April 2004 Vol. XIV, No. 3 $5.00
◆ HIPAA Revisited ◆ Educating
Rotation at the Shoulder Examining Rotator Cuff Injuries
Request No. 1
Training & Conditioning • April 2004 • Vol. XIV, No. 3
F EATURES ◆ Special Focus ◆
Honing in on HIPAA........11 Forms. Jargon. Red Tape. Lawyers. The Health Insurance Portability and Accountability Act can be a headache—but it can also help you serve your student-athletes better. By David Hill ◆ Management ◆
Head of the Class..........19 Teaching your coaches some basics about sports medicine can ensure they are in sync with your procedures. Here are some tips on what to teach them and how. By R.J. Anderson
◆ Nutrition ◆
Confused by Carbs?..........26 The low-carb fad has some truth in it, but it’s not for competitive athletes. Our nutrition expert gives the skinny on carbohydrates and performance. By Leslie Bonci ◆ Treating The Athlete ◆
Rotation at the Shoulder.........33 “Rotator cuff injury” has become a common treatment term for a sometimes misunderstood condition. Effective treatment starts with a precise diagnosis. By Jodie Humphrey
D EPARTMENTS ◆ Sideline ◆
Do Herbal Supplements Work?.........3 ◆ ATC Award ◆
This issue’s winner..........4 Nomination form..........7 ◆ Student Corner ◆
Getting Extra Help.........8
◆ Competitive Edge ◆
Moving Upfield..........39 With limited space and resources, NCAA Division III power Bridgewater College makes the most of its strength and conditioning program. By Joey Soltis Advertisers Directory..........58 Nutritional Products.........46 Catalog Showcase..........48 Rehabilitation Products.........49 Injury Prevention Software.........59 Knee Products.........60 Football Conditioning........61 More Products.........63 NEW: CEU Quiz for T&C Readers..........64
Cover Photo by Jonathan Daniel, ©Getty Images
Great Ideas For Athletes...
TRAINING & CONDITIONING • April 2004 • Vol. XIV, No. 3
Editorial Board Marjorie Albohm, MS, ATC/L Director of Sports Medicine and Orthopaedic Research, Orthopaedics Indianapolis Jon Almquist, ATC Specialist, Fairfax County (Va.) Pub. Schools Athletic Training Program Brian Awbrey, MD Dept. of Orthopaedic Surgery, Massachusetts General Hospital, and Instructor in Orthopaedics, Harvard Medical School Jim Berry, MEd, ATC, SCAT/EMT-B Director of Sports Medicine and Head Athletic Trainer, Myrtle Beach (S.C.) High School Leslie Bonci, MPH, RD Director, Sports Medicine Nutrition Program, University of Pittsburgh Medical Ctr. Health System Christine Bonci, MS, ATC Asst. A.D. for Sports Medicine, Women’s Athletics, University of Texas Cynthia “Sam” Booth, ATC, PhD Manager, Outpatient Therapy and Sportsmedicine, MeritCare Health System
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Debra Brooks, CNMT, LMT, PhD CEO, Iowa NeuroMuscular Therapy Center Cindy Chang, MD Head Team Physician, University of California-Berkeley Dan Cipriani, MEd, PT Assistant Professor, Dept. of Physical Therapy, Medical College of Ohio Gray Cook, MSPT, OCS, CSCS Clinic Director, Orthopedic & Sports Phys. Ther., Dunn, Cook, and Assoc. Bernie DePalma, MEd, PT, ATC Head Athl. Trainer/Phys. Therapist, Cornell University Lori Dewald, EdD, ATC, CHES Athletic Training Program Director and Associate Professor of Health Education, University of Minnesota-Duluth Jeff Dilts Director, Business Development & Marketing, National Academy of Sports Medicine David Ellis, RD, LMNT, CSCS Sports Alliance, Inc. Boyd Epley, MEd, CSCS Asst. A.D. & Dir. of Athletic Perf., University of Nebraska Peter Friesen, ATC, NSCA-CPT, CSCS, CAT, Head Ath. Trainer/ Cond. Coach, Carolina Hurricanes Lance Fujiwara, MEd, ATC, EMT Director of Sports Medicine, Virginia Military Institute Vern Gambetta, MA President, Gambetta Sports Training Systems Joe Gieck, EdD, ATC, PT Director of Sports Medicine and Prof., Clinical Orthopaedic Surgery, University of Virginia Brian Goodstein, MS, ATC, CSCS, Head Athletic Trainer, DC United
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Gary Gray, PT President, CEO, Functional Design Systems Maria Hutsick, MS, ATC/L, CSCS Head Athletic Trainer, Boston University Christopher Ingersoll, PhD, ATC, FACSM Director, Graduate Programs in Sports Medicine/Athletic Training University of Virginia Jeff Konin, MEd, ATC, MPT Assistant Professor of Athletic Training, James Madison University Tim McClellan, MS, CSCS Director of Perf. Enhancement, Makeplays.com Center for Human Performance Michael Merk, MEd, CSCS Director of Health & Fitness, YMCA of Greater Cleveland Jenny Moshak, MS, ATC, CSCS Asst. A.D. for Sports Medicine, University of Tennessee Steve Myrland, CSCS Owner, Manager, Perf. Coach, Myrland Sports Training, LLC Instructor and Consultant, University of Wisconsin Sports Medicine Mike Nitka, MS, CSCS Director of Human Performance, Muskego (Wisc.) High School Bruno Pauletto, MS, CSCS President, Power Systems, Inc. Stephen Perle, DC, CCSP Associate Prof. of Clin. Sciences, University of Bridgeport College of Chiropractic Brian Roberts, MS, ATC Director, Sport Performance & Rehab. Ctr. Ellyn Robinson, DPE, CSCS, CPT Assistant Professor, Exercise Science Program, Bridgewater State College Kent Scriber, EdD, ATC, PT Professor/Supervisor of Athletic Training, Ithaca College Chip Sigmon, CSCS Strength and Conditioning Coach, Carolina Medical Center
Publisher Mark Goldberg Editor-in-Chief Eleanor Frankel Circulation Director Mark Shea Associate & Assistant Editors Dennis Read Kenny Berkowitz David Hill Laura Smith Guillermo Metz RJ Anderson Editorial Assistant Greg Scholand Art Director Leslie Carrère Production Manager Kristin Ayers Assistant Production Manager Kristi Kempf Production Assistants Jonni Campbell Hildi Gerhart Prepress Manager Adam Berenstain Prepress Assistant Steve Rokitka IT Manager Mark Nye Business Manager Pennie Small Special Projects Dave Wohlhueter Administrative Assistants Sharon Barbell Amy Walton Daniela Reis Advertising Materials Coordinator Mike Townsend Advertising Sales Associates Diedra Harkenrider (607) 257-6970, ext. 24 Sheryl Shaffer (607) 257-6970, ext. 21 T&C editorial/business offices: 2488 N. Triphammer Road Ithaca, NY 14850 (607) 257-6970 Fax: (607) 257-7328 info@MomentumMedia.com
Bonnie J. Siple, MS, ATC Coordinator, Athletic Training Education Program & Services, Slippery Rock University Chad Starkey, PhD, ATC Associate Professor, Athletic Training Educ. Program, Northeastern University Ralph Stephens, LMT, NCTMB Sports Massage Therapist, Ralph Stephens Seminars Fred Tedeschi, ATC Head Athletic Trainer, Chicago Bulls Terrence Todd, PhD Co-Director, Todd-McLean Physical Culture Collection, Dept. of Kinesiology & Health Ed., University of Texas-Austin
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., 2488 N. Triphammer Rd., 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 $5. Copyright© 2004 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. POSTMASTER: Send address changes to Training & Conditioning, P.O. Box 4806, Ithaca, NY 14852-4806. Printed in the U.S.A.
Do Herbal Supplements Work? By Leslie Bonci, M.P.H., R.D.
It probably comes as no surprise to professionals working with athletes that herbal supplements are one of the fastest growing lines of nutritional products in today’s market. Manufacturers of these products have made them readily available to athletes, claiming they improve performance, alter body composition and cure a host of ailments and diseases. Since herbs are derived from non-woody, seed-producing plants, it’s easy for athletes to believe that they’re all natural and harmless. What athletes often don’t realize, however, is that taking herbs, on their own or in combination with other medications, can be risky. Concerns for Athletes Purity and safety risks top the list, as herbal supplements are exempt from almost all regulations. There are no manufacturing standards that address dosage and quality control or guarantee the active ingredients in these products. Some manufacturers follow strict self-imposed standards, while others do not. Although the Food and Drug Administration recently banned the stimulant ephedra, there are still many overthe-counter products with questionable ingredients that may impair performance, contain banned substances, or pose unknown dangers. For example, some “ephedra-free” supplements contain synephrine (also known as citrus aurantium or bitter orange), an ingredient that is banned by the National Collegiate Athletic Association. Things to Know About Supplements With that in mind, there are some key things you ought to know about supplements so you can help educate athletes. Remember that: “Natural” and “safe” are not synonymous. Labels do not always accurately reflect what’s in the bottle. More is not necessarily better and, in the case of medicines or herbal supplements, can often be worse! Potential side effects are rarely, if ever, listed on the package. Herbs do not cure diseases.
Athletes who have medication sensitivities or pre-existing chronic diseases must be extremely careful with herbs. There’s little credible research on the ergogenic potential of herbs. Herbal supplements can interact with prescription and over-the-counter medications and with vitamin and mineral supplements.
The Best Advice to Give Your Athletes It’s critical to talk to athletes about the potential dangers in taking supplements before they begin experimenting. Here are some guidelines: Ask them to write down what they take and how often. If possible, have them bring in the bottle. Tell athletes on prescription medications to clear the use of herbal supplements with their physician. Encourage them to look for products with the USP designation on the label, which indicates that they’ve been subjected to standards set by the United States Pharmacopeia.* Advise athletes to report any unusual side effects immediately! Finally, unless athletes are looking to spice up their diets, herbs should be viewed as medications.
Leslie Bonci, M.P.H., R.D., is the Director of Sports Nutrition at the University of Pittsburgh Medical Center and is a nutrition consultant to the Pittsburgh Steelers and Pittsburgh Pirates. Resources * The United States Pharmacopeia (USP) has introduced the Comprehensive Dietary Supplement Verification Program to indicate that products with the USP seal contain ingredients as stated on the label in the appropriate dose and potency, are effectively absorbed, are within the limits for presence of contaminants and have been subjected to quality control. HYPERLINK "http://ods.od.nih.gov/databases/ibids.html" http://ods.od.nih.gov/databases/ibids.html HYPERLINK "http://www.consumerlab.com" www.consumerlab.com HYPERLINK "http://www.supplementinfo.org" www.supplementinfo.org HYPERLINK "http://www.herbs.org" www.herbs.org HYPERLINK "http://www.drugfreesport.org" www.drugfreesport.org HYPERLINK "http://www.ahpa.org" www.ahpa.org (American Herbal Products Association)
For more information on herbal supplements, please visit the Sports Science Center at www.gssiweb.com.
T&C’s Above The Call Award April 2004 Winner
Growing Into Your Goals Sometimes, the best place to be is exactly where you are. By Kenny Berkowitz
y his senior year of high school, Chris Mathewson had set his sights on the perfect job. He was determined to become head athletic trainer for the Denver Broncos. And he was committed to overcoming any obstacles that stood in his way. At Cheyenne (Wyo.) Central High School, which had no program for athletic training student aides, Mathewson shadowed his athletic trainer and started studying on his own. At the University of Wyoming, he completed a pair of internships with the SMART Sports Medicine Clinic and the Arizona Cardinals, and graduated in 1994 with a bachelor’s degree in exercise physiology. Next, he and his wife—a certified athletic trainer and physical therapist—moved to Denver, where Mathewson started looking for any job in the field. One call was to Ponderosa High School in suburban Parker. As luck would have it, the school had just lost its athletic trainer an hour before, and Mathewson
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Chris Mathewson, Athletic Trainer at Ponderosa (Colo.) High School, has found his niche working with young people.
walked into the job two days before the beginning of the fall semester. At the time, he’d never worked at a high school, and he was set on pursuing his dream of working in the NFL. Ten years later, it turns out his high school dream was a little out of focus. Mathewson got a taste of the NFL, spending two summers as an Assistant Athletic Trainer with the Broncos, but he’s still at Ponderosa, and there’s nowhere else he’d rather be. “It’s been great to work with professional athletes, but I’ve decided that’s not what I want to do,” says Mathewson, MSS, ATC, CSCS. “Professional athletes know who they are and what they want to do. But here at Ponderosa, our studentathletes are still developing, and I’ve seen the effect I can have. I’d rather be here, where I can do more important work and make more of a differ-
ence in people’s lives.” After working with Mathewson for a decade, Athletic Director and Head Wrestling Coach Tim Ottman has seen the kind of difference Mathewson can make. “Chris has had a huge impact on our program, and we’re lucky to have him here,” Ottman says. “He’s organized, dependable, and thorough—he’s great in all areas. But more than anything else, he’s a true professional. His relationships with our student-athletes and his ability to get them back competing have been crucial to our success.” In the past year, Ponderosa’s athletic successes have included state championships in football and wrestling, and Mathewson has played important parts in both. “Whenever Kenny Berkowitz is an Assistant Editor at Training & Conditioning.
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Above The Call Award you need him, Chris is always there to help,” says Patrick McHenry, CSCS, Head Strength and Conditioning Coach at Ponderosa. “If it’s a night game, Chris will be there, standing on the sidelines and always being upbeat. If it’s a Saturday morning, he’ll be here before I’ve even opened the weight room, and our athletes will be taped and ready to go. If it’s summertime and one of our athletes is injured, Chris will be here, working on the rehab.” Taking the job at Ponderosa didn’t initially change Mathewson’s dream of working in pro football. He earned a Master of Sports Science, Medicine, degree from the United States Sports Academy, and during school vacations, he kept working as an Assistant Athletic Trainer with the Broncos. He was also the Head Athletic Trainer at the Steadman Hawkins Denver Clinic, which provides sports medicine and orthopedic surgery to the area’s elite athletes. But as he grew more used to working with teenagers, Ponderosa started feeling more like home. “The students have all these plans, just like I did, and they don’t understand yet that life may take them somewhere else,” says Mathewson. “They’re impressed by the fact that I’ve worked in the NFL, and that probably makes it a little more likely that they’ll listen to me. But I explain that the rehabs I do with the pros are the same ones I do here at Ponderosa. The pros do quad sets and straight leg raises, the same as us. They get ice and stim, just like we do. I tell our students that sports medicine is sports medicine, no matter what level you’re at.” The students at Ponderosa are glad he chose the high school level. “Chris has a very positive impact on his students’ lives,” says senior Hillary Cotner, a soccer player and athletic training student aide. “He demands respect for all of his student athletic trainers, and makes sure that everyone in the athletic training room 6 ◆
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Chris Mathewson Athletic Trainer Ponderosa High School, Steadman Hawkins Denver Clinic President, Colorado Athletic Trainers’ Association
treats each other well. You can really tell he enjoys his job and likes to be around kids. All the kids around the school know him and really like him. He’s more than an athletic trainer, he’s like a father figure to tons of kids.” Working with him after her second ACL injury, Cotner learned the same lessons that Mathewson tries to teach all his students, balancing patience, toughness, and encouragement. Every day Cotner came into the athletic training room, she found a checklist of exercises to complete, and steady, strong support. “Between working as a student aide and going through two rehabs, I’ve spent many hours in the training room,” says Cotner. “He taught me to stay positive throughout my rehab, which can get really frustrating when it feels like you’re not getting better. He’s taught me a lot about being tough, and he’s always been really encouraging.” Describing himself as the type of person to “give them the tools to fix it themselves,” Mathewson sees his job as providing “a shoulder to cry on and a kick in the pants.” “Some athletic trainers think they need to be working hands-on with
their rehabs every day,” he says. “I’m more likely to tell my athletes, ‘It’s your knee. I can teach you the exercises, but you’ve got to do them yourself.’ I’m not a big cheerleader standing over them, saying, ‘Okay, let’s do another set.’ I give them their chart, tell them what to do, and move along.” In his 10 years at Ponderosa, the hardest rehab that Mathewson has worked on was his first. “A junior who was a big part of our football program had torn his ACL,” says Mathewson. “When we first saw him, I knew we could get him back into shape, but actually doing it was kind of tough. I’d seen plenty of ACL rehabs at college and at the clinic, but I wasn’t making the decisions. So I learned about the true flow of how a rehab works. “He came in every single day for the next four and a half months and worked like nobody I’d ever seen before. He never missed a session,” says Mathewson. “When his senior year came, he scored our opening touchdown, ran back to the sidelines and handed me the ball, saying, ‘That was for you.’ That was the toughest rehab, but it was also the best.” Mathewson’s work at Steadman Hawkins has given him the opportunity to work closely with doctors. Plus, for Ponderosa patients at the clinic, Mathewson is a reassuring presence. “Because Chris knows the doctors, he’ll go to the surgery,” says McHenry. “He gets to see our students every step of the way, from right after surgery to the end of rehab.” “Chris is very highly regarded as an athletic trainer at the clinic,” says Meredith King, ATC, who works as an Athletic Trainer at Steadman Hawkins and the Assistant Athletic Trainer at Ponderosa High School. “The doctors think the world of him. Whenever they see one of our athletes, they’ll call Chris over to ask, ‘What do you think?’ He works with top-notch people at the clinic, and I think that adds
Above The Call Award to his skills as an athletic trainer at Ponderosa.” Every June, Steadman Hawkins physicians and physicians assistants come to Ponderosa, conducting physical examinations of the school’s student-athletes. They donate their fees back to the school to pay for King’s salary as assistant athletic trainer. Mathewson’s reach extends beyond the Ponderosa community. As President of the Colorado Athletic Trainers’ Association (CATA), he has coordinated corporate sponsorships for the CATA and made presentations on sports medicine both to the community and his colleagues at CATA. He has also edited the Web site of the Rocky Mountain Athletic Trainers’ Association. After years of building up his resume, Mathewson is now spending more time at home, taking care of his daughters—three-year-old Taylor and five-month-old Bailey—before going to Ponderosa at 2 p.m. He works only one day a week at Steadman Hawkins, where he’s now in charge of accounts payable and inventory control. “Until my first daughter was born, the thing I cared most about was my resume and what I was doing professionally,” says Mathewson. “When Taylor came along, I decided I needed to change the way I was looking at life. Being a dad has really put my priorities right: I want to continue working at Ponderosa and I want to be the best dad I can.” As he learned before, dreams can change. “For years, working in the NFL was the only job I wanted,” says Mathewson. “But I like working with high school students. I like their approach to life, I like their energy. On game days, I can feel the excitement in the locker room and remember what it was like to be in the same position. Years from now, they’ll still remember being in these games. And I get to be a part of that.” ◆
Nomination Criteria and Procedures
he “Above The Call” Awards Program serves to honor outstanding athletic trainers for work not otherwise recognized. This may include someone who has shown exemplary dedication and devotion to his or her job or outstanding work outside of the everyday ATC duties. The goal is to honor those athletic trainers who go above and beyond the already extraordinary demands placed on anyone in the profession.
Examples include: Someone who is doing something different and exciting in the profession. ◆ Someone who serves as a role model and mentor to others. ◆ Someone who has taken on ◆
additional significant duties in the field. Someone who gives 110 percent in all that he or she does. Someone who has a special way with athletes.
TO NOMINATE AN ATHLETIC TRAINER: Please fill in the form below, and attach a 500- to 1,000-word description of the athletic trainer’s achievements, including: ◆ Why you think this athletic trainer stands out from the crowd. ◆ Where he or she is currently working and any pertinent academic or work history. ◆ Testimony and/or quotes from those he or she works with.
✁ Above The Call Award NOMINATION FORM Name of Athletic Trainer:___________________________ His or Her Phone No.:______________________________ Your Name:______________________________________ Your Affiliation:___________________________________ _________________________________________________________________
Your Phone No.:___________________________________ Your Address:_____________________________________ ________________________________________________ Send nominations to: Above The Call Award Training & Conditioning 2488 N. Triphammer Road Ithaca, NY 14850 If you have any questions, feel free to call us at (607) 257-6970, xt. 18, or e-mail us at firstname.lastname@example.org.
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A Special feature for your athletic training students
Student Corner . . . .
Extra Help Tips on making the most of the people and resources all around you.
By Guillermo Metz s an athletic training student, you have a lot on your plate. There are classes, clinic hours, coverage assignments, and possibly a part-time job on the side. While student-athletes are often provided with resources to help them balance their academic and athletic lives—special computer labs, tutors, laptops to use on away games, seminars on time management—student athletic trainers rarely have such luxuries. However, some athletic training students are starting to ask for help with their busy workloads—and receive it. The key to gaining access to resources is to join forces with your fellow classmates. “I suggest forming an athletic training club, so that you have a voice,” says Leamor Kahanov, EdD, ATC, Director of Athletic Training Programs at San Jose State University. “That way, if you have an issue, such as gaining access to the athletes’ computer lab, you can bring it to your program director’s attention as a group. Because a collective voice is always stronger than a single voice. “Sometimes there’s a separation between the educational side and the athletic side,” she continues, “and the program director doesn’t have much pull, but the athletic director does. In that case, you could go as a group to your athletic director and say, ‘We work very hard and do this and that for your athletes, and you have this resource that we want. Please help us gain access to it.’” “Start by communicating with your advisors, whether it be your head athletic trainer or academic faculty, about forming a club,” agrees Scott Barker, ATC, Head Athletic Trainer at Cal State University Chico. “A number of years ago, our students organized themselves as a student club,” says Barker. “They went through the standard process, from a governance standpoint, for forming a club and that made them eligible to apply for student funding, which they received.” Students in the athletic training program at Fresno State University have also taken advantage of the club model to enhance their access to out-of-classroom resources. “They
Guillermo Metz is an Associate Editor at Training & Conditioning.
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bring in speakers from the community and organize lectures,” says Miguel Rueda, MA, ATC, Director of Sports Medicine. “They fund-raise every year to go to the national convention, too.” Beyond that, his students have gained many of the perks available to student-athletes. “Our student athletic trainers are treated very similarly to our athletes, so they have access to the same resources, the computer labs, study hall, and certain areas that are designated for student-athletes,” says Rueda. “In addition to that,” he continues, “we have a couple of extra computers around that students can use. We always put medical information on there, but we also make sure they have word processing, spread sheet, and database capabilities, as well as access to a printer. We also stock a library for them. Some of this my predecessor put in place, and some of it the students lobbied for and got.” Athletic trainers also recommend drawing on the experiences of athletic training students at other colleges and universities. “One thing I impress on our student athletic trainers is to talk to other people in the field,” says Rueda. “Meet other student athletic trainers at conventions. Talk with athletic trainers at other schools, or other program or sports medicine directors. See how they get things done. See what resources they have for their student athletic trainers.” There’s another resource that athletic training students can tap into: the advice of senior student athletic trainers. They’ve been through all this before and can provide the most sage advice on everything from memorizing the major nerve groups to working with a difficult coach. Many schools have caught onto this and have made it a formal part of their programs. “We match up our first-semester students with our seniors,” says Kahanov. “It’s important for the newer students to see how the older students manage their time, including their school work, hours in the training room, and their social life. The seniors also give advice on how to survive in this setting in order to attain their goals.” ◆
If you are interested in submitting a column of advice for athletic training students, please send it to: T&C’s Student Corner, 2488 N. Triphammer Rd., Ithaca, NY 14850. Submissions must be double-spaced, 800-1200 words long, and accompanied by the author’s resume or curriculum vita.
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Honing in on HIPAA
Forms. Jargon. Red Tape. Lawyers. The Health Insurance Portability and Accountability Act can be a headache— but it can also help you serve your student-athletes better.
ighteen months ago, the talk of the athletic training world—and much of the health care world, for that matter—was about the Health Insurance Portability and Accountability Act. The federal law’s provisions guarding the confidentiality of individuals’ medical records were
about to kick in, triggering a new way of working for most practitioners, or so the conventional wisdom had it. One result: Athletic trainers got in touch with their lawyers. “How has HIPAA affected me? I’ve probably talked to our legal counsel more this year than I ever have
BY DAVID HILL
before,” says David Polanski, MS, ATC, Head Athletic Trainer at the University of Tulsa. A year after the April 14, 2003 effective date of the privacy regulations, many athletic trainers are still David Hill is an Assistant Editor at Training & Conditioning. He also wrote on HIPAA in T&C’s March 2003 issue.
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Media Concerns any coaches and athletic administrators complain that HIPAA has caused confusion when relating student-athlete injuries to the media. That’s hardly the main concern for athletic trainers, but it can create some of the biggest headaches. There are, however, ways to cope, and there may even be a silver lining in the media-release cloud. At the University of Wisconsin, for example, the sports medicine department’s review of its policies relating to HIPAA and FERPA (the privacy law for educational institutions) raised awareness that studentathletes should be in charge of the information about their injuries and rehabilitation, says Dennis Helwig, ATC, Head Athletic Trainer. In the past, student-athletes would sometimes read or hear about their conditions in the media and complain that they didn’t realize so much detail would be made public. When told they’d signed an authorization for it, many athletes said they didn’t realize they had given such broad permission. Wisconsin has since revisited its media injuryreporting policy. “I don’t think there was an awareness by coaches and administrators about the privacy of student-athletes’ information,” says Helwig. “So there would be casual conversation about how so-and-so is doing, and things appeared in the newspaper that athletes had no knowledge were going to be there. We have tightened
wrestling with HIPAA. They call it an administrative burden, a pile of paperwork, and an intimidating morass that hangs the threat of legal action over their heads. It’s created confusion, with interpretations seeming to change week to week. A colleague in one setting seems to have it figured out, only to learn such an interpretation might be critically flawed. And yet there are athletic trainers who have conquered HIPAA instead of the other way around. They’ve taken it in stride, dealt with whatever changes in policy and procedures it might have dictated, and gotten others they work with—athletic directors, coaches, student-athletes, parents—on board with them. Some even credit the law with improving their work. In this article, we’ll talk with those members of the profession who are hip to HIPAA. CONQUERING THE CONFUSION
For nearly two years, Keith Webster, 12 ◆
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that up, which has really benefited the athletes.” Badger student-athletes said that the public really needed to know only the fact that they were injured and what body part was involved, says Helwig. So now, if journalists want to know more, they’re told to ask the student-athletes directly. And sometimes, the athletes then authorize sports medicine and sports information staff to say more so the student-athletes themselves aren’t inundated with interview requests. “We have a specific authorization for that, and the athlete knows what you’re going to say, and it’s fine—all above-board and all accounted for,” says Helwig. The University of Tulsa at first stopped releasing injury information to the media, but has since asked student-athletes what they want and adjusted policy for specific scenarios, says David Polanski, MS, ATC, Head Athletic Trainer. For example, on the football team, about 10 players didn’t sign the release. But the coaching staff didn’t want to have to keep track of which players had given authorization and who hadn’t, so they decided not to release any injury information. “A lot of the media members said they’d checked into HIPAA and told us we can release injury information,” says Polanski. “We said it wasn’t because of HIPAA that we didn’t release it, but because the players don’t want it released. So we had to do a little education with the media.”
MA, ATC, Administrative Head Athletic Trainer at the University of Kentucky, has been at the forefront of helping the profession deal with HIPAA. As Chair of the National Athletic Trainers’ Association’s Governmental Affairs Committee, Webster has been in frequent contact with the U.S. Department of Health and Human Services (HHS), the arm of Washington responsible for administering the law, which was intended to standardize electronic management and sharing of individuals’ medical information, curb abuses of the data, and make health insurance easier to obtain and maintain when workers switch jobs. It was Webster who met with HHS officials in early December 2002 to speak specifically about the effects of HIPAA’s privacy rules on athletic trainers, and who came away with the message that it may not be all that difficult to cope with. Yet early this past
January, Webster was in Philadelphia for a meeting of the Eastern Athletic Trainers’ Association and found several hundred athletic trainers seeking clarifications. “One of the reasons it remains confusing is because it hasn’t been tried in court to get some legal precedent,” says Webster. “Until there is some legal precedent, even lawyers will vary with their interpretations. Lawyers don’t like working without precedents to hang their hat on. We’re still in that gray area of everyone interpreting it differently and doing the best they can to comply with the way they read it.” Webster says HHS reports 3,100 complaints filed over HIPAA through mid-January, mostly under the privacy rules. While HHS has forwarded some cases to the Department of Justice for possible prosecution, there have yet to be any fines or penalties imposed. The leading type of complaint, he adds,
was from patients who don’t have access to their own personal medical records—one of the main reasons the privacy rules were established—and not over mishandling of records by health care professionals. Webster understands the confusion. HIPAA’s privacy rules are complicated, at times arcane, and border on being contradictory. At the core, any organization must follow the privacy rules if it is a covered entity, the term for an organization or person that conducts electronic transactions of medical records. Transactions can be billing, payments, authorization for services, certification of referrals, benefits coordination, eligibility determination, and checking on the status of claims. Thus, covered entities include most doctors’ offices and group practices, hospitals, health-insurance companies, claims clearinghouses, and medical-practice management companies. But the law doesn’t spell out every scenario, and it’s up to each organization to determine whether it is a covered entity. Most ask their lawyers to decide. For example, the University of Oklahoma’s athletic department considers itself a covered entity because it has hired an outside company to help with billing. “We really don’t do any in-house submitting of claims, per se. But we do contract with a practice-management firm that does submit some claims on our behalf, and that’s the primary reason we have to be HIPAA-compliant,” says Scott Anderson, ATC, Head Athletic Trainer at Oklahoma. “We deal with them electronically. Outside of that, HIPAA would probably have no bearing on us whatsoever.” At Tulsa, the question is still open. But to be on the safe side—and because it’s the right thing to do, regardless of federal laws—the sports medicine department has taken some HIPAA-compliance steps anyway, Polanski says. Studentathletes are told what their private health information is and that they have the right to file complaints over its handling. They’re also asked to fill out release-authorization forms. “I don’t think we are totally 100-percent positive which entity we are, covered or non-covered,” Polanski says. “We’re treating ourselves as a covered entity just to be safe. But if the government keeps reviewing things and we find out later that we’re not, then we’re not. Our legal counsel thinks maybe things will change.” GUARDING PHI
Covered entities must take certain steps to guard against improper disclosure of personal health information—PHI in HIPAA jargon. Among them are designating an employee as its privacy officer, having staff training on safeguarding identifiable PHI, and making sure that business associates only receive PHI when there is a legitimate reason and do not misuse that information. That last clause means that covered entities must take steps to ensure that any non-covered entities they regularly deal with will reasonably safeguard the information before PHI is shared. Thus, doctors, hospitals or other providers who are covered will want to be sure sports medicine departments with which they work will safeguard patients’ health information. That means the sports medicine
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department will have to follow many HIPAA-style safeguards whether it’s a covered entity or not. The privacy rules allow for PHI to be disclosed for certain purposes. Billing is an acceptable reason. More importantly for athletic training, so is treatment. Thus, a head team physician is free to discuss a case with a consulting orthopedic surgeon, for instance. Athletic trainers, too, are in the loop, as are coaches, since they have say over practice and playing time, which are
important to an athlete’s recovery, Webster says. Others are not so sure about including coaches, however, and this is a major source of potential confusion. The rule says that release of PHI for treatment purposes to an authorized provider is acceptable, says Webster, but the definition of “authorized provider” is left open to interpretation. “Someone could interpret it to mean that the person providing care needs to be a licensed provider of
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student-athletes to release their PHI. At both Tulsa and Oklahoma, for example, student-athletes sign forms authorizing release of their PHI under certain circumstances, to certain people, for certain purposes. This is Webster’s key take-away advice: Get the okay to release information when needed, and then which law governs isn’t really an issue. “I recommend everyone use a well-worded authorization-to-release form,” Webster says. “It’s just informed consent. Instead of saying, ‘It’s education records and under FERPA,’ just spell it out, and make your authorization form the key tool that allows for all the communication to take place.” An authorization form must contain a few key points, according to Elizabeth Squeglia, JD, a HIPAA expert with the Columbus, Ohio, law firm of Bricker & Eckler. First, it needs an expiration date—in college and
“Awareness of HIPAA has certainly brought out the concept that the student-athlete you deal with is in charge of their private information. If you go from that premise, everything falls in line and makes sense.” high school athletics, this is typically one sport season or an academic year. Second, it should state the person or class of people the information will be released to, such as doctors, emergency-room personnel, athletic trainers, coaches, administrators at the school, and media, if necessary. Third, it should say that no one will be denied treatment for not signing—though it can be made a condition for participa-
tion. Fourth, it should include notice that authorization to release can be revoked but only in writing. Finally, it should explain to student-athletes that if information is disclosed to a noncovered entity, it is no longer protected under HIPAA. MAKING IT WORK
The beauty of a well-written, correctly executed release-authorization form lies not just in the paperwork, but in the act of getting it signed. The process works internally by reminding athletic trainers and other practitioners of the confidential nature of personal health information, but it also shows your student athletes—and others—that you are aware of the need for privacy and will handle medical information properly. That’s what happened at the University of Missouri, says Rex Sharp, ATC, Head Athletic Trainer for Tiger sports. Going through the HIPAA education process reiterated
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the privacy of student-athletes’ medical records and the importance of sharing the information only when necessary. “We already had a general releaseof-information form, but we had to be a little bit more specific,” Sharp says. “It’s not our policy to talk about injuries anyway, but it’s made us more aware of confidentiality.” Anderson says Oklahoma’s adoption of HIPAA rules was relatively painless, but the process did uncover some room for improvement. “The
biggest adjustment has been the physical protection of the information,” Anderson says. “We talked about facilities and logistics, in terms of protecting the files and the records. For example, we make sure the X-rays aren’t left here, files there, those general types of issues.” COVERING YOUR BASES
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examine how they handle personal health information. Then it becomes a matter of finding the guidelines that are most appropriate for each situation, be they HIPAA, FERPA, or more of a reliance on authorization forms. Dennis Helwig, ATC, Head Athletic Trainer at the University of Wisconsin, says he sat in on universitywide meetings about HIPAA compliance and learned his department wouldn’t be a covered entity and that FERPA governs student-athletes’ medical records on his campus. But the process raised his awareness of FERPA’s requirements and the general handling of confidential medical information, he says. “Awareness of HIPAA has certainly brought out the existence of FERPA and the concept that the student-athlete you deal with is in charge of their private information. If you go from that premise, everything falls in line and makes sense,” Helwig says. The process also helped the Wisconsin sports medicine department become better prepared for sharing information with outside medical providers who are covered entities. “When our athletes go outside of our university providers, they now have a set format for authorizations,” Helwig says. “You don’t just call up the athlete’s physician and say, ‘Hey, I’m the athletic trainer at State University and I need to know what’s going on with Johnny’s knee.’ That’s not going to happen, and shouldn’t have happened before. You need to have the proper format to get that information.” HIPAA’s privacy rules say that authorization forms have to specify what information is going to be released, to whom, and for what purposes. It’s much more detailed than FERPA regulations, Helwig says, but following the HIPAA rules helps ensure that FERPA is followed as well. Like Wisconsin, Miami (Fla.) Country Day School also does not consider itself a covered entity. However, Athletic Trainer Theresa Belesky, LAT, ATC, still has student-athletes’ parents sign a release-authorization form. She says it helps her feel her bases are cov-
ered, and it serves as a talking point for helping to educate coaches—who have turned out to be a little harder to acclimate to the idea of medical privacy than parents, doctors, and athletes themselves. “I’ve had more flak from the coaches about the release form than anyone else,” Belesky says. “They’ll say, ‘What does it mean? Are you not going to be able to tell me anything about an injured student?’ I tell them, ‘That’s not the case. It’s just that you need to know that because the parents have signed this, they’re allowing me to talk to you. Therefore, you can’t go and talk to some other parent or somebody else.’ It was just a matter of educating my coaches as to how this all worked.” Belesky adopted the releasemust-be-signed policy at the recommendation of the NATA and modeled her form after one shown to Florida athletic trainers by David Jones, ATC, Director of Sports Medicine at Jackson
Hospital in Montgomery, Ala., and the Southeastern representative to the NATA Governmental Affairs Committee. “I was kind of surprised to hear our lawyer say it wasn’t really necessary,” Belesky says. “But to be safe, we’re doing it anyway. My school is very expensive and we have lawyers’ and doctors’ children here. It would be very easy for someone to misconstrue something or take something the wrong way.” Requiring such forms shows an athletic trainer’s professionalism toward personal health information,
says Webster, and can put parents and others at ease—especially important as more people encounter HIPAA notices when they visit their own medical providers. “If parents think providers aren’t taking the same care to protect the medical information of their son or daughter, they’re bound to ask more questions,” Webster says. “It should make the parents or the adult athletes less leery as to where their records are going and for what purpose. Obviously, there’s more to HIPAA than that, but to me, that’s the gist of it.” ◆
The following are links to two sample student-athlete authorization forms: Miami Country Day School: www.miamicountryday.org/athletics/HIPAA_form.htm University of Oklahoma Department of Intercollegiate Athletics: www.ouhsc.edu/hipaa/docs/HIPAA_AthleticDeptAuthorizationForm_3-10-03.pdf
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HEADof the Class
athletic trainer’s job description, delivering some of your knowledge may be the key to providing the best possible service—especially in a situation where an athletic trainer can’t be on every court or field, all the time. The challenge lies in deciding what coaches should learn and how you will teach them. WHAT TO TEACH
Photo: © Dede Hatch
Teaching your coaches some basics about sports medicine can ensure they are in sync with your procedures. Here are some tips on what to teach them and how. Athletic Trainer Christopher Hobler, in front, poses with Lansing (N.Y.) High School coaches Stuart Dean, Jason Eade, and Ed Redmond.
unning from school to school and field to field is nothing new for Christopher Hobler, ATC, who for 16 years has provided athletic training services for high schools in Upstate New York. Based out of the Orthopedic Surgery and Sports Medicine Group in Ithaca, Hobler facilitates sports medicine coverage for three school districts in the area.
Because of the large number of athletes he deals with and the distance between each school, Hobler can obviously provide only minimal services to his student-athletes. So to help make the athletes as safe as possible when he’s away, Hobler has taken to educating the coaches. While teaching the basics of sports medicine may not be a major part of an
BY R.J. ANDERSON
Deciding what your coaches need to know takes some thought. You don’t want to give them the idea that they can perform your job. In fact, you should do the opposite. You want to show coaches that athletic training is complicated, but if they are in sync with you on the basics, they can help you perform your job more efficiently and effectively. “Coaches may have the most pivotal role in the sports medicine chain,” says Melinda Flegel, MS, LAT, ATC, CSCS, Head Athletic Trainer at the University of Illinois Sportwell Center, an extension of the school’s student health center. Flegel, author of Sports First Aid, a guide for coaches, adds, “It’s a difficult position because they have to communicate with athletes, parents, and sports medicine personnel. And, in most cases, they are the primary responder. So they have to know the basics, but at the same time, to be safe, coaches also have to know their limits.” Most athletic trainers agree that the base-level requirement is CPR and first aid. Though coaches can attain certifications from a variety of outlets, Hobler feels that the most effective teaching scenario is when he instructs his coaches. “I prefer it that way because I can get all the coaches together, and I can handle administrative questions or policy issues,” he says. “I also make sure to hold the training at their respective schools—a setting in which the coaches are relaxed, comfortable, and more likely to ask questions.” Dealing with a medical emergency R.J. Anderson is an Assistant Editor at Training & Conditioning.
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Preseason Screening t the University of Illinois, Melinda Flegel, MS, LAT, ATC, CSCS, primarily treats athletes who are hurt in club sports or intramural-related activities. To both help prevent injuries and educate the club coaches on some sports medicine basics, she runs a preseason fitness assessment program for the school’s 50 club teams. “The point of the preseason screening is to explain what the overuse injuries are for each sport, then apply a specific test to look for any muscle imbalances that can lead to those overuse injuries,” says Flegel. “The screening sessions can be very time-consuming. But if you get the coaches involved, it will go much quicker, and at the same time, you can teach them basic assessment techniques.” To replicate her process, Flegel recommends teaching coaches simplified techniques. For example, to check any deficiencies in hamstring flexibility, she has athletes lie on the ground with one leg perpendicular to the floor and the other straight ahead. “You can show the coaches what to look for and give them specific exercises to work on based on what they see,” she says. “And then you help the coaches figure out a sport-specific conditioning program to help the athletes individually or as a group.”
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is another must-teach subject. Your school probably has written guidelines for its emergency plan, but you may want to supplement that information with education on specific life-threatening scenarios. “I would make sure to teach coaches how to handle wound care basics,” says Flegel. “What they should do if somebody is bleeding heavily, or if they can’t get the bleeding to stop. I would talk about when athletes should be taken for stitches and when to call for an ambulance. I would also go over splinting and assessing when an injured athlete needs to be immobilized.” Hobler worked with athletic directors to revise the emergency guidelines at two of his schools to include regulations for dealing with specific injuries and situations. The changes included how to treat concussions and other head injuries, and when to call an ambulance. His input also led to making pre-practice warmups standard procedure and a mandate for readily available practice-field ice and water. Hobler says this input has made his services more effective. Hobler also finds coaches need some instruction on assessing an athlete’s pain. “They need to be aware that the ‘no pain-no gain’ philosophy
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of years ago is obsolete,” he says. “Coaches need to know that athletes should not push through pain, and that they should encourage an athlete to be in tune with their body and its limits.” “Lots of coaches want to think, ‘He’s just not real tough and that’s why he continues to complain about this or that,’” says Larry Gurchiek, DA, ATC, Professor of Health and Physical Education at the University of South Alabama. “But most of the time, kids are tougher than we give them credit for—coaches need to understand that an athlete may not be performing well because he or she is in pain and has an injury.” Jerry Whetstone, MEd, ATC, Coordinator of Athletic Training Services at Ohio’s Kettering Sports Medicine Center, tells his coaches that a good time to address individual aches and pains is during post-activity stretching sessions. “We encourage them to watch their athletes closely and listen to what they are saying during this time, and maybe have a question and answer period about each team member’s injuries,” he says. “It’s also an opportunity to encourage those athletes who are hurting to get attention from the athletic trainer.” Strength and conditioning is an-
other area not to neglect. An athletic trainer should not be expected to develop a strength program for every team, but teaching some basic concepts can go a long way in preventing injuries. The most obvious may be the importance of flexibility training. Though embraced more and more, stretching remains an area where coaches can benefit from more information and prodding—especially in using stretching during cool-down periods. Whetstone—whose clinic provides athletic training services for 21 high schools, two community colleges, and two professional teams—says athletic trainers should also stress the importance of each player keeping a personal fitness log to record their training. “We tell our coaches to be wary of the repetitions they have each individual athlete do,” he says. “With plyometric training, for instance, you can’t say, ‘Day one everybody is to do
10 jumps. Day two everybody should do 20.’ In reality, on day two there are going to be athletes still struggling to do 10. You have to advance your athletes on an individual basis, while at the same time advancing the group.” Hobler finds strength training education especially important for multisport coaches. “Most high school coaches tend to generalize too much,” he says. “I’ll see a baseball coach who is also a football coach have all his athletes go in the weight room and do a ton of bench pressing. That might be okay for football players, but it’s not okay for baseball players.” To prevent these kinds of errors, Hobler meets with the coaches who utilize weight training and presents them with a basic, sport-specific program for their athletes. “I’ll sit down with the baseball coaches and give them lists of exercises to do in preseason to prevent shoulder problems, and I do the same thing for soccer coaches to reduce knee injuries,” he says.
HOW TO TEACH
Just as important as figuring out what to teach your coaches is determining how to best educate them. Sometimes it’s a balancing act between not stepping on the toes of the veteran coach who already knows some of what you’re teaching, and reaching the new coach who may be reluctant to ask any questions. Usually a mix of formal and informal methods works best. Hobler likes to start each sport season with a mandatory refresher course for all his coaches. Whether it’s to satisfy a first aid certification for the state or fulfill a staff requirement made by the athletic director, the course allows Hobler to impart knowledge to coaches he will be working with throughout the year. By getting all the coaches together, Hobler is able to keep the entire staff’s base of knowledge on a somewhat even level. It gives him a chance to find out what each coach knows about dealing with injuries. And it
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allows him to go over the specifics of the school’s injury treatment protocol. The courses, which generally last two hours, start with a 15-minute section on administrative issues like physicals and emergency contact information. Hobler then moves on to a section he calls sprains and strains. Starting with the shoulder and working his way down, Hobler describes every joint and the common injuries associated with each. “Instead of showing slides of each body part, I like to perform demonstrations on somebody from the audience,” he says. “I’ll show the group how I look at an ankle and what I’m looking for. I also go over what I’m asking the athlete while I examine the ankle in terms of trying to assess the injury.” Hobler says he finds demonstrations are more effective than slides when discussing anatomy and physiology, because they keep his audience involved. He also tries to show his coaches what type of injuries can be
“I’ll give them some information about asthma they might not know, and ask them questions like, ‘If half your team has asthma, how many inhalers should you have in your medical kit?’” treated with ice and elevation, and which require a visit to the emergency room. Going over sprains and strains is also a good time for Hobler to talk about common injuries he’s seen at his clinic and read about in trade periodicals. “For instance, when I talk about the knee, I’m going to cover ACL tears,” says Hobler. “And then I bring up a more current trend: how ACL tears among female basketball and volleyball
players are increasing at an alarming rate. Then I tell the coaches my opinions on why that is happening.” By introducing current events into a spiel that some coaches have heard for the last 10 or 15 years, Hobler is able to hold the group’s attention, whether it’s the first or the 10th time a coach has heard him talk about ACL tears. And that’s something he finds key to fostering discussion and provoking questions. “This year I’ll probably talk about steroids and supplements, as well as asthma—which seems to be affecting more and more high school athletes,” Hobler says. “I’ll give them some information about asthma they might not know, and ask them questions like, ‘If half your team has asthma, how many inhalers should you have in your medical kit?’ “With supplements, I’ll talk about the stuff that’s banned and encourage the coaches to post that information in the locker room,” he continues.
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“Then, I’ll encourage them to take a glance into the kids’ lockers as they walk around the locker room, and if they see something that shouldn’t be there, to talk to the kid and his or her parents.” Hobler estimates that he spends nearly half of a two-hour session discussing emergency preparedness. “I want them to be aware of how to handle difficult situations before they arise,” he says. “After they leave my course, I want them to think, if somebody gets hurt, ‘Where’s the nearest phone or the nearest AED?’ Or if a kid loses consciousness without having received a head injury, I want them to be able to recognize immediately that it’s probably a cardiac problem. That way they won’t waste time wondering what to do. I want them to think about it beforehand because that’s going to save lives.” Kathleen English, MS, LAT, ATC, a Primary Instructor and Clinical Supervisor at the University of Neb-
“The athletic trainer needs to develop a relationship that encourages a coach to invite them in and say, ‘Here’s what we are doing. Do you see anything we are doing wrong?’” raska-Kearney, says role play is an effective vehicle for delivering information. “Role play opens some eyes by allowing coaches to anticipate how something is going to happen, and how they will respond,” says English, who uses role play in a class for prospective coaches. “Where role play becomes important is learning how to deal with variances. The more times you are exposed to those types of things, the better prepared you are to make a pru-
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dent decision in regards to the athlete’s needs.” To incorporate role playing, English, the former Head Athletic Trainer at Nebraska-Kearney, recommends setting aside time during the preseason to target athletic injury management and care—possibly a half a day. Another formal way to teach is through handout materials. Gurchiek suggests using guidelines put together by an accredited organization—especially if you have coaches resistant to your advice. Flegel backs up her information with handouts heavy on illustrations and diagrams. Though often informative and full of great advice, handouts are effective only when the coaches actually take the time to read them. “Let’s say there’s an article in Training & Conditioning that we may be able to use,” says Whetstone. “I’ll make a copy for the coach and hand it to him and say, ‘Hey coach, I just came across this article and I thought it
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might be of interest to you.’ Then, maybe the next day I’ll see the coach and say, ‘Did you get a chance to read that article on plyometrics?’ If he hasn’t, I’ll follow up with something like, ‘Why don’t you go ahead and read it, I think it would be helpful, especially as we move forward with our conditioning program.’” Whetstone says he continues to follow up until the coach shows that he has read the article. And, he adds, you can usually tell that they’ve read the article because they’ll have questions. “The whole point is to stimulate them so that they open the door and ask you questions,” he explains. Don’t forget that all the education does not have to come directly from you. Gurchiek suggests setting up workshops run by strength and conditioning experts from clinics or local college and university athletic programs. By encouraging a coach to tap into that type of expertise, an athletic trainer is able to provide continuing education in a setting that will grab a coach’s attention in a manner that resonates without offending. ONE-ON-ONE
As effective as hand outs and mini-clinics can be for educating coaches, don’t forget the importance of old-fashioned interpersonal communication. That often means visiting each coach individually on a regular basis. “In order to approach every coach at a school, the athletic trainer has to be pretty organized,” says Gurchiek. “You can’t go in and try to wing it—you must have a program and plan out what you are going to say to each coach. I would say something like, ‘Coach, here are some things you’re going to see with soccer, here are some things to be aware of in preventing knee injuries. Here’s what we’re doing with these injuries, and here are some things you can do to give your athletes better care and help you make better decisions until we can get out there and help you.’” The key, says Gurchiek, is to present yourself as a partner to the coach, not just an authority figure on sports medicine. “The athletic trainer needs to develop a relationship that encourages a coach to invite them in and say, ‘Here’s what we are doing. Do you see anything we are doing wrong?’” he says. Hobler has found this approach effective with his coaches. He points to a situation a couple years ago in which many of the school’s football players developed shoulder problems. “The coach and I sat down together and said, ‘Why are we having all these bad shoulders,’” says Hobler. “We went over their workout routine and found out that they were overemphasizing the bench press—they were doing just one push, like it was a competition to see who could do the most weight.” Hobler says that once they modified the players’ weight lifting habits, the shoulder problems went away. Whether full-time or part-time, an athletic trainer’s main concern is providing care for student-athletes. By setting aside a little bit of time to spend with your coaching staff to share some of the basics of sports medicine, athletic trainers might find their jobs become easier and their care more comprehensive. ◆
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nf u o C se d
ust as athletes are starting to get the message that consuming carbohydrates is an important component of enhanced performance, the anticarb movement has begun jockeying for position again. From Atkins to advertising, the anti-carb movement has many athletes doubting the standard sports nutrition recommendations. Athletes need to be able to separate fact from fiction. Yes, low-carb diets can lead to weight loss. Yes, lowcarb diets can provide a healthy alternative for many non-athletes. But they’re not right for everyone, and athletes who follow low-carb diets will only compromise their performance. With a glut of misinformation in the market, your athletes need to know the facts about healthy nutrition. Fact number one is that carbohydrates are a necessary part of any healthy diet. Fact number two is that carbohydrates have always been and will always be the primary energy
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The low-carb diet fad has some truth in it, but it’s not for competitive athletes. Our nutrition expert gives the skinny on carbohydrates and performance. substrate for most exercise. Fact number three is that athletes who cut carbs will pay the price with decreased speed, strength, and stamina. THREE POINTS
Let’s begin this discussion with a definition of carbohydrate. A carbohydrate is a macronutrient composed of carbon (carbo-) and water (-hydrate). Carbohydrates are composed of saccharides (sugars) of varying length. Point No. 1. We eat food, not just
carbohydrates. Some foods are primarily carbohydrate, such as carbonated beverages. Others, such as skim milk, are a mix of carbohydrate and protein. Point No. 2. The categorization of carbohydrates into two types, simple and complex, is much too simplistic for today’s athletes. Using these terms may persuade people to cut foods from their diet unnecessarily, making the incorrect assumption that simple carbohydrates are bad and complex carbohydrates are good. The facts are more complicated. Some of the foods that people traditionally classify as simple carbohydrates—fruit, non-starchy vegetables, honey, maple syrup, grains (rice, corn, oats), and dairy foods such as milk and yogurt—are often a healthier choice than the foods we think of as complex carbohydrates. In addition, some complex carbohydrates, such as sweetened cereals, have fiber removed, and may not be as nutrient-dense as simpler carbohydrates like fruit and non-starchy vegetables (green beans and broccoli, for example) which contain fiber, phy-
by tonutrients, vitamins, and minerals. Point No. 3. Contrary to the titles of today’s top-selling diet books, your athletes need to eat a balanced diet that includes all kinds of carbohydrates. CUTTING CARBS
Low-carb diets are hot right now as the way to lose weight. According to a number of popular plans, most carbs are bad and need to be eliminated. At the same time, new low-carb products are flooding the marketplace and “success stories” abound of people who have lost weight by severely limiting or eliminating carbs. Why do people lose weight on low-carb diets? For one thing, there are fewer food choices, which makes the diets easier to follow. Many people on low-carb diets also say they are simply not as hungry, which may be because protein makes people feel fuller, and also because low-carb diets typically allow high fat foods, which also contribute to satiety. And decreasing carbohydrate intake results in fluid loss, which shows up on the scale as rapid weight loss.
? s b r a C In addition, it’s harder to cheat on a diet that restricts carbohydrates. Many carbohydrate-containing foods are handheld and ready-to-eat, like bagels or crackers, whereas proteincontaining foods tend to require preparation, utensils, and sit-down meals. Carbohydrate-containing foods are more likely to be eaten as snacks and on the go, which can lead to mindlessly consuming much more than is healthy. PERFORMANCE FACTORS
If low-carb diets result in weight loss, why shouldn’t athletes jump on the bandwagon and start cutting carbs? Because carbohydrate, not protein or fat, is stored in the muscles and liver as glycogen, which provides fuel for exercising muscles. The body cannot manufacture its own carbohydrate. If carbohydrate needs are not met, the body will either break down stored fat to provide fatty acids (which can in part be converted to glucose through a process known as
BY LESLIE BONCI
ketosis) or break down lean muscle mass to yield glucose. Most athletes would probably rather preserve muscle mass, and stored fat should be a fuel substrate for exercise, not a substitute for adequate carbohydrate intake. It is also important to realize that exercise itself depletes glycogen stores, which need to be replenished with carbohydrate, not protein or fat. Consuming carbohydrate before exercise can help prevent hunger, delay fatigue, and provide energy during the workout. Eating carbohydrate post-exercise expedites liver and muscle glycogen resynthesis so that athletes can recover more quickly. Amazingly, there are low-carb sport bars, no-carb sports drinks, and many “energy” products with water, caffeine, and artificial sweeteners as the primary ingredients. They may taste sweet, but they are not very healthy for an active body. Leslie Bonci, MPH, RD, is Director of Sports Nutrition at the University of Pittsburgh Medical Center and serves as a consultant to the Pittsburgh Steelers, Pitt athletics, and several area high schools.
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USING THE INDEX igh glycemic index foods are recommended for rapid repletion, while moderate and low glycemic index foods are preferable for endurance exercise. Here are some examples:
HIGH GLYCEMIC INDEX FOODS Angel food cake Sucrose Pretzels Sports drinks Doughnuts/croissants White bread Rye bread Hard candy Toaster pastries Bagels English muffins Watermelons Cold cereals Raisins Couscous Ice cream Pancakes/waffles Corn chips Honey/syrup Molasses Baked/mashed potatoes
100% whole wheat bread Oat bran bread Brown/white rice Basmati rice Pasta Barley/bulgur Buckwheat Citrus juices Corn Peas Sweet potatoes Oatmeal/oat bran Low-fat ice cream Candy bars Powerbars Grapes
MODERATE GLYCEMIC INDEX FOODS Sponge cake Mangoes/kiwis Banana Tortillas Pita Seven-grain bread
LOW GLYCEMIC INDEX FOODS Milk Nine-grain bread Plums 100% bran cereal Yogurt Citrus fruits Beans Nuts Rice bran Apples Apple juice Lentils Raw peaches Tomato soup Tomato juice Ironman bars Dried apricots Raw pears Chickpeas Hummus
How much carbohydrate is enough to fuel optimal performance? The Institute of Medicine’s Dietary Guidelines revisions call for a diet containing 45-65 percent of calories from carbohydrate and not less than 130 grams of carbohydrate per day. (By contrast, some of the low-carb diets recommend an initial carbohydrate intake of 20 grams a day—the equivalent of six ounces of orange juice, four gummy candies, or twothirds of a cereal bar.) Some athletes may do better with a higher percent of calories from carbohydrates, whereas
others may prefer a more moderate carbohydrate intake, but no athlete will improve performance when the carbohydrate content of their diet is less than 45 percent of their daily caloric intake. To help athletes translate the 45 to 65 percent recommendations to information they can use to plan meals, have them imagine their plate divided into thirds. The protein should fit on one third, while the rest of the plate should be covered with carbohydrate-containing grains, fruits, and vegetables.
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DISCRIMINATE, DON’T ELIMINATE
Better advice for athletes is to discriminate, not eliminate, when it comes to carbohydrates. Portions, timing, and type of carbohydrates chosen are extremely important. Instead of relying on simple and complex categories, experts have turned to a new system for sorting carbs: the glycemic index. The glycemic index helps athletes adjust carbohydrate intake by choosing and timing carbohydrates according to the glycemic response, or effect on blood glucose and insulin levels. Basically, eating any carbohydrate-containing food results in an increase in blood glucose levels, causing insulin to be secreted from the pancreas. The higher the blood glucose, the more insulin is released. Some scientists believe that the extent and rate at which carbohydrate-containing foods increase blood glucose and the insulin response may affect the risk for obesity, cardiovascular disease, hypertension, and Type II diabetes. In the glycemic index system, carbohydrate-containing foods are classified according to how quickly and how much they raise blood glucose levels (i.e., their glycemic index). Foods with a lower glycemic index raise blood glucose slowly, whereas foods with a higher glycemic index raise blood glucose more rapidly. The glycemic index of a food is affected by: Particle size. Larger particles take longer to digest and slow the rise of blood glucose. That’s why regular oatmeal has less of an effect on blood glucose than instant oatmeal, which has a smaller particle size. Soluble fiber content. Foods like oats, barley, and dried beans take longer to digest and therefore the body’s glycemic response is more gradual. Fibrous coverings. Foods such as beans and seeds take longer to digest, lowering their glycemic index. Acidity. Acid-containing foods such as fruit, vinegar, and pickled foods take longer to digest. Fat content. Foods containing fat
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Sneaky Sugars thletes who make these substitutions at snacks and meals will get fewer carbs from sugar and more carbs from healthy fruits, grains, and vegetables.
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INSTEAD OF Pretzels Frozen yogurt Chips White rice Lettuce salad Pasta with marinara Sub on white bread Taco salad Corn flakes
CHOOSE Trail mix with wheat chex, dried fruit, and some nuts Fruit flavored yogurt Popcorn Brown rice Marinated vegetables Higher protein or wheat pasta and add vegetables to the sauce Sub on whole grain Chicken or steak fajita with vegetables or salsa in a whole wheat tortilla Cheerios
take longer to digest. Sugar type. Fructose takes longer to digest than glucose. From a sports perspective, foods with a higher glycemic index will produce a greater and more rapid change in insulin, resulting in enhanced glycogen replacement in the muscle. When the goal is rapid repletion, there may be an advantage to consuming higher glycemic index foods. Moderate and low glycemic index foods take longer to enter the bloodstream and may be preferred for endurance exercise to promote sustained carbohydrate availability. I recommend that my athletes choose carbs based on the duration of their events. Athletes who have early morning practice and no time for preparing breakfast beforehand may benefit from carbs that are processed more quickly, such as sports drinks. Athletes who have long or back-toback events may feel better with a longer-lasting grain such as oatmeal, whole grain waffles, or toast before exercise. (For lists of other high, moderate, and low glycemic index foods, see “Using the Index” on page 28.) LOW-CARB PRODUCT CRAZE
What about choosing low-carb versions of regular foods as a way to keep carbohydrate intake at the recomRequest No. 20 30 ◆
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mended 45 to 65 percent? New lowcarb foods are everywhere, from health clubs to fast food restaurants. Some of the more popular products include low-carb beer, pasta, candy, chips, muffins, pizza crust, bagels, cereal, sports drinks, and milk (the lactose is replaced by artificial sweetener and extra protein). However, these foods are not the best choices for athletes. Some lowcarb products are actually higher in calories and fat than the regular-carb versions. Others contain sugar alcohols, which can have a laxative effect. Some have an unpleasant taste and texture, and most cost significantly more money! When low-carb foods are added to a low-carb diet, variety goes up, but with it go calories, portions, and weight. In addition, there is no industryaccepted definition for low-carb. Even more misleading, many products advertise on their labels the number of “net carbs” or “net effective carbs” in the food. The manufacturers have used net carbs as an advertising gimmick to make people believe that they are consuming fewer calories. This figure on the label is determined as follows: Net carbs = Total Carbohydrates – Fiber – Sugar Alcohols – Glycerine. The assumption is that fiber, sugar
alcohols, and glycerine do not contribute significant amounts of calories and don’t have to be counted, but this is an oversimplification. There are many factors that affect the glycemic response of a particular food, and lower net carbs doesn’t necessarily mean a lower glycemic index. I caution my athletes to look at all of the nutrition information on the label of a food that claims to have a low number of “net carbs.” Often, they’ll find that the product contains the same number of calories as regular versions of the same food. Also, although fiber is not a calorie source for the body, sugar alcohols and glycerine are, so the bottom line is that carb-free does not mean calorie free, and low-carb foods still need to be accounted for in the daily caloric intake. As nutrition sources, low-carb chips and muffins are not equivalent to fruits, dairy foods, and vegetables. Instead of going for low-carb gimmicks, athletes would be wise to meet their carbohydrate needs through fruit, dairy
products, and grains, while limiting added sugar in desserts and snacks as well as high fructose corn syrup in soft drinks and sweets. PORTIONS MATTER
While it’s essential for athletes to consume a diet high in carbohydrates, it is possible to have too much of a good thing. One reason it’s easy to overdo carbohydrates is that it’s easy to lose sight of what constitutes a portion of many carbohydrate-containing foods. There is a disconnect between true serving size and most student-athletes’ definition of a portion. I always tell my athletes, “Never eat anything bigger than your head,” and as silly as that advice sounds, it reminds athletes to think about portion size. Controlling portion size is easier said than done given the fact that a standard bottle of soda is now 20 ounces and contains two-thirds of a cup of sugar. A snack serving varies from the tiny one-ounce packages served on airplanes to the five-ounce
convenience store bag. To help your student-athletes visualize appropriate serving sizes, give them the following examples: • A two-ounce bagel is the size of a yo-yo, not a Frisbee. • A cup of cereal is the size of a rolled up pair of sports socks, not the sports bag. • A cup of hot cereal, pasta, or rice is the size of a tennis ball, not a basketball. • A potato is the size of a computer mouse, not the monitor! FUELING THE BODY
Despite popular diet fads, athletes will still run faster, lift more, and last longer with pasta than poultry. The body needs to be fueled, not fooled. It is the responsibility of the athletic training staff, coaches, and all others involved in the athlete’s care and well-being to encourage and recommend a varied eating plan with carbohydrate-containing foods and beverages as a major player at every meal and snack. ◆
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TREATING THE ATHLETE
“Rotator cuff injury” has become a common term for a sometimes misunderstood condition. Effective treatment starts with a precise diagnosis.
ith baseball season upon us, rotator cuff injuries are on many athletic trainers’ minds. Last year, in the professional ranks alone, we saw Ken Griffey Jr., Troy Glaus, and Mike Remlinger, to name a few, suffer from rotator cuff injuries.
Photo: © Getty Images
ROTATION at the Shoulder Chicago Cubs relief pitcher Mike Remlinger underwent arthroscopic rotator cuff surgery last fall.
Of course, this injury can affect athletes in almost any sport. The term “rotator cuff injury” has evolved to be a blanket term for shoulder injuries. The rotator cuff is actually four muscles in the shoulder that hold the humerus in place. But the public and some medical practitioners are using the term whenever some portion of the shoulder complex is involved in the athlete’s shoulder dysfunction. Comprised of the supraspinatus, infraspinatus, teres minor, and subscapularis, the rotator cuff controls fine movement at the glenohumeral
BY JODIE HUMPHREY
joint. It functions primarily to center the humeral head in the glenoid fossa by a suction cup process known as the circle concept. All four of these muscles are engaged in a tug-of-war, and in a healthy, normal shoulder there is net equilibrium to balance these forces in any movement pattern in space. However, if the balance is disrupted, injury and pain occur. The athlete’s shoulder complex is attached to the entire body, of course, Jodie Humphrey, PT, ATC, CSCS, is a Physical Therapist for Complete P.T., in Los Angeles, and a former Sports Medicine Coordinator for HealthSouth in Warwick, R.I.
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TREATING THE ATHLETE
In the Weightroom
he following are some do’s and don’ts for an athlete lifting weights with shoulder pain:
AVOID • • • •
Deltoid work and military press beyond elevation range. Hyperextension beyond the plane of the body. Sacrificing proper mechanics to lift heavier weights. Allowing poor mechanics and asymmetries in posture to follow the conditioning regime.
DO • Seek medical attention early in the onset of shoulder pain, particularly if it’s gradual, since the microtrauma has been hiding for some time before pain is felt. • Perform two sets of pulling exercise for every one set of pushing. • Stabilize the core by blocking: Contract the abdominal and pelvic muscles so no spinal movement occurs as another adjacent joint performs the exercise. • Isolate the rotator cuff with exercises at 8-10 percent max bench press weight. • I’s, T’s, Y’s, external rotation at 90 percent, and serratus punches for scapular stabilization. • Functional total body patterns to facilitate kinetic chain biomechanics. • Chin ups, chin ups, and more chin ups. hence looking at the entire kinetic chain is also important. A rotator cuff injury is the end result of a failure somewhere in the kinetic chain throughout the whole body. SYMPTOMS & CAUSES
A rotator cuff tear can occur at the muscle belly, the muscle-tendon junction, the tendon, or the insertion of the tendon to one of the bones, scapula, or humerus. The symptoms that commonly occur with rotator cuff injuries are pain, weakness, and loss of motion in the shoulder. Some athletes will feel a pop in their shoulder after which they cannot lift their arm very well. Others will report a gradual onset of shoulder symptoms, like grinding or clicking, but may not experience any loss of motion. A significant traumatic force is required to tear a healthy rotator cuff. Most often, however, rotator cuff tears result from a combination of trauma and degenerative changes. Degeneration causes muscles and tendons which should not normally be 34 ◆
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working to assist in producing the equivalent net force and power that the activity demands. The degenerative process usually starts with swelling and inflammation in the bursa from repetitive motion activities at or above shoulder level. This process causes compensatory muscles to engage during the activity to produce the required forces for the sport. This process continues until the rotator cuff tendons fight for space and develop a tendonitis. Continued overuse due to the tendons’ weakened state leads to further degeneration. Think of a rope fraying from friction around a sharp edge, and the movement of the rope causing further breakdown of the rope’s strands. Eventually the fibers tear at the surface where the point of excess friction is applied. Of course, not all rotator cuff injuries occur in isolation. Injury at other muscles, tendons, ligaments, joint surfaces, and other non-contractile supporting soft tissues can occur. With all these variables assessed
for performance deficiencies, the level of rotator cuff dysfunction can be determined and classified in a more appropriate categorization of mild, moderate, or severe shoulder complex dysfunction. That’s why the diagnostic process is so important. MUSCLES & TENDONS
All the muscles that act at the shoulder joint have one of two purposes: either to stabilize or to mobilize. A football lineman’s rotator cuff functions to produce a greater stabilizing force than a baseball pitcher’s. The baseball pitcher’s rotator cuff, in turn, functions with a greater endurance and aerobic capacity. The stabilizer muscles are those that primarily hold the joint in place so the larger muscles can produce power and strength. The stabilizers are the rotator cuff and the musculature around the scapula, which keep the scapula anchored to the thoracic wall via the spine. The scapula is stabilized to the spine by muscular actions of the levator scapulae, trapezius, rhomboid major, rhomboid minor, and serratus anterior. The stabilizing force couples at the shoulder complex provide the stable foundation for mobility to occur, particularly at high velocities in the athletic population. The stability is the hinge for all functional strength and power, since the body inherently limits muscle strength gains without a sound foundation to build upon in an automatic self preservation tactic. The mobilizers generate strength, power, and speed. These are the larger muscles traditionally involved in weight training circuits. Those that exert force over the shoulder joint are the rhomboids, levator scapulae, pectoralis major and minor, and latissimus dorsi, which are trained in the seated row, shoulder shrugs, chest press, and lat pull downs, respectively. Other combined contractile forces to consider at the shoulder complex include: • Deltoid (anterior, middle, and posterior heads) • Infraspinatus, teres minor, and subscapularis • Teres major, coracobrachialis • Biceps brachii and triceps.
The shoulder complex musculature needs to be assessed considering force production requirements of the sport (strength, endurance, and flexibility), and work-rest intervals specific to the shoulder complex. To assess scapulohumeral rhythm, look for muscular forces that are in line with the following: • Upper trapezius should be most active in coronal plane, with abduction less than 60 degrees. • Lower trapezius abduction should be most active when greater than 90 degrees. • Serratus anterior should be most active in forward flexion. • Middle trapezius should be most active during abduction at 90 degrees, and scaption less than 90 degrees. • Rhomboids should be most active at flexion and abduction at end range. The process of assessing mobility in the rotator cuff muscles is depicted well in Muscle Stretching in Manual
Therapy, by O. Evjenth, MS, and J. Hamberg, MD. They describe the best stretches in these positions: Supraspinatus: Athlete lies on his or her side with wedge in axillary, and force is applied while the shoulder is in a slight extension as the arm is adducted across the back. Subscapularis: Athlete lies supine with elbow flexed 80 degrees, abducted 30 degrees, and force is applied to externally rotate the shoulder with forearm supinated. Teres minor: Athlete sits with shoulder in full flexion with elbow flexed 90 degrees, and force is applied into internal rotation. Infraspinatus: Athlete is supine with shoulder abducted 80 degrees and elbow flexed 90 degrees, and force is applied into internal rotation. When muscles and tendons are involved, we need to incorporate a gradual progressive resistive exercise program. With injury, the muscle’s cellular system is disrupted, partly
Stabilize. Strengthen. Support.
TREATING THE ATHLETE
due to nerve disruption. Some portion of communication with the tissue is temporarily out of order. It is difficult to speak of muscles’ healing properties without acknowledging this relationship, which is critical in the healing process. As the axon approaches the muscle fiber for innervation, it loses its myelin sheath and branches into an array of terminal fibers, called motor end plates. Essentially, healing of the muscle injury is strongly dependent on the amount of shearing to these motor end plates and the axon. The supraspinatus tendon is most often involved in rotator cuff injury, because its position makes it most susceptible to impingement. For tendon tears, the connective tissue reestablishes its firm attachment of myofiber ends with scars. But excessive connective tissue scar formation between stumps may impede regeneration of myofibrils and re-innervation of abjunctional stumps. This means
ow your patient can have support with unrestricted ROM. Cadlow™ Shoulder Stabilizer helps prevent recurrent shoulder subluxations and dislocations, alleviating the fear of pain or re-injury. This dynamic shoulder stabilizing brace provides glenohumeral stability and maintains full ROM. Useful for pre- and post-op strengthening. Cadlow™ system includes compression shorts, harness and progressive resistance tubing.
Call or e-mail for free CD or video showing Cadlow™ in action.
For more information, contact: DM Systems, Inc. 1316 Sherman Avenue Evanston, IL 60201 800.254.5438 Fax: 847.328.9561 firstname.lastname@example.org www.dmsystems.com Patent No. 5,163,450
© 2004, DM Systems, Inc. All rights reserved. 1103-10
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TREATING THE ATHLETE
the tendon will heal with a lesser percentage of ROM than normal, and a weak link will occur. The balance at the tug-of-war will be disrupted, setting the stage for further pain and degeneration. JOINTS & NON-CONTRACTILE SOFT TISSUES
When diagnosing an athlete with shoulder pain, first examine the tissues and joints involved. Particular to the shoulder complex, the sternoclavicular (SC), acromioclavicular (AC), glenohumeral (GH), and scapulothoracic (ST) are the direct articulations that need thorough evaluation. Another primary cause of painful arc is the subacromial joint (SAJ), which defines the space between the coracoacromial roof and the humeral head that houses the deep portion of the subdeltoid bursa. Sternoclavicular: This intraarticular disk and fibrous capsule provide stability to the shoulder. They hold the clavicle in a normal resting position with a 10-degree upward
angle in the coronal plane. In arthrokinematic terms, it should have: • 45 degrees of movement with elevation. • Five degrees with depression. • 15 to 35 degrees of movement with protraction/retraction. • 25-50 degrees axial rotation. Note that the sternoclavicular joint is the foundation of the shoulder complex, since it is the last hinge that keeps the arm in neutral alignment. Once dysfunction affects this joint, the structural alignment for the whole shoulder complex and the entire kinetic chain must be considered. Acromioclavicular: This intraarticular disk and fibrocartilage is primarily stabilized by coracoacromial, coracoclavicular, and acromioclavicular ligaments. It has an inferiormedial oblique orientation. Its arthrokinematics around a vertical axis consist of the following features: • 15 degrees of scapular winging by clavicle rotation.
• Flexion/extension tilt is restricted by thorax-scapula space. • Abduction and adduction rotate scapula upward and downward. Subacromial: This provides a functional articulation between the coracoacromial arch and the head of the humerus. The costocoracoid fascia lies superiomedial to the pectoralis minor muscle and when contracture occurs, it causes loss of elevation of the arm. Soft tissue is often a culprit in the diagnosis of “subacromial bursitis.” Glenohumeral: This is a synovial, multiaxial ball-and-socket joint. The glenohumeral index, calculated by dividing the maximal transverse diameter of the glenoid by the maximal transverse diameter of the humeral head, is 57.5 in normal shoulders. Articular cartilage of the glenoid is thicker peripherally than centrally, whereas the cartilage on the humeral head is slightly thicker centrally. The anterior, superior, and posterior aspects of the capsule are reinforced by the
The Nesar 150 Shoulder Slide is a safe and easy solution to speed up the healing of rotator cuff injury The Nesar 150 Shoulder Slide is a 2 in 1 unit. Whether you use it for shoulder rehabilitation or for strengthening and injury prevention, it is very specific to the rotator cuff muscles and will help keep the cuff muscles balanced. I firmly believe that the Nesar 150 Shoulder Slide should be part of any basic shoulder rehabilitation program. It has made a difference in my recovery and I have witnessed it help others as well. Jeff Dawson Rehab Aide, Fitness Trainer, Three Time Shoulder Patient
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tendons of the rotator cuff, coracohumeral, and superior glenohumeral ligaments. The glenoid labrum is a flexible structure allowing adaptation of its shape to accommodate rotation of the humeral head. This deepens the glenoid cavity. If removed, there is a 20 percent reduction in resistance to superioinferior and anteroposterior translatory forces. Its arthrokinematics vary in two different research studies. The concaveconvex rule says the humeral head slides inferiorly during abduction, anteriorly during external rotation, and posteriorly during internal rotation. More recent research has shown that during the initial 30-60 degrees of elevation in the scapular plane, the humeral head moves superiorly three millimeters then stays centered within one millimeter; and during horizontal plane movement, the humeral head stays centered until maximal extension and external rotation (such as the cocking phase of pitching) when four millimeters of pos-
terior translation occurs. These studies suggest that movement of the humeral head is related to tightness in the joint capsule. Scapulothoracic: This area relies on force couples for orientation and movement patternsâ€”trapezius, rhomboid major and minor, and levator scapulae. It sits 30 to 45 degrees obliquely in the coronal plane with a forward tilt of nine degrees. The medial border of the scapula is oriented vertically. In a normal position, the glenoid fossa faces anterior, lateral, and five degrees downward. The scapulothoracic allows three rotatory motions (elevation/depression, abduction/adduction, upward rotation/downward rotation) and two translatory motions (protraction/retraction). Fifty degrees of scapular movement with protraction arises from translation of the scapula as 35 degrees of anterior clavicle movement occurs at the sternoclavicular joint when 15 degrees of rotation occurs at the acromioclavicular joint.
Request No. 25
TREATING THE ATHLETE
In regards to the joint surfaces, the SC, AC, and GH all function as ball and socket joints. When joint degeneration is present, there is low recoverability, whereas capsular restricted patterns mean high recoverability (in the sense of restoring normal joint mechanics, not necessarily equating to functional restoration). As for ligaments, they heal with scar similar to scarring elsewhere, but are mechanically inferior to normal tissue. During scarring, normal largediameter collagen fibrils in soft tissues are replaced with relatively small collagen fibrils. NERVOUS SYSTEM
If the nerve is traumatized, an extended time to fully recover is warranted due to its slow rate of repairing itself. When a nerve regenerating sprout does find an appropriate end organ (muscle cell or receptor), these regenerated and re-myelinated fibers have internodal distances, diameters, and conduction velocities around 80 percent of normal.
TREATING THE ATHLETE
Involvement of the nerve portion of the neuromuscular connection presents as muscle weakness, but overloading the muscle with resistance training to strengthen the muscle is similar to shooting the messenger. Denervation hypersensitivity is a symptom of nerve injury, and an example is a brachial plexus injury in which the athlete complains of alternating warm and cold sensations. At times the arm is warm (no vasomotor tone) and at other times cold and cyanotic (vasospasm), as a result of hypersensitivity to circulating epinephrine. Neuromuscular re-education involves working muscles and the nervous system together, with precise regard to timing, speed, power, strength, and rest-to-work ratio. The nerves and corresponding muscles that appear with a dysfunctional scapulohumeral rhythm include: Long thoracic ➪ serratus anterior Dorsal scapular ➪ rhomboids Suprascapular ➪ supraspinatus and infraspinatus
Axillary ➪ deltoid and teres minor Another variable is kinesthesia, or eye-hand coordination. Poor coordination results in inefficient movement patterns, which strain the rotator cuff. The work that the muscles perform in the arc of movement, considering millimeters of inaccuracy, will cumulatively affect the rotator strain. To associate the effects of this to an identifiable situation, consider walking with a small pebble in your shoe under the ball of your foot. The pressure over time will alter the way your foot position conforms to the ground to maintain the speed of walking. Eventually, pain occurs at stressed points that were not designed to bear weight in that fashion. Similarly, the kinesthesia at the shoulder complex adapts until pain sets in upon soft tissue destruction. As stated earlier, the body is designed to be self-guided in all of its systems, so this process of abnormal compensatory movement must be consciously re-trained.
Obviously, proper prognosis gets the treatment on the right track. Here is a list of questions to consider while diagnosing and coming up with a treatment plan: • What is the degree of movement dysfunction? • What are the diagnostic work-up results? • Does the patient need surgery? • Is the athlete willing to allot time for recovery? • How long has the problem been present? • Is there a prior injury to this area? • Is the cervical spine involved? Once damage to the tissue is determined through an evaluative process, and an understanding of the tissue’s healing capacity is appreciated, the treatment can be focused at the bull’s-eye. A complete biomechanical understanding is necessary for efficient implementation of treatment interventions. ◆
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T&C A P R I L 2 0 0 4 ◆
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C O M P E T I T I V E
E D G E
▼ With limited space and resources, NCAA Division III power Bridgewater College makes the most of its strength and conditioning program.
BY JOEY SOLTIS
ver the last four years, the Bridgewater College football team has become one of the top programs at the NCAA Division III level. This year’s senior class finished with a combined 45-6 record that included four straight NCAA playoff appearances, two South Region Championships, and an appearance in the national championship game. One reason for our success has been the student-athletes’ commitment to the strength and conditioning program. Like most Division III schools, we have limited resources and space available. One of our goals from a strength and conditioning standpoint is to not let any of these limitations keep us from fully developing our athletes. We consider ourselves fortunate to have a strength and conditioning facility dedicated to student-athletes. (There is a new fitness facility for the general student body elsewhere on campus.) And contributions from our football alumni have helped transform our weightroom from a place with old Universal machines and a few bench presses into a very effective weightroom with no shortage of weights, platforms, and power racks. However, the football team does share the weightroom with the other student-athletes at our school, and the
facility is usually pushed to its maximum limits. In addition, we have less mandatory practice time at the Division III level, thus less time to work with our players. Therefore, when developing a strength and conditioning plan for our football players, we pay close attention to scheduling, constructing efficient workouts, and figuring out how to motivate players without using a lot of hands-on supervision.
SCHEDULING & SPACE
We currently have 115 football players in our off-season program. In order to effectively deal with such a large number of players, we utilize several strategies. First, to keep lifting groups small, we organize hour-long time slots during the day for athletes to receive Joey Soltis is the Head Strength and Conditioning Coach and Wide Receivers Coach at Bridgewater College in Virginia.
A T H L E T I C B I D . C O M ◆ T&C A P R I L 2 0 0 4 ◆
C O M P E T I T I V E
E D G E
▼ Table One: Preseason Strength Work
he following plan is for our linemen during their last phase of summer workouts before reporting to training camp.
MONDAY Jump Rope Abs, 50-100 reps Clean & Jerk, 5x3 Bench Press (cycle)
THURSDAY Dot Drills Abs, 50-100 reps Snatch, 4x3 Bench Press (cycle)
WEEKS 1-3: Close Grip Rack Lockout, 6" Lockout, 3x3 Lying Triceps Extensions with Curl Bar, 1x15, 1x12, 1x10 Straight Bar Curls, 3x10
WEEKS 1-3: Alternating Dumbbell Bench, 3x5 Weighted Dips, 4x6 Dumbbell Curls, 3x8
WEEKS 4-6: Incline Dumbbell Bench, 3x5 Bodyweight Dips, 35 reps Incline Dumbbell Curls, 3x8 Neck Machine, 10 reps Bar Hang, 1:00-1:30 TUESDAY Speed Ladder Abs, 50-100 reps Split Squat & Press WEEKS 1-4: 3x4 (each leg) WEEKS 5-6: 2x3 (each leg) Power Clean (cycle) Clean Pulls (cycle) WEEKS 1-3: Lateral Squat, 1x6 Speed Squat (50% of Max), 4x5 Pull-Ups (vary grip), 3x5-10 WEEKS 4-6: Snatch Squat, 2x5 Box Step-Ups, 3x5 (each leg) Barbell Lunges, 2x5 Explosive Dumbbell Core Rows, 3x8 Calf Raises, 20 reps
WEEKS 4-6: Plate Raises from Squat Position, 2x10 One-Arm Core Press, 3x6 Dumbbell Lying Triceps Extensions, 6x8 (15 sec. rest) Straight Bar Curls, 1x15, 1x12, 1x10 Farmer’s Walk, 1:15-1:30 min. Neck Machine, 10 reps FRIDAY Jump Rope Abs, 50-100 reps Push Jerk Warmup, 3 reps WEEKS 1-2: 5x3 WEEK 3: 3x3, 3x2 WEEK 4: 3x3, 1x2, 3x1 WEEK 5: 4x3 WEEK 6: 3x3, 1x2, 2x1 Squat (cycle) WEEKS 1-3: Dumbbell Rows, 3x8 Stiff-Legged Deadlift, 2x10 WEEKS 4-6: Lat Pulldowns, 3x10 Glute Ham Raises, 2x10 OR Reverse Hyperextensions, 2x10 Calf Raises, 20 reps
supervised instruction. We begin sessions at 11 a.m. and go every hour thereafter. If they can’t make any of those sessions, they can come in at 40 ◆
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6:30 a.m. Either myself or my assistant is always there to supervise the group. We also try to fully utilize our weightroom space when designing
training programs. We do this by splitting our team into Cardinal lifters (beginner level) and Gold lifters (advanced level), with each group having a different emphasis at different times. For instance, on Monday, the Cardinal group will emphasize upper-body pushing movements while the Gold group will emphasize the lower body and upper-body pulling movements. To perform agility and speed development work during the winter, we utilize our rubberized hallways. In this limited space, we perform drills such as pro shuttles, tennis ball drops, arm action drills, speed ladder drills, resisted speed drills, and start drills. One of our resisted speed drill adaptations is performing belt starts instead of harness starts. Using practice pants belts, we are able to have a resisted start without the extra expense of purchasing harnesses. Because off-season work is voluntary in Division III, communication between myself and the head coach is important. By maintaining consistent communication, the head coach has a better understanding of who is putting forth the effort needed to improve. Since the head coach is aware of their weekly performance, the players see the strength and conditioning program as a high priority. Thus, they are less likely to miss workouts and more motivated to exert maximum effort each week. OLYMPIC LIFTS
Here at Bridgewater, we mainly focus on explosive Olympic lifts and their variations. Since we started emphasizing these lifts six years ago, our players have become more explosive and more successful on the field. As a general rule, we have found that athletes in Division III do not have the same hip mobility as Division I athletes. Therefore, we perform about 90 percent of the power movements from the floor. By performing lifts such as power cleans instead of hang cleans and adding hip mobility drills such as hurdle drills to the training regimen, we
Request No. 27
C O M P E T I T I V E
E D G E
▼ Table Two: Award Levels Position Linemen
Level Iron Eagle Gold Cardinal
Squat 500 450 420
Bench 330 315 290
Power Clean Total 290 1120 280 1045 255 965
TE, FB, LB
Iron Eagle Gold Cardinal
465 410 380
315 300 270
285 270 240
1065 980 890
Iron Eagle Gold Cardinal
415 380 355
275 260 240
255 240 225
945 880 820
QB, WR, CB, K
Iron Eagle Gold Cardinal
390 365 340
260 235 220
250 235 215
900 835 775
have fewer “stiff hipped” players than before we incorporated these lifts. We also like Olympic lifts and their variations because complex movements allow us to incorporate multiple body parts at once. This
allows us to more effectively use our limited time and space. For instance, some of the lifts we frequently perform are the clean and jerk, snatch squats, split squat and press, and the power clean-front squat combination. All of
these lifts also enable our players to learn better body control. We break our training year into five phases. The first phase generally consists of a six-week cycle that begins in January when the student-athletes return from semester break. During this phase, the student-athletes lift four days a week and do agility and acceleration drills twice a week. After completing this phase, we test each student-athlete. The second phase begins after the student-athletes return from spring break. Again, this is generally a six- to seven-week cycle with four days of lifting. However, we begin to incorporate more agility work as well as speed development work twice a week. Upon the completion of this phase, we test our athletes before giving them the two-week exam period off. The third phase, consisting of the next six weeks, marks the start of our summer workouts. In addition to our lifting and agility work, we begin to add
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Request No. 28
C O M P E T I T I V E
E D G E
▼ sprint conditioning drills twice a week. We become more position specific in the workouts during the fourth phase, which covers the last six weeks of summer before our players report. Skill players lift weights three days a week and perform sprint conditioning and agility drills five days a week. Linemen, tight ends, and linebackers maintain their previous workout regimen. We test our players when they return from summer break at the end of this phase. Most of our players do not stay on campus during the summer, so we don’t introduce any new lifts during the third and fourth phases. Many of our athletes use the strength training facilities at their former high schools while home for summer. If they can’t, we work with them to find an appropriate work out venue. We find they are self-motivated to complete the work, since it helps determine whether they will win a starting spot in the fall.
We test our players in three lifts, then categorize them by their scores. We break down the players by position and have four award levels. Tables One and Three provide an example of how we prepare our linemen for the final six weeks leading up to the camp reporting date. We use a variety of explosive lifts in addition to our core lifts consisting of the power clean, squat, and bench press to peak our athletes’ strength and power for the upcoming season. We also work in hand-speed drills to reinforce hand placements and generate punching power and upper
body endurance. Hip mobility drills are another important area we try to address throughout this phase. The fifth phase is our in-season work. Our top 60 players lift twice a week, while the other players lift three days a week. The extra day of lifting is designed to help those players develop enough strength and power to be effective on the field. MOTIVATIONAL TOOLS
One of the best motivational tools we use at Bridgewater College is our award level system. We test our players in three lifts—the squat, bench press, and power clean—then categorize them by their scores. We break down the players by position and have four award levels for each position (see Table Two on page 42). Our first award level is the Cardinal level. These numbers represent the minimum amount of weight we think a player should be able to lift
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C O M P E T I T I V E
E D G E
▼ Table Three: Preseason Conditioning Work MONDAY PRE-WORKOUT High Knees Walking Toe Touches “B” Skips Low Shuffle Form Starts, 5 sets x 10 yd. Jump Rope Abs POST-WORKOUT Weeks 1-2: 3 x 400s (Rest 2:50 between sprints) 4 x 200s (Rest 1:30 between sprints & 2:00 after last 200) 5 x 110s (Rest 45 sec. between sprints) 6x 40s (Rest 15 sec. between sprints) Weeks 3-4: 14 x 110s (Rest 45 sec. between sprints) Weeks 5-6: 16 x 110s (Rest 45 sec. between sprints)
TUESDAY PRE-WORKOUT Walking Knee Hugs Butt Kicks Power Skips For Height Carioca Position Starts, 5 x 10 yd. Speed Ladder, 6 sets Abs to be competitive. A player must meet these requirements in all three lifts to achieve Cardinal status. If they don’t reach Cardinal status, we keep working with them until they do. Our next award level is the Gold level. This level encompasses players who generally are able to make a bigger contribution to the program. As a player approaches the Gold level, his playing time usually increases. In order to achieve Gold level status, a player must reach Gold level in two exercises 44 ◆
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POST-WORKOUT Half Moons, 5 each way Circles, Individual & Chase, 4 sets each Figure Eights, 4 sets Tennis Ball Drills, 3 sets Punch Drill (upper body) Hip Mobility - Hurdles (cycle)
POST-WORKOUT Weeks 1-2: Cone Drills Four-Corner Drill Butterflies Iron Cross Figure Eights 90-Degree Power Cut Get Up and Sprint, 5 sets Punch Drill (cycle)
PRE-WORKOUT High Knees Walking Toe Touches “B” Skips Power Skips For Distance Form Starts, 5 sets x 10 yd. Dot Drills, 4 sets x 15 sec. Abs POST-WORKOUT Weeks 1-2: 11 x 110s (Rest 45 sec. between sets) Weeks 3-4: Pattern Run Speed Pack Four-Quarters (Arm Action Drill)
PRE-WORKOUT Walking Toe Touches Walking Knee Hugs Low Shuffle Position Starts, 5 x 10 yd. Jump Rope, 1:30 Abs
Weeks 3-4: Pattern Runs (speed cuts, power cuts, spins) Circles-Individual & Chase (4 sets each) Punch Drill (cycle)
Week 6: Pattern Run Speed Pack Four-Quarters (Arm Action Drill) Hip Mobility-Hurdles (cycle)
Weeks 5-6: Cone Drills Four-Corner Drill Butterflies Iron Cross Figure Eights 90-Degree Power Cut Get Up and Sprint, 5 sets Punch Drill (cycle)
as well as the total. We do this to acknowledge progress and to ensure we get explosive athletes, not just bench pressers. The Iron Eagle level is reached when a player meets the Iron Eagle requirement in one exercise and the total. Players who achieve this level tend to become starters and often reach all-conference status. And finally, our last award level is called Super Iron Eagle. To reach this level the athlete must achieve the Iron
Eagle requirements for all three lifts. Players who achieve this award level— almost to a man—are starters and many reap postseason honors. The players who have achieved Super Iron Eagle status include numerous all-conference players and All-Americans as well as school record holders in passing, rushing, receiving, and total yardage. Thus, it is evident our strength and conditioning strategies have been effective in producing game results, not just weightroom numbers. ◆
Week 5: 18 x 110s (Rest 45 sec. between sets)
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Nutritional Products COOPER CONCEPTS, INC. 877-2-HEALTH (243-2584) WWW.COOPERWELLNESS.COM Sold direct or through distributors: Direct to consumers through the company’s Web site and toll-free number. Also available at health food stores, and sports clubs/gyms. OCOOPER COMPLETE JOINT MAINTENANCE FORMULA Primary Ingredients: Glucosamine, chondroitin & bromelain ... Quantity Discounts/Pricing: $29.95-One month supply. 20 percent discount for Training & Conditioning readers. Use coupon code “TRAINING” through toll-free number or on Web site. ... Primary Advantages: Maintain and support healthy joints with this blend of glucosamine, chondroitin and bromelain. Glucosamine and chondroitin are amino sugars that occur naturally in the body and work to lubricate the joints and promote flexibility. Bromelain, an extract from the stem of pineapple, is useful for reducing muscle and tissue inflammation. Circle No. 50
OCOOPER COMPLETE BASIC ONE Primary Ingredients: Multivitamin and Minerals ... Vitamins and Minerals: E, D, B6, B12, folic acid ... Quantity Discounts/ Pricing: $16.95-Two month supply. 20 percent discount for Training & Conditioning readers. Use coupon code “TRAINING” through tollfree number or on Web site. ... Primary Advantages: Cooper Complete Basic One is formulated to meet the needs of those who want to cover their “basic” vitamin and mineral requirements with just one tablet a day. Basic One includes levels of antioxidants and “B” vitamins you won’t find in competing “one a day” products, including 400 IU of natural vitamin E, 200 mg of vitamin C, and 800 IU of vitamin D, plus optimum levels of the key nutrients, B6, B12 and folic acid. Basic One comes in both an Iron Free formulation (suggested for men and post menopausal women) and a With Iron formulation (suggested for women of
child bearing age.) Circle No. 51
GATORADE 877-3-PROPEL WWW.PROPELWATER.COM Sold direct or through distributors: Grocery stores, convenience stores, club stores, and drug stores. OPROPEL FITNESS WATER Primary Ingredients: Filtered water, natural flavors, sucrose syrup ... Calories Per Serving: 10 ... Protein/Carbohydrate/Fat Content: 0%/1%/0% ... Vitamins and Minerals: B6, Niacin, Pantothenic Acid, B12, C, E ... Quantity Discounts/ Pricing: 700ml $1.19-$1.39 in grocery, 6-pack $4.49, C-store $1.39-$1.49, 500ml $.99 ... Primary Advantages: Created by the hydration experts at The Gatorade Company, Propel Fitness Water is lightly flavored to encourage improved hydration over plain water. Propel also contains vitamins for an active lifestyle. Circle No. 52
OGATORADE NUTRITION SHAKE, NEW IMPROVED FORMULA—BETTER TASTE Calories Per Serving: 370 ... Protein/Carbohydrate/Fat Content: 20g/54g/8g ... Vitamins and Minerals: C, calcium, and iron ... Quantity Discounts/ Pricing: N/A ... Primary Advantages: Gatorade Nutrition Shake is a balanced nutrition supplement that is ideal as a nutritious high-energy meal replacement, or a pre-event or between-meal snack. Gatorade Nutrition Shake is for athletes who want to perform at their best, and often need to supplement their diet with a convenient, balanced, and nutritious product. Gatorade Nutrition Shake is available in two flavors—chocolate and vanilla. Circle No. 53
HORMEL HEALTHLABS 800-866-7757 WWW.HORMELHEALTHLABS.COM Sold direct or through distributors: Through Distributors. OPLUS-2™ Primary Ingredients: Milk, milk protein
46 ◆ T & C A P R I L 2 0 0 4 ◆
concentrates, high fructose corn syrup, malto dextrin ... Calories Per Serving: 8 oz. = 480 calories ... Protein/Carbohydrate/Fat Content: 16g/48g/24g ... Vitamins and Minerals: Vitamin H 20%, Vitamin C 26%, Calcium 60%, Riboflavin 15%, Phosphorus 15% ... Quantity Discounts/ Pricing: NA ... Primary Advantages: Extra effort takes extra calories. Hormal HealthLabs’ Plus-2 is packed with 960 calories and 32 grams of protein in every 16 oz. serving—perfect for sustaining or gaining weight. Plus-2 is specially formulated for weight gain. Circle No. 54
SUN CHLORELLA USA 800-605-6556 WWW.SUNCHLORELLAUSA.COM Sold direct or through distributors: Direct to consumers through the company’s Web site and toll-free number. Also available at health food stores. OSUN CHLORELLA GREEN SUPERFOOD Primary Ingredients: Naturally superconcentrated with vitamins & minerals, protein, dietary fiber, betacarotene, nucleic acids (RNA and DNA), Chlorella Growth Factor (CGF), high amounts of chlorophyll, and essential amino acids ... Calories Per Serving: 15 calories per 3 gram serving ... Protein/Carbohydrates/Fat: 2g/1g/0g ... Quantity Discounts/Pricing: Discounts and pricing from Sun Chlorella USA vary due to the many specials that are available ... Primary Advantages: SUN CHLORELLA is a freshwater single-celled green alga. Chlorella may strengthen the immune system, improve digestion, provide daily detoxification of impurities in the environment, escalate energy levels, maintain healthy tissues, and revitalize and fortify the entire body at the cellular level. With its exclusive patented pulverization process utilizing the DYNO®-Mill, Sun Chlorella has made the naturally indigestible chlorella cell 85% digestible. This assures your body optimum assimilation and digestion of all of chlorella’s precious and vital nutrients. Contact the company for a free sample and free health journal. Circle No. 55
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CREATIVE HEALTH PRODUCTS 800-742-4478 WWW.CHPONLINE.COM Creative Health Products, in business since 1976, is a leading discount supplier of rehabilitation, fitness, exercise, and athletic equipment and also health, medical, fitness testing, and measuring products all at discounted prices. Products include heart rate monitors, blood pressure testers, pulse oximeters, bodyfat calipers, scales, strength testers, flexibility testers, stethoscopes, pedometers, exercise bikes, ergometers, stopwatches, fitness books and software, exercise bands, step benches, hand and finger exercisers, heating pads, and more. Circle No. 112
POWER SYSTEMS, INC. 800-321-6975 WWW.POWER-SYSTEMS.COM Since 1986 Power Systems has been a leading supplier of sport training, health and fitness products. Power Systems prides itself in being the one resource for all of your training needs. Its new 2004 catalog has a new look with better graphics and photos. Included areas are core strength, medicine balls, speed, plyometrics, agility, strength equipment, strength accessories and flooring. You will find the catalog full of hundreds of new products and dozens of products available exclusively from Power Systems. The company has also lowered some of its prices to enable the customer to get premium products at great prices. Go online or call Power Systems to request a free 2004 catalog today. Circle No. 113
Rehabilitation Products 3-POINT PRODUCTS 888-378-7763 WWW.3POINTPRODUCTS.COM Reflex® Putty with Memoryflex®, from 3Point Products, increases resistance the more it is pulled. Reflex® Putty can be pulled and stretched like exercise bands but, unlike bands, it provides consistent resistance throughout the range of stretch. Muscles receive resistance throughout their contraction for a more effective strengthening regime. Reflex Putty is available in three resistance levels and in the new Pro Series for athletes and others requiring a higher resistance level for rehabilitation. Circle No. 57
BALL DYNAMICS INTERNATIONAL 800-752-2255 WWW.BALLDYNAMICS.COM Achieve deep muscular and fascial
The lightweight, flexible Action
release with this groundbreaking body therapy program. The FitBALL® Small Ball Release Program provides complete step-by-step instructions for releasing tension in the pelvic, hip, back, neck, and shoulder areas. Use three balls of decreasing size for increasing challenge as you enhance your skill level on this self-guided journey. The professional set includes one ball of each size, a 45-minute instructional video and an 80-page manual. Circle No. 58
CHATTANOOGA GROUP 800-592-7329 WWW.CHATTGROUP.COM Chattanooga Group is pleased to introduce the new Vectra™ Genisys. Vectra Genisys is the first modular therapy system that consolidates six therapeutic modalities into one system. The clinician
can access dual channel sEMG, sEMG activated muscle stimulation, multiple waveform electrotherapy, dual frequency ultrasound, and combination electrotherapy. The Genisys also offers the ability to add two more channels of electrotherapy, a battery or a future laser module. Circle No. 59 Chattanooga Group is offering a new line of PresSsion Compression Therapy Systems, the Multi 6 and the Multi 3. Both are truly high performance gradient sequential compression systems at an economical price. The Multi 6 is the top of the line, offering adjustable treatment parameters and therapy time control. The economical Multi 3 is designed for home therapy or clinical use. Circle No. 60
Pure Potent Complete
COOPER C O M P L E T E®
supplements you can trust
reduces pain from Arthritis, Tendinitis and Ligament
Action Ultra MP
Injuries. Ultra splints can be custom fit in seconds.
Call for our introductory offer and a free catalog:
888-378-7763 Stevensville, Maryland
Visit our on-line catalog at:
Also try the Action Ultra Spica for thumb and wrist control.
Multivitamins Advanced Omega-3 Fish Oil Joint Maintenance Formula Calcium
www.coopercomplete.com 877-243-2584 toll free Formulated by Kenneth H. Cooper, M.D., M.P.H., and a team of leading researchers. Health benefits are scientifically proven.
www.3pointproducts.com Request No. 31
Request No. 32
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Rehabilitation Products CONTEMPORARY DESIGN COMPANY 800-411-1979 WWW.SHUTTLESYSTEMS.COM From acute phase closed chain activities to end stage plyometrics, the Shuttle MVP leads the way in progressive functional rehabilitation and training. Its horizontal rebound technology utilizes smooth and predictable resistance, perfect for unstable joints, and rapid non-weight bearing rebounding to improve the eccentric phase necessary for injury prevention and the development of power. Circle No. 61 The Shuttle Balance functionally trains the neuromuscular system of athletes to seniors alike. It’s long been recognized
that the body’s ability to negotiate unpredictable changes in force, direction, and placement in space at the neuromuscular level are critical building blocks for performance and skill development. The Shuttle Balance provides a safe platform for individuals to develop and hone proprioceptive responses while performing a variety of activities. Circle No. 62
advantages over other tapes. Use as an anchor for tape applications. It is excellent for use as a compression bandage and it contours to the body to allow for effortless wrap of any appendage. Circle No. 63
CRAMER PRODUCTS, INC. 913-856-7511 WWW.CRAMERSPORTSMED.COM
Cadlow™ Shoulder Stabilizer, the multisport, dynamic shoulder stabilizing brace, is available from DM Systems, producers of wound care and orthopedic rehab products. Specifically for chronic subluxations and sporadic dislocations of the shoulder, Cadlow Shoulder Stabilizer allows the athlete to fully function in his or her sport without fear of shoulder pain or re-injury. It
Cramer Co-Stretch Non-Adhesive Stretch Tape is the innovative choice over traditional stretch and self-adhering tapes. Excellent tensile strength, clean tears, and “no-slip grip” combine for many
DM SYSTEMS, INC. 800-254-5438 WWW.DMSYSTEMS.COM
Lightning-Fast Plyometrics & Action-Ready Core Stabilization Make This Duo More Dynamic Than Any Other System.
Your Dynamic Duo!
Check out www.AthleticBid.com to contact these companies.
The serious athlete relies on the Shuttle Balance for – • Proprioception • Pertubation training • Dynamic core stabilization • Fun and creative sport-specific activities
As powerful as it is versatile, the Shuttle MVP is ideal for – • Skill development • Explosive overspeed plyometrics • Strength training • Aerobic and anaerobic conditioning • Functional rehabilitation
by Contemporary Design Co. Call or visit on-line www.shuttlesystems.com for more information or to find the authorized dealer nearest you. Call toll-free 800-334-5633 Request No. 33 50 ◆
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Rehabilitation Products provides glenohumeral stability while maintaining the athlete's full range of motion (ROM). This stabilizer's unique patented pull system strengthens the shoulder by providing graduated resistance through the full ROM. The variable resistance can be increased as the athlete's strength increases. Cadlow protects the athlete by helping to prevent recurrent shoulder subluxations and dislocations without restricting motion/movement. It can also be used for post-operative protection and strengthening. Circle No. 64 In response to requests from rehab professionals, DM Systems, manufacturer of the AnkleTough® Rehab System, has introduced low-cost eight-packs for each of the four resistive tension straps. The original system pack, comprised one each of the four color-coded resistive tension
straps, will continue to be offered. But for those rehab professionals who prefer to purchase a limited resistance offering based on their typical patient profile, the new eightpacks fill the requirement. The eight-packs are offered in a handy, clear pouch with a zip lock top. Each package also contains a complete full-color instruction guide. Circle No. 65
DONOVAN INDUSTRIES, INC. 800-345-3456 WWW.DONOVANINDUSTRIES.COM Donovan™ Fitness Balls help athletes develop core strength in their abdominal and back regions, which improves physical performance. Donovan™
Professional Burst-Resistant balls will not rapidly deflate like the cheaper balls and all Donovan™ Balls come with a pump and measuring device to assure proper inflation. Experts strongly recommend using the correct size therefore Donovan offers eight sizes to cover all athletic needs. Circle No. 66 Donovan’s new Multi-Use Shoulder Pulley increases range of motion in all planes of shoulder movement. The design makes the rehabilitation process quicker, easier, and convenient as well as comfortable. The MultiUse Shoulder Pulley features durable plastic handles, nylon wheel, web door attachment, super strong but lightweight construction and an exercise manual. Used at home, it allows patients to increase gains made in the clinic and helps speed the recovery process. Circle No. 67
Finally, a Plantar Fasciitis Night Splint Comfortable Enough to Sleep In! PLANTAR FASCIITIS
NIGHT SPLINT RESTING COMFORT SLIPPER™ This ingenious, comfortable device prevents plantar flexion during rest and helps alleviate the pain and discomfort associated with plantar fasciitis, leg calf cramps, and other conditions. Adjustable dorsiflexion settings at 0°, 5° and 10° with integrated toe wedge. ©2003 FLA Orthopedics, Inc., Miramar, FL 33025
Available at Fine Home Medical Dealers Nationwide, Circle Response Card or Call
For more information, please visit
1-800-327-4110 Request No. 34 A T H L E T I C B I D . C O M ◆ T&C A P R I L 2 0 0 4 ◆
Rehabilitation Products FERNO 888-206-7802 WWW.FERNOPERFORMANCEPOOLS.COM Ferno Performance Pools now offers the complete line of MedZoneÂŽ topical relief products, which are proven to last longer than competitors to minimize swelling, scarring and scabbing. With six formulas available, trainers can treat pain immediately, and continue treatment with other products as the athlete heals. The MedZone formula line includes PainZoneÂŽ, BurnZoneÂŽ, ChafeZoneÂŽ, DepthZoneÂŽ, MassageZoneÂŽ, and DermalZoneÂŽ. MedZone products target the source of the condition quickly to get athletes back in the game faster. Circle No. 68 Toss the bulky ice bags and never again have to worry about re-freezing wraps to treat athlete sprains and strains. Ferno Performance Pools now offers Liquid Iceâ„˘
non-dyed, nonadhesive bandages to treat athlete injuries using compression cooling. Liquid Ice reduces pain fast, and stays cold for two hours, which is six times longer than the nearest alternative! The bandages are washable and reusable with a recharger solution for up to 40 applications. Circle No. 69
FLA ORTHOPEDICS, INC. 800-327-4110 WWW.FLAORTHOPEDICS.COM The Thermal Lumbar Support, from FLA Orthopedics, Inc., is ideal for treating minor back aches and pains resulting from sprains, muscle soreness and strains, cramping, or contusion (bruising). It features a reusable soft gel packâ€”thermal gel is microwavable for therapeutic heat and freezable for cold therapy. The
Thermal Lumbar Support has plush, ventilated elastic panelsâ€” lightweight for cool, comfortable compression. The panels overlap to give a contouring shape to most body types. Easy applied, the thermal lumbar support is available in black and beige. Circle No. 70
FOOT MANAGEMENT 800-HOT-FOOT WWW.FOOTMANAGEMENT.COM Foot Management, Inc., manufactures a wide variety of footpads and other foot related products for all your
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)RRW0DQDJHPHQW,QF &XVWRP2UWKRWLFV )RRW5HODWHG3URGXFWV +27)227 ZZZIRRWPDQDJHPHQWFRP Âł:HDU:KDWWKH3URV:HDUÂ´ Request No. 35 52 â—†
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GAME READY INC. 866-266-5797 WWW.GAMEREADY.COM Trainers for more than 50 pro teams and 70 universities turn to the Game Ready Accelerated Recovery System to help their injured athletes heal faster. The portable system consists of a control unit, which delivers adjustable cold therapy and four levels of intermittent compression, and patented wraps based on NASA spacesuit technology. The easy-to-administer treatment reduces pain and swelling,
HOW TO REQUEST OR RENEW A FREE SUBSCRIPTION: The easiest way is to complete the subscription request card provided in every issue. If a request card is not available, then on your institution’s letterhead provide us with your: 1. request to receive or renew a free subscription 2. signature and date of request 3. title and school name 4. mailing address
ARE YOU MOVING? The USPS will not forward your subscription. In order to keep receiving your free subscription, you must notify us and provide us with your: 1. new mailing address 2. title and school name 3. signature and date of request All subscription requests and changes of address must be in writing, and mailed to: TRAINING & CONDITIONING, SUBSCRIPTION DEPT., PO BOX 4806, ITHACA, NY 14852-4806 or faxed to: 607-257-7328 Attn: TRAINING & CONDITIONING, SUBSCRIPTION DEPT.
resulting in accelerated recovery time and stronger healing. Circle No. 72
THE GEBAUER COMPANY 800-321-9348 WWW.GEBAUERCO.COM. The Gebauer Company has introduced Gebauer’s Spray and Stretch, which replaces Gebauer’s Fluori-Methane. Nonozone depleting Gebauer’s Spray and Stretch is a nonflammable topical skin refrigerant intended for use with the Spray & Stretch Technique in the management of myofascial pain, restricted motion, muscle spasms, and the temporary relief of minor sports injuries. Used to reduce or relieve the initial trauma of an injury, Gebauer’s Spray and Stretch controls the pain of bruises, contusions, swelling, and minor sprains. Circle No. 73
Perform Better With TurfCordz!
athletic needs. For a detailed description on the footpads and their application, visit www.footmanagement.com. Foot Management also manufactures custom orthotics, moleskin, felt, Turf Toe plates, and off-the-shelf insoles. Make Foot Management your distributor and wear what the pros wear. Circle No. 71
From the most trusted name in skin refrigerants for over 100 years comes a new, non-prescription topical skin refrigerant, Gebauer's Instant Ice™. Use it like ice for the temporary relief of minor pain and swelling from sprains and strains, minor sports injuries, bruising, and contusions. Instead of using ice to treat on-thescene minor sports injuries, high school and recreational league coaches, high school athletic trainers, and others will now be able to use what professional athletic trainers recommend. In fact, Jim Ramsay, head athletic trainer for the New York Rangers, has been using Gebauer topical skin refrigerants for years. "Instant Ice is great for on-the-scene care," said Ramsay. "If a player gets hit on the wrist or takes a puck off the shin, I can easily anesthetize the area with Instant Ice to reduce the pain, allowing the player to get back in the game quickly.” Circle No. 74
This Season be Faster! Quicker! Stronger! TurfCordz Cuff Tuff offers... • Outstanding shoulder rotator strengthening! • Performs both internal and external rotation exercises! • Available in 5 resistance levels! • Maximum comfort and function at a reasonable cost! • The safety and reliability professional athletes demand! • To learn more call us at 800-556-7464 or visit us online at www.performbetter.com TM
TurfCordz Cuff Tuff shown with MediCordz Wall Mount (sold separately)
TurfCordz are distributed by M-F Athletic Company
© 2004 NZ MFG LLC, Tallmadge, OH T&C 0404
Request No. 37 A T H L E T I C B I D . C O M ◆ T&C A P R I L 2 0 0 4 ◆
Rehabilitation Products KEISER CORPORATION 800-888-7009 WWW.KEISER.COM Success, 1/10 pound at a time! The Infinity Series Equipment, from Keiser Corporation, allows for full freedom of movement. This ultimate equipment allows individuals to train safely at any resistance, at any speed and at any angle without shock-loading the joints! These pieces allow for an infinite number of exercises and are space efficient. Circle No. 75
PERFORM BETTER 800-556-7464 WWW.PERFORMBETTER.COM Perform Better has introduced Smart Hurdle, a lightweight training hurdle you can easily set up, transport, and store. The unique three-point base system decreases the chance of stepping on the leg when the hurdles are close together. Use for over and under hurdle walks, hops, jumps, and more. Available in four sizes: 6" and 12" high with carry handle, and adjustable 12"-18", and 21"-30" sizes, both of which fold flat for easy carrying. Circle No. 76
NATIONAL ACADEMY OF SPORTS MEDICINE (NASM) 800-460-6276 WWW.NASM.ORG The athlete’s ability to consistently perform at higher levels while avoiding injury is essential to his long-term success in any sporting arena. Drawing on the exclusive Optimum Performance Training™ (OPT™) method—a system that has successfully empowered peak performance in pro-
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fessional, Olympic, college, and highschool athletes—Optimum Performance Training™ for the Performance Enhancement Specialist sets the international pace for athletic training and sports medicine professionals. Circle No. 77 The National Academy of Sports Medicine (NASM) is proud to present Body Map, a unique, state-of-the-art dynamic movement assessment and program-design tool that will revolutionize the way you train. Whether your goal is to lose fat, gain muscle or increase your performance in a specific sport, Body Map helps you reach your goals quickly, safely and effectively. Based on NASM’s exclusive Optimum Performance Training (OPT™) model, Body Map takes less than 10 minutes and creates individualized assessments and corrective strategies, including flexibility, postural control and functional strength. If success is your destination, let the Body Map be your guide! For more information about where you can get your Body Map, visit www.nasm.org. Circle No. 78
NZ MFG. LLC 800-886-6621 WWW.NZMFG.COM NZ Mfg. LLC's TurfCordz Cuff Tuff is a portable tool designed for shoulder strengthening. It is used to perform internal and external rotation exercises to rehabilitate an injury or to help prevent one. Made with the highest quality materials for safety and security, it is available in five resistance levels. To learn more about the full line of innovative TurfCordz products, call the company or view its entire catalog online. Circle No. 79
case help it travel easily from training rooms to sidelines. The unique aluminum understructure is tough enough to support a 600-lb. UL weight load rating and the sealed seams and removable field feet mean the Boss works rain or shine. Easy height adjustments make the Boss the ergonomic answer for every ATC. Circle No. 80 The ProLuxe™ is an affordable, hard working, steel framed lift table that will make your work much easier. With a high performing super quiet lift motor and extra wide top, bariatric patient transfer of up to 550 lbs is easy. The ProLuxe is adjustable to a low position of 18", enabling wheelchair transfer and helping to qualify for the ADA tax credit. Plus with five different top options and automatic locking wheels the ProLuxe can be easily moved from room to room to support a wide variety of modalities and treatments. Circle No. 81
OPTP 800-367-7393 WWW.OPTP.COM
OAKWORKS, INC. 800-558-8850 WWW.OAKWORKS.COM
OPTP's newly designed and expanded fullcolor Volume Sixteen Catalog features new publications from internationallyrenowned physical therapy experts, including Rick Jemmett PT, Diane Lee PT, Robin McKenzie, Brian Mulligan PT, and more. OPTP still offers standards such as TheraBand®, new formulated Rep-Band™, Gymnic® Balls, OPTP Foam Rollers, and the Original McKenzie® Lumbar Rolls, the Stretch Out® Strap, as well as new resources based on Pilates, post-partum health, and core stability. Circle No. 82
The Boss is a great treatment table designed specifically for ATCs. Its lightweight design and protective carrying
OPTP has introduced the versatile, inflatable exercise roll called the FitBALL® Roller. It is a new exercise roll that com-
Rehabilitation Products bines the best aspects of inflatable exercise balls and foam rollers into one dynamic inflatable fitness roll for the entire body. The FitBALL Roller allows you to inflate to your personal comfort level to optimize exercises that strengthen and tone the abs, obliques, and core muscle groups. Improve stability and balance, stretch more effectively or use for mobility exercises. The dynamic, adjustable firmness of the FitBALL Roller provides an ideal stability challenge for prone and supine exercises. Circle No. 83
BIOFREEZE 800-246-3733 E-MAIL: HEALTH@BIOFREEZE.COM
For more information and your no-charge trial package please contact the company. Circle No. 84
For pain management programs, Performance Health, Inc., offers Biofreeze®, which can help reduce swelling, pain and stiffness; increase mobility and recovery time; and effectively aid in the overall healing process. Apply Biofreeze before, during and after each therapy session to reduce swelling and stiffness, enabling greater range of motion and flexibility for therapeutic exercises. Biofreeze can enhance any situation that would require the use of ice and breathable wraps and also enhances and prolongs the benefits of ultrasound, electrical stimulation, and massage therapy treatments.
Biofreeze® is an extremely effective topical pain reliever used in Pain Management Programs to treat athletic injuries, muscle injuries and strains, stiff joints and upper/lower back pain and spasm. Biofreeze helps with both deep trigger and soft tissue work. Prior to massage, it helps athletes relax for a more effective treatment and minimizes post-treatment swelling when applied after massage. Athletes who rarely bother to use ice can be counted on to use Biofreeze. Athletes can also use Biofreeze at home to relieve pain. Biofreeze is available in a no-touch roll-on, perfect for trainers’ supply bag. Circle No. 85
Check out www.AthleticBid.com to contact these companies.
Request No. 38 A T H L E T I C B I D . C O M ◆ T & C A P R I L 2 0 0 4 ◆ 55
Rehabilitation Products POWERWEB 888-823-0310 WWW.PWRWEBINTL.COM PowerWeb is the all-in-one finger, hand, wrist, forearm, and ankle exerciser. It allows duplication of all joint actions: flexion, extension, opposition and supination. Original PowerWeb comes in six color-coded resistance levels, and the new PowerWeb Combo offers two resistance levels in one. Call the company or visit its Web site for a complete brochure. Circle No. 86
PRO-TEC ATHLETICS 800-779-3372 WWW.INJURYBEGONE.COM Iliotibial Band Syndrome, commonly referred as ITBS, is a difficult injury to treat. Pro-Tec Athletics does, however, have an answer. The Iliotibial Band Wrap, by Pro-Tec Athletics, stabilizes the IT Band and reduces stress to the area, alleviating symptoms of ITBS. Applied above the patella, it is designed with a compression pad that provides direct compression on the Iliotibial Band. Circle No. 87 Unparalleled in comfort and effectiveness, the Shin Splints Compression Wrap, by Pro-Tec Athletics, alleviates symptoms of medial and anterior shin splints. It includes a compression strip to provide targeted compression. This helps prevent tearing of the soft tissue away from the tibia. In addition, the Shin Splints Compression Wrap absorbs stress to the tibia and helps stabilize the area. Its contoured design keeps pressure off the calf area in cases of Medial Tibial Stress Syndrome. Circle No. 88
RICH-MAR CORPORATION 800-762-4665 WWW.RICHMARWEB.COM Rich-Mar’s new AutoSound 7.6 Combo uses the patented Hands-Free ultrasound design now combined with a two-channel 56 ◆
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stimulator for Hands-Free Combo and the AutoPrism Light Therapy attachment. The AutoSound 7.6 Combo design provides better treatments and incredible timesavings for ultrasound, combination, and light therapy treatments, therefore allowing longer, more effective treatments. And that makes for happier patients and staff! Circle No. 89 Rich-Mar now offers innovative Light Therapy with the AutoPrism unit. This device has over 600 mW of output that will allow you to treat larger areas in shorter amounts of time. It has preset dosages that allow you to apply 1 J/cm2 in 30 seconds or you can apply up to 10 J/cm2 in five minutes. Perfect for a variety of soft-tissue conditions. The AutoPrism’s unique design allows you to use it as a hand-held applicator for quick treatments or simply strap it in place for Hands-Free use with longer protocols. The really nice thing about the AutoPrism is its affordable price. You can get the AutoPrism as an affordable standalone product if you just want to add Light Therapy. You do not have to buy a whole Stim/US Combo device or a $15,000 “Laser”. It is available as an attachment for our AutoSound Hands-Free ultrasounds/stim combos. Circle No. 90
SPORTS HEALTH 800-323-1305 WWW.ESPORTSHEALTH.COM Sports Health offers a variety of rehabilitation products used by athletic trainers everywhere. From everyday products like exercise balls, stability trainers, hot/cold packs, dumbbells and ice bags to the more extensive products like whirlpools, TENS and stim units, ultrasounds and massage therapy - Sports Health has all the rehabilitation products you're looking for. Circle No. 91
SWEDE-O, INC. 800-525-9339 WWW.SWEDEO.COM The Swede-O Tarsal Lok® combines the greater support of a rigid brace with the superior comfort of a lace-up brace. The upgraded Fortilene stabilizer material will actually form to the shape of your ankle simply from body heat. The low profile design fits in almost any style of shoe, not just athletic shoes. Speed lacing system for easy application and removal. Circle No. 92 New Thermoskin Thermal Supports, from Swede-O, may be used for prevention, treatment, and rehabilitation. They are clinically proven to increase your subcutaneous temperature 2 - 3° F, making muscles, tendons, and ligaments more elastic to reduce the risk of injury when under stress. Only Thermoskin has Trioxon lining that allows air flow in and wicks moisture out for hours of continuously comfortable wear. Circle No. 93
EFI SPORTS MEDICINE 800-525-6901 WWW.EFISPORTSMEDICINE.COM The new Total Gym 26000 comes with a built-in folding wide-base squat stand that adjusts to three heights and a highly adaptable folding foot holder that can be raised or lowered as required for the performance of various lower body and trunk exercises. It also features the new Adjustable Pulley Bar accessory that allows clinicians to adjust the height and width of the cable pulley angle for each individual’s size and specific to each exercise. Circle No. 94
Rehabilitation Products No longer requiring a patient to get on and off the unit between exercises, the new, fully electronic Power Tower, by efi Sports Medicine, delivers level changes at the touch of a button. This results in a more comfortable experience for the patient, fewer transitions, and a more cohesive exercise session. The Power Tower features a ground-breaking dynamic pulley system that adjusts to a patient’s girth and height to allow for optimum force angles specific to each exercise. Other features include a wide base, telescoping squat stand with three adjustable heights, built in pull-up bars and a fold away foot holder for hamstring and abdominal work. Circle No. 95
X VEST 800-697-5658 WWW.THEXVEST.COM
author of Jumping into Plyometrics. Circle No. 96
“I have found the X Vest to be an excellent tool for providing overloads in both plyometric and strength training, conditioning, and rehabilitation programs. The fit and adaptability are excellent. The X Vest allows for freedom of movement and doesn’t interfere with any of the agility, bounding or running programs that I write for a wide variety of athletes, both collegiate and professional. The X Vest has proven itself in my programs! Thank you for all your efforts and help in improving my capability as a strength & conditioning specialist.” — Donald A. Chu Ph.D., PT, ATC, CSCS and
Xvest has a new weight configuration and it's heavy, 84 pounds of heavy. The new Xvest, known as the Fire Fighter model, was developed strictly for the Fire Fighter and their rigorous training. It has the basic design as the original Xvest but internally it has a new weight configuration allowing for 84 pounds. Because of its ability to adjust weight like the original Xvest, numerous individuals from bodybuilders to the military are buying them. Circle No. 97
Check out www.AthleticBid.com to contact these companies.
How Exertools puts a better spin on foam rollers. Better Prices
9 33 EA
Combo Foller 4" inside 6" x 36" Order 2 or more
10 00 EA
Foller Covers in 6 colors Washable, keeps rollers clean *Patent Pending
Visit us today at www.exertools.com or call 800-235-1559 Request No. 39
NEW! Features TWO resistance levels in one, for greater value and flexibility!
6" x 36" High-density Foller Order 2 or more Just $
Now users can perform all joint actions! Six individual color-coded resistance levels plus two new Power •Web Combos! Includes fully illustrated manual! For more information, call 888-823-0310, fax 330-630-5091, or online at www.pwrwebintl.com
POWER•WEB...The #1 Finger, Hand, Wrist, Forearm, Ankle Exerciser! Request No. 40 A T H L E T I C B I D . C O M ◆ T&C A P R I L 2 0 0 4 ◆
ADVERTISERS DIRECTORY CIRCLE NO.
AD VO E RDTUI C S ET R TO PR S SDD I RI R EE CC TO RR YY CIRCLE NO.
31 . . . . . 3-Point Products (Action Ultra) . . . . . . . 49
35 . . . . . Foot Management. . . . . . . . . . . . . . . 52
40 . . . . . Power-Web . . . . . . . . . . . . . . . . . . . . 57
4 . . . . . Biofreeze . . . . . . . . . . . . . . . . . . . . . . 9
20 . . . . . Game Ready . . . . . . . . . . . . . . . . . . . 30
15 . . . . . PoweringAthletics . . . . . . . . . . . . . . . 22
5 . . . . . BioSkin Performance Supports . . . . . 10
11 . . . . . Gebauer . . . . . . . . . . . . . . . . . . . . . . 17
18 . . . . . Pro-Tec Athletics . . . . . . . . . . . . . . . . 25
23 . . . . . Cadlow Shoulder Stabilizer . . . . . . . . 35
19 . . . . . GNC . . . . . . . . . . . . . . . . . . . . . . . . . 29
7 . . . . . Quest Technologies . . . . . . . . . . . . . . 14
12 . . . . . Chattanooga Group . . . . . . . . . . . . . 18
21 . . . . . Hormel HealthLabs (Plus-2) . . . . . . . . . 31
22 . . . . . Rich-Mar . . . . . . . . . . . . . . . . . . . . . . 32
2 . . . . . Cho-Pat . . . . . . . . . . . . . . . . . . . . . . . 2
27 . . . . . Keiser . . . . . . . . . . . . . . . . . . . . . . . . 41
33 . . . . . Shuttle Systems . . . . . . . . . . . . . . . . . 50
32 . . . . . Cooper Complete . . . . . . . . . . . . . . . 49
41 . . . . . Medical Specialties . . . . . . . . . . . . . . 61
9 . . . . . Smart-Hurdle (Train To Play) . . . . . . . . . 15
1 . . . . . Cramer. . . . . . . . . . . . . . . . . . . . . . . IFC
38 . . . . . NASM . . . . . . . . . . . . . . . . . . . . . . . . 55
26 . . . . . Swede-O . . . . . . . . . . . . . . . . . . . . . . 38
17 . . . . . Donovan . . . . . . . . . . . . . . . . . . . . . . 24
24 . . . . . Nesar . . . . . . . . . . . . . . . . . . . . . . . . 36
45 . . . . . Townsend Design. . . . . . . . . . . . . . . IBC
3 . . . . . efi Sports Medicine . . . . . . . . . . . . . . 5
16 . . . . . NSCA Certification Commission . . . . 23
37 . . . . . TurfCordz/NZ Manufacturing . . . . . . . 53
8 . . . . . eSimtrak.NET . . . . . . . . . . . . . . . . . . 15
46 . . . . . Oakworks . . . . . . . . . . . . . . . . . . . . BC
13 . . . . . Vertec (Sports Imports) . . . . . . . . . . . . . 20
39 . . . . . Exertools . . . . . . . . . . . . . . . . . . . . . . 57
29 . . . . . OPTP . . . . . . . . . . . . . . . . . . . . . . . . 43
30 . . . . . VertiMax . . . . . . . . . . . . . . . . . . . . . . 45
25 . . . . . Ferno Performance Pools . . . . . . . . . 37
14 . . . . . Perform Better . . . . . . . . . . . . . . . . . 21
6 . . . . . Woodway USA . . . . . . . . . . . . . . . . . 13
42 . . . . . FitBALL USA (Ball Dynamics) . . . . . . . . . 62
43 . . . . . Perform Better (seminars) . . . . . . . . . . 63
28 . . . . . Xvest . . . . . . . . . . . . . . . . . . . . . . . . . 42
34 . . . . . FLA Orthopedics/Night Splint . . . . . . 51
10 . . . . . Power Systems . . . . . . . . . . . . . . . . . 16
RO D IIRREECCT TOO RYR Y P RPO DDUUCCTTSS D
PRODUCTS DIRECTORY CIRCLE NO.
PRODUCTS DIRECTORY PAGE NO.
57 . . . . 3-Point Products . . . . . . . . . . . . . . . . 49
71 . . . . Foot Management (footpads) . . . . . . . 52
118 . . . . Power Systems (Power Toss Football) . . . 61
58 . . . . Ball Dynamics International . . . . . . . . 49
115 . . . . Foot Management (Static Calf Stretcher) 61
86 . . . . Power-Web . . . . . . . . . . . . . . . . . . . . 56
84 . . . . Biofreeze . . . . . . . . . . . . . . . . . . . . . . 55
72 . . . . Game Ready . . . . . . . . . . . . . . . . . . . 53
110 . . . . Premier Software. . . . . . . . . . . . . . . . 59
85 . . . . Biofreeze (no-touch roll-on) . . . . . . . . . . 55
74 . . . . Gebauer (Instant Ice) . . . . . . . . . . . . . . 53
87 . . . . Pro-Tec Athletics (Iliotibial Band Wrap) . . 56
99 . . . . BioSkin (Gladiator) . . . . . . . . . . . . . . . . 60
73 . . . . Gebauer (Spray and Stretch) . . . . . . . . . 53
88 . . . . Pro-Tec Athletics (Shin Splints Wrap) . . . 56
100 . . . . BioSkin (Q Lok APT) . . . . . . . . . . . . . . . 60
109 . . . . Injury Tracker. . . . . . . . . . . . . . . . . . . 59
126 . . . . Quest Technologies . . . . . . . . . . . . . . 63
101 . . . . Brace Int’l. (Fluk) . . . . . . . . . . . . . . . . 60
75 . . . . Keise . . . . . . . . . . . . . . . . . . . . . . . . . 54
90 . . . . Rich-Mar (AutoPrism) . . . . . . . . . . . . . . 56
60 . . . . Chattanooga (PresSsion) . . . . . . . . . . . 49
104 . . . . Medical Specialties (Dynatrack) . . . . . . 60
89 . . . . Rich-Mar (AutoSound) . . . . . . . . . . . . . 56
59 . . . . Chattanooga (Vectra Genisys) . . . . . . . . 49
105 . . . . Medical Specialties (Gripper) . . . . . . . . 60
91 . . . . Sports Health . . . . . . . . . . . . . . . . . . 56
102 . . . . Cho-Pat . . . . . . . . . . . . . . . . . . . . . . . 60
125 . . . . Mistral Cooling Systems . . . . . . . . . . 63
119 . . . . Sports Imports. . . . . . . . . . . . . . . . . . 62
62 . . . . Contemporary Design (Shuttle Balance) 50
78 . . . . NASM (Body Map) . . . . . . . . . . . . . . . . 54
92 . . . . Swede-O (Tarsal Lok) . . . . . . . . . . . . . . 56
61 . . . . Contemporary Design (Shuttle MVP) . . 50
77 . . . . NASM (Optimum Performance Training) . . 54
93 . . . . Swede-O (Thermoskin Supports) . . . . . . 56
63 . . . . Cramer (Non-Adhesive Stretch Tape) . . . . 50
81 . . . . Oakworks (ProLuxe) . . . . . . . . . . . . . . . 54
106 . . . . Townsend Design (Motion Hinges) . . . . 60
124 . . . . Cramer (ProShox) . . . . . . . . . . . . . . . . 63
80 . . . . Oakworks (The Boss) . . . . . . . . . . . . . . 54
107 . . . . Townsend Design (RebelTM5) . . . . . . . 60
112 . . . . Creative Health Products. . . . . . . . . . 48
82 . . . . OPTP (catalog) . . . . . . . . . . . . . . . . . . 54
120 . . . . Train To Play . . . . . . . . . . . . . . . . . . . 62
65 . . . . DM Systems (Ankle Tough) . . . . . . . . . . 51
83 . . . . OPTP (FitBALL Roller) . . . . . . . . . . . . . . 54
79 . . . . TurfCordz/NZ Manufacturing . . . . . . . 54
64 . . . . DM Systems (Cadlow Shoulder Stabilizer) 50
116 . . . . Perform Better (plyo boxes) . . . . . . . . . 61
121 . . . . VertiMax . . . . . . . . . . . . . . . . . . . . . . 62
66 . . . . Donovan (Fitness Balls). . . . . . . . . . . . . 51
76 . . . . Perform Better (Smart Hurdle) . . . . . . . 54
122 . . . . VertiMax (V6) . . . . . . . . . . . . . . . . . . . 62
67 . . . . Donovan (Shoulder Pulley) . . . . . . . . . . 51
113 . . . . Power Systems (catalog) . . . . . . . . . . . 48
96 . . . . Xvest (Don Chu). . . . . . . . . . . . . . . . . . 57
95 . . . . efi Sports Medicine (Power Tower) . . . . 57
117 . . . . Power Systems (Power Chute) . . . . . . . 61
97 . . . . Xvest (Fire Fighter model) . . . . . . . . . . . 57
94 . . . . efi Sports Medicine (Total Gym 26000) . 56 69 . . . . Ferno (Liquid Ice) . . . . . . . . . . . . . . . . . 52 68 . . . . Ferno (MedZone) . . . . . . . . . . . . . . . . . 52
For Quicker Response, Request Information From Advertisers On-Line at
70 . . . . FLA Orthopedics (Lumbar Support) . . . . 52 103 . . . . FLA Orthopedics (Safe-T-Sport) . . . . . . 60
58 ◆ T & C A P R I L 2 0 0 4 ◆
Injury Prevention Software
IN THE MAY/JUNE 2004 ISSUE:
NATA SHOW PLANNER & EXHIBITOR PRODUCT PREVIEW NSCA EXHIBITOR PRODUCT PREVIEW SCOUTING REPORT: CHEST & BACK PRODUCTS SCOUTING REPORT: CLIMATE CONTROL
INJURY TRACKER 888-465-8725 WWW.INJURYTRACKER.COM
PREMIER SOFTWARE, INC. 630-906-6630 WWW.ESIMTRAK.COM
Sports organizations worldwide are leveraging InjuryZone™ to minimize injuries and related costs, accelerate medical treatment, and ensure athletes return to play safely and quickly. Designed to unite the entire organization in a common information network that is HIPAA compliant, InjuryZone™ delivers revolutionary templating, internal messaging, and off-line capabilities as well as state-of-theart security, complete with audit trail and electronic signatures, offering organizations a web-based facility to easily report, track, and manage critical athlete information on- and off-line. Circle No. 109
The Web-based eSimtrak.NET injury tracking and treatment records system provides access to your training room records 24 hours a day from anywhere. This system offers the most advanced technology at an affordable monthly access fee designed for low cost of ownership. Scanned documents and digital X-Rays are supported, bringing together the athletic training room and physician. Users can enter an unlimited number of athletes at no extra charge. Visit www.eSimtrak.com for more details and to register for a free demonstration. Circle No. 110
Check out www.AthleticBid.com to contact these companies.
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Knee Products BIO SKIN/CROPPER MEDICAL 800-541-2455 WWW.BIOSKIN.COM
CHO-PAT 800-221-1601 WWW.CHO-PAT.COM
Bio Skin® introduces the Gladiator XT™ and Gladiator DT™ (front closure) limited range of motion hinged knee brace. The Gladiator treats mild to moderate ACL, PCL, MCL, and LCL instabilities. Outstanding Features: Flexion and Extension pins are easily accessible and are attached by “keepers” preventing loss. Struts may be adjusted to accommodate various contours of the leg. Unique strapping design improves knee stability, minimizing medial and lateral shift, as well as anterior/posterior drawer. The lightweight and low profile features add comfort to design. Circle No. 99
Cho-Pat’s patented Dual Action Knee Strap provides an extra level of relief for painful and weakened knees. It applies pressure upon the tendon below the knee to reduce patellar subluxation and improve tracking and elevation. It also places pressure on the tendon above the knee to give added support and stability. It allows full mobility. Circle No. 102
Patellofemoral joint dysfunction and pain has a new treatment. The patent pending Q Lok APT™ (Adjustable Patella Traction), from BioSkin, diminishes pain, increases function, and achieves desired patella tracking. The Q Lok™ controls patella pressure in the trochlear groove to increase joint surface area contact. In addition, the Q Lok allows adjustable medial patella traction to loosen tight lateral connective tissue, providing successful patellafemoral treatment when linked with an exercisestrengthening program. Circle No. 100
BRACE INTERNATIONAL 800-545-1161 WWW.BRACEINT.COM Brace International provides information on its line of bracing and support products. The FLUK™ knee strap is ideal for treating such injuries as patellar tendonitis, chondromalacia patella, and OsgoodSchlatter’s disease. It applies compression to the knee area without restricting circulation. Circle No. 101
T&C A P R I L 2 0 0 4 ◆
FLA ORTHOPEDICS, INC. 800-327-4110 WWW.FLAORTHOPEDICS.COM The Safe-T-Sport® Wrap-Around Hinged Knee Brace, from FLA Orthopedics, Inc., is ideal for treating slight to moderate ligament sprains and tears, medial/lateral meniscal tears, arthritis, and knee joint instability. The brace’s neoprene provides therapeutic warmth to the knee. Its wrap around design makes application easy for swollen or injured knees. Metal medial/lateral hinges stabilize the knee, allow for full flexion, and prevent hyperextension. An open popliteal eliminates bunching and irritation behind the knee. Adjustable support straps prevent migration. Circle No. 103
MEDICAL SPECIALTIES, INC. 800-582-4040 WWW.MEDSPEC.COM Med Spec introduces the DynaTrack™ patella stabilizer for the treatment of patellofemoral dysfunction. The easy-toapply design features an internal buttress with Skinloc™ material and an outer neoprene wrap that can be adjusted to provide the optimum amount of dynamic pressure against the patella. A large popliteal opening
permits a high degree of flexion with no discomfort. Each size fits either the left or right knee. Circle No. 104 Med Spec introduces the Gripper™ Hinged Knee Brace for the treatment of MCL or LCL sprains. The neoprene brace may also be used post operatively or during sports to provide medial and lateral stability and to protect against hyperextension. The Skinloc™ material inside the brace grips the proximal end of the gastrocnemius (calf) muscle to maintain a proper position on the knee and resist distal migration. Circle No. 105
TOWNSEND DESIGN 800-840-2722 WWW.TOWNSENDDESIGN.COM Townsend Design has introduced the next generation of its patented Townsend Motion Hinges for functional and osteoarthritis knee braces. The new ultra low profile TM5 Hinges are half the size of the previous joint designs, and reduce the medial-lateral dimension of Townsend's braces—at joint line—by nearly one inch. The hinges are available in a variety of materials (aircraft aluminum, stainless steel and titanium), and can decrease the overall weight of the brace by as much as five ounces. Circle No. 106 Townsend Design has released a new generation of custom and pre-sized functional knee braces. The 2004 edition of Townsend's acclaimed Premier graphite shell brace weighs in at just 16 ounces. The new RebelTM5 (fabricated from aircraft aluminum) weighs only 18 ounces. These braces feature Townsend's patented hinge motion and suspension technology and are backed by a no migration guarantee. New shell options are available to maximize control and prevent injuries. Circle No. 107
Football Conditioning FOOT MANAGEMENT, INC. 800-HOT-FOOT WWW.FOOTMANAGEMENT.COM The newest product available from Foot Management is the Static Calf Stretcher. Made from durable, weather resistant materials, it’s designed to help relieve the pain of plantar fasciitis and to increase calf flexibility. Lightweight and portable, it’s perfect in any setting. Ideal for use with cleats of all types. No more slipping when trying to stretch out on the field or court. Use in the home as well for maximum benefit. Circle No. 115
PERFORM BETTER 800-556-7464 WWW.PERFORMBETTER.COM Part of its First Place® line, Perform Better has introduced plyo boxes made of 1", 13-gauge tubular welded steel with a large
landing surface covered with 1/8" nonskid rubber. The legs are tapered to a six degree outward angle to prevent tipping. Sold with a two-year warranty and reasonably priced. The boxes are available in 12", 18", 24", and 30" heights. Contact Perform Better for more information or a free copy of the 2004 catalog. Circle No. 116
POWER SYSTEMS, INC. 800-321-6975 WWW.POWER-SYSTEMS.COM Some products stand the test of time. The Power Systems Power Chute is one of those products. The best running chute on the market, you get resistance running and over-speed training in the same run. The Power Chute enables you to improve two key elements of speed—stride length and stride frequency. This unique training product offers diversity and motivation for you, while improving a key aspect of your
football training program. The Power Chute comes in four sizes to accommodate all training levels. The Power Chute instructional manual and video are also now available. Circle No. 117 The Power Toss Football, from Power Systems, is a great training tool for quarterbacks, centers and receivers at all playing levels. The football-shaped weighted ball provides greater resistance than a standard football (standard football weighs 1 lb.) for throwing, option pitching and long snapping. It improves arm and grip strength. The Power Toss Football is made of molded latex and is available in 2 lb. and 3 lb. Circle No. 118
Request No. 41 A T H L E T I C B I D . C O M ◆ T&C A P R I L 2 0 0 4 ◆
Football Conditioning SPORTS IMPORTS 800-556-3198 WWW.SPORTSIMPORTS.COM Virtually all professional and college sports teams, including the NFL Scouting Combine, use the VERTEC jump training system, distributed by Sports Imports. It is the best way to evaluate and improve jump reach and lower-body explosive power. The Vertec jump training system challenges athletes to improve their vertical leap through instantaneous feedback and recognition. The process is simple, offering a true vertical target, visual motivation and an immediate, accurate measure of success and growth. Wall mount version is now available. Request No. 119
TRAIN TO PLAY 608-824-0068 WWW.TRAINTOPLAY.COM SMART-HURDLE™, from Train To Play, is
the new line of rehabilitation and performance tools that work. It is great for low-impact plyometric training. Develops full range of motion and athletic power. Try OverUnder drills with the versatile SMART-HURDLE™ 4 system. The SMART-HURDLE™ has a three-point base for stability on all surfaces. They are durable yet light, fold flat for easy storage, and are bright yellow-and-black so they stand out in any training area. Training is not only effective, it’s fun! Circle No. 120
VERTIMAX 800-699-5867 WWW.VERTIMAX.COM No matter what kind of lower body strength and speed training you are doing, it will fall into one of three categories: (1) Heavy Resistance, (2) Plyometrics, or (3) Low-Load Velocity-Specific training (the VertiMax). If Heavy Resistance were 10
on a scale of 1 thru 10, and if plyometrics were 1, VertiMax would be a 5. It's plyo with overload—the best of both worlds. Maximum transfer to the sports field. Circle No. 121 "Only the VertiMax V6 incorporates upperbody loading into an already highly effective explosion training device. Training the upper body to improve the lift aspect of vertical jump is a giant breakthrough. You can use it for arm action in the running phase, jam techniques, or combine all resistance bands for run into jump maneuvers. I can say without hesitation, this device is of great importance in any training program." — Garrett Giemont, Professional Football 2002 S&C Coach of the Year. Circle No. 122
The Burst Resistant Exercise Ball!
CUSTOMIZE YOUR TREADMILL AT THE ‘WOODWAY CAFE’ Woodway is happy to annouce the launch of their new Web site. Please visit WWW.WOODWAY.COM and see what the company has added. You will be able to custom build your own treadmill at “Woodway Café”, or get online and exchange training ideas and ask questions on the “Coaches Corner.” You can download product information, be a part of the Coaches Corner where you can get tips on training from the profesionals and so much more. For a unique experience, click on www.woodway.com.
Available Through Leading Dealers Everywhere! 800-752-2255 • www.fitball.com QUALITY • VALUE • SERVICE • SELECTION Request No. 42
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More Products CRAMER PRODUCTS, INC. 913-856-7511 WWW.CRAMERSPORTSMED.COM
MISTRAL COOLING SYSTEMS 888-540-8770 WWW.MISTRALCOOLING.COM
QUEST TECHNOLOGIES, INC. 800-245-0779 WWW.QUEST-TECHNOLOGIES.COM.
Cramer Products, Inc., offers the ProShox™ Custom Mouth Guard. Professional fit. Maximum protection. ProShox’s unique, professional fitting system provides the same fit and protection from oral head injuries as a dentistdesigned mouth guard. The ProShox professional fitting system uses a dental tray to ensure proper fit and ultimate comfort. It also works as a protective carrying case. The mouth guard is constructed out of a Dupont shock-absorbing material that helps prevent jaw-related concussions, TMJ dislocation, and dental trauma. Circle No. 124
The new 2004 line of misting fans, from Mistral, includes a portable model and a wide range of wall mounted systems. A Mistral system provides economically viable means of providing a safe and comfortable open-air area, regardless of weather. The operator can set the mist to match the conditions, giving maximum cooling and conserving water. The industrial-grade construction insures that Mistral systems will perform for years to come. Circle No. 125
Exertional heat illnesses inhibit an athlete’s ability to perform at peak levels, threatens their life safety, and can expose an organization to unprecedented liabilities. Quest’s environmental monitors enable athletic trainers, coaches, and sports medicine researchers to obtain comprehensive and accurate information in real-time, display, and record correlated core temperature and heart rate, and provide real-time alerts and time history profiles of measured data that directly affect an athlete’s safety and performance. Circle No. 126
TWO WAYS TO INCREASE FUNCTIONAL TRAINING SKILLS IN 2004 FOR EVERYONE WHO TRAINS OR REHABS CLIENTS, PATIENTS, ATHLETES
TRAINING SUMMIT June 25-27, 2004 in Providence, RI
$279 Call for Our 2004 Perform Better Catalog
• 20 Speakers-Well Known Experts • 2 Lectures and 2 Hands-On Register Now For Classes Each Hour Jan. 10 Los Angeles • CEUs Available Jan. 17 San Francisco Highly Respected Instructors Feb. 7 Atlanta • Juan Carlos Santana Feb. 21 Seattle • Robb Rogers March 20 Boston • Walter Norton, Jr. March 21 Boston • Duane Carlisle April 3 Chicago • Annette Lang • 5 Presenters Each Seminar May 1 Columbus • Gray Cook • Each Seminar Includes • Mike Macchioni May 29 Colorado Springs Lectures in AM Followed By • Mike Clark Learn-By-Doing in Afternoon • Al Vermeil • CEUs Available • Steve Plisk • Mark Verstegen REQUEST OUR SEMINAR BROCHURE All One-Day • Loren Seagrave Sessions • Roger Marandino All Affordable, • Alan Russell $109 • Mike Boyle Pre-Registration • Thomas Inclendon • Peter Friesen • Diane Vives For More Information – Call Toll-Free 800-556-7464 • Chuck Wolf Visit Our Web Site www.performbetter.com 3-Day Summit or • Rod Corn • Updated Weekly • Timely Specials
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Write us, Fax us at PERFORM BETTER • 11 Amflex Drive • P.O. Box 8090 • Cranston, RI 02920-0090 • Toll-Free Fax 800-682-6950 Request No. 43 A T H L E T I C B I D . C O M ◆ T&C A P R I L 2 0 0 4 ◆
T&C April 2004
Vol. XIV, No. 3
QUIZ Training & Conditioning is pleased to provide NATA 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 and mailing it back to T&C, certified athletic trainers can earn two continuing education units.
INSTRUCTIONS: Fill in the circle on the Answer Form (on page 67) that represents your selection of the best answer for each of the questions below. Complete the form at the bottom of page 67, include a $15 payment to Training & Conditioning, and mail it to the following address: Training & Conditioning, ATTN: 14.3 Quiz, 2488 N. Triphammer Road, Ithaca, NY 14850. Athletic trainers who correctly answer 70 percent of the questions will be notified of their earned credit by mail no later than June 15, 2004.
HEAD OF THE CLASS
5) Which of the following is NOT considered to be a scapular stabilizer?
Objective: Understanding how best to inform sport coaches about the basics of treating and assessing injured athletes, emphasizing the differences between a coach’s limited responsibilities and those of a certified athletic trainer 1) According to the “Head of the Class” article, most ATCs agree that a base-level knowledge requirement for coaches should include: a) ACL rehabilitation b) Learning CPR and first aid c) Spine boarding technique d) Taping for MCL instability 2) According to Christopher Hobler, ATC, one way to initiate coach education is to: a) Provide the coach with an athletic training curriculum textbook b) Have coaches attend the NATA annual symposium c) Have coaches perform an internship with an ATC d) Start each season with a mandatory refresher course conducted by the ATC 3) Kathleen English, MS, LATC, ATC, says “__________________” opens some eyes by allowing coaches to anticipate how something is going to happen and how they will respond. a) Role play b) Reading c) Watching video d) Listening to tapes 4) The intent of educating coaches is to: a) Alleviate some of the demands on the ATC b) Allow coaches to be first responders c) Make the athletes as safe as possible and provide more comprehensive care when athletic training services are limited d) Give coaches more responsibility
ROTATION AT THE SHOULDER
Objective: Understanding the causes, diagnosis, and treatment of rotator cuff injuries by focusing on the relevant musculoskeletal and nervous components of the shoulder complex and the kinetic chain as a whole
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a) Serratus anterior b) Trapezeus c) Deltoid d) Rhomboids 6) According to Muscle Stretching in Manual Therapy by O. Evjenth, MS and J. Hamberg, MD, the best way to stretch the supraspinatus is: a) With the athlete lying on his side with an axillary wedge, applying a force with the shoulder in slight extension and adducting across the back b) In the empty can position c) Passively abducting the shoulder d) Passively externally rotating the shoulder 7) The healing of a muscle injury is strongly dependent on the: a) Muscle involved b) Amount of connective tissue involved c) ROM deficit d) Amount of shearing to the motor end plates and the axon 8) The glenohumeral index is calculated by: a) Measuring the depth of the subacromial space b) Dividing the maximal transverse diameter of the glenoid by the maximal transverse diameter of the humeral head c) Dividing the length of the humerus by the length of the spine of the scapula d) Dividing the amount of passive abduction by the amount of active abduction 9) Recent research has shown that during the initial 30-60 degrees of elevation in the scapular plane, the: a) Humeral head depresses b) Humeral head moves anterior c) Humeral head moves superior 3mm then stays centered within 1mm d) Humeral head moves posterior 5mm 10) Which of the following is not considered by most to be a rotator cuff muscle? a) Teres major b) Subscapularis c) Infraspinatus d) Teres Minor
CEU QUIZ HONING IN ON HIPAA
Objective: Understanding the legal and ethical obligations of sports-medicine professionals who have access to private medical information, specifically those related to federal HIPAA legislation 11) For an organization to be a covered entity, the organization must: a) Complete a covered entity application b) Conduct electronic transactions of medical records c) File as a sub-S corporation d) Bill for services rendered
18) The body cannot manufacture: a) Glucose b) Insulin c) Carbohydrates d) Adrenaline 19) If carbohydrate needs are not met, the body will:
12) HIPAA is an acronym for: a) Health Insurance Portability and Accountability Act b) Health Insurance Physical Application Act c) Hospital Issuance of Privacy and Accountability Act d) Hospital Insurance Portability Accounts Act 13) To help with tracking of athletes who signed authorization for release of injury information versus those that didn’t, the University of Tulsa: a) Kept a list at all sporting events b) Directed all requests for information to the athletic department c) Decided not to release any injury information d) Is not concerned with this issue 14) The Family Educational Rights and Privacy Act (FERPA) limits: a) Medical records from becoming student records b) The amount of liability the ATC has regarding documentation c) Family responsibility of medical expenses d) Disclosure of students’ individual educational records by any institution receiving federal funds 15) According to Elizabeth Sequeglia, JD, an authorization form must contain all of the following except: a) An explanation of why sports media has access to medical records b) A statement stating no one will be denied treatment for not signing the form c) A list of people the information may be released to d) An expiration date 16) The media may be given the following information: a) An athlete’s name and injury b) The expected date of return to full participation c) No information unless a specific authorization to release information is signed d) An athlete’s prognosis
CONFUSED ABOUT CARBS?
17) One reason people lose weight quickly on low carbohydrate diets is: a) Low carbohydrate diets are usually low in fat and protein creating satiety b) Decreased carbohydrate intake results in fluid loss c) Increased protein intake results in fluid loss d) Foods high in carbohydrates have more calories than those high in protein.
Objective: Learning the biological effects of limiting carbohydrate intake related to health and athletic performance, and understanding how to communicate with athletes about dietary choices and nutritional needs
a) Break down stored fat to provide fatty acids or break down lean muscle mass to yield glucose b) Maintain higher energy levels c) Retain water d) Decrease its metabolism 20) The Institute of Medicine’s Dietary Guidelines revisions call for a diet containing: a) 20-40% CHO and not less than 200 grams per day b) 30-50% CHO and not less than 220 grams per day c) 35-45% CHO and not less than 180 grams per day d) 45-65% CHO and not less than 130 grams per day 21) The glycemic index is a system classifying carbohydrate-containing foods according to: a) The amount of total carbohydrates b) How quickly and how much they raise blood glucose levels c) The amount of calories certain foods contain d) The extent the food may affect high blood pressure, cardiovascular disease, or obesity 22) Moderate and low glycemic index food may be preferred for the following athletes: a) Long jumpers b) Punt returners c) Sprinters d) Endurance athletes 23) A 64-ounce soda may contain ____________. a) 6 grams of fiber b) 2 cups of sugar c) Vitamin D d) The nutrition equivalent of an apple 24) Which of the following is considered to be a high glycemic index food? a) Pasta b) Grapes and citrus juices c) Corn d) Watermelon, white bread, and pretzels 25) Which of the following is a low glycemic index food? a) Nine grain bread and apples b) Buckwheat c) Rice and tortillas d) Raisins and ice cream
ANSWER SHEET IS ON PAGE 67
T & C A P R I L 2 0 0 4 ◆ 65
Presenting Educational and Advancement Programs available to ATCs WEST