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Riding the Wave Examining light therapy in rehab Lacrosse Workouts Talking about Ethics
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December 2005, Vol. XV, No. 9
Comeback Athlete Candace Parker University of Tennessee Bulletin Board ACSM advises preseason football changes … Diets and stress fractures … NATA to continue fight with CMS. Sideline The Science Behind Sports Drinks
56 Advertisers Directory 44 50 53 54 57
Product Pages State of the Industry Laser & Light Therapy Electrotherapy Plyometrics Topical Analgesics
CEU Quiz For NATA and NSCA Members
27 Sport Specific
Ground 15 Gaining At Towson University, off-season training for men’s lacrosse emphasizes speed, conditioning, and being ready for the game’s quick shifts in momentum. By John Poitras Leadership
Right Route? 21 The Being a healthcare professional in the world of competitive athletics can lead to some ethical quandaries. This article examines how to make tough decisions in complex situations. By David Hill Optimum Performance
in the Hips 27 All In just about any sport, hip strength is critical to performance. Consider these simple exercises to give your athletes the upper hand. By Jim Kielbaso Treating the Athlete
the Wave 32 Riding Ready to put your athletes on a new wavelength in their rehab? Then it might be time to give light therapy a ride. By R.J. Anderson Management
On the cover: Lance Armstrong and Team Discovery used light therapy on its way to winning the 2005 Tour de France. Story begins on page 32. Photo by Joel Saget, © Getty Images.
the Road Again 39 On Traveling to away games can be a test of your organizational skills. The keys are planning ahead, communicating, and being prepared for every bend in the road. By Abigail Funk
T&C DECEMBER 2005
Great Ideas For Athletes...
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
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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, PhD, ATC, PT Assistant Athletic Director for Sports Medicine, James Madison University Tim McClellan, MS, CSCS Director of Perf. Enhancement, Makeplays.com Center for Human Performance
December 2005 Vol. XV, No. 9 Publisher Mark Goldberg Editorial Staff Eleanor Frankel, Director R.J. Anderson, Kenny Berkowitz, Abigail Funk, David Hill, Dennis Read, Greg Scholand, Laura Smith Circulation Staff David Dubin, Director John Callaghan
Leslie Bonci, MPH, RD Director, Sports Medicine Nutrition Program, University of Pittsburgh Medical Ctr. Health System
Michael Merk, MEd, CSCS Director of Health & Fitness, YMCA of Greater Cleveland
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Christine Bonci, MS, ATC Asst. A.D. for Sports Medicine, Women’s Athletics, University of Texas
Jenny Moshak, MS, ATC, CSCS Asst. A.D. for Sports Medicine, University of Tennessee
Production Staff Kristin Ayers, Director Adam Berenstain, Jonni Campbell, Jim Harper
Cynthia “Sam” Booth, ATC, PhD Manager, Outpatient Therapy and Sportsmedicine, MeritCare Health System
Steve Myrland, CSCS Owner, Manager, Perf. Coach, Myrland Sports Training, LLC Instructor and Consultant, University of Wisconsin Sports Medicine
Debra Brooks, CNMT, LMT, PhD CEO, Iowa NeuroMuscular Therapy Center Cindy Chang, MD Head Team Physician, University of California-Berkeley Dan Cipriani, PhD, PT Assistant Professor, Dept. of Exercise and Nutritional Sciences, San Diego State Univ. 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
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 Bonnie J. Siple, MS, ATC Coordinator, Athletic Training Education Program & Services, Slippery Rock University Chad Starkey, PhD, ATC Visiting Professor Athletic Training Education Program Ohio 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
IT Manager Mark Nye Business Manager Pennie Small Special Projects Dave Wohlhueter Administrative Assistant Sharon Barbell Advertising Materials Coordinator Mike Townsend Marketing Director Sheryl Shaffer Marketing/Sales Assistant Danielle Catalano Advertising Sales Associates Diedra Harkenrider (607) 257-6970, ext. 24 Rob Schoffel (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 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© 2005 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 selfaddressed, stamped envelope. Application to mail at periodicals rate pending in Ithaca, N.Y., and additional mailing offices. POSTMASTER: Send address changes to Training & Conditioning, P.O. Box 4806, Ithaca, NY 14852-4806. Printed in the U.S.A.
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T&C DECEMBER 2005
Circle No. 102
Candace Parker University of Tennessee
Fresh off a summer spent leading the U.S. Women’s Junior World Championship qualifying team to a gold medal in Puerto Rico—where she led the squad in scoring, rebounding, assists, blocks, and steals—Parker arrived in Knoxville with limitless potential and championship expectations. But when the 6’3” freshman stepped on campus for the start of the fall semester, she did so with a very swollen left knee, one she had played on all summer. While Parker thought nothing of it, the swelling concerned Tennessee Head Athletic Trainer and Assistant Athletic Director for Sports Medicine Jenny Moshak, ATC, MS, CSCS, and she had Parker undergo an MRI on Aug. 20. Moshak was troubled by the results, which revealed some degenerative changes and possible meniscus damage. Amid concerns that Parker may have also aggravated an ACL injury she sustained in high school, an arthroscopy was performed four days later. Those results were even more discouraging. “I remember waking up from my scope and asking what happened three or four times,” says Parker. “Everybody was looking so sad. Then Jenny came over and said it didn’t go too well and that I was out for the season. At that point, I started bawling.” Parker’s knee had 10 to 15 mm of surface damage to the lateral articular cartilage, and her lateral meniscus was no longer completely attached. However, there was a sliver of good news: Her ACL was fine. Still, after surgery, she would be looking at a six- to 12-month rehab. On Sept. 8, Tennessee Team Orthopedist William Youmans, MD, successfully performed surgery to repair the meniscus and cartilage damage, and Parker was fitted for a hinged fullleg brace. She would be non-weight bearing for six weeks and partial-weight bearing for two weeks after that. Despite these 4
T&C DECEMBER 2005
When Larry and Sara Parker dropped off their daughter Candace at the University of Tennessee in August of 2004, they were delivering one of high school basketball’s most decorated female players to the Lady Vols. A two-time national high school player of the year, Parker also garnered national attention after winning the slam dunk contest at the McDonald’s High School Boys’ All-Star game.
A year of rehab behind her, Candace Parker is ready to make her debut for the Lady Vols. limitations, Parker immediately began her rehab and set a goal to return sometime in the middle of the season. “When they told me six to 12 months, I told myself that I would try to come back in December, around winter break,” ATHLETICBID.COM
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REHAB | PILATES | WELLNESS | ATHLETIC TRAINING | POST-REHAB Circle No. 103
says Parker. “Whether that was a smart goal or not, it made me work hard every day in rehab to get my leg as strong as I possibly could.” Parker was limited in the first few weeks because the brace was initially set to allow only restricted flexion and extension. As a result, despite the work she put in—mostly straight-leg raises, three-way leg raises, and other open-chain exercises—her leg muscles suffered significant atrophy. Nearly a month post-surgery, the brace was released to accommodate full range of motion, though Parker remained non-weight bearing for two more weeks. Moshak continued the open-chain exercises, which by this time Parker was completing with 20-pound ankle weights attached to the brace. She was also doing limited ankle, hip, core, and upper-body work in the weightroom to maintain her overall strength. One of the main challenges for Parker during this early stage was simply getting around campus. However, Parker persevered, made it to class, and her schoolwork never suffered. In addition to beefing up her triceps muscles while commuting on crutches, Parker used this time to bolster her academic average, eventually landing on the Southeastern Conference All-Academic Freshman Team. Parker also utilized a number of Lady Vols support services, including an injury support group and a sports psychologist to help her deal with the mental challenges of rehab. “We realize that it’s a pretty big bummer when you’re on top
of your game one day, expecting to come in all-world, then we say, ‘You can’t play,’” says Moshak. “That had to be addressed, and our counseling services helped us take a very holistic approach to her rehab.” Having successfully rehabbed from an ACL tear during her senior year of high school, Parker was frustrated at the beginning of her newest challenge. “Candace thought, ‘I did the ACL rehab, that chapter should be over, why is it being re-opened?’” says Moshak. “I think that was a big obstacle she had to overcome at first.” “Sometimes Jenny had to kick me in the behind to get me to go to the counseling group,” Parker admits, “but once I got there, I realized those meetings were beneficial.” The brace was removed on Oct. 14, and though she would still be partial-weight bearing for two more weeks, Parker began more functional rehabilitation. Working with Moshak for three to four hours each day, Parker attacked her rehab, improving the knee’s range of motion and strength as well as her overall conditioning. One aspect of the rehab that Parker enjoyed was hydrotherapy. “We did a lot of work in chest-high water where she would run, jump, slide, cut, and so on,” says Moshak. “We did that once or twice a week, and she really liked it because she was doing basketball-type moves.” On Nov. 11, Parker was cleared to return to the court for light walk-through basketball drills, which consisted mostly of
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Comeback shooting. She wasn’t allowed to jump, but she could rise up on her toes. At this point, still focused on returning after winter break, Parker ratcheted up the intensity of her workouts, spending four to five hours a day with Moshak. “The whole time the team was on the practice floor, we were doing stuff on the side of the court and in the weightroom, and sometimes she would come see me after practice and after dinner,” says Moshak. “We got to know each other very well.” During November and into December, Parker began to notice dramatic improvements and her goal seemed more and more reachable. “Fortunately, she has a physique that responds to intense training,” says Moshak. “As she saw that response, it motivated her even more.” It also helped that Parker had a partner she could share the rehab experience with. During preseason, fellow freshman Alex Fuller tore her ACL and meniscus and was beginning her own long road back. Fuller, herself a highly touted prospect in high school, had surgery a month after Parker and had already been redshirted for the 2004-05 season. Because of their similar situations, Parker says she and Fuller share a special bond. “I would never wish an injury on anybody, but if we both had to be injured, it was better that we were injured at the same time,” says Parker. “We worked side by side and really pushed each other. Because of that we will forever have a button we can push on each other to light a fire
or pump the other one up.” “It was a good combination,” says Moshak, who routinely matched Parker and Fuller up in weightroom contests to keep things lively. “They were doing the same exercises, but because Alex had her surgery later, she was a little behind Candace in the amount of weight she could lift. “Having them together was also really good for me because I didn’t over-analyze what one of them was doing,” Moshak continues. “I could give them some autonomy and stand back and cheerlead instead of sitting there counting every rep.” Eventually those reps paid off and Parker worked up to controlled drills, like mini-tramp jumping and box jumping. “It was all about landing soft,” says Moshak. “We also did a lot of sidewinder exercises with a resistive band on the ankles, working on defensive stance, strengthening, and explosive speed work in controlled settings.” Gaining proficiency in those drills, Parker quickly built strength and confidence in her left leg. After a physical examination and an MRI on Dec. 20, Youmans cleared Parker to practice with her teammates upon their return from a short winter break on Dec. 26. “I viewed Dec. 26 as my Christmas,” says Parker. “That was the day I had been awaiting for four months—I was going to start playing college basketball.” Restless with anticipation, Parker hardly slept the night before her first practice. “I was a little tired coming into practice, but everything went well,” she says. “I didn’t favor my knee at
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T&C DECEMBER 2005
all, and I even dunked. Then we did our weight workout and my knee started feeling a little stiff. I couldn’t get the amount of flexion and extension that I wanted. “That night I iced it,” Parker continues, “and when I woke up the next day, my knee was huge.” The swelling remained the following day, and Parker was restricted to participating in halfcourt drills with no running. Even after backing off, the knee continued to swell, so Youmans and Moshak decided that Parker should shut it down for a while.
Even though Parker was probably strong enough to run and play, Moshak asked her to not play any basketball until the fall. “Candace understood what wouldn’t allow her to play: swelling, sharp pain, and lack of range of motion. And when her knee swelled, she knew we had to pull her from playing,” says Moshak. “So we regrouped, and she began shooting for another goal: returning for the postseason.” After three more weeks of rehab, Parker realized it was probably in her best interests to call it a season and redshirt. “I told her we gave it the old college try, but we needed to pay attention to what the knee was telling us,” says Moshak. “I said, ‘We’re only doing this once—we’re not going back six
months from now and revisiting the surgery.’ “Sometimes elite athletes think they’re invincible, but Candace is a very mature athlete and she understood,” continues Moshak. “Looking back, she’s very pleased with the decisions we helped her make and that we cared enough about her to not let her play on a swollen knee.” Parker says that big-picture approach didn’t come easy, but nonetheless she’s glad she didn’t push the knee’s limits. “What if I had come back and played the remaining 10 games and the NCAA tournament, then found out in the offseason that I had to have another knee surgery?” she asks. “That kind of stress on my knee could have taken years off my career.” Still, sitting on the bench watching her teammates battle night after night was no easy chore for Parker. She attended every game and made every road trip, while continuing her rehab. The toughest part was watching her teammates struggle. “She would get very frustrated when we’d lose to Duke by two points or have an awful road trip,” says Moshak. “She’d say, ‘I can help this team, I know I could have made a difference.’” Parker wasn’t the only one anxious for her return. Head Coach Pat Summitt admits that the season could have ended much differently had Parker been in the lineup. Instead of losing to Baylor in the national title game, Summitt wonders if Parker could have been the missing piece to a seventh national championship banner hanging at Thompson-Boling Arena.
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T&C DECEMBER 2005
Comeback ■ Candace Parker
Injury: Detached lateral meniscus and 10 to 15 mm of surface damage to the lateral articular cartilage of left knee. Rehab Hurdle: Overcoming multiple setbacks to begin highly anticipated first season for the Tennessee women’s basketball team. Result: Redshirted her freshman season, ready to lead the team in 2005-06. Quote: “I’m so thankful [Jenny Moshak] recognized the problem and turned a potentially career-ending injury into just a season-ender.”
“Obviously Coach Summitt would have been thrilled to have her at any point in the season, but she has never questioned a medical decision I’ve made,” says Moshak. “And she did a wonderful job in keeping Candace and Alex in the system—having them watch film and making sure they felt like they were part of the team.” Knowing that she would have a full year of recovery under her belt before returning to competition, Parker worked even harder throughout the spring and stayed in Knoxville for two summer sessions. And even though Parker was probably strong enough to run and play, Moshak asked her to adhere to a non-pounding approach and not play any basketball until the fall. “Why beat it up when you don’t have to?” Moshak told Parker. Instead, the remainder of the rehab was focused on controlled speed, agility, and quickness drills. Parker returned home to Naperville, Ill., about a month before school started. Wary that she would be tempted to join a pickup game during that time, Moshak had a heart-to-heart talk with her star patient. “It would be unfair for you to try and play basketball without me being the first to see you play,” Moshak told Parker. “Given the amount of time and energy I’ve put into you, this is what you owe me. You’ll have plenty of opportunities to play.” As she had been throughout her rehab, Parker was compliant with Moshak’s request, and she returned to campus in August feeling stronger than ever. “I’m not rehabbing anymore, I’m strengthening,” Parker said after a preseason practice. Adding 10 pounds of muscle to her frame, Parker also tacked another two inches onto her already impressive vertical leap. From a standing start, she can now reach 10 feet, seven and a half inches. Moshak says that the Lady Vols opened preseason practices with Parker back as her old dominating self, dunking virtually at will. Wearing orthotics but no knee brace, Parker has only one limitation imposed by Moshak and Summitt: No dunking in traffic during practice—yet. ATHLETICBID.COM
Moshak credits Parker’s tireless work ethic and desire to be the best as the biggest reason for her improvement. “She did the things outside of our rehab time that it took to win this battle, and she was always asking, ‘What else can I do at home?’” says Moshak. “From extra icing, using a stretch band and tubing on her own, to spending extra time with me after the rest of the team left, she really put in the extra effort.” Parker in turn gives Moshak much of the credit for her return. “She’s definitely a great motivator and was there for me every day, pushing me through rehab. And she was there as a shoulder to lean on when I needed somebody to talk to,” says Parker. “Jenny and I are really, really close.” Parker also appreciates how Moshak continually looked out for her future. “I’m so thankful she recognized the problem and turned a potentially career-ending injury into just a season-ender.” Having basketball taken away for a year has also given Parker a new perspective on the sport, which she says will keep her from taking her talent and opportunity for granted. You won’t find Tennessee’s newest star complaining about an early-morning practice, even if she has to stay up late studying the night before. “I remember those times I was sitting on the sideline praying that I could just do a shooting drill with the team,” says Parker. “I do a lot of writing. Sometimes I look back on my journal entries from when I was injured, and they motivate me to bring it every day in practice and be thankful that I’m able to play basketball again.” ■
Send Us Your Success Stories! To nominate an athlete to be featured in this Comeback Athlete section, please send your name, the athlete’s name, his or her rehab story, and contact information to: 2488 N. Triphammer Rd., Ithaca, NY 14850; email: ef@MomentumMedia.com; fax: 607-257-7328; or call us at: 607-257-6970, ext. 18. T&C DECEMBER 2005
Board ACSM Recommends Preseason Football Changes With hopes of reducing heat-related illness and death among football players, the American College of Sports Medicine (ACSM) recently released guidelines for youth and high school preseason practices. The most prominent recommendation is to prohibit two-a-day practices during the first week of preseason. According to the ACSM, “the overwhelming majority of serious heat illnesses occur in the first four days of preseason football practice (especially on the first and second days), when players are not acclimatized to the heat, the intensity/duration of practice, or the uniform.” Similar to those adopted by the NCAA two seasons ago, the guidelines also: • Restrict multiple workouts on consecutive days. • Limit single practices to no more than three hours, including conditioning drills. • Limit practice time for multiple sessions to no more than five hours a day. • Require a minimum of three hours between sessions. • Prohibit wearing full uniforms and pads, which can increase heat risk, until day six. • Prohibit full contact until week two. Jerry Diehl, Assistant Director of the National Federation of State High School Associations (NFHS) and liaison to the organization’s Sports Medicine Advisory Committee, says that heat illness is a point of concern for his group. Along with re-evaluating its current guidelines on this topic, which do not include any language pertaining to two-a-day practices or session length, Diehl says the NFHS will examine the ACSM’s recommendations. ■ The ACSM guidelines are from an ACSM roundtable series called Youth Football: Heat Stress and Injury Risk. Copies of the report can be obtained by e-mailing the ACSM Communications and Public Information department at: firstname.lastname@example.org.
NATA Fights CMS Decision Despite protests from the National Athletic Trainers’ Association (NATA), the Centers for Medicare and Medicaid Services (CMS) has implemented rules that limit athletic trainers’ ability to be reimbursed by Medicare for their services. The NATA, however, continues its legal battle to have the decision overruled. The new CMS rules allow only physical therapists, occupational therapists, and speech and language pathologists to receive Medicare reimbursement for service provided incident to a physician’s office visit. Previously there had been no 10
T&C DECEMBER 2005
restriction on who could provide “incident to” therapy services. Certified athletic trainers were sometimes used by physicians to provide those services and received reimbursement. The NATA filed a lawsuit challenging the CMS decision, but a Federal District Court ruled it did not have jurisdiction to decide the case because administrative remedies available to physicians to challenge the rule had not been exhausted. The court, which did not rule on the merits of the case, also declined the NATA’s request for an injunction, citing its lack of jurisdiction. The NATA has filed an appeal with the Fifth Circuit Court of Appeals, located in New Orleans, but Hurricane Katrina has slowed the appeals process. “The NATA continues to maintain that what the CMS has done is illegal and will continue to seek a ruling on the merits of CMS’s actions,” says Paul Genender, the NATA outside legal counsel handling the case. “Until an injunction is granted by the court of appeals or the district court, the new rule is in effect. Athletic trainers should check with their billing coordinators regarding the effects of the new rule on their practices.” While relatively few athletic trainers are directly affected by the CMS rules, they are still a major concern to the NATA. “This isn’t just about ATCs who are practicing as physician extenders,” Marjorie Albohm, MS, LAT, ATC, Director of Business Development and Orthopaedic Research at OrthoIndy and The Indiana Orthopaedic Hospital, said in the NATA’s Convention Daily News. “This is about every athletic trainer, because the rule incorrectly implies that athletic trainers are not trained to provide rehabilitation services. That will affect every ATC in every practice setting, and if that’s not overturned, it will be used against us as we go forward.”
Can Diet Stress Cause Fractures? Cutting out the stress over eating might help reduce stress fractures in women runners. Or so a group of sports-nutrition researchers hypothesize after studying the eating attitudes and behaviors of 79 Canadian women with and without stress fractures in their legs. Researchers at the University of British Columbia asked the runners, whose average age was 29 and most of whom were recreational distance runners, to record what they ate for three days and answer a questionnaire assessing physical activity, age, height, weight, their menstrual cycle history, and their perceived stress. Their diets were analyzed and found to be basically sound and similar, with calcium intakes about average and even slightly higher than that of American or Canadian women as a whole, according to Susan Barr, PhD, RDN, FACSM, FDC, Professor of Nutrition, who worked with lead researcher Nanci Guest, MS, CSCS, then a graduate student at UBC. ATHLETICBID.COM
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