d) Hips and knees

Hitting Their Stride (pages 11-15)

Objective: To discover how a university’s performanceenhancement program for its studentathletes emphasizes both body and mind.

6. Which of these is not a component of the Championship Performance Initiative? a) Mental preparation b) First-Year Transition Program c) Final-Year Transition Program d) Career Development Four-Year Action Plan

3. Researchers found that taking creatine after a workout increases fat-free mass by an average of: a) 0.9 kg b) 1.4 kg c) 2.0 kg d) 2.3 kg

7. One of the most common reasons athletes seek the author’s psychological services is: a) Performance anxiety b) Problems with a coach c) Problems with a teammate d) Difficulty balancing academics and athletics

4. What muscle groups showed increased activity when curveballs were being thrown compared to fastballs? a) Extensor and supinator b) Flexor and teres c) Extensor and pronator d) Teres and supinator

8. The adversity training used by many of the coaches can include games in which: a) Athletes cannot use their strengths b) Teammates of an athlete are secretly told to underperform c) The officiating is deliberately poor d) a and c

TR AINING-CONDITIONING.COM

9. What type of biofeedback is used in the iPad stations? a) Heart rate b) Brain wave c) Muscle tension d) Skin temperature 10. The vision board improves athletes’ reaction times and decisionmaking skills and can also be used for: a) Enhancing muscle memory b) Adversity training c) Relaxation exercises d) a and b

Heart of the Matter (pages 18-25) Objective: To understand how two schools implemented cardiac screenings for student-athletes.

11. In the Bryan (Texas) School District, ECG screens were made available to: a) Varsity athletes only b) High school athletes only c) Middle school and high school athletes d) All students 12. A common concern raised at the town hall meeting to discuss the high school cardiac screenings was: a) Cost of screenings b) Whether the screenings would become mandatory c) How the results would be disseminated d) All of the above

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CEU QUIZ

13. NCAA athletes in which sport have the highest incidence of sudden cardiac death? a) Football b) Track and field c) Men’s basketball d) Women’s basketball 14. Since cardiac screenings began at the University of Washington, the most commonly diagnosed disorder is: a) Hypertrophic cardiomyopathy b) Long QT syndrome c) Left ventricular non-compaction d) Wolff-Parkinson-White syndrome

Many Hands (pages 31-34)

Objective: To discover how a large medical center provides sports medicine services to a wide array of sports teams.

Objective: To learn about the University of North Carolina’s nutrition program for its men’s basketball players.

18. Professional sports organizations utilize the services of Vanderbilt Sports Medicine’s: a) Athletic trainers b) Physical therapists c) Physicians d) All of the above

15. Players should get the proper recovery nutrition within how many minutes of finishing a workout? a) 10 b) 30 c) 45 d) 50

19. The largest growth area for Vanderbilt Sports Medicine’s athletic training services is currently: a) High school sports b) College sports c) Professional sports d) Youth sports

16. Along with creating fueling strategies, what are the three areas UNC focuses on? a) Body composition, game-day meal plans, and hydration b) Recovery nutrition, cooking, and body composition c) Recovery nutrition, supplementation, and hydration d) Supplementation, grocery shopping, and game-day meal plans

20. Staff members hold in-services for new: a) Treatment techniques b) Taping protocols c) Evaluation techniques d) All of the above

Fueled for Takeoff (pages 27-30)

44

17. In addition to replacing fluid lost during physical activity, the American College of Sports Medicine recommends how many ounces of water for male athletes daily? a) 100 b) 125 c) 150 d) None of the above

T&C DECEMBER 2013

21. The CoachSmart app provides information on topics such as: a) Lightning strikes in the area b) Motivational techniques for coaches c) Coaching strategies d) None of the above

Twofold Approach (pages 37-40)

Objective: To learn about the offseason strength and conditioning program used by the University of South Carolina baseball team.

22. At South Carolina, if a baseball player has had back problems, full squats may be removed from his workout and replaced with: a) Lunges b) Leg presses c) Squat variations d) All of the above 23. What exercise is omitted from pitchers’ workouts? a) Straight bench press b) Dumbbell press c) Full squat d) Pull-down 24. For both position players and pitchers, exercises used instead of Olympic lifts are: a) Dumbbell jump squats and Paloff press holds b) Hurdle hops and box jumps c) Med-ball exercises and Bulgarian split squats d) None of the above 25. What ratio is maintained for push-to-pull exercises in the position players’ workout? a) 1:1 b) 1:2 c) 2:1 d) 3:1

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

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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 23.9 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

A B C D

Bulletin Board

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1. m 2. m 3. m 4. m

5. m

m m m m m

m m m m m

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Hitting Their Stride

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7. m

8. m 9. m 10. m

m m m m m

m m m m m

m m m m m

m m m

m m m

m m m

Heart of the Matter

11. m 12. m

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Fueled for Takeoff 15. m

16. m 17. m

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m

m

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20. m 21. m Twofold Approach

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

Last Name ____________________________________ First Name _______________________________ MI______ Title ______________________________________________________________________________________________ Mailing Address ____________________________________________________________________________________ City ________________________________________________ State _________ Zip Code _____________________ Daytime Telephone ( _________ ) ________________________________________ E-Mail Address ____________________________________________________________________________________ Payment Information

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T&C DECEMBER 2013

45

state

of the

industry

HiTrainer

855-726-3300 www.hitrainer.com

New York Barbells of Elmira, Inc. Circle No. 500

New Technology: It is well known that high-intensity interval training is a superior method of conditioning.

The HiTrainer Pro takes conditioning one step further with maximum effort interval training, which provides unbeatable energy system development training. The HiTrainer Pro helps athletes achieve a near-maximum heart rate for sustained periods, while measuring their exact performance.

Independent testing showed the HiTrainer Pro increased an Olympic-level Judoka fighter’s overall power output by 11.5 percent. The performance analysis features include direct, instant feedback on the user’s effort, including details on speed, acceleration, power output, fatigue index, and balance.

800-446-1833 www.newyorkbarbells.com

Circle No. 501

Industry Trend: The trend of using

rubber Olympic weights is related to the ever-growing interest in CrossFit and Olympic lifting. Rubber plates are frequently preferred over steel alternatives for this type of exercise.

Benefits:

• Offers superior protection to floors and equipment • Feet are thankful • Reduced costs due to partnership in China • Same-day shipping in most cases

Benefits:

• High-level conditioning for every level of athlete at any time • Fast and effective conditioning in the minimum amount of time • Minimum impact on athletes’ bodies • Boost motivation with direct performance feedback

Powering Athletics

866-672-1700 poweringathletics.com

Dynatronics Circle No. 502

New Technology: Over the past several years, training has gravitated to movement-based programming with functional training activities. Powering Athletics designs products that are multifunctional and centered on movement, with functional training at the core of the design criteria. Its new Activity Rack product line provides for functional training methodologies for a single individual up to a 20-person configuration. The T-Slot technology in multiple extrusion profiles becomes the erector set platform for unlimited configurations of exercise. Powering Athletics’s products integrate balance, strength, and movement for core conditioning, quickness, agility, endurance, and explosiveness. The goal of the products is to make every movement count.

Benefits:

• The T-Slot profile provides for unlimited attachment points on every rack configuration, allowing for hundreds of exercises in each design • The erector set concept is always expandable and never outdated, which accommodates any personalized facility or layout • You can now turn a traditional power rack into a smart rack to do more in less space

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T&C DECEMBER 2013

800-874-6251 www.dynatronics.com

Circle No. 503

New Technology: Dynatronics has done it again. The revolutionary Dynatron® ThermoStim™ probe is the first of its kind and combines cold or heat with electrical stimulation and soft-tissue mobilization.

The multi-surface head with distinctive edges and corners optimizes ThermoStim transfer and tissue mobilization. With a temperature range of 39° F to 112° F, the probe reaches target temperatures in less than 60 seconds. The ThermoStim probe is designed to operate in conjunction with Dynatronics’s most feature-laden electrotherapy device to date, with the power to deliver up to five channels of stim, ultrasound, and tri-wave light therapy all at the same time. The product is also available with a stateof-the-art three-drawer cart.

Benefits:

• Performs multiple treatments at the same time • Saves treatment time • Practitioner can treat more aggressively because the treatment is more comfortable • More effective tool to perform tissue mobilization

TR AINING-CONDITIONING.COM

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

Circle No. 504

Benefits:

• Non-stick permanent coating prevents excessive adhesive build-up • Coating makes blade clean-up quick and easy • Ergonomic shape greatly enhances cutting ease

Mission Competition Fitness Equipment

Circle No. 524

New Technology: Doctors and concussion experts believe that the number of serious head injuries in sports could be reduced or minimized by properly and diligently training the most vulnerable area of an athlete’s body--the neck region. If the neck is strong, then the head is better supported and the brain is better protected. The Iron Neck is a neckstrengthening device that works all the muscles of the neck in a rotational method. It is the only equipment available that works the neck muscles by applying horizontal and rotational resistance, giving the athlete a dynamic neck workout while building force-dissipating muscle strength.

Benefits:

• Gives an athlete a better chance of avoiding serious head injury • Costs less than a sixth of other neck-strengthening devices • Can be used with a bungee cord or attached to an adjustable cable machine • Leaves no footprint in the gym or weightroom

TR AINING-CONDITIONING.COM

industry

Samson Equipment

New Technology: Cutting adhesivebacked materials such as foams and felts can lead to a heavy build-up of the adhesive on scissor blades. PRO introduces the 11T Scissor. The PRO 11T Scissor features a non-stick coating permanently adhered to the entire shear. The non-stick coating greatly reduces adhesive build-up and makes cleaning much easier. Based on the PRO 11 Scissor, the 11T has the same oversized finger rings and ergonomic angle for easier cutting.

310-776-0621 www.halostrong.com

of the

800-472-6766 www.samsonequipment.com

Circle No. 505

Industry Trend: More so now than ever,

it’s becoming imperative to provide athletes with more options at each workout station.

Strength and conditioning coaches need their athletes to have more options for greater versatility during each workout.

The more versatility at each work station, the less movement and hassle for the athlete. Samson Equipment is known world wide for specifically addressing each coaching staff’s individual needs. As a result of this need/trend, Samson Equipment has developed a few new and exciting products, such as the Samson Equipment Functional Training Rack and Adjustable Dumbbells. Check us out online at www. samsonequipment.com for more information!

Benefits:

• The Functional Training Rack combines a functional trainer within a full-functioning half rack, giving each athlete unlimited possibilities • Adding the Adjustable Dumbbells--which go from 15 to 95 pounds in five pound increments--into the mix means athletes no longer have to move from station to station to complete their full workout

Rich-Mar

423-648-7730 www.richmarweb.com

Circle No. 511

New Technology: Rich-Mar is pleased to

announce the addition of the Hydra-THERM™ heating units and Hydra-Heat Packs™ to their rugged, reliable product lineup. The stateof-the-art, fully composite Hydra-THERM heating unit eliminates rust issues caused by traditional units. The Hydra-Heat Packs are bacteria resistant and virtually indestructible. Both offer a much-needed alternative to the traditional hot pack and heating units available in the market today.

Benefits:

• The Hydra-THERM heating unit eliminates rust and offers low-voltage control, a digital low-water sensor, composite dividers, and an isolated heating element • The Hydra-Heat Packs are virtually indestructible, flexible to body contours, bacteria resistant, easy to clean, and completely sealed

T&C DECEMBER 2013

47

Case Study

Why it is Best to Invest in the Iron Neck

W

hile this may seem obvious given the media attention, many people remain unaware that small repetitive brain injuries can cause long-term damage.

It has been well documented that continuous, subconcussive-level impacts have resulted in long-term neurological deficits that manifest themselves during the playing career or after the athlete has retired from the sport. (The Forensic Examiner, Spring 2011) According to Ralph Cornwell, PhD, the number of serious sports injuries could be reduced or minimized by properly and diligently training the most vulnerable area of an athlete’s body—the neck region. The neck supports the head, which encases our control center and allows us to function. Without our brain, we have no body. Dr. Cornwell espouses that if the foundation is strong, then the head is better supported and the brain is better protected. This makes perfect sense.

Neck muscles act as springs and shock absorbers.

Bigger and stronger necks can better absorb a blow with less deformation.

Dr. Cornwell states that a stiffer spring—a stronger neck—deflects greater frontal or side impact forces.

It is also important to realize that most injuries and/ or concussions occur from a rotational blow to the head or body. Robert Cantu, MD, Co-Director of the Center for the Study of Traumatic Encephalopathy, states that a concussion is nerve strain caused largely from rotation of the brain.

The Iron Neck is a neck-strengthening device that works all the muscles of the neck in a rotational method. A bigger, stronger neck gives an athlete a better chance of avoiding serious injury. Since the experts in the field are telling us to strengthen our

necks to avoid injuries, why aren’t we all doing it? The Iron Neck is the only neckstrengthening equipment available that works the neck muscles by applying horizontal and rotational resistance. The Iron Neck gives an athlete a dynamic neck workout while building forcedissipating muscle strength.

Mike Jolly’s goal when creating The Iron Neck was to provide a neck-strengthening tool that could help prevent concussions by strengthening the neck and preparing it for violent contact. He feels it is important to put the head and neck under load and tension in the gym in every possible position it can be in during a sporting event. That ensures the athlete is better prepared for a possible blow to the head.

The great news is that The Iron Neck costs less than a sixth of other neck-strengthening devices. This allows a program to train several athletes while simultaneously saving valuable time and money. This versatile piece of equipment can be used with a bungee cord, or it can be attached to an adjustable cable machine—not to mention that it leaves no footprint in the gym or weightroom.

The bottom line: The Iron Neck strengthens and builds the neck muscles. This could ultimately mean less injuries and/or concussions that can lead to CTE, depression, dementia, and loss of life.

Mission Competition Fitness Equipment 310-776-0621 www.IronNeck.net

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T&C DECEMBER 2013

TR AINING-CONDITIONING.COM

Topical Analgesics

Aquatic Therapy Pools ENHANCES RECOVERY

Encourage active recovery with the use of the HydroWorx ThermalPlunge and PolarPlunge pools. Utilization of these innovative hot and cold pools can be a catalyst in regeneration. “The contrasting use is very time-efficient, taking less than 10 minutes to fully complete a 2:1 or 1:1 cycle of hot:cold immersion with massage. With contrasting, the CNS/ANS is recovering faster and more completely, and the athletes come to the next session with higher functioning levels of neuromuscular firing.” - Lance Walker, Director of Performance at Michael Johnson Performance.

HydroWorx International, Inc. • 800-753-9633 www.hydroworx.com

Circle No. 529

PAIN RELIEF

Thera-Gesic® is many athletic trainers’ brand of choice 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, TheraGesic becomes colorless and transparent. Once it penetrates the skin, the area may be washed, leaving it dry and fragrance-free without decreasing Thera-Gesic’s effectiveness.

Mission Pharmacal Co. • 800-373-3037 www.missionpharmacal.com Circle No. 507

SUPERIOR HOT & COLD RETENTION

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

SwimEx Inc. • 800-877-7946 www.swimex.com

Circle No. 527

RADICALLY FUNCTIONAL

The HydroWorx 2000 Series is a radically functional aquatic therapy and performance pool.

This state-of-the-art aquatic therapy equipment boasts a host of high-performance features that represent the cooperative efforts of visionaries, engineers, and clinicians. The moveable floor, 8’x12’ underwater treadmill, resistance jet technology, and computer and camera systems satisfy the varied demands of traditional sports medicine, as well as those of dominant, world-class athletes. The pool and underwater treadmill size allow you to create group-training sessions with four people at a time.

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 ultrasoundcoupling gel. Professional sizes are available.

Ari-Med/Diversa Products Group • 800-527-4923 www.ari-med.com Circle No. 508

IMMEDIATE AND LONGLASTING RESULTS

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

Mike Lesako, Head Athletic Trainer at Washington & Jefferson College, uses RAW Heat and Ice 3 oz roll on topical analgesics from The Pressure Positive Company 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 longlasting 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.”

SwimEx, Inc. • 800-877-7946 www.swimex.com

The Pressure Positive Company • 800-603-5107 www.pressurepositive.com Circle No. 520

HydroWorx International, Inc. • 800-753-9633 www.hydroworx.com

Circle No. 530

FORM AND FUNCTION

TR AINING-CONDITIONING.COM

Circle No. 528

T&C DECEMBER 2013

49

Product Launch

DCS Plantar Fasciitis Sleeve

Activity Rack Powering Athletics 866-672-1700 poweringathletics.com Circle No. 518

DARCO International 304-522-4883 darcointernational.com Circle No. 517

Unique features:

• Targeted medical grade compression zones provide a sustained stretch to the plantar fascia • Six graduated compression zones improve circulation and reduce edema • Constructed of medical grade fabric that is latex-free

Benefits for the user:

• Provides 24-hour support • Wear while sleeping or under socks when active

Unique features:

• With over 30 functional attachments, the Activity Rack is more than just a power rack • Erector set exercise components that are never outdated and always expandable for whole-body functional training

Catalyst CryoHelmet

• You can do more in less space • Custom or standard layouts • Up to 20-person workout configurations

Gel-SHOT

Rich-Mar 423-648-7730 www.richmarweb.com Circle No. 519

All-Star Sporting Goods 800-777-3810 www.iceyourhead.com www.cryohelmet.com Circle No. 525

50

Benefits for the user:

Unique features:

Benefits for the user:

Unique features:

Benefits for the user:

• Studies show that every hit counts, whether big or small, especially in sports where there are repeated hits to the head during practices and games • Medical research consistently shows that cooling the brain reduces inflammatory effects that occur from head trauma

• Treats head injuries • Relieves migraines • Dissipates heat • Helps athletes recover after exercise

• Gel-SHOT is the next generation of patented ultrasound technology from Rich-Mar

• There is low freight cost and a lower application cost

T&C DECEMBER 2013

• The product provides a no-mess, highoutcome solution to treatments

• Gel-SHOT offers sterility, superior coupling, dosage control, an extended treatment area, and better efficiency and outcomes

TR AINING-CONDITIONING.COM

More Products LEAP HIGHER

Reach new heights in athletic conditioning with the Jump Belt, a TurfCordz® product designed to strengthen leg muscles to increase vertical leap. The Jump Belt features an adjustable belt and two 30inch tubes connected to foot straps. It is available in resistance levels from three to eight pounds, up to 14 to 34 pounds.

TurfCordz resistance products provide a versatile, safer, and more comfortable workout.

NZ Manufacturing • 800-886-6621 www.turfcordz.com

Circle No. 509

TOP INDUSTRY PROFESSIONALS

IDENTIFY CARDIAC ABNORMALITIES

Sudden Cardiac Arrest (SCA) is the leading medical cause of death in athletes and often is the first symptom of a cardiac condition. The traditional preparticipation exam has low sensitivity and high cost, relative to the ECG, in detecting cardiac abnormalities.

The CardeaScreen ECG device, developed for screening athletes’ hearts, helps physicians quickly and accurately identify abnormal conditions that may lead to SCA. Cardea Associates • 855-800-0760 www.cardeascreen.com

Circle No. 515

DROPS OF ENERGY

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.

Cytomax Energy Drops™ are a portable and chewable way to deliver a precise blend of carbohydrates and essential electrolytes. Cytomax Energy Drops™ may be used before and during training.

Each portable pouch provides 10 individual chews. Cytomax Energy Drops™ are available in two great-tasting flavor options: Tropical Fruit + Pomegranate Berry (non-caffeinated), and Orange + Tangerine (50 mg of caffeine per pouch). Tropical Fruit + Pomegranate Berry is collegiate compliant.

NSCA • 800-815-6826 www.nsca.com

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

Circle No. 510

Circle No. 512

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More Products ULTRA-CONCENTRATED

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

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

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FLEXIBLE SCREENING PROGRAM

When it comes to heart health, the best offense is a good defense. A simple electrocardiogram (ECG) helps detect cardiac risk early enough to treat it. Cypress ECG Project is a nonprofit organization that works with schools across the country. Screening more than 35,000 students over 13 years, it has proven its experience and dedication to heart health. Its flexible screening program results in maximum student participation and minimum stress for athletic staff.

Cypress ECG Project • 713-487-6704 www.cypressecgproject.org

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ICE YOUR HEAD

Right now, there is no great treatment for mild or severe traumatic brain injuries.

Rest is the only recommended course of action. Trauma accumulates over time from repeated impacts during practices and games. Catalyst CryoHelmet by All-Star Sporting Goods’s approach uses cold therapy to treat some of the inflammation that occurs with these injuries. Selective therapeutic hypothermia is a rapidly growing field in medicine. For the most up-to-date research, please visit www.iceyourhead.com/research.

All-Star Sporting Goods • 800-777-3810 www.all-starsports.com

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POSITIVE FEEDBACK

The Football Bar has been receiving rave reviews. Here’s what Syracuse University Head Strength Coach Will Hicks wrote Football Bar inventor Joe LaCroce recently: “With fall camp coming to an end and starting game week, we are fairly healthy.

The Football Bar is one of the reasons—to be able to train many different upper-body lifts with our hands in a more natural exercise has helped in not putting extra stress on our shoulders. The neutral hand position also helps reinforce the football techniques taught by the coaches.

This bar should be in every school.”

The Football Bar • 800-541-4755 www.repsdirect.net

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FLEXIBLE SCHEDULES

The 12-month, 36-credit Master of Science in Exercise Science and Health Promotion at California University of Pennsylvania is 100-percent Web-based. The flexibility of the online program allows professionals or military personnel, who would be precluded from attending graduate school in the traditional sense, to complete the M.S. program while still maintaining their full-time positions. For more information and a list of degree programs, contact Cal-U.

California University of Pennsylvania • 866-595-6348 www.calu.edu/go Circle No. 522

DETECT OVERTRAINING

Firstbeat SPORTS system is a heart rate variability based tool for real-time training load monitoring and overnight recovery detection. The advanced HRVbased analysis detects early signs of overtraining providing coaches and athletes a practical tool to avoid injuries and optimize performance.

Firstbeat Technologies Ltd. • 310-259-2277 www.firstbeat.com

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FUTURE OF THERAPY

STRONG & STABLE

Strengthen and stabilize the shoulder joint and girdle with the Scap & Cuff Trainer™. Designed by a physical therapist, the Scap & Cuff Trainer features a 12-ounce weighted ball that can be oscillated linearly while the user performs isometric and isodynamic exercises. Use alone or in combination with an exercise ball or the BOSU®

Balance Trainer.

OPTP • 800-367-7393 www.optp.com

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Dynatronics has done it again, by introducing another revolutionary product—the Dynatron® ThermoStim™ Probe. Combining cold or heat with electrical stimulation, ThermoStim represents the future of therapeutic modalities. ThermoStim is the newest accessory for the Dynatron Solaris® Plus featuring 7-Stim waveforms; the Tri-Wave Light; plus, it has enough power to generate eight separate treatments simultaneously. This product also complements the new three-drawer Solaris Cart. Call Dynatronics for a demonstration.

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

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TR AINING-CONDITIONING.COM

WWW.NEWYORKBARBELLS.COM SERVING THE INDUSTRY FOR OVER 35 YEARS! PLYO BOXES MEDICINE AND SLAM BALLS CROSSFIT OLYMPIC BLACK BEARING BARS

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New York Barbell of Elmira, Inc. 15,000 Square Ft. Showroom Open to the Public Circle No. 122

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GIVE ME STRENGTH

FOR TEAM SALES INFORMATION: PERFORMANCE@CYTOSPORT.COM 707-747-3372 • CYTOSPORT.COM

*Our products are tested for athletic banned substances in compliance with the NSF International Certified for Sport® program, which includes semi-annual facility audits, verifying that no NSF 306-Certification Guideline Annex A List banned substances exist in our facility.

©2013 CytoSport, Inc. MUSCLEMILK.COM

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WORKOUT RECOVERY FUEL

TO WORK HARDER TO RUN FASTER TO WIN